Adrie Withagen - Academia.edu (original) (raw)

Papers by Adrie Withagen

Circulation, 2000

Background: In the treatment of patients with unstable angina and non-ST segment elevation myocar... more Background: In the treatment of patients with unstable angina and non-ST segment elevation myocardial infarction (UA/NSTEMI), debate exists as to whether an early invasive vs. a conservative strategy is optimal therapy. Methods: In the international TACTICS-TIMI 18 trial, 2220 patients with UA/NSTEMI who had either electrocardiographic changes, elevated cardiac markers or a history of prior coronary artery disease, were immediately treated with aspirin, heparin and the glycoprotein (GP) IIb/IIIa inhibitor tirofiban. They were randomized to an early invasive strategy with routine catheterization and revascularization as appropriate within 4-48 hours, or to a conservative, or "selective invasive" strategy, with catheterization performed only if the patient had objective evidence of recurrent ischemia or a positive stress test. The primary endpoint was a composite of death, myocardial infarction or rehospitalization for acute coronary syndromes at 6 months. Results: The rate of the primary endpoint was significantly reduced with the invasive strategy compared to the conservative strategy, 15.9% vs. 19.4%, odds ratio (OR) 0.78, pϭ0.025. The rate of death or MI at 6 months was also significantly reduced (9.5% vs. 7.3%, respectively, OR 0.74, pϽ0.05). Conclusion: In patients with UA/NSTEMI treated with the GP IIb/IIIa inhibitor tirofiban, an early invasive strategy resulted in a significant reduction in major cardiac events. These data suggest a need to update the ACC/AHA Unstable angina Guidelines, and to modify the clinical approach to managing unstable angina with broader use of an early invasive strategy with upstream GP IIb/IIIa inhibition.

Journal of the American College of Cardiology, 2011

Journal of the American College of Cardiology, 1997

Objectives. This study sought to examine whether lipoprotein(a) levels predict coronary artery lu... more Objectives. This study sought to examine whether lipoprotein(a) levels predict coronary artery lumen changes in patients with symptomatic coronary artery disease (CAD) and normal to moderate hypercholesterolemia.

Acta Psychologica, Feb 1, 2012

and sharing with colleagues.

Journal of the American College of Cardiology, 1997

Objectives. This study sought to examine whether lipoprotein(a) levels predict coronary artery lu... more Objectives. This study sought to examine whether lipoprotein(a) levels predict coronary artery lumen changes in patients with symptomatic coronary artery disease (CAD) and normal to moderate hypercholesterolemia.

Journal of the American College of Cardiology, 1993

Objectives . This study was conducted to determine the efficacy and safety of long-term treatment... more Objectives . This study was conducted to determine the efficacy and safety of long-term treatment with the orally active dopamine t i mine In patients with mild to moderate chronic congestive heart failure and to compare the results with those of treatment with digoxin and placebo . l ire and dkoxin are drugs that exert hemodynamic and neu

Journal of the American College of Cardiology, 2011

The Journal of Clinical Pharmacology, 1999

The combination of calcium channel blockers and beta-blockers is more effective for the treatment... more The combination of calcium channel blockers and beta-blockers is more effective for the treatment of exercise-induced angina pectoris than beta-blocker monotherapy. As ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with a negative chronotropic property may perform better for this purpose than nonchronotropic compounds. A 335-patient, 10-week, double-blind, parallel-group comparison of amlodipine 5 mg and 10 mg, diltiazem 200 mg and 300 mg, and mibefradil 50 mg and 100 mg treatment added to baseline beta-blocker treatment was performed. Exercise testing (ETT) was performed by bicycle ergometry. All of the calcium channels blockers significantly delayed the onset of 1 mm ST-segment depression on ETT (p < 0.001 for any treatment vs. baseline). In addition, mibefradil, in both low- and high-dose treatments, produced the largest delays (low dose: different from diltiazem and amlodipine by 24.1 and 29.8 seconds, respectively, p < 0.003 and < 0.001; high dose: different from diltiazem and amlodipine by 33.7 and 37.0 seconds, respectively, p < 0.001 and < 0.001). A stepwise logistic regression analysis revealed that this beneficial effect of calcium channel blockers was largely dependent on their effect on heart rate. Serious symptoms of dizziness likewise occurred significantly more frequently on mibefradil (p < 0.05 vs. diltiazem) and urged no fewer than 19 patients on mibefradil to withdraw from the trial. The authors conclude that calcium channel blockers with a negative chronotropic property provide a better delay of ischemia in patients with exercise-induced angina, but the concomitant risk of intolerable dizziness may reduce this benefit.

