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Editorial - December 2020



Dear members of the ESC Working Group on Cardiovascular Pharmacotherapy,


I am happy to share exciting news from our WG Cardiovascular Pharmacotherapy about our virtual educational activities, our handbook and important readings published in our journal.
In this issue of the European Heart Journal of Cardiovascular Pharmacotherapy there is a focus on blood pressure and risk factor intervention:
Various drugs increase the risk of out-of-hospital cardiac arrest (OHCA) in the general population by impacting cardiac ion channels, thereby causing ventricular tachycardia/fibrillation (VT/VF).1,2 Dihydropyridines block L-type calcium channels, but their association with OHCA risk is less well known. In this issue of the journal, Tan and co-workers aimed to study whether nifedipine and/or amlodipine, commonly used dihydropyridines, were associated with increased OHCA risk, and how these drugs impact on cardiac electrophysiology. The authors conducted a case–control study with VT/VF-documented OHCA cases with a presumed cardiac cause from ongoing population-based OHCA registries in the Netherlands and Denmark. They concluded that high-dose nifedipine, but not low-dose nifedipine or any dose of amlodipine, was associated with increased OHCA risk in the general population.
It is unclear whether intensive blood pressure lowering is well tolerated and modifies risk uniformly across the age spectrum. Dr Pareek and co-workers analysed the SPRINT study.3 SPRINT randomized 9361 high-risk adults without diabetes and aged ≥50 years with systolic blood pressure 130–180 mmHg to either intensive or standard antihypertensive treatment. The primary efficacy endpoint was the composite of acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes. The primary safety endpoint was composite serious adverse events. The authors report that in the SPRINT study, the benefits and risks of intensive blood pressure lowering did not differ according to the age categories proposed by the ESC/ESH guidelines for hypertension.4
In a study by Schmieder et al. from Germany, the aim was to analyse the efficacy of two combination therapies on vascular function in subjects with type 2 diabetes mellitus (T2DM). Subjects were randomized to either the combination therapy empagliflozin 10 mg with linagliptin 5 mg once daily or metformin 850 or 1000 mg twice daily with insulin once daily. The authors concluded that beyond the effects on glycaemic control, the combination therapy of empagliflozin + linagliptin significantly improved central blood pressure and vascular function compared with the classic combination of metformin + insulin.
In another study from Germany, Dr Orban and co-workers analyse variations in antiplatelet drug response and clinical outcomes5–7 between smokers and non-smokers. The multicentre TROPICAL-ACS trial8 randomized 2610 acute coronary syndrome patients 1:1 to standard treatment with prasugrel for 12 months (control group) or a platelet function testing-guided de-escalation of dual antiplatelet therapy (DAPT). Current smokers (n = 1182) showed comparable event rates between study groups. In non-smokers (n = 1428), a guided DAPT de-escalation was associated with a lower 1-year incidence of the primary endpoint compared with control group patients. This paper is accompanied by an Editorial by Dr Flather.
Furthermore, it is a pleasure to publish a position paper from the ESC Council on Hypertension entitled ‘Peripartum management of hypertension. A position paper of the ESC Council on Hypertension and the European Society of Hypertension’.9,10
In a review paper, Dr Galati and co-workers discuss new advances in pharmacological treatment both in cardiovascular prevention and in heart failure management with a special focus on T2DM patients. A large number of randomized clinical trials and meta-analyses have provided strong evidence about therapeutic strategies acting on glucose metabolism such as glucagon-like peptide-1 receptor agonists (GLP-1 RAs) and sodium–glucose co-transporter-2 (SGLT2) inhibitors and about lipid-lowering treatment such as proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors and icosapent ethyl. Moreover, SGLT2 inhibitors demonstrated strong evidence of benefit particularly in heart failure management in both diabetic and non-diabetic patients. These new drugs in the cardiovascular therapeutic armamentarium are establishing a new comprehensive approach from prevention to therapy of heart failure.
In the Pharmapulse we focus on Cardiorenal protection of sodium-glucose cotransporter 2 inhibitors beyond diabetes: news from the European Society of Cardiology Congress 2020 and Latest news on heart failure and atrial fibrillation from the European Society Of Cardiology Congress 2020 in addition to report about CAD/valvular disease: ESC meeting 2020
Regarding educational activities, we have been forced by the corona pandemic to change the formats of our courses on "All About Clinical Trials" (AACT) (10. and 11. December 2020). This transition has many advantages for you to participate. On our webpage you will find the preliminary programs. In the near future this will be our favorite format. I will highlight that the " All About Clinical Courses" is in collaboration with the Karolinska Institute, Stockholm, Sweden, where it is a PhD course.
Pharmacotherapy in Older People (POP) was held for the second time, first time in London 2019, but now virtually the 25th and 26th November: Of the 606 persons registered prior to the event, 317 logged in for attending the online course (271 attendees on 25th November, and 232 on the 26th November), and even more will access the content “On demand” during the month to come.
Development of the Masters in Clinical Trials has been done in collaboration with the European Heart Academy and Oxford University. The first intake for this 2 year course opened in October 2020 with 14 students and is running very well thru the virtual platform at Oxford. Applications to the MSc in Clinical Trials at Oxford University are now open, for October 2021 intake. ESC Educational grants are available for this course to selected applicants, but there are strict deadlines: In order to be considered for the grant you need to finalize your application to the programme via the University of Oxford’s website before 8 January 2021, 12:00 noon, GMT.
Next year the Annual congress of the ESC Working Group on Cardiovascular
Pharmacotherapy (EuroCVP) will take place online, addressing new frontiers in cardiovascular pharmacotherapy. A major focus of the EuroCVP 2021 will be held on key treatment breakthroughs and experts will provide up to date discussions regarding the clinical applicability and significance of new drugs and novel available data. Beyond high quality plenary and keynote lectures by experts in cardiovascular pharmacotherapy, there will be several activities dedicated to the cardiovascular pharmacotherapists and trialists of tomorrow (CPTT). The EuroCVP 2021 mirrors the unique opportunity to meet the greatest experts in cardiovascular pharmacotherapy, exchange ideas and expand your knowledge - not miss this opportunity. Date of the EuroCVP 2021 and a preliminary program will be announced soon.

