1201
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Cordero A, Rodríguez-Mañero M, Fácila L, Fernández-Olmo MR, Gómez-Martínez MJ, Valle A, Castellano JM, Toro MM, Seijas-Amigo J, Vicedo A, González-Juanatey JR. Prevention of myocardial infarction and stroke with PCSK9 inhibitors treatment: a metanalysis of recent randomized clinical trials. J Diabetes Metab Disord 2020; 19:759-765. [PMID: 33520801 DOI: 10.1007/s40200-020-00557-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 05/18/2020] [Accepted: 05/26/2020] [Indexed: 12/11/2022]
Abstract
Purpose Proprotein convertase subtilisin/kexin 9 (PCSK9) inhibitors treatment induce large reductions in low-density lipoprotein cholesterol (LDLc) and major cardiovascular events. Clinical trials might have been underpowered to test the effect of PSCK9 inhibitors treatment on myocardial infarction and stroke, two of the most relevant cardiovascular events, since all analyzed a combined endpoint. Methods we performed a meta-analysis, with currently available studies involving PCSK9 inhibitors and event rate adjudication, with the aim of assessing treatment effects on myocardial infarction and stroke. Results We included 81,700 patients, 41,979 treated with a PSCK9 inhibitors: 17,244 with evolocumab; 13,720 with bococizumab and 11,015 with alirocumab. A total of 1,319 cases of myocardial infarctions were registered in the treatment group vs. 1,608 in controls, resulting in 19.0% reduction associated with PCSK9 treatment (RR: 0.81, 95% CI 0.76-0.87). Similarly, PCSK9 inhibitors treatment resulted in a 25% reduction of stroke (RR: 0.75, 95% CI 0.65-0.85) when all studies were analyzed together and the statistically significant heterogeneity was not observed in the analysis restricted to end-point based clinical trials. PCSK9 inhibitors treatment had no effect on mortality (RR: 0.95, 95% CI 0.86-1.04). Conclusions PCSK9 inhibitors reduce the incidence of myocardial infarction by 19% and stroke by 25%.
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Affiliation(s)
- Alberto Cordero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Hospital Universitario de San Juan, Carretera Valencia-Alicante sn, San Juan de Alicante, 03550 Spain
| | - Moisés Rodríguez-Mañero
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Lorenzo Fácila
- Cardiology Department, Hospital General Universitario de Valencia, Valencia, Spain
| | | | | | - Alfonso Valle
- Cardiology Department, Hospital de Denia, Denia, Spain
| | - Jose Mª Castellano
- Centro Nacional de Investigaciones Cardiovasculares (CNIC), Madrid, Spain.,Cardiology Department, Hospitales de Madrid, Madrid, Spain
| | | | - José Seijas-Amigo
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
| | - Alvaro Vicedo
- Cardiology Department, Hospital de Denia, Denia, Spain
| | - José R González-Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.,Cardiology Department, Complejo Hospital Universitario de Santiago, Santiago de Compostela, Spain
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1202
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Shapiro MD, Fazio S. Lipoprotein(a). JACC Basic Transl Sci 2020; 5:558-560. [PMID: 32614936 PMCID: PMC7315180 DOI: 10.1016/j.jacbts.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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1203
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Ruiz García A, Guijarro Herráiz C. Guías de prevención cardiovascular de sociedades científicas y administraciones sanitarias: la necesidad de convergencia. Rev Clin Esp 2020; 220:294-296. [DOI: 10.1016/j.rce.2020.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Accepted: 02/25/2020] [Indexed: 10/24/2022]
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1204
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Nanna MG, Peterson ED, Wojdyla D, Navar AM. The Accuracy of Cardiovascular Pooled Cohort Risk Estimates in U.S. Older Adults. J Gen Intern Med 2020; 35:1701-1708. [PMID: 31667745 PMCID: PMC7280419 DOI: 10.1007/s11606-019-05361-4] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 07/24/2019] [Accepted: 09/12/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND The ACC/AHA guidelines for primary prevention rely on the Pooled Cohort Risk Equations (PCE) risk estimates of atherosclerotic cardiovascular disease (ASCVD) to guide treatment decisions. In light of the PCE being derived in younger populations, their accuracy in older adults is uncertain. OBJECTIVE To evaluate the predictive accuracy and calibration of the PCE in older individuals. DESIGN AND SETTING We estimated CVD predicted and observed risk among individuals from four large prospective cohort studies: Cardiovascular Health Study, Multiethnic Study of Atherosclerosis, Framingham Original, and Framingham Offspring. PARTICIPANTS 12,527 overall individuals without ASCVD, including 9864 individuals aged 40-74 years and 2663 aged ≥75 years. MEASUREMENTS We examined the operating characteristics of the PCE to estimate 5-year risk of stroke, MI, and CHD death overall and by age and sex strata. The associations between individual components of the PCE and cardiovascular events by age group (≥75 vs 40-74 years) were also evaluated. RESULTS The PCE had low discrimination for 5-year ASCVD risk in older (≥75 years) (c-statistic = 0.62, 95% CI 0.60-0.65) vs. younger (40-74 years) adults (c-statistic = 0.75, 95% CI 0.73-0.76). Calibration of the PCE was suboptimal in both older and younger adults, overestimating risk in the highest risk groups. Performance of the PCE in older adults was similarly poor when stratified by sex and age ≥ 80 years. LIMITATIONS Since the PCE were derived from similar cohorts, though using different age groups and exams, this analysis likely overestimates the performance of the PCE. CONCLUSION The performance of the PCE for ASCVD risk estimation in older adults is suboptimal; new models to effectively risk-stratify older adults are needed.
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Affiliation(s)
- Michael G Nanna
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, 27710, USA.
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Daniel Wojdyla
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, 27710, USA
| | - Ann Marie Navar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, 27710, USA
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1205
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Nicolas J, Claessen B, Mehran R. Implications of Kidney Disease in the Cardiac Patient. Interv Cardiol Clin 2020; 9:265-278. [PMID: 32471668 DOI: 10.1016/j.iccl.2020.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Cardiovascular and renal diseases share common pathophysiological grounds, risk factors, and therapies. The 2 entities are closely interlinked and often coexist. The prevalence of kidney disease among cardiac patients is increasing. Patients have an atypical clinical presentation and variable disease manifestation versus the general population. Renal impairment limits therapeutic options and worsens prognosis. Meticulous treatment and close monitoring are required to ensure safety and avoid deterioration of kidney and heart functions. This review highlights recent advances in the diagnosis and treatment of cardiac pathologies, including coronary artery disease, arrhythmia, and heart failure, in patients with decreased renal function.
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Affiliation(s)
- Johny Nicolas
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Bimmer Claessen
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA
| | - Roxana Mehran
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, One Gustave L. Levy Place, Box 1030, New York, NY 10029-6574, USA.
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1206
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Dunleavy MP, Guha A, Cardona A, Fortuna C, Daoud EG, Raman SV, Harfi TT. Prevalence of Coronary Artery Calcification on Pre-Atrial Fibrillation Ablation CT Pulmonary Venograms and its Impact on Selection for Statin Therapy. J Clin Med 2020; 9:jcm9061631. [PMID: 32481592 PMCID: PMC7356831 DOI: 10.3390/jcm9061631] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 11/20/2022] Open
Abstract
Atherosclerotic cardiovascular disease (ASCVD) shares many risk factors with atrial fibrillation (AF). Obtaining computed tomography images of the pulmonary veins (CTPV) before AF ablation procedures is common and can incidentally detect coronary artery calcification (CAC). The purpose of this study was to investigate the prevalence of CAC on pre-ablation CTPV, the frequency of CAC reporting on CTPV reports, and its impact on statin therapy among patients hospitalized for AF procedures. We retrospectively evaluated consecutive patients undergoing CTPV and AF procedures from October 2016 to December 2017 in a single-center tertiary hospital. The patients’ demographic and clinical characteristics were analyzed. The CAC presence on CTPV was visually assessed. The severity was classified qualitatively. The statin therapy status was evaluated using the patient’s admission and discharge medication lists. A total of 638 subjects were included in our study, with 34.5% female. The mean age was 63.3 ± 10.8 years. CAC was detected in 70.1% of all patients, and in 58.1% of patients without a history of ASCVD. When present, CAC was documented in 92.6% of the clinical CTPV reports. While coronary artery atherosclerosis was present in a majority of AF patients, and its presence was widely reported, it was not associated with increased statin therapy at discharge.
