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Lindahl B, Baron T, Erlinge D, Hadziosmanovic N, Nordenskjöld A, Gard A, Jernberg T. Medical Therapy for Secondary Prevention and Long-Term Outcome in Patients With Myocardial Infarction With Nonobstructive Coronary Artery Disease. Circulation 2017; 135:1481-1489. [PMID: 28179398 DOI: 10.1161/circulationaha.116.026336] [Citation(s) in RCA: 283] [Impact Index Per Article: 40.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Accepted: 01/31/2017] [Indexed: 12/12/2022]
Abstract
BACKGROUND Myocardial infarction with nonobstructive coronary arteries (MINOCA) occurs in 5% to 10% of all patients with myocardial infarction. Clinical trials of secondary prevention treatment in MINOCA patients are lacking. Therefore, the aim of this study was to examine the associations between treatment with statins, renin-angiotensin system blockers, β-blockers, dual antiplatelet therapy, and long-term cardiovascular events. METHODS This is an observational study of MINOCA patients recorded in the SWEDEHEART registry (the Swedish Web-system for Enhancement and Development of Evidence-based care in Heart disease Evaluated According to Recommended Therapy) between July 2003 and June 2013 and followed until December 2013 for outcome events in the Swedish Cause of Death Register and National Patient Register. Of 199 162 myocardial infarction admissions, 9466 consecutive unique patients with MINOCA were identified. Among those, the 9136 patients surviving the first 30 days after discharge constituted the study population. Mean age was 65.3 years, and 61% were women. No patient was lost to follow-up. A stratified propensity score analysis was performed to match treated and untreated groups. The association between treatment and outcome was estimated by comparing between treated and untreated groups by using Cox proportional hazards models. The exposures were treatment at discharge with statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and dual antiplatelet therapy. The primary end point was major adverse cardiac events defined as all-cause mortality, hospitalization for myocardial infarction, ischemic stroke, and heart failure. RESULTS At discharge, 84.5%, 64.1%, 83.4%, and 66.4% of the patients were on statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, β-blockers, and dual antiplatelet therapy, respectively. During the follow-up of a mean of 4.1 years, 2183 (23.9%) patients experienced a major adverse cardiac event. The hazard ratios (95% confidence intervals) for major adverse cardiac events were 0.77 (0.68-0.87), 0.82 (0.73-0.93), and 0.86 (0.74-1.01) in patients on statins, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, and β-blockers, respectively. For patients on dual antiplatelet therapy followed for 1 year, the hazard ratio was 0.90 (0.74-1.08). CONCLUSIONS The results indicate long-term beneficial effects of treatment with statins and angiotensin-converting enzyme inhibitors/angiotensin receptor blockers on outcome in patients with MINOCA, a trend toward a positive effect of β-blocker treatment, and a neutral effect of dual antiplatelet therapy. Properly powered randomized clinical trials to confirm these results are warranted.
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Affiliation(s)
- Bertil Lindahl
- From Department of Medical Sciences, Cardiology, Uppsala University, Sweden (B.L., T.B., A.G.); Uppsala Clinical Research Center, Uppsala University, Sweden (B.L., T.B., N.H., A.G.); Department of Cardiology, Lund University, Sweden (D.E.); Örebro University, Faculty of Health, Department of Cardiology, Sweden (A.N.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.J.).
| | - Tomasz Baron
- From Department of Medical Sciences, Cardiology, Uppsala University, Sweden (B.L., T.B., A.G.); Uppsala Clinical Research Center, Uppsala University, Sweden (B.L., T.B., N.H., A.G.); Department of Cardiology, Lund University, Sweden (D.E.); Örebro University, Faculty of Health, Department of Cardiology, Sweden (A.N.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.J.)
| | - David Erlinge
- From Department of Medical Sciences, Cardiology, Uppsala University, Sweden (B.L., T.B., A.G.); Uppsala Clinical Research Center, Uppsala University, Sweden (B.L., T.B., N.H., A.G.); Department of Cardiology, Lund University, Sweden (D.E.); Örebro University, Faculty of Health, Department of Cardiology, Sweden (A.N.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.J.)
| | - Nermin Hadziosmanovic
- From Department of Medical Sciences, Cardiology, Uppsala University, Sweden (B.L., T.B., A.G.); Uppsala Clinical Research Center, Uppsala University, Sweden (B.L., T.B., N.H., A.G.); Department of Cardiology, Lund University, Sweden (D.E.); Örebro University, Faculty of Health, Department of Cardiology, Sweden (A.N.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.J.)
| | - Anna Nordenskjöld
- From Department of Medical Sciences, Cardiology, Uppsala University, Sweden (B.L., T.B., A.G.); Uppsala Clinical Research Center, Uppsala University, Sweden (B.L., T.B., N.H., A.G.); Department of Cardiology, Lund University, Sweden (D.E.); Örebro University, Faculty of Health, Department of Cardiology, Sweden (A.N.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.J.)
| | - Anton Gard
- From Department of Medical Sciences, Cardiology, Uppsala University, Sweden (B.L., T.B., A.G.); Uppsala Clinical Research Center, Uppsala University, Sweden (B.L., T.B., N.H., A.G.); Department of Cardiology, Lund University, Sweden (D.E.); Örebro University, Faculty of Health, Department of Cardiology, Sweden (A.N.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.J.)
| | - Tomas Jernberg
- From Department of Medical Sciences, Cardiology, Uppsala University, Sweden (B.L., T.B., A.G.); Uppsala Clinical Research Center, Uppsala University, Sweden (B.L., T.B., N.H., A.G.); Department of Cardiology, Lund University, Sweden (D.E.); Örebro University, Faculty of Health, Department of Cardiology, Sweden (A.N.); and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden (T.J.)