Heart, 2013

Objective To quantify the impact of a practical, hospital-based nurse-coordinated prevention prog... more Objective To quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared with usual care only. Design RESPONSE (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial. Setting Multicentre trial in secondary and tertiary healthcare settings. Participants 754 patients admitted for acute coronary syndrome. Intervention A nurse-coordinated prevention programme, consisting of four outpatient nurse clinic visits, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care. Main outcome measures The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at 12 months followup. Secondary outcomes included Framingham Coronary Risk Score at 12 months, in addition to changes in individual risk factors. Risk factor control was classified as 'poor' if 0 to 3 factors were on target, 'fair' if 4 to 6 factors were on target, and 'good' if 7 to 9 were on target. Results The mean Systematic Coronary Risk Evaluation at 12 months was 4.4 per cent (SD 4.5) in the intervention group and 5.4 per cent (SD 6.2) in the control group (p=0.021), representing a 17.4% relative risk reduction. At 12 months, risk factor control classified as 'good' was achieved in 35% of patients in the intervention group compared with 25% in the control group (p=0.003). Attendance to the nurse-coordinated prevention programme was 92%. In the intervention group, 86 rehospitalisations were observed against 132 in the control group (relative risk reduction 34.8%, p=0.023). Conclusions The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical, yet effective method for reduction of cardiovascular risk in patients with coronary disease. Our data suggest that the counselling component of the programme may lead to a reduction in hospital readmissions. Trial Registration trialregister.nl Identifier TC1290.

British Journal of Visual Impairment, 2009

A B S T R AC T The Tactual Profile assesses tactual functioning of children with severe visual im... more A B S T R AC T The Tactual Profile assesses tactual functioning of children with severe visual impairments between zero and 16 years of age. The Tactual Profile consists of 430 items, measuring tactile skills required for performing everyday tasks at home and in school. Items are graded according to age level and divided into three domains: tactual sensory, tactual motor and tactual perceptual. The development of the instrument is described and the psychometric properties that were studied reported. Most items had an acceptable difficulty level and test-retest reliability proved to be good. The analyses for the construct validity showed moderately high correlations between the Tactual Profile and intelligence tests. These correlations were higher for the haptic performance subtests than the verbal tests. High correlations with other haptic tests were found. However, these associations disappeared after factoring out intelligence, possibly because current methods for examining tactual functioning are strongly affected by intelligence. A summary of work planned in further development of the procedure is provided.

The American Journal of Cardiology, 1997

Four hundred seventy-three patients with acute myocardial infarction (AMI) were treated with eith... more Four hundred seventy-three patients with acute myocardial infarction (AMI) were treated with either saruplase (80 mg/hour, n Å 236) or alteplase (100 mg every 3 hours, n Å 237). Comedication included heparin and acetylsalicylic acid. Angiography was performed at 45 and 60 minutes after the start of thrombolytic therapy. When flow was insufficient, angiography was repeated at 90 minutes. Coronary angioplasty was then performed if Thrombolysis In Myocardial Infarction (TIMI) trial 0 to 1 flow was seen. Control angiography was at 24 to 40 hours. Baseline characteristics were similar. Angiography showed comparable and remarkably high early patency rates (TIMI 2 or 3 flow) in both treatment groups: at 45 minutes, 74.6% versus 68.9% (p Å 0.22); and at 60 minutes 79.9% versus 75.3% (p Å 0.26). Patency rates at 90 minutes before additional interventions were also comparable (79.9% and 81.4%). Angiographic reocclusion rates were not significantly different:

