ESC Congress 2016 - ii

Dear Practitioner, We are pleased to share with you highlights from the European Society of Cardiology (ESC) Congress 2016 held in Rome, Italy. The featured article provides a topline summary of the new guidelines released by the ESC during the congress. These guidelines cover atrial fibrillation, cardiovascular disease prevention, heart failure, and dyslipidemia. Both European and US guidelines recommend prophylactic implantation of an implantable cardioverter-defibrillator (ICD) for patients with heart failure and reduced left ventricular systolic function. Results from the DANISH trial however, showed no significant survival benefit with primary prophylactic ICD implantation among patients with symptomatic non-ischemic cardiomyopathy and moderate-to-high background use of optimal medical cardiac resynchronization therapy. These results have already sparked discussion about how this may impact clinical practice and future guideline recommendations. Since the arrival of the non-vitamin K oral anticoagulants, barriers to their widespread acceptance in clinical practice have included the limited periprocedural data and the lack of a reversal agent. The ENSURE-AF trial was the largest randomized trial of anticoagulation for patients undergoing electrical cardioversion for atrial fibrillation. Results from the study showed that both edoxaban and traditional treatment with warfarin plus as-needed enoxaparin provide low and similar rates of ischemic and bleeding outcomes, suggesting that edoxaban is a safe and convenient (once daily oral) alternative to standard therapy. In ANNEXA-4, the recombinant modified factor Xa protein, andexanet alfa, effectively reversed factor Xa activity in patients presenting with acute major bleeding within 18 hours of receiving a factor Xa inhibitor. A landmark analysis utilizing genetic and cardiovascular risk factor data from over 100,000 subjects of 14 prospective cohort or case-control studies illustrated that LDL-cholesterol and systolic blood pressure have independent, multiplicative, and cumulative causal effects on the risk of cardiovascular events. These results confirm that cardiovascular disease is largely preventable and suggest that prevention can be substantially simplified by focusing on programs that promote long-term lowering of both lower LDL-cholesterol and blood pressure. In addition to the results from Hot Line session clinical trials and registry updates, you will also find information on selected areas of cardiovascular medicine including new drugs developed for the treatment of heart failure and the reversal of the effects of non-vitamin K oral anticoagulants. We hope that you find the articles and practical perspectives that are contained in the pages of this issue of ESC Congress 2016 in Review helpful in integrating this new information into your clinical practice. ii Robert P. Giugliano, MD, SM Staff Physician Cardiovascular Division Brigham and Women's Hospital Associate Professor in Medicine Harvard Medical School Boston, MA Marc P. Bonaca, MD, MPH Physician Vascular Section, Cardiovascular Division Brigham and Women's Hospital Assistant Professor in Medicine Harvard Medical School Boston, MA Jacob A. Udell, MD, MPH Physician Cardiovascular Division Women's College Hospital Toronto General Hospital Assistant Professor of Medicine University of Toronto Toronto, Ontario, Canada Nihar R. Desai, MD, MPH Associate Physician Cardiovascular Division Yale-New Haven Hospital Assistant Professor Medicine Yale School of Medicine New Haven, CT Matthew Cavender, MD, MPH Assistant Professor of Medicine University of North Carolina Chapel Hill, NC Erin A. Bohula May, MD, PhD Associate Physician Cardiovascular Division Brigham and Women's Hospital Instructor in Medicine Harvard Medical School Boston, MA October 2016 medicom-publishers.com/mcr http://www.medicom-publishers.com/mcr

Table of Contents for the Digital Edition of ESC Congress 2016