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1152
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Dimmitt SB, Martin JH. Lipid and other management to improve arterial disease and survival in end stage renal disease. Expert Opin Pharmacother 2017; 18:343-349. [DOI: 10.1080/14656566.2017.1285905] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Simon B Dimmitt
- School of Medicine and Pharmacology, University of Western Australia, Crawley, Australia
| | - Jennifer H Martin
- School of Medicine and Public Health, University of Newcastle, Callaghan, New South Wales, Australia
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1154
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Abstract
PURPOSE OF REVIEW This review summarizes the recent population-based studies, clinical trials, clinical metabolic studies, and genetic studies reporting the effects of statin therapy on the risk of diabetes. Recent studies aiming to explain the mechanisms how statin treatment affects insulin sensitivity and insulin secretion are also reviewed. RECENT FINDINGS Statin therapy increases the risk of diabetes by 9%-12% in the two meta-analyses of statin trials and by 18%-99% in five population-based studies. Statin therapy impairs insulin sensitivity and insulin secretion based on clinical and epidemiologic studies. In vitro studies demonstrate that the most diabetogenic statins impair insulin sensitivity and insulin secretion by multiple mechanisms. Recent genetic studies suggest that the increased risk of type 2 diabetes may be partially explained by gene variants in the target genes for low-density lipoprotein cholesterol lowering drugs. Population-based studies report higher incidence rates for diabetes in individuals on statin treatment compared with clinical trials. Incident diabetes has not been a prespecified endpoint in statin trials and glucose and/or HbA1c have not been routinely measured. Therefore, it is possible that the risk of diabetes in individuals on statin treatment has been underestimated in previous statin trials. Accumulating evidence from several statin trials, population-based studies, clinical studies, and in vitro studies suggests that pravastatin is the least diabetogenic statin, and simvastatin, atorvastatin, and rosuvastatin the most diabetogenic statins. In vitro studies have reported new findings on mechanisms how statin treatment affects insulin sensitivity and insulin secretion. In spite of diabetogenicity of different statins, the consensus is that the benefits of statins in reducing cardiovascular events clearly outweigh the risk of diabetes.
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Affiliation(s)
- Markku Laakso
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, 70210, Kuopio, Finland.
| | - Johanna Kuusisto
- Institute of Clinical Medicine, Internal Medicine, University of Eastern Finland and Kuopio University Hospital, 70210, Kuopio, Finland
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1155
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Sage AP, Mallat Z. Readapting the adaptive immune response - therapeutic strategies for atherosclerosis. Br J Pharmacol 2017; 174:3926-3939. [PMID: 28052311 DOI: 10.1111/bph.13700] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 12/13/2016] [Accepted: 12/20/2016] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular diseases remain a major global health issue, with the development of atherosclerosis as a major underlying cause. Our treatment of cardiovascular disease has improved greatly over the past three decades, but much remains to be done reduce disease burden. Current priorities include reducing atherosclerosis advancement to clinically significant stages and preventing plaque rupture or erosion. Inflammation and involvement of the adaptive immune system influences all these aspects and therefore is one focus for future therapeutic development. The atherosclerotic vascular wall is now recognized to be invaded from both sides (arterial lumen and adventitia), for better or worse, by the adaptive immune system. Atherosclerosis is also affected at several stages by adaptive immune responses, overall providing many opportunities to target these responses and to reduce disease progression. Protective influences that may be defective in diseased individuals include humoral responses to modified LDL and regulatory T cell responses. There are many strategies in development to boost these pathways in humans, including vaccine-based therapies. The effects of various existing adaptive immune targeting therapies, such as blocking critical co-stimulatory pathways or B cell depletion, on cardiovascular disease are beginning to emerge with important consequences for both autoimmune disease patients and the potential for wider use of such therapies. Entering the translation phase for adaptive immune targeting therapies is an exciting and promising prospect. LINKED ARTICLES This article is part of a themed section on Targeting Inflammation to Reduce Cardiovascular Disease Risk. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v174.22/issuetoc and http://onlinelibrary.wiley.com/doi/10.1111/bcp.v82.4/issuetoc.