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Affiliation(s)
- Michael P. Dunleavy
- Division of Hospital Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA;
| | - Avirup Guha
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
- Division of Cardiovascular Medicine, Harrington Heart and Vascular Institute, Cleveland, OH, 44106, USA
| | - Andrea Cardona
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
| | | | - Emile G. Daoud
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
| | - Subha V. Raman
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
| | - Thura T. Harfi
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, OH 43210, USA; (A.G.); (A.C.); (E.G.D.); (S.V.R.)
- Correspondence: ; Tel.: +1-614-685-6161
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1207
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Cho L, Davis M, Elgendy I, Epps K, Lindley KJ, Mehta PK, Michos ED, Minissian M, Pepine C, Vaccarino V, Volgman AS. Summary of Updated Recommendations for Primary Prevention of Cardiovascular Disease in Women: JACC State-of-the-Art Review. J Am Coll Cardiol 2020; 75:2602-2618. [PMID: 32439010 PMCID: PMC8328156 DOI: 10.1016/j.jacc.2020.03.060] [Citation(s) in RCA: 151] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2020] [Revised: 03/10/2020] [Accepted: 03/23/2020] [Indexed: 02/06/2023]
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality for women in the United States and worldwide. There has been no American College of Cardiology (ACC)/American Heart Association guideline update specifically for the prevention of CVD in women since 2011. Since then, the body of sex-specific data has grown, in addition to updated hypertension, cholesterol, diabetes, atrial fibrillation, and primary prevention guidelines. The ACC CVD in Women Committee undertook a review of the recent guidelines and major studies to summarize recommendations pertinent to women. In this update, the authors address special topics, particularly the risk factors and treatments that have led to some controversies and confusion. Specifically, sex-related risk factors, hypertension, diabetes, hyperlipidemia, anticoagulation for atrial fibrillation, use of aspirin, perimenopausal hormone therapy, and psychosocial issues are highlighted.
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Affiliation(s)
- Leslie Cho
- Cleveland Clinic Foundation, Heart Vascular Institute, Cleveland, Ohio.
| | | | - Islam Elgendy
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Kelly Epps
- Inova Heart and Vascular Institute, Falls Church, Virginia
| | | | | | - Erin D Michos
- Johns Hopkins University Medical Center, Baltimore, Maryland
| | | | - Carl Pepine
- UF Health, University of Florida, Gainesville, Florida
| | - Viola Vaccarino
- Emory University Rollins School of Public Health, Atlanta, Georgia
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1208
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Li XY, Shi ZW, Zhao D, Yin DW. 2019 Chinese expert consensus statement on aspirin application in primary prevention of cardiovascular disease. Chin Med J (Engl) 2020; 133:1221-1223. [PMID: 32433054 PMCID: PMC7249706 DOI: 10.1097/cm9.0000000000000762] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Indexed: 11/25/2022] Open
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1209
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McGettrick P, Mallon PWG, Sabin CA. Cardiovascular disease in HIV patients: recent advances in predicting and managing risk. Expert Rev Anti Infect Ther 2020; 18:677-688. [PMID: 32306781 DOI: 10.1080/14787210.2020.1757430] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Cardiovascular disease (CVD) is one of the leading causes of mortality in virally suppressed people living with HIV (PLWH) and with an aging population, is likely to become one of the leading challenges in maintaining good health outcomes in HIV infection. However, factors driving the risk of CVD in PLWH are multiple and may be different from those of the general population, raising challenges to predicting and managing CVD risk in this population. AREAS COVERED In this review, we examine the relevant data regarding CVD in HIV infection including CVD prevalence, pathogenesis, and other contributing factors. We review the data regarding CVD risk prediction in PLWH and summarize factors, both general and HIV specific, that may influence CVD risk in this population. And finally, we discuss appropriate management of CVD risk in PLWH and explore potential therapeutic pathways which may mitigate CVD risk in the future in this population. EXPERT OPINION Following a comprehensive review of CVD risk in PLWH, we give our opinion on the primary issues in risk prediction and management of CVD in HIV infected individuals and discuss the future direction of CVD management in this population.
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Affiliation(s)
- Padraig McGettrick
- Centre for Pathogen Host Research, UCD School of Medicine, University College Dublin , Dublin, Ireland
| | - Patrick W G Mallon
- Centre for Pathogen Host Research, UCD School of Medicine, University College Dublin , Dublin, Ireland.,Department of Infectious Diseases, St. Vincent's University Hospital , Dublin, Ireland
| | - Caroline A Sabin
- Centre for Clinical Research, Epidemiology, Modelling and Evaluation, Institute for Global Health, University College London , London, UK
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1210
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Hooper L, Martin N, Jimoh OF, Kirk C, Foster E, Abdelhamid AS. Reduction in saturated fat intake for cardiovascular disease. Cochrane Database Syst Rev 2020; 5:CD011737. [PMID: 32428300 PMCID: PMC7388853 DOI: 10.1002/14651858.cd011737.pub2] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Reducing saturated fat reduces serum cholesterol, but effects on other intermediate outcomes may be less clear. Additionally, it is unclear whether the energy from saturated fats eliminated from the diet are more helpfully replaced by polyunsaturated fats, monounsaturated fats, carbohydrate or protein. OBJECTIVES To assess the effect of reducing saturated fat intake and replacing it with carbohydrate (CHO), polyunsaturated (PUFA), monounsaturated fat (MUFA) and/or protein on mortality and cardiovascular morbidity, using all available randomised clinical trials. SEARCH METHODS We updated our searches of the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid) and Embase (Ovid) on 15 October 2019, and searched Clinicaltrials.gov and WHO International Clinical Trials Registry Platform (ICTRP) on 17 October 2019. SELECTION CRITERIA Included trials fulfilled the following criteria: 1) randomised; 2) intention to reduce saturated fat intake OR intention to alter dietary fats and achieving a reduction in saturated fat; 3) compared with higher saturated fat intake or usual diet; 4) not multifactorial; 5) in adult humans with or without cardiovascular disease (but not acutely ill, pregnant or breastfeeding); 6) intervention duration at least 24 months; 7) mortality or cardiovascular morbidity data available. DATA COLLECTION AND ANALYSIS Two review authors independently assessed inclusion, extracted study data and assessed risk of bias. We performed random-effects meta-analyses, meta-regression, subgrouping, sensitivity analyses, funnel plots and GRADE assessment. MAIN RESULTS We included 15 randomised controlled trials (RCTs) (16 comparisons, ~59,000 participants), that used a variety of interventions from providing all food to advice on reducing saturated fat. The included long-term trials suggested that reducing dietary saturated fat reduced the risk of combined cardiovascular events by 21% (risk ratio (RR) 0.79; 95% confidence interval (CI) 0.66 to 0.93, 11 trials, 53,300 participants of whom 8% had a cardiovascular event, I² = 65%, GRADE moderate-quality evidence). Meta-regression suggested that greater reductions in saturated fat (reflected in greater reductions in serum cholesterol) resulted in greater reductions in risk of CVD events, explaining most heterogeneity between trials. The number needed to treat for an additional beneficial outcome (NNTB) was 56 in primary prevention trials, so 56 people need to reduce their saturated fat intake for ~four years for one person to avoid experiencing a CVD event. In secondary prevention trials, the NNTB was 32. Subgrouping did not suggest significant differences between replacement of saturated fat calories with polyunsaturated fat or carbohydrate, and data on replacement with monounsaturated fat and protein was very limited. We found little or no effect of reducing saturated fat on all-cause mortality (RR 0.96; 95% CI 0.90 to 1.03; 11 trials, 55,858 participants) or cardiovascular mortality (RR 0.95; 95% CI 0.80 to 1.12, 10 trials, 53,421 participants), both with GRADE moderate-quality evidence. There was little or no effect of reducing saturated fats on non-fatal myocardial infarction (RR 0.97, 95% CI 0.87 to 1.07) or CHD mortality (RR 0.97, 95% CI 0.82 to 1.16, both low-quality evidence), but effects on total (fatal or non-fatal) myocardial infarction, stroke and CHD events (fatal or non-fatal) were all unclear as the evidence was of very low quality. There was little or no effect on cancer mortality, cancer diagnoses, diabetes diagnosis, HDL cholesterol, serum triglycerides or blood pressure, and small reductions in weight, serum total cholesterol, LDL cholesterol and BMI. There was no evidence of harmful effects of reducing saturated fat intakes. AUTHORS' CONCLUSIONS The findings of this updated review suggest that reducing saturated fat intake for at least two years causes a potentially important reduction in combined cardiovascular events. Replacing the energy from saturated fat with polyunsaturated fat or carbohydrate appear to be useful strategies, while effects of replacement with monounsaturated fat are unclear. The reduction in combined cardiovascular events resulting from reducing saturated fat did not alter by study duration, sex or baseline level of cardiovascular risk, but greater reduction in saturated fat caused greater reductions in cardiovascular events.