Atherosclerosis, 1997

Low incidence of coronary ischacmic disease is associated with elevated levels of plasma high den... more Low incidence of coronary ischacmic disease is associated with elevated levels of plasma high density lipoproteins (HDL). The main apolipoprotcin constituent of these particles is apolipopmtcin A-l (ape A-l). In previous studies, we have described an hcpatic increase of mRNA for apolipoprotcin A-I as consequence of feeding a monounsaturated-enriched fat diet. The present study has been designed to explore the relationships among this finding and plasma concentration of high density lipoproteins and apolipoprotcin A-l. In the present study, we have also addressed the role of different amount of fat on the same parameters. To these goals, sewn groups of male Wistar rats have hecn established: Control group consuming chow diet, Cholesterol group fed on a chow diet containing 0.1% (w/w) cholesterol, Coca group fed on a chow diet containing 0.1% (w/w) cholesterol and 40 % coconut oil, Corn group group fed on a chow diet containing 0.1% (w/w) cholesterol and 40 % corn oil and three Olive groups consuming a chow diet containing 0.1% (w/w) cholesterol and percentages of 5,lO and 40% rcspcctively of olive oil. Animals were kept on these diets for two months and then sacrifized for lipoprotein, apolipoprotein and hcpatic mRNA analysis. The main fmdings of this work are that the monounsaturated diet does not decrease plasma HDL cholesterol levels as does polyunsatoratcd fat diet. Both diets saturated and monounsahwated induced an increase in plasma concentration of apolipoprotcin A-l. This increase is dependent on the ingested amount of fat in the later case. Considering the correlation between plasma apolipoprotein A-l concentration and hcpatic mRNA expression in these diets, it seems that the plasmatic ape A-l increase in olive diets is mainly due to the hcpatic mRNA expression. This fact is more relevant aa the dietary amount of olive oil is increased. Nonetheless, the observed plasma ape A-l increase in saturated fat diet is not related to the hcpatic mRNA content. All these data together arc consistent with the hypothesis of that different fatty acids regulate apolipoprotcin A-l expression through different mechanisms.

Circulation, 2000

Background: In the treatment of patients with unstable angina and non-ST segment elevation myocar... more Background: In the treatment of patients with unstable angina and non-ST segment elevation myocardial infarction (UA/NSTEMI), debate exists as to whether an early invasive vs. a conservative strategy is optimal therapy. Methods: In the international TACTICS-TIMI 18 trial, 2220 patients with UA/NSTEMI who had either electrocardiographic changes, elevated cardiac markers or a history of prior coronary artery disease, were immediately treated with aspirin, heparin and the glycoprotein (GP) IIb/IIIa inhibitor tirofiban. They were randomized to an early invasive strategy with routine catheterization and revascularization as appropriate within 4-48 hours, or to a conservative, or "selective invasive" strategy, with catheterization performed only if the patient had objective evidence of recurrent ischemia or a positive stress test. The primary endpoint was a composite of death, myocardial infarction or rehospitalization for acute coronary syndromes at 6 months. Results: The rate of the primary endpoint was significantly reduced with the invasive strategy compared to the conservative strategy, 15.9% vs. 19.4%, odds ratio (OR) 0.78, pϭ0.025. The rate of death or MI at 6 months was also significantly reduced (9.5% vs. 7.3%, respectively, OR 0.74, pϽ0.05). Conclusion: In patients with UA/NSTEMI treated with the GP IIb/IIIa inhibitor tirofiban, an early invasive strategy resulted in a significant reduction in major cardiac events. These data suggest a need to update the ACC/AHA Unstable angina Guidelines, and to modify the clinical approach to managing unstable angina with broader use of an early invasive strategy with upstream GP IIb/IIIa inhibition.

Journal of the American College of Cardiology, 2011

Journal of the American College of Cardiology, 1997

Objectives. This study sought to examine whether lipoprotein(a) levels predict coronary artery lu... more Objectives. This study sought to examine whether lipoprotein(a) levels predict coronary artery lumen changes in patients with symptomatic coronary artery disease (CAD) and normal to moderate hypercholesterolemia.

Acta Psychologica, Feb 1, 2012

and sharing with colleagues.

Journal of the American College of Cardiology, 1997

Objectives. This study sought to examine whether lipoprotein(a) levels predict coronary artery lu... more Objectives. This study sought to examine whether lipoprotein(a) levels predict coronary artery lumen changes in patients with symptomatic coronary artery disease (CAD) and normal to moderate hypercholesterolemia.

