Lipids and antithrombotic treatment

In this issue of the journal, Rutherford and co-workers from Norway compare the risk of stroke or systemic embolism (SE) and major bleeding in patients with atrial fibrillation (AF) using dabigatran, rivaroxaban, and apixaban in routine clinical practice. The authors used nationwide registries in Norway and established a cohort of 52 476 new users of non-vitamin K antagonist oral anticoagulants (NOACs) with AF. Users of individual NOACs were matched 1:1 on the propensity score to create three pair-wise matched cohorts: dabigatran vs. rivaroxaban (20 504 patients), dabigatran vs. apixaban (20 826 patients), and rivaroxaban vs. apixaban (27 398 patients). The authors conclude that in this nationwide study of patients with AF in Norway, no statistically significant differences in risk of stroke or SE in propensity-matched comparisons between dabigatran, rivaroxaban, and apixaban were found. However, dabigatran and apixaban were both associated with a significantly lower risk of major bleeding compared with rivaroxaban. In a paper led by Dr Savarese, the author, together with his co-workers, presents a systematic review and meta-analysis from the European Society of Cardiology Working Group on Cardiovascular Pharmacotherapy in Collaboration with the European Society of Cardiology Working Group on Aorta & Peripheral Vascular Diseases. The authors conducted a meta-analysis to examine the efficacy and safety of antithrombotic and more intense antithrombotic therapy on limb outcomes and limb salvage in patients with chronic lower extremity artery disease (LEAD). The authors concluded that in patients with LEAD, more intense antithrombotic therapy reduces risk of limb amputation and revascularization as well as stroke, with an increase in the risk of bleeding events. The paper is commented on in an Editorial by Professor Koji Hasegawa from Japan.1 In a review paper, Dr Drexel and co-workers present ‘The age of randomized clinical trials: three important aspects of randomized clinical trials in cardiovascular pharmacotherapy with examples from lipid and diabetes trials’. The authors claim that efficacy endpoints must be clinically relevant and can be hierarchically divided.2–4 In a position paper from the ESC Working Group, Dr Hollan and co-workers present ‘Lipid management in rheumatoid arthritis: a position paper by the Cardiovascular Pharmacotherapy Working Group of the European Society of Cardiology’. The group proposes strategies for monitoring of lipid parameters and treatment of dyslipidaemia in rheumatoid arthritis (including lifestyle, statins, and other lipid-modifying therapies, and disease-modifying antirheumatic drugs). These opinion-based recommendations are intended to facilitate lipid management in rheumatoid arthritis until more evidence is available. Furthermore, the journal presents the ‘ESC position paper on statins adherence and implementation of new lipid-lowering medications: barriers to be overcome’. The aim of this position paper is to give an up to date indication from the European Society of Cardiology in order to discuss the barriers towards statin adherence and implementation of new lipid-lowering drugs in Europe.5–10