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Biomedical subjects

Asmund Reikvam

Publications and source records attributed to Asmund Reikvam.

At least 19 recordsLinked to original sources
PubMed2006

[Clinical use of COX inhibitors--a consensus].

BACKGROUND: Many physicians have been uncertain about treatment options following reports that linked cyclooxygenase (COX) inhibitors to serious cardiovascular events and the subsequent withdrawal of two selective COX-2 inhibitors. Therefore, on June 14, 2005, the Norwegian Medicines Agency and the Department of Pharmacotherapeutics, University of Oslo, held an expert meeting on COX inhibitors. METHODS: Presentations and discussions based on existing literature and statements from European (EMEA) and American (FDA) medicine authorities. This constitutes the basis for the current recommendations. RESULTS AND INTERPRETATION: COX inhibitors have solely symptomatic effects, and there are no differences in analgesic and anti-inflammatory efficacy between the various COX-inhibitors. These drugs should, if possible, be used at the lowest effective dose and for as short a time as possible. Some of the COX-2 selective inhibitors show a lower incidence of gastrointestinal side effects than unselective COX inhibitors, but this advantage can be outweighed by increased occurrence of cardiovascular side effects. Generally, the cardiovascular adverse effects are more serious, and more often irreversible, than the gastrointestinal adverse effects. Patients with established or increased risk of cardiovascular disease should not use COX-2-selective inhibitors. In general, COX inhibitors should, if possible, not be administered to individuals with previous peptic ulcer disease, hypertension, heart failure, or kidney disease. There is a need for more data on the effect and safety of COX inhibitors.

Adult↗
PubMed2006

Treatment with statins after acute myocardial infarction in patients >or=80 years: underuse despite general acceptance of drug therapy for secondary prevention.

PURPOSE: It has not been decided to what extent the results from statin trials should be transferred to clinical practice in the very old. The aim of the study was to assess the use of cardiovascular drugs after an acute myocardial infarction (MI), with particular focus on statins, in very old patients as compared to younger patients. METHOD: A sample of 901 acute MI patients was drawn from 16 hospitals in 1999/2000; the patients were followed up for 2.5 years. Information on demographic variables and drug therapy was obtained from hospital records, and in the follow-up period by direct patient contact or questionnaire. The main indications for prescribing the various cardiovascular drugs were recorded. RESULTS: At discharge, drug use in patients >or=80 and <80 years, respectively, was as follows: ACE-inhibitors 48 versus 32%, nitrates 55 versus 32%, diuretics 64 versus 26%, aspirin 72 versus 86%, and beta-blockers 67 versus 85%. A striking difference was found for statins: 9% in the very old and 72% in younger patients. The pattern of drug use generally remained unchanged after 2.5 years. Survival rates for patients >or=80 and <80 years: at discharge 72 versus 90%, after 2.5 years 34 versus 73%. CONCLUSIONS: Drug therapy was widely accepted for the indication secondary prevention after MI in patients above 80 years of age. The various cardiovascular drugs were prescribed to about the same extent for very old and younger patients. The exception was lipid lowering drugs which, despite the physicians' recognition of the indication secondary prevention in the very old patients, were prescribed to a limited extent.

Aged↗
PubMed2005

[Do vitamins C and E protect against the development of carotid stenosis and cardiovascular disease?].

BACKGROUND: Some observational and randomized, clinical interventional studies have indicated that the antioxidative vitamins C (ascorbic acid) and E (alpha-tocopherol) can reduce intima-media thickness of the carotid arteries. It is, however, not clarified whether these vitamins may have a preventive effect against cardiovascular events. MATERIAL AND METHODS: The literature on the effects in relation to several cardiovascular endpoints of vitamins C and E, also used in combination, has been evaluated. The literature has been continuously and systematically collected over many years and supplemented by recent studies retrieved from Medline. RESULTS: Observational studies including mainly healthy individuals have shown a favourable relationship between intake of vitamins C and E, also taken in combination, and subsequent cardiovascular events. However, most randomized, clinical interventional studies including patients with manifest atherosclerotic disease have not been able to document such a relationship. INTERPRETATION: The discrepancy found between observational studies and clinical interventional studies may be due to different study populations (healthy/ill individuals) and differences regarding age, sex, diet, smoking, degree of oxidative stress and other probable confounding factors. The significance of vitamins C and E in preventing cardiovascular disease is in our opinion not yet clarified.