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Affiliation(s)
- Lee Hooper
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Nicole Martin
- Institute of Health Informatics Research, University College London, London, UK
| | - Oluseyi F Jimoh
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Christian Kirk
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - Eve Foster
- Norwich Medical School, University of East Anglia, Norwich, UK
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1211
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A focused review of cardiovascular guideline related recommendations for the primary care physician in the USA. Cardiovasc Endocrinol Metab 2020; 9:36-41. [PMID: 32537563 DOI: 10.1097/xce.0000000000000192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 12/23/2019] [Indexed: 11/25/2022]
Abstract
Primary care physicians in the USA serve the critical role of first contact for undiagnosed or mismanaged pathologies as well as providers of continuous care in multiple communities. Their scope of practice is broad from medication reconciliation to coordinating specialty care and even performing office procedures. Primary care physicians in the USA commonly encounter patients with diabetes and associated comorbidities related to prolonged insulin resistance. Mainly these include heart failure exacerbation or major adverse cardiovascular events. The demanding roles primary care physicians serve may render these providers encumbered to navigate through long, verbose and dynamic guidelines related to managing diabetes and cardiac diabetology sequelae. Our aim is to compose current, prominent evidence-based points from American medical societies such as the American College of Cardiology/American Heart Association and the American Diabetes Association central to lifestyle modifications, antiplatelet therapy, anti-hyperglycemic and SGLT2-inhibitor utilization, hypertension, dyslipidemia, and heart failure screening in a way that is both succinct and valuable to primary care physicians.
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1212
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Jung M, Lee S. Efficacy of Aspirin in the Primary Prevention of Cardiovascular Diseases and Cancer in the Elderly: A Population-Based Cohort Study in Korea. Drugs Aging 2020; 37:43-55. [PMID: 31755069 DOI: 10.1007/s40266-019-00723-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
INTRODUCTION Aspirin is widely used to prevent cardiovascular diseases (CVDs). However, the balance of its benefits and risks in the primary prevention of CVDs and cancer is unclear, especially in elderly Asians. The present study aimed to evaluate the efficacy of aspirin in the primary prevention of major adverse cardiac and cerebrovascular events (MACCE), bleeding risk, and cancer in elderly Koreans with cardiovascular (CV) risk factors. METHODS This retrospective cohort study used data from the Korean National Health Insurance Service-Senior cohort database (2002-2015). Patients aged 60-90 years with hypertension, type 2 diabetes mellitus (T2DM), or dyslipidemia were identified. Aspirin users were compared with non-users using propensity score matching at a 1:3 ratio. The primary outcome was MACCE, a composite of CV mortality, myocardial infarction, and ischemic stroke. The secondary outcomes were the components of MACCE, all-cause mortality, angina pectoris, heart failure, the incidence and mortality of cancer, and the risks of hemorrhagic stroke and gastrointestinal bleeding. Hazard ratios (HRs) and 95% confidence intervals (CIs) were estimated using a Cox proportional hazard model. RESULTS A total of 3366 aspirin users and 10,089 non-users were finally included in the study. During a mean follow-up of 7.8 years, the incidence of MACCE was 15.2% in aspirin users and 22.4% in non-users. The risk of MACCE was significantly lower in aspirin users than in non-users (HR 0.76; 95% CI 0.69-0.85), and this risk was significantly reduced in patients using aspirin over 5 years (HR 0.52; 95% CI 0.46-0.60). Aspirin use was associated with a 21% reduction in the risk of primary cancer (HR 0.79; 95% CI 0.70-0.88) and cancer-related mortality (HR 0.72; 95% CI 0.61-0.84). No significant differences in bleeding risks were observed between the two groups. CONCLUSION Aspirin reduced the risks of MACCE and cancer without increasing the bleeding risk in elderly Koreans with hypertension, T2DM, or dyslipidemia. Moreover, the benefits of the long-term use of aspirin in reducing the risks of MACCE were demonstrated. However, the decision of using aspirin for primary prevention must be carefully made on an individual basis, while estimating the benefit-risk balance of aspirin.
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Affiliation(s)
- Minji Jung
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, 206 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea
| | - Sukhyang Lee
- Division of Clinical Pharmacy, College of Pharmacy, Ajou University, 206 Worldcup-ro Yeongtong-gu, Suwon, 16499, Republic of Korea.
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1213
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Shapiro MD, Fazio S. Preventive cardiology as a dedicated clinical service: The past, the present, and the (Magnificent) future. Am J Prev Cardiol 2020; 1:100011. [PMID: 32835348 PMCID: PMC7217102 DOI: 10.1016/j.ajpc.2020.100011] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 04/19/2020] [Accepted: 04/19/2020] [Indexed: 12/30/2022] Open
Abstract
Ischemic cardiovascular disease continues to be most common cause of death after age 55 everywhere in the world. As the average person is exposed over life to a variety of artery-damaging insults it is easy to predict that this trend will continue for decades. We face an unprecedented opportunity to consolidate, strengthen, and broaden the effort to prevent cardiovascular events, both ischemic and non ischemic. This effort requires professional lifestyle counseling, dietary interventions, use of natural supplements, pharmacotherapy, and efficient cross-referral strategies. The nascent subspecialty of preventive cardiology must reach uniformity in protocols of care, and must develop a system of training and certification for the next generation of expert providers.
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Affiliation(s)
- Michael D Shapiro
- Center for Prevention of Cardiovascular Disease, Section on Cardiovascular Medicine, Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA
| | - Sergio Fazio
- Center for Preventive Cardiology, Knight Cardiovascular Institute, Department of Medicine, Oregon Health & Science University, Portland, OR, USA
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1214
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Park JH, Shin HJ, Choi JY, Lim JS, Park MS, Kim MJ, Oh HJ, Chung YE. Is there association between statin usage and contrast-associated acute kidney injury after intravenous administration of iodine-based contrast media in enhanced computed tomography? Eur Radiol 2020; 30:5261-5271. [PMID: 32399711 DOI: 10.1007/s00330-020-06897-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Revised: 03/20/2020] [Accepted: 04/15/2020] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Contrast-induced acute kidney injury (CI-AKI) is one of the leading causes of new-onset renal failure in hospitalized patients. Statin has been evaluated for its protective effect against CI-AKI but rarely in patients receiving intravenous (IV) administrations of iodine-based contrast media for enhanced computed tomography (CT). METHODS In total, 12,371 patients who underwent contrast-enhanced abdominopelvic CT were retrospectively reviewed and stratified into statin users and statin nonusers. Subgroup analyses comparing high-intensity statins with low- to moderate-intensity statins were conducted within statin users and similar comparisons were performed within statin users stratified based on baseline eGFR. RESULTS Overall, CI-AKI events did not occur less in statin users compared with non-statin users (p = 0.342). Within statin users, CI-AKI events did not decrease in high-intensity statin users compared with low- to moderate-intensity statin users (p = 0.355). Moreover, no significant difference in CI-AKI events was found between high-intensity statin users and low- to moderate-intensity statin users even after stratifying the patients with baseline eGFR. CONCLUSIONS Collectively, statin was not significantly associated with the risk of CI-AKI events in patients undergoing contrast-enhanced abdominopelvic CT and high-intensity statins did not show significant association with CI-AKI over low- to moderate-intensity statins in the subgroup analysis. KEY POINTS • Statin is not associated with risk of CI-AKI events in patients undergoing intravenous administration of contrast-enhanced CT. • CI-AKI incidence among high-intensity statin users was not significantly different from that of low- to moderate-intensity statin users.
