CARDIOVASCULAR JOURNAL OF AFRICA • Volume 35, No 3, September – October 2024 AFRICA 165 Acute kidney injury in patients with myocardial infarction undergoing percutaneous coronary intervention using radial versus femoral access. BMC Nephrol 2019; 20(1): 28. 13. Kolte D, Spence N, Puthawala M, Hyder O, Tuohy CP, Davidson CB, et al. Association of radial versus femoral access with contrast-induced acute kidney injury in patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction. Cardiovasc Revasc Med 2016; 17(8): 546–551. 14. Barbieri L, Verdoia M, Suryapranata H, De Luca G; Novara Atherosclerosis Study Group (NAS). Impact of vascular access on the development of contrast induced nephropathy in patients undergoing coronary angiography and/or percutaneous coronary intervention. Int J Cardiol 2019; 275: 48–52. 15. Levey AS, Coresh J, Greene T, Stevens LA, Zhang YL, Hendriksen S, et al.; Chronic Kidney Disease Epidemiology Collaboration. Using standardized serum creatinine values in the modification of diet in renal disease study equation for estimating glomerular filtration rate. Ann Intern Med 2006; 145(4): 247–254. 16. Marenzi G, Cosentino N, Bartorelli AL. Acute kidney injury in patients with acute coronary syndromes. Heart 2015; 101(22): 1778–1785. 17. Iakovou I, Dangas G, Mehran R, Lansky AJ, Ashby DT, Fahy M, et al. Impact of gender on the incidence and outcome of contrast-induced nephropathy after percutaneous coronary intervention. J Invasive Cardiol 2003; 15(1): 18–22. 18. Scolari F, Ravani P. Atheroembolic renal disease. Lancet 2010; 375(9726): 1650–1660. Cardiovascular benefits from weight-loss drugs, a ‘game-changer’ Two important studies were presented at this year’s European Congress on Obesity (ECO), based on the landmark Semaglutide and Cardiovascular Outcomes (SELECT) trial from the same international author group. Led by Professor John Deanfield from University College London, one study examined the relationship between weight measures at baseline and change in weight during the study with cardiovascular outcomes. The other study, led by Professor Donna Ryan from Pennington Biomedical Research Centre, New Orleans, examined the long-term weight effects of semaglutide. Deanfield said the anti-obesity injections reduced the cardiovascular disease (CVD) risk in obese people regardless of the amount of weight they lost while on the drug, and that the findings suggest the treatment could have effects beyond reducing unhealthy body fat. He hailed the drugs as having a ‘potentially very important place in treatment’, with ‘widescale opportunity’, reports The Independent. The five-year study comprised 17 604 adults from 45 countries and examined the amount of time before patients suffered major cardiovascular events. After 20 weeks on semaglutide, 62% of patients had lost more than 5% of their body weight compared with 10% in the placebo group, with the risk reduction of heart attacks, stroke or heart failure similar in patients regardless of whether they lost weight or not. In August, researchers found semaglutide reduced the risk of a heart attack or stroke in obese people with cardiovascular disease by a fifth. A 2.4-mg once-weekly dose of Wegovy, alongside standard care for the prevention of heart attacks or stroke, lowered the risk by 20% compared with those given a placebo. Speaking at the ECO recently, where he presented the findings, Deanfield called the trial a game changer. ‘In the 1990s, when statins came in, we figured out there was a class of drugs that would change the biology of this disease. That was a major breakthrough to transform cardiology practice. We now have a class of drugs that could equally transform many chronic diseases of ageing. ‘Our findings show… the drug has other actions that lower cardiovascular risk beyond reducing unhealthy body fat. These alternative mechanisms may include positive impacts on blood sugar, blood pressure or inflammation, as well as direct effects on the heart muscle and blood vessels, or a combination of one or more of these.’ Sustained weight loss On a second piece of research based on the SELECT trial, presented at the ECO and led by Ryan, she said weight loss using semaglutide can be sustained for up to four years in overweight or obese adults who do not have diabetes. Patients on semaglutide lost an average 10.2% of their body weight and 7.7 cm from their waistline, compared with 1.5% and 1.3 cm, respectively, in the group on a placebo. After two years, 52% of people treated with semaglutide had moved down to a lower BMI category compared with 16% in the placebo group. The findings were published in Nature Medicine. ‘While our trial focused on cardiovascular events, many other chronic diseases, including several types of cancer, osteoarthritis and anxiety and depression would benefit from effective weight management,’ said Ryan. Despite these important findings, the authors caution that SELECT is not a primary-prevention trial so that the data cannot be extrapolated to all adults with overweight and obesity to prevent major adverse cardiovascular events; and despite being large and diverse, it does not include enough individuals from different racial groups to understand different potential effects. Source: MedicalBrief 2024
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