Journal of the American College of Cardiology, 1993

Objectives . This study was conducted to determine the efficacy and safety of long-term treatment... more Objectives . This study was conducted to determine the efficacy and safety of long-term treatment with the orally active dopamine t i mine In patients with mild to moderate chronic congestive heart failure and to compare the results with those of treatment with digoxin and placebo . l ire and dkoxin are drugs that exert hemodynamic and neu

Journal of the American College of Cardiology, 2011

The Journal of Clinical Pharmacology, 1999

The combination of calcium channel blockers and beta-blockers is more effective for the treatment... more The combination of calcium channel blockers and beta-blockers is more effective for the treatment of exercise-induced angina pectoris than beta-blocker monotherapy. As ischemia in exercise-induced angina is essentially preceded by an increase in heart rate, calcium channel blockers with a negative chronotropic property may perform better for this purpose than nonchronotropic compounds. A 335-patient, 10-week, double-blind, parallel-group comparison of amlodipine 5 mg and 10 mg, diltiazem 200 mg and 300 mg, and mibefradil 50 mg and 100 mg treatment added to baseline beta-blocker treatment was performed. Exercise testing (ETT) was performed by bicycle ergometry. All of the calcium channels blockers significantly delayed the onset of 1 mm ST-segment depression on ETT (p < 0.001 for any treatment vs. baseline). In addition, mibefradil, in both low- and high-dose treatments, produced the largest delays (low dose: different from diltiazem and amlodipine by 24.1 and 29.8 seconds, respectively, p < 0.003 and < 0.001; high dose: different from diltiazem and amlodipine by 33.7 and 37.0 seconds, respectively, p < 0.001 and < 0.001). A stepwise logistic regression analysis revealed that this beneficial effect of calcium channel blockers was largely dependent on their effect on heart rate. Serious symptoms of dizziness likewise occurred significantly more frequently on mibefradil (p < 0.05 vs. diltiazem) and urged no fewer than 19 patients on mibefradil to withdraw from the trial. The authors conclude that calcium channel blockers with a negative chronotropic property provide a better delay of ischemia in patients with exercise-induced angina, but the concomitant risk of intolerable dizziness may reduce this benefit.

Heart, 2013

Objective To quantify the impact of a practical, hospital-based nurse-coordinated prevention prog... more Objective To quantify the impact of a practical, hospital-based nurse-coordinated prevention programme on cardiovascular risk, integrated into the routine clinical care of patients discharged after an acute coronary syndrome, as compared with usual care only. Design RESPONSE (Randomised Evaluation of Secondary Prevention by Outpatient Nurse SpEcialists) was a randomised clinical trial. Setting Multicentre trial in secondary and tertiary healthcare settings. Participants 754 patients admitted for acute coronary syndrome. Intervention A nurse-coordinated prevention programme, consisting of four outpatient nurse clinic visits, focusing on healthy lifestyles, biometric risk factors and medication adherence, in addition to usual care. Main outcome measures The main outcome was 10-year cardiovascular mortality risk as estimated by Systematic Coronary Risk Evaluation at 12 months followup. Secondary outcomes included Framingham Coronary Risk Score at 12 months, in addition to changes in individual risk factors. Risk factor control was classified as 'poor' if 0 to 3 factors were on target, 'fair' if 4 to 6 factors were on target, and 'good' if 7 to 9 were on target. Results The mean Systematic Coronary Risk Evaluation at 12 months was 4.4 per cent (SD 4.5) in the intervention group and 5.4 per cent (SD 6.2) in the control group (p=0.021), representing a 17.4% relative risk reduction. At 12 months, risk factor control classified as 'good' was achieved in 35% of patients in the intervention group compared with 25% in the control group (p=0.003). Attendance to the nurse-coordinated prevention programme was 92%. In the intervention group, 86 rehospitalisations were observed against 132 in the control group (relative risk reduction 34.8%, p=0.023). Conclusions The nurse-coordinated hospital-based prevention programme in addition to usual care is a practical, yet effective method for reduction of cardiovascular risk in patients with coronary disease. Our data suggest that the counselling component of the programme may lead to a reduction in hospital readmissions. Trial Registration trialregister.nl Identifier TC1290.