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Affiliation(s)
- Andrew P Sage
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge, UK
| | - Ziad Mallat
- Division of Cardiovascular Medicine, Department of Medicine, University of Cambridge, Cambridge, UK.,INSERM U970, Paris Cardiovascular Research Center, Paris, France, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
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Giugliano RP, Mach F, Zavitz K, Kurtz C, Schneider J, Wang H, Keech A, Pedersen TR, Sabatine MS, Sever PS, Honarpour N, Wasserman SM, Ott BR. Design and rationale of the EBBINGHAUS trial: A phase 3, double-blind, placebo-controlled, multicenter study to assess the effect of evolocumab on cognitive function in patients with clinically evident cardiovascular disease and receiving statin background lipid-lowering therapy-A cognitive study of patients enrolled in the FOURIER trial. Clin Cardiol 2017; 40:59-65. [PMID: 28207168 PMCID: PMC6490624 DOI: 10.1002/clc.22678] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/08/2017] [Accepted: 01/11/2017] [Indexed: 12/13/2022] Open
Abstract
Some observational studies raised concern that statins may cause memory impairment, leading to a US Food and Drug Administration warning. Similar questions were raised regarding proprotein convertase subtilisin/kexin-type 9 inhibitors (PCSK9i) and neurocognitive function. No prospectively designed study has evaluated the relationship between long-term PCSK9i use and cognition changes. Patients with prior cardiovascular disease treated with maximally tolerated statin enrolled in FOURIER (the randomized, double-blind, placebo-controlled cardiovascular outcome study of the PCSK9i evolocumab) could participate in this prospective assessment of cognitive function (EBBINGHAUS). Key additional exclusion criteria for EBBINGHAUS were dementia, cognitive impairment, or other significant mental or neurological disorder. Cognitive testing was performed using the Cambridge Neuropsychological Test Automated Battery, a tablet-based tool assessing executive function, working memory, memory function, and psychomotor speed at baseline, weeks 24 and 48, every 48 weeks thereafter, and study end. The primary endpoint was spatial working memory strategy index of executive function (SWMSI). The primary hypothesis was that evolocumab would be noninferior to placebo in the mean change from baseline over time in SWMSI. Fifteen hundred cognitively normal patients completing the assessments provided approximately 97% power to demonstrate that the upper 95% confidence interval for the treatment difference in mean change from baseline in SWMSI over time is <20% of the SD of the mean change in the placebo group. An exploratory analysis will compare neurocognitive function in patients with post-baseline low-density lipoprotein cholesterol <25 mg/dL. EBBINGHAUS will evaluate whether the addition of evolocumab to statin therapy affects cognitive function over time in patients with stable cardiovascular disease.
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Affiliation(s)
| | - Francois Mach
- Division of Cardiology, Cantonal HospitalGeneva University HospitalsGenevaSwitzerland
| | | | | | | | | | - Anthony Keech
- NHMRC Clinical Trials Centre, Sydney Medical Schoolthe University of SydneyAustralia
| | - Terje R. Pedersen
- Center for Preventive Medicine, Oslo University Hospital, Ullevål; and Medical FacultyUniversity of OsloNorway
| | - Marc S. Sabatine
- TIMI Study Group, Brigham and Women's HospitalBostonMassachusetts
| | - Peter S. Sever
- International Centre for Circulatory Health, Imperial College LondonLondonUnited Kingdom
| | | | | | - Brian R. Ott
- Department of Neurologythe Warren Alpert Medical School of Brown UniversityProvidenceRhode Island
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1157
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Tietge UJF. 'Examine my kidneys and my heart': linking renal and cardiovascular disease. Curr Opin Lipidol 2017; 28:83-84. [PMID: 28030454 DOI: 10.1097/mol.0000000000000379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Uwe J F Tietge
- Department of Pediatrics, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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1158
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Robson J, Dostal I, Madurasinghe V, Sheikh A, Hull S, Boomla K, Griffiths C, Eldridge S. NHS Health Check comorbidity and management: an observational matched study in primary care. Br J Gen Pract 2017; 67:e86-e93. [PMID: 27993901 PMCID: PMC5308122 DOI: 10.3399/bjgp16x688837] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 09/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The NHS Health Check programme completed its first 5 years in 2014, identifying those at highest risk of cardiovascular disease and new comorbidities, and offering behavioural change support and treatment. AIM To describe the coverage and impact of this programme on cardiovascular risk management and identification of new comorbidities. DESIGN AND SETTING Observational 5-year study from April 2009 to March 2014, in 139 of 143 general practices in three clinical commissioning groups (CCGs) in east London. METHOD A matched analysis compared comorbidity in NHS Health Check attendees and non-attendees. RESULTS A total of 252 259 adults aged 40-74 years were eligible for an NHS Health Check and, of these, 85 122 attended in 5 years. Attendance increased from 7.3% (10 900/149 867) in 2009 to 17.0% (18 459/108 525) in 2013 to 2014, representing increasing coverage from 36.4% to 85.0%. Attendance was higher in the more deprived quintiles and among South Asians. Statins were prescribed to 11.5% of attendees and 8.2% of non-attendees. In a matched analysis, newly-diagnosed comorbidity was more likely in attendees than non-attendees, with odds ratios for new diabetes 1.30 (95% confidence interval [CI] = 1.21 to 1.39), hypertension 1.50 (95% CI = 1.43 to 1.57), and chronic kidney disease 1.83 (95% CI = 1.52 to 2.21). CONCLUSION The NHS Health Check programme provision in these CCGs was equitable, with recent coverage of 85%. Statins were 40% more likely to be prescribed to attendees than non-attendees, providing estimated absolute benefits of public health importance. More new cases of diabetes, hypertension, and chronic kidney disease were identified among attendees than a matched group of non-attendees.