Antioxidants↗
PubMed2005

[ACE inhibitor or ATII receptor blocker in heart failure and myocardial infarction?].

Angiotensin converting enzyme (ACE) inhibitors are important drugs in the treatment of hypertension, heart failure and after acute myocardial infarction. The patents for most of these agents have now expired and the industry has introduced angiotensin II receptor blockers (ATII receptor blockers) with a mode of action similar to that of ACE inhibitors. All six ATII receptor blockers on the Norwegian market have the indication hypertension, while one of them also has the indication heart failure when treatment with ACE inhibitors is not appropriate. Some studies have compared ACE inhibitors with ATII receptor blockers in the treatment of heart failure and after acute myocardial infarction and found the two classes of drugs to be about equally efficacious. There is no reason to change the current practice of choosing ACE inhibitors as first line treatment for these conditions. If ACE inhibitors cannot be used, ATII receptor blockers represent an acceptable alternative.

Angiotensin II Type 1 Receptor Blockers↗
PubMed2004

[Clinical trials in Norway--completion and reporting are not satisfactory].

OBJECTIVE: To investigate how drug trials are carried out and reported in Norway and to what extent they are published. MATERIAL AND METHODS: All drug trials notified in 1996 were included in the study. Data were obtained from the standard notification form, correspondence with investigators, end-of-study reports, and a questionnaire designed for this study. RESULTS: A total of 208 drug trials were notified. Most trials were initiated by the pharmaceutical industry (85%) and international multicenter studies constituted a major part (73%). Mandatory end-of-study reports were submitted to the health authorities on 48 (23%) of the trials. Out of a total of 159 trials for which we have data, 39 (25%) were interrupted or not started. Out of a total of 143 trials for which we have data on publishing, 77 (54%) were not published. Trials with a positive conclusion (54%) were more likely to be published than those with a negative conclusion (38%). INTERPRETATION: The reporting of drug trials is not satisfactory. Because of low reporting frequency, health authorities do not obtain a comprehensive overview. The pharmaceutical industry initiates the majority of the trials and clinical researchers in Norway increasingly participate in international multicentre trials. Many trials are not carried out as planned; less than half are published.

Clinical Trials as Topic↗
PubMed2004

The majority of hospitalised patients have drug-related problems: results from a prospective study in general hospitals.

OBJECTIVE: To describe the frequency and types of drug-related problems (DRPs) in hospitalised patients, and to identify risk factors for DRPs and the drugs most frequently causing them. METHODS: From May to December 2002, 827 patients from six internal medicine and two rheumatology departments in five hospitals in Norway were included in this study. We recorded demographic data, drugs used, relevant medical history, laboratory data and clinical/pharmacological risk factors, i.e. reduced renal function, reduced liver function, heart failure, diabetes, compliance problems, drugs with a narrow therapeutic index and drug allergy. DRPs were documented after reviewing medical records and participation in multidisciplinary team discussions. An independent quality assessment team retrospectively assessed the DRPs in a randomly selected number of the study population. RESULTS: Of the patients, 81% had DRPs, and an average of 2.1 clinically relevant DRPs was recorded per patient. The DRPs most frequently recorded were dose-related problems (35.1% of the patients) followed by need for laboratory tests (21.6%), non-optimal drugs (21.4%), need for additional drugs (19.7%), unnecessary drugs (16.7%) and medical chart errors (16.3%). The patients used an average of 4.6 drugs at admission. A multivariate analysis showed that the number of drugs at admission and the number of clinical/pharmacological risk factors were both independent risk factors for the occurrence of DRPs, whereas age and gender were not. The drugs most frequently causing a DRP were warfarin, digitoxin and prednisolone, with calculated risk ratios 0.48, 0.42 and 0.26, respectively. The drug groups causing most DRPs were B01A-antithrombotic agents, M01A-non-steroidal anti-inflammatory agents, N02A-opioids and C09A-angiotensin converting enzyme inhibitors, with risk ratios of 0.22, 0.49, 0.21 and 0.35, respectively. CONCLUSIONS: The majority of hospitalised patients in our study had DRPs. The number of drugs used and the number of clinical/pharmacological risk factors significantly and independently influenced the risk for DRPs. Procedures for identification of, and intervention on, actual and potential DRPs, along with awareness of drugs carrying a high risk for DRPs, are important elements of drug therapy and may contribute to diminishing drug-related morbidity and mortality.