We are very pleased to give a brief report on the ESC Handbook on Cardiovascular Pharmacotherapy. The handbook published in May last year and already the content has been reviewed and revised multiple times to keep up to date, with almost 70% of the book having been updated this year. These updates are available via the online version of the handbook accessible through the digital access code printed in each copy of the book. This digital version is really key for you to get the best from the handbook and we hope you will make use of it. In early 2021 we will be adding further updates to keep in line with current ESC Clinical Practice Guidelines and every year there will be a full review and annual update of the content prepared by the authors and Editors.

ESC Members can receive 30% off the print version of the title when purchasing from the European Society of Cardiology website through their membership. If you are keen to just have access to the digital version then this is also available via an annual subscription for £14 via the information here.

Here’s what others say about the handbook:
‘Very good handbook. Concise yet comprehensive enough.’
‘Very good handbook, has everything I need for my job.

 

On behalf of the Working Group nucleus,
Alexander Niessner, Chair 2020-2022

References

1. Fukuda T, Kondo Y, Hayashida K, Sekiguchi H, Kukita I. Time to epinephrine and
survival after paediatric out-of-hospital cardiac arrest. Eur Heart J Cardiovasc
Pharmacother 2018;4:144–151.

2. Grimfja¨rd P, Lagerqvist B, Erlinge D, Varenhorst C, James S. Clinical use of cangrelor:
nationwide experience from the Swedish Coronary Angiography and
Angioplasty Registry (SCAAR). Eur Heart J Cardiovasc Pharmacother 2019;5:151–157.

3. SPRINT Research Group, Wright JT Jr, Williamson JD, Whelton PK, Snyder JK,
Sink KM, Rocco MV, Reboussin DM, Rahman M, Oparil S, Lewis CE, Kimmel PL,
Johnson KC, Goff DC Jr, Fine LJ, Cutler JA, Cushman WC, Cheung AK,
Ambrosius WT. A randomized trial of intensive versus standard blood pressure
control. N Engl J Med 2015;373:2103–2116.

4. Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, Clement
DL, Coca A, de Simone G, Dominiczak A, Kahan T, Mahfoud F, Redon J, Ruilope
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Narkiewicz K, Ruschitzka F, Schmieder RE, Shlyakhto E, Tsioufis C, Aboyans V,
Desormais I, ESC Scientific Document Group. 2018 ESC/ESH Guidelines for the
management of arterial hypertension. Eur Heart J 2018;39:3021–3104.

5. Agewall S. Antiplatelet treatment in acute coronary syndrome. Still an issue. Eur
Heart J Cardiovasc Pharmacother 2019;5:125–126.

6. Haller PM, Sulzgruber P, Kaufmann C, Geelhoed B, Tamargo J, Wassmann S,
Schnabel RB, Westermann D, Huber K, Niessner A, Gremmel T. Bleeding and ischaemic
outcomes in patients treated with dual or triple antithrombotic therapy:
systematic review and meta-analysis. Eur Heart J Cardiovasc Pharmacother 2019;5:
226–236.

7. Held C. Should we consider early de-escalation of maintenance dose of
antiplatelet therapy post-ACS? Eur Heart J Cardiovasc Pharmacother 2019;5:
149–150.

8. Sibbing D, Aradi D, Jacobshagen C, Gross L, Trenk D, Geisler T, Orban M,
Hadamitzky M, Merkely B, Kiss RG, Komocsi A, Dezsi CA, Holdt L, Felix SB,
Parma R, Klopotowski M, Schwinger RHG, Rieber J, Huber K, Neumann FJ,
Koltowski L, Mehilli J, Huczek Z, Massberg S, TROPICAL-ACS Investigators.
Guided de-escalation of antiplatelet treatment in patients with acute coronary
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randomised, open-label, multicentre trial. Lancet 2017;390:1747–1757.

9. Coca A, Dome´nech M. How to implement the recommendations of the 2018
ESC/ESH Hypertension Guidelines in a given patient: a step by step approach.
Eur Heart J Cardiovasc Pharmacother 2019;5:164–170.

10. van den Born BH, Lip GYH, Brguljan-Hitij J, Cremer A, Segura J, Morales E,
Mahfoud F, Amraoui F, Persu A, Kahan T, Agabiti Rosei E, de Simone G, Gosse
P, Williams B. ESC Council on hypertension position document on the management
of hypertensive emergencies. Eur Heart J Cardiovasc Pharmacother 2019;5:
37–46.