British Journal of Visual Impairment, 2009

A B S T R AC T The Tactual Profile assesses tactual functioning of children with severe visual im... more A B S T R AC T The Tactual Profile assesses tactual functioning of children with severe visual impairments between zero and 16 years of age. The Tactual Profile consists of 430 items, measuring tactile skills required for performing everyday tasks at home and in school. Items are graded according to age level and divided into three domains: tactual sensory, tactual motor and tactual perceptual. The development of the instrument is described and the psychometric properties that were studied reported. Most items had an acceptable difficulty level and test-retest reliability proved to be good. The analyses for the construct validity showed moderately high correlations between the Tactual Profile and intelligence tests. These correlations were higher for the haptic performance subtests than the verbal tests. High correlations with other haptic tests were found. However, these associations disappeared after factoring out intelligence, possibly because current methods for examining tactual functioning are strongly affected by intelligence. A summary of work planned in further development of the procedure is provided.

The American Journal of Cardiology, 1997

Four hundred seventy-three patients with acute myocardial infarction (AMI) were treated with eith... more Four hundred seventy-three patients with acute myocardial infarction (AMI) were treated with either saruplase (80 mg/hour, n Å 236) or alteplase (100 mg every 3 hours, n Å 237). Comedication included heparin and acetylsalicylic acid. Angiography was performed at 45 and 60 minutes after the start of thrombolytic therapy. When flow was insufficient, angiography was repeated at 90 minutes. Coronary angioplasty was then performed if Thrombolysis In Myocardial Infarction (TIMI) trial 0 to 1 flow was seen. Control angiography was at 24 to 40 hours. Baseline characteristics were similar. Angiography showed comparable and remarkably high early patency rates (TIMI 2 or 3 flow) in both treatment groups: at 45 minutes, 74.6% versus 68.9% (p Å 0.22); and at 60 minutes 79.9% versus 75.3% (p Å 0.26). Patency rates at 90 minutes before additional interventions were also comparable (79.9% and 81.4%). Angiographic reocclusion rates were not significantly different:

Atherosclerosis, 1997

Low incidence of coronary ischacmic disease is associated with elevated levels of plasma high den... more Low incidence of coronary ischacmic disease is associated with elevated levels of plasma high density lipoproteins (HDL). The main apolipoprotcin constituent of these particles is apolipopmtcin A-l (ape A-l). In previous studies, we have described an hcpatic increase of mRNA for apolipoprotcin A-I as consequence of feeding a monounsaturated-enriched fat diet. The present study has been designed to explore the relationships among this finding and plasma concentration of high density lipoproteins and apolipoprotcin A-l. In the present study, we have also addressed the role of different amount of fat on the same parameters. To these goals, sewn groups of male Wistar rats have hecn established: Control group consuming chow diet, Cholesterol group fed on a chow diet containing 0.1% (w/w) cholesterol, Coca group fed on a chow diet containing 0.1% (w/w) cholesterol and 40 % coconut oil, Corn group group fed on a chow diet containing 0.1% (w/w) cholesterol and 40 % corn oil and three Olive groups consuming a chow diet containing 0.1% (w/w) cholesterol and percentages of 5,lO and 40% rcspcctively of olive oil. Animals were kept on these diets for two months and then sacrifized for lipoprotein, apolipoprotein and hcpatic mRNA analysis. The main fmdings of this work are that the monounsaturated diet does not decrease plasma HDL cholesterol levels as does polyunsatoratcd fat diet. Both diets saturated and monounsahwated induced an increase in plasma concentration of apolipoprotcin A-l. This increase is dependent on the ingested amount of fat in the later case. Considering the correlation between plasma apolipoprotein A-l concentration and hcpatic mRNA expression in these diets, it seems that the plasmatic ape A-l increase in olive diets is mainly due to the hcpatic mRNA expression. This fact is more relevant aa the dietary amount of olive oil is increased. Nonetheless, the observed plasma ape A-l increase in saturated fat diet is not related to the hcpatic mRNA content. All these data together arc consistent with the hypothesis of that different fatty acids regulate apolipoprotcin A-l expression through different mechanisms.