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Affiliation(s)
- John Robson
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Isabel Dostal
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | | | - Aziz Sheikh
- Centre for Primary Care and Public Health, eHealth Research Group, Centre for Population Health Sciences, University of Edinburgh, Edinburgh
| | - Sally Hull
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Kambiz Boomla
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Chris Griffiths
- Centre for Primary Care and Public Health, Queen Mary University of London, London
| | - Sandra Eldridge
- Centre for Primary Care and Public Health, Queen Mary University of London, London
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1159
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Shah P, Glueck CJ, Goldenberg N, Min S, Mahida C, Schlam I, Rothschild M, Huda A, Wang P. Efficacy, safety, Low density lipoprotein cholesterol lowering, and calculated 10-year cardiovascular risk reduction of alirocumab and evolocumab in addition to maximal tolerated cholesterol lowering therapy: a post-commercialization study. Lipids Health Dis 2017; 16:19. [PMID: 28115017 PMCID: PMC5259842 DOI: 10.1186/s12944-017-0416-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Accepted: 01/16/2017] [Indexed: 01/20/2023] Open
Abstract
Background Efficacy and safety of proprotein convertase subtilisin-kexin type 9 (PCSK9) inhibitors, alirocumab (ALI) and evolocumab (EVO) have previously been evaluated through controlled clinical trials with selective patient groups. Post-commercially, in patients with heterozygous familial hypercholesterolemia (HeFH) and/or cardiovascular disease (CVD) with suboptimal LDL cholesterol (LDLC) lowering on maximal tolerated cholesterol lowering therapy, we assessed efficacy and safety of ALI and EVO. Methods Post-commercially, we started 25 patients on ALI 75 mg, 15 on ALI 150 mg, and 32 on EVO 140 mg bi-weekly added to entry LDLC lowering regimen, with follow-up for a median 24 weeks. History, physical exam, demographics, and adverse event data were collected. Changes in LDLC and AHA and NIH calculated 10-year CVD risks were assessed on ALI and EVO. Results Of 72 patients, 25 had HeFH only, 25 CVD only, 22 had both, median age was 65 years, 63% females, 38% males, 86% Caucasian, 11% African-Americans, 17% diabetics, 63% on anti-hypertensives, and 7% smokers. At entry, 30 (42%) were on a statin and 42 (58%) could not tolerate any statins. At 24-weeks, median LDLC decreased on ALI 75 mg from 117 to 62 mg/dL (−54%), on ALI 150 mg from 175 to 57 mg/dL (−63%), and on EVO 140 mg from 165 to 69 mg/dL (−63%), p <0.0001 for all. Absolute and percent LDLC reduction did not differ (p >.05) between ALI 150 and EVO 140 mg, but were less on ALI 75 mg vs ALI 150 mg and EVO 140 mg (p <.05). Percent reductions in 10-year CVD risks by AHA and NIH calculators, respectively were ALI 75 mg −22 and −44%, ALI 150 mg −31 and −50%, and EVO 140 mg −29 and −56%, p ≤.002 for all. The three most common adverse events included flu-like myositis 10%, respiratory tract symptoms 8%, and injection site reaction 6%. Conclusion In patients with HeFH and/or CVD, LDLC was lowered by 63% on EVO and ALI 150 mg, and 54% on ALI 75 mg. Adverse events were minimal and tolerable. ALI and EVO represent paradigm shifts in LDLC lowering. Long term, post-commercial safety and efficacy remain to be determined.
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Affiliation(s)
- Parth Shah
- Graduate Medical Education Department, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA.
| | - Charles J Glueck
- Graduate Medical Education Department, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA
| | - Naila Goldenberg
- Graduate Medical Education Department, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA
| | - Sarah Min
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Chris Mahida
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Ilana Schlam
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Matan Rothschild
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Ali Huda
- The Jewish Hospital Internal Medicine Residency Program, 4777 E Galbraith Rd, Cincinnati, Ohio, 45236, USA
| | - Ping Wang
- Graduate Medical Education Department, Jewish Hospital of Cincinnati, Cincinnati, Ohio, USA
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1160
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Kheloufi F, Default A, Blin O, Micallef J. Investigating patient narratives posted on Internet and their informativeness level for pharmacovigilance purpose: The example of comments about statins. Therapie 2017; 72:483-490. [PMID: 28065444 DOI: 10.1016/j.therap.2016.10.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2016] [Accepted: 10/26/2016] [Indexed: 12/01/2022]
Abstract
AIM OF THE STUDY Health-related networks like patient health forums may be considered as potential sources of information to early detect pharmacovigilance issues or complete data on drug safety. However, the clinical and pharmacological relevancy of such a source has not been clearly explored. We aimed to describe the characteristics and the informativeness level of Internet narratives posted by patients and mentioning adverse drug reactions (ADRs) related to statins. METHODS A retrospective cross-sectional study was conducted on an Internet website dedicated to share experience on medicines. One day of December 2012, postings about simvastatin, rosuvastatin and atorvastatin publicly available on the website were collected. Their informativeness according to 16 key elements of information (including drug start and stop date, duration of treatment, time to onset and duration of the ADR, outcome, medical history, concomitant medication) was assessed. General information about reported ADRs was also investigated. RESULTS Among the 96 postings related to statins, 72 (40 women, 32 men; mean age: 59 [40-78]) mentioned at least one ADR accounting for a total of 176 ADRs. Musculoskeletal and connective tissue disorders (42.6%) and nervous system disorders (15.3%) were the main represented ADRs. Only 2 patients mentioned ADRs that could be considered as serious but 24 patients mentioned they stopped or switched their treatment toward another lipid modifying agent because of the ADR. Mean number of available key elements of information per narrative was 6/16. Time to onset and duration of the ADR were respectively available in only 31% and 3% of the narratives. Medical history and concomitant medication were respectively lacking in 87% and 86% of the narratives. Outcome was found only in 39% of the narratives. CONCLUSION Patient narratives posted on Internet include mainly non-serious expected ADR. However, their informativeness level is very incomplete and makes difficult their assessment and use for pharmacovigilance purpose.
