Updates from the ACC Scientific Sessions

I’ve been keeping track of the ACC Scientific Sessions through Medscape. (It’s my dream to one day actually attend an ACC Conference but for now, this’ll have to do.) Here’s a summary of what I’ve read so far together with what I think about the study results:

1.) ON TARGET (Ongoing Telmisartan Alone and in Combination With Ramipril Global Endpoint Trial)

• Angiotensin receptor blocker Telmisartan was proven to be non-inferior to the ACE-inhibitor Ramipril
• Combination treatment (ARB+ACE inhibitor) was not better than monotherapy and in fact lead to increased adverse events, with increased risk of renal dysfunction requiring dialysis
• Clinical bottomline: Telmisartan is an option in ACE-inhibitor intolerant patients, and combination therapy may in fact be harmful.

2) ACCOMPLISH (Avoiding Cardiovascular Events in Combination Therapy in Patients Living with Systolic Hypertension)

• ACE-inhibitor+duiretic versus ACE-inhibitor+Amlodipine
• Combination of Benazepril (an ACE-inhibitor) and Amlodipine (a calcium channel blocker) provided similar BP control but resulted in a 20% decreased risk for cardiovascular adverse events
• Results may lead to a change in the guidelines, which recommend combinations of a diuretic with either ARB or ACE-inhibitor
• Still awaiting complete results though

3) ENHANCE (Effect of Combination Ezetimide and High-Dose Simvastatin vs Simvastatin Alone on the Atherosclerotic Process in Patients with Heterozygous Familial Hypercholesterolemia)

• A lot of hoopla about this one. This was even reported in the New York Times.
• Combination of Ezetimibe and Simvastatin was compared to Simvastatin alone and was found to be no better at changing the intima-media thickness
• Combination therapy was better at reducing LDL however
• Bottomline: The study suggests that the combination therapy provides no clinical benefit, but let’s take into consideration that clincal outcomes were not measured here, only intima-media thickness (a surrogate outcome). Let’s wait for further studies before we jump to any conclusions.

Links to the published studies:

Yusuf S, Teo KK, Pogue J, et al for the ONTARGET investigators. Telmisartan, ramipril, or both in patients at high risk for vascular events. N Engl J Med 2008: 358:1547-1559.

Kastelein JJ, Akdim F, Stroes ES, et al. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med 2008; 358:1431-1443.