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Affiliation(s)
- Jae Hyon Park
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hye Jung Shin
- Department of Biomedical Systems Informatics, Biostatics Collaboration Unit, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Jin-Young Choi
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Mi-Suk Park
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Hyung Jung Oh
- Nephrology Department, Sheikh Khalifa Specialty Hospital, P.O.Box 6365, Al Shohadaa Road, Ras al Khaimah, United Arab Emirates.
| | - Yong Eun Chung
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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1215
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Weinberg RL, Rubenfire M, Brook RD. Coronary artery calcium scoring in patients with hypertension. J Hum Hypertens 2020; 34:609-616. [PMID: 32398769 DOI: 10.1038/s41371-020-0350-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Revised: 04/20/2020] [Accepted: 04/28/2020] [Indexed: 12/28/2022]
Abstract
Coronary artery calcium (CAC) is increased by high blood pressure (BP), predicts new-onset hypertension, and is a powerful predictor of atherosclerotic cardiovascular disease events in patients with and without hypertension. Unlike other diseases (e.g., hypercholesterolemia), the clinical use of CAC scoring to personalize the treatment of high BP has not received much attention and therefore remains less well defined. Herein, we provide an updated review of studies investigating the relationship between CAC and BP. Finally, we propose a clinical algorithm to incorporate CAC into hypertension management, with a focus on its potential value in tailoring the timing of medication therapy and in helping to personalize BP goals.
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Affiliation(s)
- Richard L Weinberg
- Division of Cardiovascular Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Melvyn Rubenfire
- Division of Cardiovascular Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Robert D Brook
- Division of Cardiovascular Medicine, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA
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1216
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Chapman MJ, Ginsberg HN. Evolocumab Treatment of Hypercholesterolemia in OSLER-1: Enduring Efficacy, Tolerability, and Safety Over 5 Years. J Am Coll Cardiol 2020; 74:2147-2149. [PMID: 31648706 DOI: 10.1016/j.jacc.2019.07.087] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 07/31/2019] [Indexed: 01/17/2023]
Affiliation(s)
- M John Chapman
- Endocrinology-Metabolism Division, Pitié-Salpetriere Hospital, Sorbonne University and National Institute for Health and Medical Research (INSERM), Paris, France.
| | - Henry N Ginsberg
- Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
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1217
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1218
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Worldwide Prevalence of Familial Hypercholesterolemia. J Am Coll Cardiol 2020; 75:2553-2566. [DOI: 10.1016/j.jacc.2020.03.057] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 02/18/2020] [Accepted: 03/23/2020] [Indexed: 12/11/2022]
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1219
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Starich MR, Tang J, Remaley AT, Tjandra N. Squeezing lipids: NMR characterization of lipoprotein particles under pressure. Chem Phys Lipids 2020; 228:104874. [PMID: 31978380 PMCID: PMC7232691 DOI: 10.1016/j.chemphyslip.2020.104874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Revised: 01/10/2020] [Accepted: 01/10/2020] [Indexed: 11/25/2022]
Abstract
Determining the particle size and number of lipoprotein components found in blood plasma (HDL, LDL and VLDL) has become an important clinical tool in diagnosing risk of cardiovascular disease. Proton (1H) NMR spectroscopy methods to quantify lipoprotein particle subclasses have been advancing since NMR lineshape analysis of plasma samples was first proposed in the 1990's. NMR methods, including a more recent DOSY-based diffusion spectroscopy test, provide the foundation for the advanced lipoprotein tests, including Lipoprotein® and Liposcale® analyses available for clinical use to determine particle size and number. At the time of this submission, no NMR studies exist which explore physical parameters of individual lipoprotein fractions when they are deformed by pressure. This study reports 1H NMR frequency shifts and T2* measurements for the broad methyl peak attributed to terminal methyls (cholesteryl positions 26, 27 and terminal acyl methyl groups) in three primary lipoprotein fractions as a function of hydraulic pressure. This terminal CH3 resonance shifted linearly upfield as a function of pressure for HDL and VLDL (observed slopes of -0.014 Hz/bar). The LDL terminal CH3 resonance shows segmented behavior, with a shallow slope between 0-900 bar (-0.008 hz/bar) and a slope similar to HDL and VDL across the range from 1000 to 2400 bar (slope -0.016 Hz/bar). 1H T2* values measured for VLDL and HDL dropped linearly with increasing pressure. 1H T2* values for LDL demonstrated segmented behavior as a function of pressure. The unique behavior observed for LDL terminal CH3 frequency and 1H T2* trends suggests an approximate pressure at which phase transition occurs.
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Affiliation(s)
- Mary R Starich
- Biochemistry and Biophysics Center, National Heart, Lung, and Blood Institute National Institutes of Health, Bethesda, MD 20892, USA
| | - Jingrong Tang
- Lipoprotein Metabolism Laboratory, National Heart, Lung, and Blood Institute National Institutes of Health, Bethesda, MD 20892, USA
| | - Alan T Remaley
- Lipoprotein Metabolism Laboratory, National Heart, Lung, and Blood Institute National Institutes of Health, Bethesda, MD 20892, USA
| | - Nico Tjandra
- Biochemistry and Biophysics Center, National Heart, Lung, and Blood Institute National Institutes of Health, Bethesda, MD 20892, USA.
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1220
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Singh M, McEvoy JW, Khan SU, Wood DA, Graham IM, Blumenthal RS, Mishra AK, Michos ED. Comparison of Transatlantic Approaches to Lipid Management: The AHA/ACC/Multisociety Guidelines vs the ESC/EAS Guidelines. Mayo Clin Proc 2020; 95:998-1014. [PMID: 32370858 DOI: 10.1016/j.mayocp.2020.01.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 01/08/2020] [Indexed: 01/20/2023]
Abstract
The 2018 American Heart Association/American College of Cardiology/Multisociety (AHA/ACC) guidelines and the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines on lipid management were published less than a year apart. Both guidelines focus on reducing cardiovascular risk, but they follow different approaches in terms of methods of risk estimation, definitions of at-risk groups, and treatment goals to achieve this common underlying objective. Both recommend achieving risk-based percentage reductions of low-density lipoprotein cholesterol (LDL-C) levels with statin therapy. The ESC/EAS guidelines additionally recommend target LDL-C levels and are more liberal in supporting the use of both statin and nonstatin therapies across broader patient groups. The AHA/ACC guidelines may be considered more conservative, reserving the addition of nonstatins to maximally tolerated statins for only select patient groups based on specific LDL-C thresholds. One of the main reasons for these differences is incorporation of cost value considerations by the AHA/ACC guidelines, whereas the ESC/EAS guidelines consider an ideal setting with unlimited resources while making recommendations. In this review, we discuss similarities and differences between the 2 lipid guidelines to help clinicians become more cognizant of these recommendations and provide the best individualized patient care.
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Affiliation(s)
- Maninder Singh
- Division of Cardiology, Guthrie Clinic/Robert Packer Hospital, Sayre, PA; Geisinger Commonwealth School of Medicine, Scranton, PA.
| | - John W McEvoy
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway; Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | - Safi U Khan
- Department of Hospital Medicine, West Virginia University School of Medicine, Morgantown
| | - David A Wood
- National Institute for Prevention and Cardiovascular Health, National University of Ireland, Galway; National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - Ian M Graham
- Division of Cardiology, Trinity College, Dublin, Ireland
| | - Roger S Blumenthal
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD
| | | | - Erin D Michos
- Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins School of Medicine, Baltimore, MD; Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
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1221
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Liew JW, Dubreuil M. Treat to Target in Axial Spondyloarthritis: Pros, Cons, and Future Directions. Rheum Dis Clin North Am 2020; 46:343-356. [PMID: 32340706 PMCID: PMC8106802 DOI: 10.1016/j.rdc.2020.01.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Treat to target describes a management paradigm that involves choosing a clinically relevant target, assessment with validated measures at a prespecified frequency, and a change in therapy if the target is not met. Although guidelines recommend treating to target in axial spondyloarthritis (axSpA), ideal methods to reach this target remain controversial. This review focuses on background for a treat-to-target strategy in axSpA. Potential targets of treatment, association of targets with outcomes, evidence of treatment impact on outcomes, and how treat to target has been incorporated into treatment guidelines are discussed. Treat-to-target trials and the research agenda for studies in axSpA are discussed.