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Affiliation(s)
- Farid Kheloufi
- Regional pharmacovigilance center of Marseille Provence Corse, department of clinical pharmacology and pharmacovigilance, Assistance publique-Hôpitaux de Marseille, 13009 Marseille, France; Aix-Marseille university, Neurosciences institut Timone, CNRS 7289, 13385 Marseille, France
| | - Anne Default
- Regional pharmacovigilance center of Marseille Provence Corse, department of clinical pharmacology and pharmacovigilance, Assistance publique-Hôpitaux de Marseille, 13009 Marseille, France; Aix-Marseille university, Neurosciences institut Timone, CNRS 7289, 13385 Marseille, France
| | - Olivier Blin
- Regional pharmacovigilance center of Marseille Provence Corse, department of clinical pharmacology and pharmacovigilance, Assistance publique-Hôpitaux de Marseille, 13009 Marseille, France; Aix-Marseille university, Neurosciences institut Timone, CNRS 7289, 13385 Marseille, France
| | - Joelle Micallef
- Regional pharmacovigilance center of Marseille Provence Corse, department of clinical pharmacology and pharmacovigilance, Assistance publique-Hôpitaux de Marseille, 13009 Marseille, France; Aix-Marseille university, Neurosciences institut Timone, CNRS 7289, 13385 Marseille, France.
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1161
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Stewart J, Manmathan G, Wilkinson P. Primary prevention of cardiovascular disease: A review of contemporary guidance and literature. JRSM Cardiovasc Dis 2017; 6:2048004016687211. [PMID: 28286646 PMCID: PMC5331469 DOI: 10.1177/2048004016687211] [Citation(s) in RCA: 177] [Impact Index Per Article: 25.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Revised: 11/22/2016] [Accepted: 12/02/2016] [Indexed: 12/25/2022] Open
Abstract
Cardiovascular disease is a significant and ever-growing problem in the United Kingdom, accounting for nearly one-third of all deaths and leading to significant morbidity. It is also of particular and pressing interest as developing countries experience a change in lifestyle which introduces novel risk factors for cardiovascular disease, leading to a boom in cardiovascular disease risk throughout the developing world. The burden of cardiovascular disease can be ameliorated by careful risk reduction and, as such, primary prevention is an important priority for all developers of health policy. Strong consensus exists between international guidelines regarding the necessity of smoking cessation, weight optimisation and the importance of exercise, whilst guidelines vary slightly in their approach to hypertension and considerably regarding their approach to optimal lipid profile which remains a contentious issue. Previously fashionable ideas such as the polypill appear devoid of in-vivo efficacy, but there remain areas of future interest such as the benefit of serum urate reduction and utility of reduction of homocysteine levels.
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Affiliation(s)
- Jack Stewart
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, London, UK; Institute of Cardiovascular Research, Biological Sciences, University of London, Surrey, UK
| | | | - Peter Wilkinson
- Department of Cardiology, Ashford & St Peter's NHS Foundation Trust, London, UK
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1162
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Should a statin be given to all hypertensive patients? Artery Res 2017. [DOI: 10.1016/j.artres.2017.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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1163
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Investigating the prevalence, predictors, and prognosis of suboptimal statin use early after a non-ST elevation acute coronary syndrome. J Clin Lipidol 2016; 11:204-214. [PMID: 28391887 PMCID: PMC5399750 DOI: 10.1016/j.jacl.2016.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 12/06/2016] [Accepted: 12/16/2016] [Indexed: 11/24/2022]
Abstract
Background High-potency statin therapy is recommended in the secondary prevention of cardiovascular disease but discontinuation, dose reduction, statin switching, and/or nonadherence occur in practice. Objectives To determine the prevalence and predictors of deviation from high-potency statin use early after a non-ST elevation acute coronary syndrome (NSTE-ACS) and its association with subsequent major adverse cardiovascular events (MACE) and all-cause mortality (ACM). Methods A total of 1005 patients from a UK-based prospective NSTE-ACS cohort study discharged on high-potency statin therapy (atorvastatin 80 mg, rosuvastatin 20 mg, or 40 mg daily) were included. At 1 month, patients were divided into constant high-potency statin users, and suboptimal users incorporating statin discontinuation, dose reduction, switching statin to a lower equivalent potency, and/or statin nonadherence. Follow-up was a median of 16 months. Results There were 156 suboptimal (∼15.5%) and 849 constant statin users. Factors associated in multivariable analysis with suboptimal statin occurrence included female sex (odds ratio 1.75, 95% confidence interval [CI] 1.14–2.68) and muscular symptoms (odds ratio 4.28, 95% CI 1.30–14.08). Suboptimal statin use was associated with increased adjusted risks of time to MACE (hazard ratio 2.10, 95% CI 1.25–3.53, P = .005) and ACM (hazard ratio 2.46, 95% CI 1.38–4.39, P = .003). Subgroup analysis confirmed that the increased MACE/ACM risks were principally attributable to statin discontinuation or nonadherence. Conclusions Conversion to suboptimal statin use is common early after NSTE-ACS and is partly related to muscular symptoms. Statin discontinuation or non-adherence carries an adverse prognosis. Interventions that preserve and enhance statin utilization could improve post NSTE-ACS outcomes. Deviation from high-potency statin therapy is common early in secondary prevention. Deviation can be by discontinuation, dose reduction, switching, or nonadherence. Muscular symptoms are associated with suboptimal statin use. Statin discontinuation/nonadherence is associated with increased adverse outcomes. Interventions to enhance statin use could improve secondary prevention outcomes.