Adolescent↗
PubMed2003

[Nitrate therapy during and after acute myocardial infarction].

BACKGROUND: Nitrates have been an integral part of the therapy of ischaemic heart disease for more than 130 years. < MATERIAL AND METHODS: We have studied the relevant literature on the benefits of therapy with nitrates in acute myocardial infarction. RESULTS AND INTERPRETATION: During an acute myocardial infarction, intravenous nitroglycerine therapy has demonstrated favourable haemodynamic properties, and some studies have shown that nitrates reduce infarct size. Whether this could improve prognosis is uncertain. A meta-analysis from 1988 showed reduced mortality (35 %) of early intravenous nitrate therapy. Newer and larger studies have not documented a positive effect. A reason for this discrepancy may be the fact that in these studies about half of the control/placebo patients, having a low mortality, were treated with nitroglycerine. In addition, most of these patients were given thrombolytic and antiplatelet therapy. Nitroglycerine administered intravenously is, according to present knowledge, recommended during the first 24 hours after an acute myocardial infarction. In addition, patients with recurrent ischaemia, uncontrolled hypertension and heart failure should also be given nitroglycerine.

Humans↗
PubMed2003

[Marked increase of the number of myocardial infarctions following introduction of the new diagnostic criteria].

BACKGROUND: Hospital admissions for acute myocardial infarction (AMI) declined in Norway during the 1990s. Recently, clinical guidelines for diagnosing AMI have been changed. We wanted to investigate whether this change might have influenced the number of patients hospitalised for AMI. MATERIAL AND METHODS: Data on all AMI admissions from 1991 to 2002 were provided by the Norwegian Patient Register and analysed by gender and by age. Particular emphasis was given to the analysis of change over the last three years. RESULTS: From 1991 to 2000, the numbers of hospital admissions for AMI (ICD-9 410 and ICD-10 I21/I22) declined by 18%, from 14 457 to 11 892. The reduction was stronger in men (20%) than in women (14%). At the same time striking age differences occurred with a decrease among people below 80 years of age (29%) and an increase among those older than 80 (25%). There was, however, a shift in the downward trend in numbers of AMIs in 2000. From 2000 to 2002, AMI admissions were up from 11 892 to 15 829 (33%). INTERPRETATION: The striking change in the age distribution among AMI patients could be attributed to a lower incidence in the younger age groups over the last decades, which might have deferred AMIs to older age groups. The increase in AMI numbers from 2000 to 2002 is probably due to the introduction of new diagnostic guidelines and not to a higher real incidence. Application of troponins for the diagnosis of AMI has probably shifted patients previously diagnosed with unstable angina pectoris to the AMI diagnosis.

Adult↗
PubMed2003

[Warfarin treatment and bleeding].

BACKGROUND: Warfarin is involved in the majority of fatal adverse drug events in Norway. The aim of this study is to identify risk factors behind the haemorrhagic complications. MATERIAL AND METHODS: We analysed all adverse event reports involving bleeding related to warfarin that were received by the Norwegian Medicines Agency from 1990 to 2000. RESULTS: 713 reports were included; 71% of the patients were above 70 years of age. The most frequent diagnosis was atrial fibrillation (39%). Cerebral bleedings were reported in 57% of the cases, 73% of which were fatal, as were 39 % of gastrointestinal bleedings and 14% of other bleedings. International normalised ratio values (INR values) at the time of bleeding were reported in 83% of the cases; mean INR value was 4.4 (range 1.2 - > 8.0). INR values above recommended limits at the time of bleeding were found in 74% of the patients. In 63%, bleedings occurred during the first month; in 30% during the first five days. Median duration of treatment was shorter in fatal (16 days) than in non-fatal cases (24 days). INTERPRETATION: Our results show that haemorrhagic complications are associated with high INR values and initiation of treatment. Simple strategies for reducing bleedings include better monitoring of patients, careful dose adjustment, and INR values in the lower end of the recommended ranges.