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Affiliation(s)
- Jean W Liew
- Division of Rheumatology, Department of Medicine, University of Washington, 1959 Northeast Pacific Street, BB561, Seattle, WA 98195, USA. https://twitter.com/rheum_cat
| | - Maureen Dubreuil
- Section of Rheumatology, Boston University School of Medicine, 650 Albany Street, X201, Boston, MA 02119, USA.
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1222
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Hecht HS. Coronary Artery Calcium and Prevention Guidelines. JACC Cardiovasc Imaging 2020; 13:1187-1190. [DOI: 10.1016/j.jcmg.2019.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 10/11/2019] [Indexed: 11/16/2022]
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1223
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Board C, Kelly MS, Shapiro MD, Dixon DL. PCSK9 Inhibitors in Secondary Prevention-An Opportunity for Personalized Therapy. J Cardiovasc Pharmacol 2020; 75:410-420. [PMID: 32379108 DOI: 10.1097/fjc.0000000000000809] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death worldwide. Low-density lipoprotein cholesterol (LDL-C) is the primary cause of ASCVD and reducing LDL-C levels with statin therapy significantly reduces ASCVD risk; however, significant residual risk remains. Two monoclonal antibodies (mAbs), alirocumab and evolocumab, that target proprotein convertase subtilisin/kexin-type 9 (PCSK9), reduce LDL-C levels by up to 60% when used in combination with statins and significantly reduce the risk of recurrent ASCVD events in both stable secondary prevention and acute coronary syndrome populations. Prespecified analyses of recent randomized controlled trials have shed light on how best to prioritize these therapies to maximize their value in select high-risk groups. These data have also informed recent clinical practice guidelines and scientific statements resulting in an expanded role for PCSK9-mAbs compared with previous guidelines, albeit there are notable differences between these recommendations. Ongoing research is exploring the long-term safety of PCSK9-mAbs and their role in the acute setting and patients without prior myocardial infarction or stroke. Novel therapies that inhibit PCSK9 synthesis via small interfering RNA, such as inclisiran, are also in development and may reduce LDL-C levels similar to PCSK9-mAbs, but with less frequent administration. Nonetheless, the PCSK9-mAbs are a breakthrough therapy and warrant consideration in very high-risk patients who are most likely to benefit. Such a personalized approach can help to ensure cost-effectiveness and maximize their value.
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Affiliation(s)
- Chase Board
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
| | - Michael S Kelly
- Department of Pharmacy Practice, Chapman University School of Pharmacy, Irvine, CA; and
| | - Michael D Shapiro
- Section on Cardiovascular Medicine, Center for the Prevention of Cardiovascular Disease, Wake Forest Baptist Health, Winston-Salem, NC
| | - Dave L Dixon
- Department of Pharmacotherapy & Outcomes Science, Virginia Commonwealth University School of Pharmacy, Richmond, VA
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1224
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Effect of pharmacist interventions on reducing low-density lipoprotein cholesterol (LDL-C) levels: A systematic review and meta-analysis. J Clin Lipidol 2020; 14:282-292.e4. [DOI: 10.1016/j.jacl.2020.04.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 04/07/2020] [Accepted: 04/07/2020] [Indexed: 12/29/2022]
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1225
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Clemens KK, Woodward M, Neal B, Zinman B. Sex Disparities in Cardiovascular Outcome Trials of Populations With Diabetes: A Systematic Review and Meta-analysis. Diabetes Care 2020; 43:1157-1163. [PMID: 32312859 DOI: 10.2337/dc19-2257] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Accepted: 02/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Sex differences have been described in diabetes cardiovascular outcome trials (CVOTs). PURPOSE We systematically reviewed for baseline sex differences in cardiovascular (CV) risk factors and CV protection therapy in diabetes CVOTs. DATA SOURCES Randomized placebo-controlled trials examining the effect of diabetes medications on major adverse cardiovascular events in people ≥18 years of age with type 2 diabetes. STUDY SELECTION Included trials reported baseline sex-specific CV risks and use of CV protection therapy. DATA EXTRACTION Two reviewers independently abstracted study data. DATA SYNTHESIS We included five CVOTs with 46,606 participants. We summarized sex-specific data using mean differences (MDs) and relative risks (RRs) and pooled estimates using random effects meta-analysis. There were fewer women than men in included trials (28.5-35.8% women). Women more often had stroke (RR 1.28; 95% CI 1.09, 1.50), heart failure (RR 1.30; 95% CI 1.21,1.40), and chronic kidney disease (RR 1.33; 95% CI 1.17; 1.51). They less often used statins (RR 0.90; 95% CI 0.86, 0.93), aspirin (RR 0.82; 95% CI 0.71, 0.95), and β-blockers (RR 0.93; 95% CI 0.88, 0.97) and had a higher systolic blood pressure (MD 1.66 mmHg; 95% CI 0.90, 2.41), LDL cholesterol (MD 0.34 mmol/L; 95% CI 0.29, 0.39), and hemoglobin A1c (MD 0.11%; 95% CI 0.09, 0.14 [1.2 mmol/mol; 1.0, 1.5]) than men. LIMITATIONS We could not carry out subgroup analyses due to the small number of studies. Our study is not generalizable to low CV risk groups nor to patients in routine care. CONCLUSIONS There were baseline sex disparities in diabetes CVOTs. We suggest efforts to recruit women into trials and promote CV management across the sexes.
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Affiliation(s)
- Kristin K Clemens
- Division of Endocrinology and Metabolism, Department of Medicine, Western University, London, Ontario, Canada .,Lawson Health Research Institute, London, Ontario, Canada
| | - Mark Woodward
- The George Institute for Global Health, University of Oxford, Oxford, U.K.,Department of Epidemiology and Welch Center for Prevention, Epidemiology, and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Bruce Neal
- The George Institute for Global Health, Sydney, Australia.,Imperial College London, London, U.K
| | - Bernard Zinman
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada
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1226
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Buckley LF, Ting C, Fatani N, Fanikos J. Changes in nationwide Medicare and Medicaid expenditures on lipid-lowering therapies after proprotein convertase/subtilisin type 9 inhibitor availability. J Clin Lipidol 2020; 14:315-321.e4. [DOI: 10.1016/j.jacl.2020.04.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/29/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
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1227
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1228
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Wong ND. Cardiovascular risk assessment: The foundation of preventive cardiology. Am J Prev Cardiol 2020; 1:100008. [PMID: 34327451 PMCID: PMC8315480 DOI: 10.1016/j.ajpc.2020.100008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Revised: 03/23/2020] [Accepted: 03/27/2020] [Indexed: 11/25/2022] Open
Abstract
The foundation of preventive cardiology begins with knowing the patient's baseline cardiovascular disease (CVD) risk from which the patient-clinician risk discussion informs on the best ways to lower risk through lifestyle management, as well as a decision about the initiation and intensity of pharmacologic therapy. Global CVD risk assessment involves estimation of cardiovascular risk using a basic panel of risk factors. The Framingham Heart Study championed the first such risk scores, followed by others around the world. Most recently, the Pooled Cohort Equations (PCE) have been recommended in the United States as a starting point in CVD risk assessment. Persons at low (<5%) 10-year risk are generally recommended for lifestyle management only and those at highest (>20%) 10-year risk are recommended for both lifestyle and pharmacologic therapy to reduce risk. Assessing the presence of one or more "risk enhancing" factors is intended to inform the treatment decision in those at borderline (5-<7.5%) or intermediate (7.5-20%) risk, with the use of coronary calcium scores to further refine the treatment decision. Moreover, not all those with ASCVD are treated equal, and recent guidelines provide criteria for identifying those at very high risk. While current techniques best predict long-term risk of CVD events, biomarkers strategies are being developed to predict near-term events, and other imaging techniques such as coronary CT angiography and vascular MRI hold promise to identify vulnerable plaque. Validation and incorporating into clinical practice such state of the art techniques will be vital to moving CVD risk assessment to the next level.