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1164
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Otto CM. Statins for primary prevention of cardiovascular disease : Patients need better tools to navigate divergent recommendations. Heart 2016; 103:477-478. [PMID: 27940966 DOI: 10.1136/heartjnl-2016-310959] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
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1165
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Putzu A, Capelli B, Belletti A, Cassina T, Ferrari E, Gallo M, Casso G, Landoni G. Perioperative statin therapy in cardiac surgery: a meta-analysis of randomized controlled trials. Crit Care 2016; 20:395. [PMID: 27919293 PMCID: PMC5139027 DOI: 10.1186/s13054-016-1560-6] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 11/07/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Several studies suggest beneficial effects of perioperative statin therapy on postoperative outcome after cardiac surgery. However, recent randomized controlled trials (RCTs) show potential detrimental effects. The objective of this systematic review is to examine the association between perioperative statin therapy and clinical outcomes in cardiac surgery patients. METHODS Electronic databases were searched up to 1 November 2016 for RCTs of preoperative statin therapy versus placebo or no treatment in adult cardiac surgery. Postoperative outcomes were acute kidney injury, atrial fibrillation, myocardial infarction, stroke, infections, and mortality. We calculated odds ratios (ORs) and 95% confidence intervals (CIs) using fixed-effects meta-analyses. Primary analysis was restricted to trials with low risk of bias according to Cochrane methodology, and sensitivity analyses examined whether the risk of bias of included studies was associated with different results. We performed trial sequential analysis (TSA) to test the strength of the results. RESULTS We included data from 23 RCTs involving 5102 patients. Meta-analysis of trials with low risk of bias showed that statin therapy was associated with an increase in acute kidney injury (314 of 1318 (23.82%) with statins versus 262 of 1319 (19.86%) with placebo; OR 1.26 (95%CI 1.05 to 1.52); p = 0.01); these results were supported by TSA. No difference in postoperative atrial fibrillation, myocardial infarction, stroke, infections, or mortality was present. On sensitivity analysis, statin therapy was associated with a slight increase in hospital mortality. Meta-analysis including also trials with high or unclear risk of bias showed no beneficial effects of statin therapy on any postoperative outcomes. CONCLUSIONS There is no evidence that statin therapy in the days prior to cardiac surgery is beneficial for patients' outcomes. Particularly, statins are not protective against postoperative atrial fibrillation, myocardial infarction, stroke, or infections. Statins are associated with a possible increased risk of acute kidney injury and a detrimental effect on hospital survival could not be excluded. Future RCTs should further evaluate the safety profile of this therapy in relation to patients' outcomes and assess the more appropriate time point for discontinuation of statins before cardiac surgery.
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Affiliation(s)
- Alessandro Putzu
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Bruno Capelli
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Alessandro Belletti
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milano, Italy
| | - Tiziano Cassina
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Enrico Ferrari
- Department of Cardiac Surgery, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Michele Gallo
- Department of Cardiac Surgery, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Gabriele Casso
- Department of Cardiovascular Anesthesia and Intensive Care, Cardiocentro Ticino, Via Tesserete 48, Lugano, Switzerland
| | - Giovanni Landoni
- Department of Anesthesia and Intensive Care, IRCCS San Raffaele Scientific Institute, Via Olgettina 60, Milano, Italy
- Vita-Salute San Raffaele University, Via Olgettina 58, Milano, Italy
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1166
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Razak F, Davey Smith G, Subramanian SV. The idea of uniform change: is it time to revisit a central tenet of Rose's "Strategy of Preventive Medicine"? Am J Clin Nutr 2016; 104:1497-1507. [PMID: 27935518 DOI: 10.3945/ajcn.115.127357] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2015] [Accepted: 08/19/2016] [Indexed: 01/22/2023] Open
Abstract
A mean-centric view of populations, whereby a change in the mean of a health variable at the population level is assumed to result in uniform change across the distribution, is a core component of Geoffrey Rose's concept of the "population strategy" to disease prevention. This idea also has a critical role in Rose's observation that individuals who are considered abnormal or sick (the rightward tail of the distribution) and those who are considered normal (the center) are very closely related, and that true preventive medicine must focus on shifting the normal or average. In this Perspective, we revisit these core tenets of Rose's concept of preventive medicine after providing an overview of the key concepts that he developed. We examine whether these assumptions apply to population changes in body mass index (BMI) and show that there is considerable evidence of a widening of the BMI distribution in populations over time. We argue that, with respect to BMI, the idea of using statistical measures of a population solely on the basis of means and the assumption that populations are coherent entities that change uniformly over time may not fully capture the true nature of changes in the population. These issues have important implications for how we assess and interpret the health of populations over time with implications for the balance between universal and targeted strategies aimed at improving health.
