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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003ECHARISMA (Clopidogrel for High Atherothrombotic Risk, Ischemic Stabilization, Management, and Avoidance) is the first clinical trial to evaluate long-term effectiveness of clopidogrel plus aspirin in a population of high-risk patients, including symptomatic individuals with documented disease. Principal investigator Deepak Bhatt, MD, of the Cleveland Clinic Cardiovascular Coordinating Center, presented results from more than 15,000 study participants followed for a median of 2.3 years.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003Eclinical trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003Ecoronary artery disease\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003ECHARISMA (Clopidogrel for High Atherothrombotic Risk, Ischemic Stabilization, Management, and Avoidance) is the first clinical trial to evaluate long-term effectiveness of clopidogrel plus aspirin in a population of high-risk patients, including symptomatic individuals with documented disease. Principal investigator Deepak Bhatt, MD, of the Cleveland Clinic Cardiovascular Coordinating Center, presented results from more than 15,000 study participants followed for a median of 2.3 years.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe median patient age in CHARISMA was 65, with women constituting 30% of the study population. Risk factor profiles were categorized as \u201ctwo major,\u201d \u201cthree minor,\u201d or \u201cone major\/two minor,\u201d with major risk factors including diabetes, diabetic nephropathy, an ankle brachial index (ABI) \u0026lt;0.9 (consistent with peripheral arterial disease), or asymptomatic carotid stenosis \u0026gt;70% (or 1 or more carotid atheroma identified by intimamedia thickness measurement).\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EMinor risk factors included male gender 65 years or older, females 70 years or older, systolic blood pressure \u0026gt;150 mm Hg despite antihypertensive therapy for at least 3 months, primary hypercholesterolemia, and smoking \u0026gt;15 cigarettes a day.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EThe study population was randomized to either clopidogrel (75 mg daily) or placebo. All study participants took aspirin (75\u2013162 mg daily).\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EStudy data indicated that clopidogrel plus ASA failed to demonstrate a statistically significant reduction in the primary endpoints of non-fatal MI, stroke, or CV-related death compared to ASA alone in a broad patient population with either established atherothrombotic disease or multiple risk factors for atherothrombotic events.\u003C\/p\u003E\n         \u003Cp id=\u0022p-7\u0022\u003EWhile patients with risk factors but no clinical evidence of disease saw no benefit in the primary endpoints, the subgroup of patients with documented cardiovascular disease at enrollment demonstrated some benefit with clopidogrel plus ASA for the primary endpoints (6.9% for clopidogrel\/ASA vs 7.9% for placebo, RR 0.88, p=0.046).\u003C\/p\u003E\n         \u003Cp id=\u0022p-8\u0022\u003EThese findings suggest that dual antiplatelet therapy (clopidogrel plus aspirin) may not be useful as a primary prevention strategy. But in those individuals with established disease, dual therapy may be effective in reducing events. (CHARISMA\u0027s findings in regard to the study\u0027s secondary endpoints are consistent with other major trials\u2014CURE, COMMIT and CLARITY-TIMI 28\u2014that have demonstrated efficacy for dual antiplatelet therapy in the context of PCI and acute coronary syndromes.) Therefore the results of CHARISMA do not alter the established efficacy of dual therapy in patients with acute coronary syndrome and\/or PCI.\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/12\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-1946998147\u0022 data-figure-caption=\u0022\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure1\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/12\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/12\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure1\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/6\/1\/12\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/16084\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-9\u0022\u003EIn presenting results of the CHARISMA trial, Dr. Bhatt noted that \u201cby strict statistical terms, our primary endpoint was negative. But the secondary endpoints dig a little deeper, and actually raise questions that we now need to answer. It\u0027s clear that the question of dual antiplatelet therapy demands further study.\u201d\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2006 MD Conference Express\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/6\/1\/12.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzm6ap\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzm6ap\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}