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Affiliation(s)
- Nathan D Wong
- Heart Disease Prevention Program, Division of Cardiology, C240 Medical Sciences, University of California, Irvine, CA, 92697-4079, USA
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1229
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Reda A, Almahmeed W, Dobrecky-Mery I, Huang PH, Juarez-Herrera U, Ranjith N, Sayre T, Urina-Triana M. A Narrative Review and Expert Panel Recommendations on Dyslipidaemia Management After Acute Coronary Syndrome in Countries Outside Western Europe and North America. Adv Ther 2020; 37:1754-1777. [PMID: 32227306 PMCID: PMC7467479 DOI: 10.1007/s12325-020-01302-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Indexed: 11/28/2022]
Abstract
Patients who have experienced an acute coronary syndrome (ACS) are at very high risk of recurrent atherosclerotic cardiovascular disease (CVD) events. Dyslipidaemia, a major risk factor for CVD, is poorly controlled post ACS in countries outside Western Europe and North America, despite the availability of effective lipid-modifying therapies (LMTs) and guidelines governing their use. Recent guideline updates recommend that low-density lipoprotein cholesterol (LDL-C), the primary target for dyslipidaemia therapy, be reduced by ≥ 50% and to < 1.4 mmol/L (55 mg/dL) in patients at very high risk of CVD, including those with ACS. The high prevalence of CVD risk factors in some regions outside Western Europe and North America confers a higher risk of CVD on patients in these countries. ACS onset is often earlier in these patients, and they may be more challenging to treat. Other barriers to effective dyslipidaemia control include low awareness of the value of intensive lipid lowering in patients with ACS, physician non-adherence to guideline recommendations, and lack of efficacy of currently used LMTs. Lack of appropriate pathways to guide follow-up of patients with ACS post discharge and poor access to intensive medications are important factors limiting dyslipidaemia therapy in many countries. Opportunities exist to improve attainment of LDL-C targets by the use of country-specific treatment algorithms to promote adherence to guideline recommendations, medical education and greater prioritisation by healthcare systems of dyslipidaemia management in very high risk patients. Video Abstract
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Affiliation(s)
- Ashraf Reda
- Department of Cardiology, Menoufia University, 127 Mohamed Fareed Street, Babellouk, Cairo, Egypt.
| | - Wael Almahmeed
- Department of Cardiovascular Medicine, Cleveland Clinic, Abu Dhabi, UAE
| | | | - Po-Hsun Huang
- Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | | | | | | | - Miguel Urina-Triana
- Cardiology Division, Faculty of Health Sciences, Simón Bolívar University, Barranquilla, Colombia
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1230
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Dehmer GJ, Badhwar V, Bermudez EA, Cleveland JC, Cohen MG, D'Agostino RS, Ferguson TB, Hendel RC, Isler ML, Jacobs JP, Jneid H, Katz AS, Maddox TM, Shahian DM. 2020 AHA/ACC Key Data Elements and Definitions for Coronary Revascularization: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Data Standards (Writing Committee to Develop Clinical Data Standards for Coronary Revascularization). J Am Coll Cardiol 2020; 75:1975-2088. [PMID: 32217040 DOI: 10.1016/j.jacc.2020.02.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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1231
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Ko DT, Sivaswamy A, Sud M, Kotrri G, Azizi P, Koh M, Austin PC, Lee DS, Roifman I, Thanassoulis G, Tu K, Udell JA, Wijeysundera HC, Anderson TJ. Calibration and discrimination of the Framingham Risk Score and the Pooled Cohort Equations. CMAJ 2020; 192:E442-E449. [PMID: 32392491 PMCID: PMC7207198 DOI: 10.1503/cmaj.190848] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Although accurate risk prediction is essential in guiding treatment decisions in primary prevention of atherosclerotic cardiovascular disease, the accuracy of the Framingham Risk Score (recommended by a Canadian guideline) and the Pooled Cohort Equations (recommended by US guidelines) has not been assessed in a large contemporary Canadian population. Our primary objective was to assess the calibration and discrimination of the Framingham Risk Score and Pooled Cohort Equations in Ontario, Canada. METHODS We conducted an observational study involving Ontario residents aged 40 to 79 years, without a history of atherosclerotic cardiovascular disease, who underwent cholesterol testing and blood pressure measurement from Jan. 1, 2010, to Dec. 31, 2014. We compared predicted event rates generated by the Framingham Risk Score and the Pooled Cohort Equations with observed event rates at 5 years using linkages from validated administrative databases. RESULTS Our study cohort included 84 617 individuals (mean age 56.3 yr, 56.9% female). Over a maximum follow-up period of 5 years, we observed 2162 (2.6%) events according to the outcome definition of the Framingham Risk Score, and 1224 (1.4%) events according to the outcome definition of the Pooled Cohort Equations. The predicted event rate of 5.78% by the Framingham Risk Score and 3.51% by the Pooled Cohort Equations at 5 years overestimated observed event rates by 101% and 115%, respectively. The degree of overestimation differed by age and ethnicity. The C statistics for the Framingham Risk Score (0.74) and Pooled Cohort Equations (0.73) were similar. INTERPRETATION The Framingham Risk Score and Pooled Cohort Equations significantly overpredicted the actual risks of atherosclerotic cardiovascular disease events in a large population from Ontario. Our finding suggests the need for further refinement of cardiovascular disease risk prediction scores to suit the characteristics of a multiethnic Canadian population.
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Affiliation(s)
- Dennis T Ko
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta.
| | - Atul Sivaswamy
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Maneesh Sud
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Gynter Kotrri
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Paymon Azizi
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Maria Koh
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Peter C Austin
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Douglas S Lee
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Idan Roifman
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - George Thanassoulis
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Karen Tu
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Jacob A Udell
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Harindra C Wijeysundera
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
| | - Todd J Anderson
- Schulich Heart Centre (Ko, Sud, Roifman, Wijeysundera), Sunnybrook Health Sciences Centre; ICES (Ko, Sivaswamy, Sud, Kotrri, Azizi, Koh, Austin, Lee, Roifman, Udell, Wijeysundera); Institute of Health Policy, Management and Evaluation (Ko, Azizi, Austin, Lee, Roifman, Tu, Udell, Wijeysundera), University of Toronto; University Health Network (Lee, Tu), Toronto, Ont.; Department of Medicine (Thanassoulis), McGill University; McGill University Health Centre (Thanassoulis), Montréal, Que.; North York General Hospital (Tu), Department of Family and Community Medicine, University of Toronto; Women's College Research Institute (Udell), Toronto, Ont.; Libin Cardiovascular Institute of Alberta (Anderson); Cumming School of Medicine (Anderson), University of Calgary, Alta
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1232
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Yegezu Z, Mollon L, Alshayban DM, Bilal J, Bhattacharjee S. Health-related risk behaviors among myocardial infarction survivors in the United States: A propensity score matched study. Res Social Adm Pharm 2020; 17:307-314. [PMID: 32360124 DOI: 10.1016/j.sapharm.2020.04.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 04/04/2020] [Accepted: 04/19/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND According to the American College of Cardiology/the American Heart Association (ACC/AHA) recommendations, health-related risk behaviors for secondary prevention of myocardial infarction (MI) are critical to determine. OBJECTIVE This study aimed to compare health-related risk behaviors between MI survivors and propensity-score-matched non-MI controls using nationally representative data. METHODS This cross-sectional, matched case-control study used publicly available Behavioral Risk Factor Surveillance System (BRFSS) 2017 data. Older adults with MI were propensity-score-matched to their non-MI controls. The 10 dependent variables included body mass index (BMI), smoking status, heavy alcohol consumption, influenza vaccine, length of time since last routine and cholesterol checkup, alcohol consumption, fruit and vegetable consumption, and physical activity. Chi-square tests and binomial logistic regression were used to examine the health-related risk behaviors differences between MI survivors and propensity-score-matched non-MI controls. RESULTS The final study sample consisted of 18,021 MI survivors and 54,063 non-MI controls after propensity score matching. Multivariable logistic regression analysis showed significant differences between MI survivors and matched non-MI controls in terms of cholesterol checkup, smoking status, and alcohol consumption. For example, multivariate analysis of health-related risk behaviors showed MI survivors were more likely to be smokers (AOR = 1.46, 95% CI: 1.28-1.68). CONCLUSION Based on this national survey of adults, MI survivors were more likely to be smokers but less likely to consume alcohol compared to their propensity-score-matched controls. Moreover, MI survivors were more likely to have their cholesterol checkup within the past 2 years compared to matched non-MI controls. Although lower alcohol consumption and greater chances of cholesterol checkups are reassuring health-related behaviors, interventions are needed to minimize the chances of smoking in this population.