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Affiliation(s)
- Fahad Razak
- Department of Medicine, University of Toronto, Toronto, Canada.,Li Ka Shing Knowledge Institute and Division of General Internal Medicine, St. Michael's Hospital, Toronto, Canada.,Harvard Center for Population and Development Studies, Cambridge, MA
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit and.,School of Social and Community Medicine, University of Bristol, Bristol, United Kingdom; and
| | - S V Subramanian
- Harvard Center for Population and Development Studies, Cambridge, MA; .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA
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1167
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Scattolini V, Luni C, Zambon A, Galvanin S, Gagliano O, Ciubotaru CD, Avogaro A, Mammano F, Elvassore N, Fadini GP. Simvastatin Rapidly and Reversibly Inhibits Insulin Secretion in Intact Single-Islet Cultures. Diabetes Ther 2016; 7:679-693. [PMID: 27830474 PMCID: PMC5118248 DOI: 10.1007/s13300-016-0210-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Epidemiological studies suggest that statins may promote the development or exacerbation of diabetes, but whether this occurs through inhibition of insulin secretion is unclear. This lack of understanding is partly due to the cellular models used to explore this phenomenon (cell lines or pooled islets), which are non-physiologic and have limited clinical transferability. METHODS Here, we study the effect of simvastatin on insulin secretion using single-islet cultures, an optimal compromise between biological observability and physiologic fidelity. We develop and validate a microfluidic device to study single-islet function ex vivo, which allows for switching between media of different compositions with a resolution of seconds. In parallel, fluorescence imaging provides real-time analysis of the membrane voltage potential, cytosolic Ca2+ dynamics, and insulin release during perfusion under 3 or 11 mM glucose. RESULTS We found that simvastatin reversibly inhibits insulin secretion, even in high-glucose. This phenomenon is very rapid (<60 s), occurs without affecting Ca2+ concentrations, and is likely unrelated to cholesterol biosynthesis and protein isoprenylation, which occur on a time span of hours. CONCLUSIONS Our data provide the first real-time live demonstration that a statin inhibits insulin secretion in intact islets and that single islets respond differently from cell lines on a short time scale. FUNDING University of Padova, EASD Foundation.
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Affiliation(s)
- Valentina Scattolini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35129, Padua, Italy
- Venetian Institute of Molecular Medicine, Via Orus 2, 35128, Padua, Italy
| | - Camilla Luni
- Venetian Institute of Molecular Medicine, Via Orus 2, 35128, Padua, Italy
- Shanghai Institute for Advanced Immunochemical Studies, ShanghaiTech University, 99 Haike Road, Shanghai, 201210, China
- Department of Industrial Engineering, University of Padova, Via Marzolo 9, 35131, Padua, Italy
| | - Alessandro Zambon
- Venetian Institute of Molecular Medicine, Via Orus 2, 35128, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Marzolo 9, 35131, Padua, Italy
| | - Silvia Galvanin
- Venetian Institute of Molecular Medicine, Via Orus 2, 35128, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Marzolo 9, 35131, Padua, Italy
| | - Onelia Gagliano
- Venetian Institute of Molecular Medicine, Via Orus 2, 35128, Padua, Italy
- Department of Industrial Engineering, University of Padova, Via Marzolo 9, 35131, Padua, Italy
| | | | - Angelo Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35129, Padua, Italy
| | - Fabio Mammano
- CNR Institute of Cell Biology and Neurobiology, 00015, Monterotondo, Italy
- Department of Physics, University of Padova, Via Marzolo 8, 35131, Padua, Italy
| | - Nicola Elvassore
- Venetian Institute of Molecular Medicine, Via Orus 2, 35128, Padua, Italy.
- Department of Industrial Engineering, University of Padova, Via Marzolo 9, 35131, Padua, Italy.
| | - Gian Paolo Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35129, Padua, Italy.
- Venetian Institute of Molecular Medicine, Via Orus 2, 35128, Padua, Italy.
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1168
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Gitsels LA, Kulinskaya E, Steel N. Survival Benefits of Statins for Primary Prevention: A Cohort Study. PLoS One 2016; 11:e0166847. [PMID: 27861639 PMCID: PMC5115824 DOI: 10.1371/journal.pone.0166847] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 11/05/2016] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Estimate the effect of statin prescription on mortality in the population of England and Wales with no previous history of cardiovascular disease. METHODS Primary care records from The Health Improvement Network 1987-2011 were used. Four cohorts of participants aged 60, 65, 70, or 75 years at baseline included 118,700, 199,574, 247,149, and 194,085 participants; and 1.4, 1.9, 1.8, and 1.1 million person-years of data, respectively. The exposure was any statin prescription at any time before the participant reached the baseline age (60, 65, 70 or 75) and the outcome was all-cause mortality at any age above the baseline age. The hazard of mortality associated with statin prescription was calculated by Cox's proportional hazard regressions, adjusted for sex, year of birth, socioeconomic status, diabetes, antihypertensive medication, hypercholesterolaemia, body mass index, smoking status, and general practice. Participants were grouped by QRISK2 baseline risk of a first cardiovascular event in the next ten years of <10%, 10-19%, or ≥20%. RESULTS There was no reduction in all-cause mortality for statin prescription initiated in participants with a QRISK2 score <10% at any baseline age, or in participants aged 60 at baseline in any risk group. Mortality was lower in participants with a QRISK2 score ≥20% if statin prescription had been initiated by age 65 (adjusted hazard ratio (HR) 0.86 (0.79-0.94)), 70 (HR 0.83 (0.79-0.88)), or 75 (HR 0.82 (0.79-0.86)). Mortality reduction was uncertain with a QRISK2 score of 10-19%: the HR was 1.00 (0.91-1.11) for statin prescription by age 65, 0.89 (0.81-0.99) by age 70, or 0.79 (0.52-1.19) by age 75. CONCLUSIONS The current internationally recommended thresholds for statin therapy for primary prevention of cardiovascular disease in routine practice may be too low and may lead to overtreatment of younger people and those at low risk.