Adult↗
PubMed2003

[Secondary prevention after acute myocardial infarction: aspirin, warfarin or both?].

BACKGROUND: In patients suffering from acute myocardial infarction (AMI), new cardiovascular events can be prevented by aspirin or warfarin or a combination of both. Results from studies examining this issue have been published in recent years. We have evaluated the study results together with other factors that are decisive for implementation of the findings in clinical practice. MATERIAL AND METHODS: The following four studies were evaluated: the Coumadin Aspirin Reinfarction Study (CARS); the Combination Hemotherapy and Mortality Prevention (CHAMP) Study; the Warfarin, Aspirin Reinfarction Study (WARIS)-II; the Antithrombotics in the Secondary Prevention of Events in Coronary Thrombosis (ASPECT)-2 Study. RESULTS: The studies had somewhat different design, particularly with regard to the intensity of anticoagulation. CARS and CHAMPS did not show any benefit with combined therapy. WARIS II concluded that warfarin had better preventive effect than aspirin; so had the two drugs in combination. ASPECT-2 suggested a benefit with the combined treatment (coumadin and aspirin) but had limited study power. In all studies, bleedings occurred most frequently in groups of patients treated with anticoagulants. In clinical practice, relatively few AMI patients would be candidates for warfarin treatment, as this drug is not recommended for the oldest patients. Adverse event profile, guidance of treatment and relation to invasive treatment procedures are factors in favour of aspirin. INTERPRETATION: Aspirin should be the antithrombotic agent of choice in secondary prevention after acute myocardial infarction. Warfarin could be used when there are specific additional indications. Combining these two agents is not recommended as a routine treatment.

Anticoagulants↗
PubMed2003

Antihypertensive therapy at the onset of an acute myocardial infarction predicts in-hospital mortality.

Several studies, which have compared the efficacy of conventional antihypertensive drugs (thiazide diuretics and beta-blockers) with the newer agents [calcium blockers and angiotensin-converting enzyme (ACE) inhibitors], have shown that they are almost equally efficacious with regard to effects on blood pressure, and in preventing cardiovascular morbidity and mortality. The potential value of these drugs when hypertensive patients suffer an acute myocardial infarction (AMI) has, however, not been fully elucidated. The objective of the present observational study was to investigate whether prior use of different antihypertensive drugs could modify or influence in-hospital death in hypertensives suffering an AMI. A total of 299 hypertensive patients with the diagnosis of AMI were included. The demographic data were obtained from medical records. Variables were entered into a logistic regression model. The main predictors of death were age (adjusted odds ratio (ORa) 1.07, p = 0.002 (per each year), and the use of diuretics (ORa 2.54, p = 0.018) and calcium blockers (ORa 2.54, p = 0.010). On the other hand, the use of ACE inhibitors was associated with a marked reduction of in-hospital death (ORa 0.44, p = 0.045). The present study indicates that while the use of ACE inhibitors was associated with a reduced risk of in-hospital death in hypertensive patients suffering an AMI, the use of diuretics and calcium blockers was associated with increased risks.

Adrenergic beta-Antagonists↗
PubMed2002

[Guidelines for pharmacological primary prevention of cardiovascular diseases--who should be treated?].

BACKGROUND: Several clinical practice guidelines for the treatment of hypertension and hypercholesterolaemia are available. The quality of these guidelines varies and the basis for their conclusions is often not clear. We have used systematic and explicit methods in the development of a new set of recommendations. This is the first of three articles describing these guidelines. MATERIAL AND METHODS: Evidence was found by a systematic search in databases and reference lists in guidelines and articles. A set of recommendations was prepared based on a critical appraisal of the literature. These recommendations were revised through discussions with a panel of physicians and agreed upon after several iterations. The guidelines were circulated to professional, governmental and patient organisations, with a request for feedback on errors or shortcomings. RESULTS AND INTERPRETATION: The absolute risk of cardiovascular disease should be used as the basis for discussing with a patient whether drug treatment should be initiated. A 20% risk of developing angina or myocardial infarction over the next ten years is a reasonable threshold for considering treatment. The effects of antihypertensives for persons older than 80 years and of cholesterol-lowering drugs for persons older than 70 years are uncertain. Treatment of blood pressure above 170/100 mm Hg is recommended independent of the risk of cardiovascular disease.

Adult↗