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Affiliation(s)
- Zufan Yegezu
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
| | - Lea Mollon
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
| | - Dhafer Mahdi Alshayban
- Pharmacy Practice Department, College of Clinical Pharmacy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Jawad Bilal
- Department of Medicine, Division of Rheumatology, University of Arizona, USA.
| | - Sandipan Bhattacharjee
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Arizona, Tucson, AZ, USA.
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1233
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Tan M, MacEachern MP. Treating Dyslipidemias in the Primary Prevention of Atherosclerotic Cardiovascular Disease in Older Adults with Diabetes Mellitus. Clin Geriatr Med 2020; 36:457-476. [PMID: 32586475 DOI: 10.1016/j.cger.2020.04.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
People with diabetes mellitus (DM), especially those who are older, are at higher risk for premature morbidity and mortality related to atherosclerotic cardiovascular disease (ASCVD). Clinical practice guidelines recommend statin therapy for people with DM ages 40 to 75 years. The evidence for those greater than 75 years of age is relatively limited at present. Other health problems should be considered when planning ASCVD primary prevention in adults ages greater than 75 years with DM. Clinicians should discuss the risks and benefits of each plan with these patients and their caregivers.
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Affiliation(s)
- MengHee Tan
- Division of Metabolism, Endocrinology & Diabetes, Department of Internal Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, Ann Arbor, MI 48105, USA.
| | - Mark Paul MacEachern
- Taubman Health Sciences Library, University of Michigan, 1135 Catherine Street, Ann Arbor, MI 48109, USA
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1234
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Ray KK, Wright RS, Kallend D, Koenig W, Leiter LA, Raal FJ, Bisch JA, Richardson T, Jaros M, Wijngaard PLJ, Kastelein JJP. Two Phase 3 Trials of Inclisiran in Patients with Elevated LDL Cholesterol. N Engl J Med 2020; 382:1507-1519. [PMID: 32187462 DOI: 10.1056/nejmoa1912387] [Citation(s) in RCA: 676] [Impact Index Per Article: 169.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Inclisiran inhibits hepatic synthesis of proprotein convertase subtilisin-kexin type 9. Previous studies suggest that inclisiran might provide sustained reductions in low-density lipoprotein (LDL) cholesterol levels with infrequent dosing. METHODS We enrolled patients with atherosclerotic cardiovascular disease (ORION-10 trial) and patients with atherosclerotic cardiovascular disease or an atherosclerotic cardiovascular disease risk equivalent (ORION-11 trial) who had elevated LDL cholesterol levels despite receiving statin therapy at the maximum tolerated dose. Patients were randomly assigned in a 1:1 ratio to receive either inclisiran (284 mg) or placebo, administered by subcutaneous injection on day 1, day 90, and every 6 months thereafter over a period of 540 days. The coprimary end points in each trial were the placebo-corrected percentage change in LDL cholesterol level from baseline to day 510 and the time-adjusted percentage change in LDL cholesterol level from baseline after day 90 and up to day 540. RESULTS A total of 1561 and 1617 patients underwent randomization in the ORION-10 and ORION-11 trials, respectively. Mean (±SD) LDL cholesterol levels at baseline were 104.7±38.3 mg per deciliter (2.71±0.99 mmol per liter) and 105.5±39.1 mg per deciliter (2.73±1.01 mmol per liter), respectively. At day 510, inclisiran reduced LDL cholesterol levels by 52.3% (95% confidence interval [CI], 48.8 to 55.7) in the ORION-10 trial and by 49.9% (95% CI, 46.6 to 53.1) in the ORION-11 trial, with corresponding time-adjusted reductions of 53.8% (95% CI, 51.3 to 56.2) and 49.2% (95% CI, 46.8 to 51.6) (P<0.001 for all comparisons vs. placebo). Adverse events were generally similar in the inclisiran and placebo groups in each trial, although injection-site adverse events were more frequent with inclisiran than with placebo (2.6% vs. 0.9% in the ORION-10 trial and 4.7% vs. 0.5% in the ORION-11 trial); such reactions were generally mild, and none were severe or persistent. CONCLUSIONS Reductions in LDL cholesterol levels of approximately 50% were obtained with inclisiran, administered subcutaneously every 6 months. More injection-site adverse events occurred with inclisiran than with placebo. (Funded by the Medicines Company; ORION-10 and ORION-11 ClinicalTrials.gov numbers, NCT03399370 and NCT03400800.).
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Affiliation(s)
- Kausik K Ray
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - R Scott Wright
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - David Kallend
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - Wolfgang Koenig
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - Lawrence A Leiter
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - Frederick J Raal
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - Jenna A Bisch
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - Tara Richardson
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - Mark Jaros
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - Peter L J Wijngaard
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
| | - John J P Kastelein
- From the Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London (K.K.R.); the Department of Cardiology, Mayo Clinic, Rochester, MN (R.S.W.); the Medicines Company, Zurich, Switzerland (D.K.); Deutsches Herzzentrum München, Technische Universität München, and Deutsches Zentrum für Herz-Kreislauf-Forschung (German Center for Cardiovascular Research), partner site Munich Heart Alliance, Munich, and the Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm - all in Germany (W.K.); Li Ka Shing Knowledge Institute, St. Michael's Hospital, University of Toronto, Toronto (L.A.L.); the Department of Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg (F.J.R.); the Medicines Company, Parsippany, NJ (J.A.B., T.R., P.L.J.W.); Summit Analytical, Denver (M.J.), and the Department of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam (J.J.P.K.)
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1235
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Guedeney P, Sorrentino S, Giustino G, Chapelle C, Laporte S, Claessen BE, Ollier E, Camaj A, Kalkman DN, Vogel B, De Rosa S, Indolfi C, Lattuca B, Zeitouni M, Kerneis M, Silvain J, Collet JP, Mehran R, Montalescot G. Indirect comparison of the efficacy and safety of alirocumab and evolocumab: a systematic review and network meta-analysis. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2020; 7:225-235. [PMID: 32275743 DOI: 10.1093/ehjcvp/pvaa024] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 02/03/2020] [Accepted: 04/04/2020] [Indexed: 12/22/2022]
Abstract
AIMS Although alirocumab and evolocumab have both been associated with improved outcomes in patients with dyslipidaemia or established atherosclerotic cardiovascular disease, data on their respective performances are scarce. This study aimed at providing an indirect comparison of the efficacy and safety of alirocumab vs. evolocumab. METHODS AND RESULTS We conducted a systematic review and network meta-analysis of randomized trials comparing alirocumab or evolocumab to placebo with consistent background lipid-lowering therapy up to November 2018. We estimated the relative risk (RR) and the 95% confidence intervals (CIs) using fixed-effect model in a frequentist pairwise and network meta-analytic approach. A total of 30 trials, enrolling 59 026 patients were included. Eligibility criteria varied significantly across trials evaluating alirocumab and evolocumab. Compared with evolocumab, alirocumab was associated with a significant reduction in all-cause death (RR 0.80, 95% CI 0.66-0.97) but not in cardiovascular death (RR 0.83, 95% CI 0.65-1.05). This study did not find any significant differences in myocardial infarction (RR 1.15, 95% CI 0.99-1.34), stroke (RR 0.96, 95% CI 0.71-1.28), or coronary revascularization (RR 1.13, 95% CI 0.99-1.29) between the two agents. Alirocumab was associated with a 27% increased risk of injection site reaction compared to evolocumab; however, no significant differences were found in terms of treatment discontinuations, systemic allergic reaction, neurocognitive events, ophthalmologic events, or new-onset of or worsening of pre-existing diabetes. CONCLUSION Alirocumab and evolocumab share a similar safety profile except for injection site reaction. No significant differences were observed across the efficacy endpoints, except for all-cause death, which may be related to the heterogeneity of the studied populations treated with the two drugs.
