Cumulative Incidence of Cardiovascular Events

 

Anyone in the middle to older age group either has personally had or knows someone who has experienced shingles. This is a very painful "resurfacing" of the chickenpox virus. For the past several years we have been vaccinating older adults (50 and above have been eligible) with a vaccine called Zostavax.  This product has been a major breakthrough as it lowered the actually incidence of an acute shingles episode by about 55-58% and the severity of pain from an outbreak by about 65%. 

A recent short followup duration but powerfully positive outcomes trial was recently reported in the New England Journal Of Medicine.  The product studied is a subunit vaccine containing a chickenpox virus glycoprotein combined with a "adjuvant" system called HZ/su. Adjuvant means "serving to help".  Boy did it!  This involved over 15000 people in over 18 countries. They followed these subjects 3.2 years and a clinical outbreak occurred in 6 vaccinated subjects versus 210 people in the control group.  That translates to an effective "take rate" of 97 %! People studied were age 50 and up.  I assume they will follow this group further into time and if this efficacy holds up, expect a new and far improved vaccine to come to the market. 

This is not the first time I have read about this novel approach to stroke prevention but this is the most recent report I have seen. So far this option is reserved for persons who have been determined unsafe to take the present "gold standard" treatment of anti-coagulation.  This recent study from the Cleveland Clinic Journal Of Medicine showed "noninferiority" when the Watchman percutaneous device was compared to warfarin (Coumadin). 

Atrial fibrillation independently increases the risk of stroke by a factor of 4-5.  It accounts for 15% of all stroke and 30% of strokes in the 80 plus age range. Untreated folks run a 2-5% risk of a stroke in any given year.  

If the results found in this report can be replicated and if we can follow people out several years and find the same success rate this could well become the treatment of choice.  

As the diagram to the right shows,. the left atrial appendage has a rough surface. Roughness in the presence of blood flow will propagate a clot.  This device basically is deployed through the venous system in the groin and eliminates the rough surface of the appendage from the circulation. It apparently works well, as well as traditional therapy in this reported analysis.