CLINICAL
NEWS JACC in a FLASH
valve repair but should be interpreted
as a marker for higher risk of procedural and post-procedural complications
and adverse events.” Moving forward,
they suggested requiring individualized
risk stratification to determine the best
type and timing of therapy.
Baron SJ, Arnold SV, Herrmann HC, et al.
J Am Coll Cardiol. 2016;67(20):2349-58.
standardize CEC methods and develop
assays that are amenable for clinical use.
In an accompanying editorial
comment, Winirief März, MD, and
Andreas Ritsch, PhD, wrote that “the
originality and validity of these results
is beyond any doubt as they stand and
the methodology is state of the art.”
They add that “A number of questions, however, need to be addressed
before this measure is exploited in risk
stratification: Are there assays for CEC
on the basis of stable components avoiding the use of cultured cells? To which
extent does CEC reflect the net traffic of
cholesterol on its road from of the vessel
wall into the bile? Finally, is cholesterol
efflux indeed a rate-limiting step for
reverse cholesterol transport, ultimately
turning its modification into a target for
pharmacological intervention?”
Mody P, Joshi PH, Khera A, et al. J Am Coll
Cardiol. 2016;67(21):2481-91.
Can Cholesterol
Efflux Capacity
Predict ASCVD Risk?
Cholesterol efflux capacity (CEC)
improves atherosclerotic cardiovascular disease (ASCVD) risk prediction,
according to a study published May
23 in JACC. This prognostic value
was independent of the established
predictive measures of coronary
artery calcium (CAC) scoring, familial
hypercholesterolemia (FH) and highsensitivity C-reactive protein (hs-CRP).
Purav Mody, MD, and colleagues
examined 1,972 participants in the
Dallas Heart Study who were free
of ASCVD at baseline. Participants
completed risk factor assessment,
laboratory testing, imaging studies
and CAC scans.
Prevalent CAC (> 0) was found in
52% of participants, FH and premature FH were reported in 31% and
10% of participants, respectively,
and hs-CRP > 2 mg/L was found in
58% of participants. Over a median
follow-up of 9.4 years, 97 participants
experienced a first ASCVD event.
Those with CEC more than the
median versus less than the median
had a decreased risk of ASCVD (3.1%
vs. 6.7%). In a fully adjusted model
including prevalent CAC, FH and elevated hs-CRP, CEC remained inversely
associated with incident ASCVD
without attenuation. Among patients
with these risk factors, CEC was able
to meaningfully stratify ASCVD risk.
According to the study authors, in
those patients with CEC above the median, the risk of ASCVD was lowered
by half or more over the study period.
The addition of CEC to CAC, FH and
hs-CRP improved the ability to predict
incident ASCVD events. They note
that the findings support efforts to
14
CardioSource WorldNews
Actor Portrayal
Indication
Ranexa is indicated for the
treatment of chronic angina.
Ranexa may be used with
beta-blockers, nitrates, calcium
channel blockers, anti-platelet
therapy, lipid-lowering therapy,
ACE inhibitors, and angiotensin
receptor blockers.
Important Safety Information
Contraindications
Ranexa is contraindicated in patients:
Taking strong inhibitors of CYP3A
(e.g., ketoconazole, itraconazole,
clarithromycin, nefazodone,
nelfinavir, ritonavir, indinavir,
and saquinavir).
Taking inducers of CYP3A (e.g.,
rifampin, rifabutin, rifapentine,
phenobarbital, phenytoin,
carbamazepine, and
St John’s wort)
With liver cirrhosis
Warnings and Precautions
Ranexa blocks lKr and prolongs the
QTc interval in a dose-related
manner.
Clinical experience in an acute
coronary syndrome population
did not show an increased risk of
proarrhythmia or sudden death.
However, there is little experience
with high doses (> 1000 mg twice
daily) or exposure, with other QTprolonging drugs, with potassium
channel variants resulting in a
long QT interval, in patients with
a family history of (or congenital)
long QT syndrome, or in patients
with known acquired QT interval
prolongation.
Acute renal failure has been
observed in patients with severe
renal impairment while on
Ranexa. Monitor renal function
after initiation and periodically in
patients with moderate to severe
renal impairment. Discontinue
Ranexa if acute renal failure
develops.
Adverse Reactions
The most common adverse
reactions (> 4% and more
common than with placebo) during
treatment with Ranexa were
dizziness, headache, const ipation,
and nausea.