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  1. Iqbal Malik, Editor

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ISCHAEMIC HEART DISEASE

Aspirin and clopidogrel: no need treat with both in general ▸

Dual antiplatelet treatment with clopidogrel plus low-dose aspirin has not been studied in a broad population of patients at high risk for atherothrombotic events. The authors randomly assigned 15 603 patients with either clinically evident cardiovascular disease or multiple risk factors to receive clopidogrel (75 mg per day) plus low-dose aspirin (75–162 mg per day) or placebo plus low-dose aspirin, and followed them for a median of 28 months. The primary efficacy end point was a composite of myocardial infarction (MI), stroke, or death from cardiovascular causes. The rate of the primary efficacy end point was 6.8% with clopidogrel plus aspirin and 7.3% with placebo plus aspirin (relative risk (RR) 0.93, 95% confidence interval (CI) 0.83 to 1.05; p  =  0.22). The respective rate of the principal secondary efficacy end point, which included hospitalisations for ischaemic events, was 16.7% and 17.9% (RR 0.92, 95% CI 0.86 to 0.995; p  =  0.04), and the rate of severe bleeding was 1.7% and 1.3% (RR 1.25, 95% CI 0.97 to 1.61%; p  =  0.09). The rate of the primary end point among patients with multiple risk factors was 6.6% with clopidogrel and 5.5% with placebo (RR 1.2, 95% CI 0.91 to 1.59; p  =  0.20) and the rate of death from cardiovascular causes also was higher with clopidogrel (3.9% v 2.2%, p  =  0.01). However, in the subgroup with clinically evident atherothrombosis the rate was 6.9% with clopidogrel and 7.9% with placebo (RR 0.88, 95% CI 0.77 to 0.998; p  =  0.046). Overall, clopidogrel plus aspirin was not significantly more effective than aspirin alone in reducing the rate of MI, stroke, or death from cardiovascular causes

Treating homocysteine values are not justified ▸

In observational studies, lower homocysteine values are associated with lower rates of coronary heart disease and stroke. Folic acid and vitamins B6 and B12 lower homocysteine concentrations. …

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