Browsing by Author "Gavina, C"
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- Heterogeneity Amongst GLP-1 RA Cardiovascular Outcome Trials Results: Can Definition of Established Cardiovascular Disease Be the Missing Link?Publication . Melo, M; Gavina, C; Silva-Nunes, J; Andrade, L; Carvalho, DAtherosclerotic cardiovascular diseases are the leading cause of adverse outcomes in patients with type 2 diabetes, and all new anti-diabetic agents are mandated to undergo cardiovascular outcome trials (CVOTs). Glucagon-like peptide-1 receptor agonists (GLP-1 RA) are incretin mimetics that reduce blood glucose levels with a low associated risk of hypoglycaemia. CVOTs with different GLP-1 RAs yielded different results in terms of major cardiovascular composite outcome (MACE), with some trials showing superiority in the treatment arm, whereas other simply displayed non-inferiority. More importantly, the significance of each component of MACE varied between drugs. This begs the question of whether these differences are due to dissimilarities between drugs or other factors, namely trial design, are at the root of these differences. We analyse the trial designs for all CVOTs with GLP-1 RAs and highlight important differences between them, namely in terms of definition of established cardiovascular disease, and discuss how these differences might explain the disparate results of the trials and preclude direct comparisons between them. We conclude that a fair comparison between GLP-1 RA CVOTs would involve post-hoc analysis re-grouping the patients into different cardiovascular risk categories based upon their baseline clinical parameters, in order to even out the criteria used to classify patients.
- Investigação Clínica da Iniciativa do Investigador em Portugal: Identificação de Problemas e Propostas para MelhoriaPublication . Ferreira, JP; Leite-Moreira, A; Costa-Pereira, A; Soares, AJ; Robalo-Cordeiro, C; Jerónimo, C; Gavina, C; J. Pinto, F; Schmitt, F; Saraiva, F; Vasques-Nóvoa, F; Canhão, H; Cyrne-Carvalho, H; Palmeirim, I; Pimenta, J; Cabral da Fonseca, JE; Firmino-Machado, J; Correia Pinto, J; Gonçalves, L; Castelo Branco, M; Sousa, N; Fontes de Carvalho, R; Machado Luciano, T; Gil Oliveira, T; Resende Oliveira, C
- Perceptions of Cardiology, Professional Preferences and Impact on Career Choices Among Portuguese Cardiologists: Results From the Portuguese Society of Cardiology's Women and Cardiology Task Force SurveyPublication . Timóteo, AT; Ribeiras, R; Gavina, C; Cabral, S; Almeida, A; António, N; Calé, R; Moura, B; Franco, F; Ilhão Moreira, R; Gonçalves, LIntroduction and objectives: Cardiology has not been seen as an attractive specialty, and women have avoided it for many years. Some surveys have been performed in other countries, but in Portugal, the situation is largely unknown. Methods: An online survey on perceptions of cardiology and professional preferences was sent to 1371 members of the Portuguese Society of Cardiology, of whom 18.2% completed the survey. Results: We included 219 cardiologists or cardiology trainees, of whom 50.2% were female, with decreasing proportions from younger to older age groups, in which males still predominate. Women are less often married and more frequently childless, particularly those working in an invasive subspecialty, where they represent only 16% of all respondents working in these areas. Men's perception is that women do not choose these areas due to family reasons, radiation concerns and difficult working conditions, but from the female perspective, male dominance, lack of female role models and restricted access are the main barriers. Women consider it is difficult for them to obtain a leadership role, but men do not think the same (75.5% vs. 27.5%). Conclusion: In Portugal, females predominate in younger age groups, suggesting a paradigm change. Women are less frequently married and more frequently childless, particularly women working in invasive subspecialties. Women consider that it is more difficult for them to obtain a leadership role. Moreover, the barriers reported by women are substantially different from men regarding the reasons for not choosing an invasive subspecialty.
- Practical Guide for the Use of PCSK9 Inhibitors in PortugalPublication . Fontes-Carvalho, R; Marques da Silva, P; Rodrigues, E; Araújo, F; Gavina, C; Ferreira, J; Morais, JReducing low-density lipoprotein cholesterol (LDL-C) levels is one of the most important strategies for reducing the risk of cardiovascular events. However, in clinical practice, a high proportion of patients do not achieve recommended LDL-C levels through lifestyle and lipid-lowering therapy with statins and ezetimibe. PCSK9 inhibitors (PCSK9i) are a new therapeutic option that significantly (50-60%) reduces LDL-C levels, which in clinical trials translates into an additional reduction in risk for cardiovascular events, and has a good safety profile. However, it is a high-cost therapy, and therefore its use in clinical practice should take its cost-effectiveness into account. Priority should be given to use in patients at higher cardiovascular risk and those in whom high LDL-C levels persist despite optimal lipid-lowering therapy. This consensus document aims to summarize the main data on the clinical use of PCSK9i and to make recommendations for Portugal on the profile of patients who may benefit most from this therapy.