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Affiliation(s)
- Lisanne A. Gitsels
- School of Computing Sciences, University of East Anglia, Norwich, United Kingdom
| | - Elena Kulinskaya
- School of Computing Sciences, University of East Anglia, Norwich, United Kingdom
| | - Nicholas Steel
- Norwich Medical School, University of East Anglia, Norwich, United Kingdom
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1169
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Armitage J, Baigent C, Collins R. Lessons from the controversy over statins - Authors' reply. Lancet 2016; 388:2237-2238. [PMID: 27825506 DOI: 10.1016/s0140-6736(16)32075-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Accepted: 10/06/2016] [Indexed: 12/30/2022]
Affiliation(s)
- Jane Armitage
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Colin Baigent
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Rory Collins
- Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK.
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1170
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Barbour V. Lessons from the controversy over statins. Lancet 2016; 388:2237. [PMID: 27825504 DOI: 10.1016/s0140-6736(16)32074-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2016] [Accepted: 10/06/2016] [Indexed: 10/20/2022]
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1171
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Ala-Korpela M, Davey Smith G. Metabolic profiling-multitude of technologies with great research potential, but (when) will translation emerge? Int J Epidemiol 2016; 45:1311-1318. [PMID: 27789667 PMCID: PMC5100630 DOI: 10.1093/ije/dyw305] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Affiliation(s)
- Mika Ala-Korpela
- Computational Medicine, Faculty of Medicine, University of Oulu and Biocenter Oulu, Oulu, Finland .,Medical Research Council Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, Bristol, UK
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit and School of Social and Community Medicine, University of Bristol, Bristol, UK
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1172
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Waters DD, Boekholdt SM. An Evidence-Based Guide to Cholesterol-Lowering Guidelines. Can J Cardiol 2016; 33:343-349. [PMID: 28034582 DOI: 10.1016/j.cjca.2016.10.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/13/2016] [Accepted: 10/13/2016] [Indexed: 01/19/2023] Open
Abstract
Since 2014, guidelines for the management of lipid disorders to reduce cardiovascular (CV) events have been updated in the United States, the United Kingdom, Europe, and Canada. Some of these guidelines are almost entirely evidence-based whereas others are a mix of evidence and expert opinion. Guidelines differ on such simple questions as to whether blood samples should be fasting or nonfasting, and whether low-density lipoprotein cholesterol (LDL-C) or another lipid parameter should be the primary focus of treatment. Different risk assessment tools are recommended by different guidelines. Lifetime risk is highlighted in some guidelines, with the suggestion that earlier treatment will reduce lifetime risk in younger people even when short-term risk is low. Some guidelines have numerical treatment targets that differ according to level of risk, while others eschew targets but recommend statins at high or moderate intensity to reduce LDL-C by ≥ 50% or 30%-50%, respectively. Statins are the backbone of therapy in all guidelines. Ezetimibe produced a 6.4% relative risk reduction in the only large clinical outcomes trial in which it was tested, and is recommended for high-risk patients with an inadequate response to statins, despite the high number needed to treat to prevent 1 CV event. Proprotein convertase subtilisin/kexin 9 inhibitors lack outcome data to support their use, but are approved for patients with familial hypercholesterolemia or clinical atherosclerotic CV disease who require additional LDL-C lowering beyond statins. All these new guidelines are aimed at improving the problem of undertreatment of high-risk groups, leading to better outcomes for these patients.
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Affiliation(s)
- David D Waters
- Division of Cardiology, San Francisco General Hospital, San Francisco, California, USA; Department of Medicine, University of California, San Francisco, California, USA.
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1173
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Dahagam C, Hahn VS, Goud A, D’Souza J, Abdelqader A, Blumenthal RS, Martin SS. Role of Statins in Glucose Homeostasis and Insulin Resistance. CURRENT CARDIOVASCULAR RISK REPORTS 2016. [DOI: 10.1007/s12170-016-0523-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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1174
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Ruiz-Hurtado G, Vigil L, Ruilope L. La mejoría del pronóstico cardiovascular de la diabetes mellitus tipo 2 ¿es una realidad? HIPERTENSION Y RIESGO VASCULAR 2016; 33:123-125. [DOI: 10.1016/j.hipert.2016.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/03/2016] [Indexed: 11/29/2022]
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1175
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