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Affiliation(s)
- Paul Guedeney
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France.,Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sabato Sorrentino
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Gennaro Giustino
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Celine Chapelle
- Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
| | - Silvy Laporte
- Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
| | - Bimmer E Claessen
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Edouard Ollier
- Unité de Recherche Clinique Innovation et Pharmacologie CHU de Saint-Etienne, Saint-Etienne, France
| | - Anton Camaj
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Deborah N Kalkman
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA.,Department of Clinical and Experimental Cardiology, Amsterdam UMC, University of Amsterdam, Heart Center, Amsterdam Cardiovascular Sciences, Meibergdreef 9, Amsterdam, The Netherlands
| | - Birgit Vogel
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Salvatore De Rosa
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Ciro Indolfi
- Division of Cardiology, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro, Italy
| | - Benoit Lattuca
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Michel Zeitouni
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Mathieu Kerneis
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Johanne Silvain
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Jean-Philippe Collet
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
| | - Roxana Mehran
- Department of Interventional Cardiovascular Research and Clinical Trials, The Zena and Michael A. Weiner Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Gilles Montalescot
- Department of Cardiology, Sorbonne Université, ACTION study group, UMR_S 1166, Institut de Cardiologie, Pitié Salpêtrière Hospital (AP-HP), Paris, France
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Kaltoft M, Langsted A, Nordestgaard BG. Triglycerides and remnant cholesterol associated with risk of aortic valve stenosis: Mendelian randomization in the Copenhagen General Population Study. Eur Heart J 2020; 41:2288-2299. [DOI: 10.1093/eurheartj/ehaa172] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 12/17/2019] [Accepted: 03/09/2020] [Indexed: 01/12/2023] Open
Abstract
AbstractAimsWe tested the hypothesis that higher levels of plasma triglycerides and remnant cholesterol are observationally and genetically associated with increased risk of aortic valve stenosis.Methods and resultsWe included 108 559 individuals from the Copenhagen General Population Study. Plasma triglycerides, remnant cholesterol (total cholesterol minus low-density lipoprotein and high-density lipoprotein cholesterol), and 16 genetic variants causing such increased or decreased levels were determined. Incident aortic valve stenosis occurred in 1593 individuals. Observationally compared to individuals with triglycerides <1 mmol/L (<89 mg/dL), the multifactorially adjusted hazard ratio for aortic valve stenosis was 1.02 [95% confidence interval (CI) 0.87–1.19] for individuals with triglycerides of 1.0–1.9 mmol/L (89–176 mg/dL), 1.22 (1.02–1.46) for 2.0–2.9 mmol/L (177–265 mg/dL), 1.40 (1.11–1.77) for 3.0–3.9 mmol/L (266–353 mg/dL), 1.29 (0.88–1.90) for 4.0–4.9 mmol/L (354–442 mg/dL), and 1.52 (1.02–2.27) for individuals with triglycerides ≥5 mmol/L (≥443 mg/dL). By age 85, the cumulative incidence of aortic valve stenosis was 5.1% for individuals with plasma triglycerides <2.0 mmol/L (77 mg/dL), 6.5% at 2.0–4.9 mmol/L (177–442 mg/dL), and 8.2% for individuals with plasma triglycerides ≥5.0 mmol/L (443 mg/dL). The corresponding values for remnant cholesterol categories were 4.8% for <0.5 mmol/L (19 mg/dL), 5.6% for 0.5–1.4 mmol/L (19–57 mg/dL), and 7.4% for ≥1.5 mmol/L (58 mg/dL). Genetically, compared to individuals with allele score 13–16, odds ratios for aortic valve stenosis were 1.30 (95% CI 1.20–1.42; Δtriglycerides +12%; Δremnant cholesterol +11%) for allele score 17–18, 1.41 (1.31–1.52; +25%; +22%) for allele score 19–20, and 1.51 (1.22–1.86; +51%; +44%) for individuals with allele score 21–23.ConclusionHigher triglycerides and remnant cholesterol were observationally and genetically associated with increased risk of aortic valve stenosis.
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Affiliation(s)
- Morten Kaltoft
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 73, Elevator 7, DK-2730 Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, DK-2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Anne Langsted
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 73, Elevator 7, DK-2730 Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, DK-2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Borgmester Ib Juuls Vej 73, Elevator 7, DK-2730 Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, DK-2730 Herlev, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, DK-2200 Copenhagen, Denmark
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1237
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Chrysant SG. Noninvasive vascular function tests for the future prediction of primary cardiovascular diseases. Hosp Pract (1995) 2020; 48:113-118. [PMID: 32252568 DOI: 10.1080/21548331.2020.1752506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVES Cardiovascular diseases (CVDs) still remain the main causes of death and disability in the US and worldwide, and the prediction for their future incidence is not well established. The utilization of the new cardiovascular risk score (CVRS) developed by the new ACC/AHA blood pressure treatment guidelines has improved the 10-year prediction of CVDs. However, its predictive value could be further increased with the addition of other risk factors identified with the use of several noninvasive vascular tests. These tests include, the older tests such as flow-mediated dilation (FMD), pulse wave velocity (PWV), pulse pressure (PP), and the newly developed noninvasive vascular tests of, reactive hyperemia-peripheral arterial tonometry (RH-PAT), cardio-ankle vascular index (CAVI), and the inter-arm/inter-leg pressure difference (IAPD/ILPD). METHODS In order to get a current perspective regarding the usefulness of these new noninvasive vascular tests for the future prediction of CVDs, a Medline search of the English language literature was conducted between 2014 and 2019 using the terms cardiovascular disease, coronary heart disease, noninvasive vascular tests, risk factors, and 26 pertinent papers were retrieved. RESULTS The analysis of results from these papers showed that these noninvasive vascular tests have an independent predictive value for the future incidence of CVDs and hypertension. However, their long-term predictive value is not well established, since there are no currently, available data from long-term clinical outcome studies. CONCLUSION The analysis of data from the retrieved papers demonstrated that the new noninvasive vascular tests have an independent predictive value for the future incidence of CVDs and hypertension. However, their long-term predictive value is not established as yet for the lack of long-term outcome studies. When the currently ongoing long-term trials are completed, it is quite possible that the data from these tests added to CVRS could enhance its predictive value.
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Affiliation(s)
- Steven G Chrysant
- Department of Cardiology, University of Oklahoma Health Sciences Center , Oklahoma City, OK, USA
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1238
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Neupane G, Acharya S, Bhattarai M, Upadhyay A, Belbase B, Bhandari M, Pandeya D, Pokharel S, Ghimire S, Thapa G, Karmacharya B, Bhatt MR, Spertus JA, Neupane D, Timsina L, Pokharel Y. Study, Design, and Rationale of Noncommunicable Diseases in Nepal (NCD Nepal) Study: A Community-Based Prospective Epidemiological and Implementation Study in Rural Nepal. Glob Adv Health Med 2020; 9:2164956120917379. [PMID: 32284911 PMCID: PMC7139172 DOI: 10.1177/2164956120917379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/24/2020] [Accepted: 03/11/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Noncommunicable diseases (NCDs) are the leading causes of deaths globally. Currently, there are limited high-quality data on the epidemiology and usefulness of community-based screening and treatment of NCDs in low-to-middle-income countries (LMIC), like Nepal. We describe the protocol of a community-based, longitudinal epidemiological study of screening and management of NCDs in rural Nepal. METHODS We organize monthly mobile health clinics to screen NCDs among 40- to 75-year-old residents from municipal subdivision wards 3, 4, 6, and 7 of Ghorahi submetropolitan city, Dang, Nepal (approximately 406 km west of the capital, Kathmandu). We estimate a total of 7052 eligible participants. After obtaining informed consent, trained personnel will collect sociodemographic and lifestyle data, medical, medication, and family history using validated questionnaires, plus anthropometric measures and capillary glucose levels. We will screen for hypertension, diabetes, obesity, dyslipidemia, tobacco and alcohol use, self-reported physical activity, dietary habits, cardiovascular disease, stroke, chronic lung disease, cancer, and chronic kidney disease. We will also check hemoglobin A1C, lipid panel, serum creatinine, sodium, potassium, urine dipstick, and urine albumin-to-creatinine ratio in high-risk participants. We will offer lifestyle counseling, pharmacotherapy or refer to higher level care, where appropriate; routinely follow participants with NCDs for continuity of care; and follow individuals without NCDs but with elevated glucose, prehypertension or other risk factors every year, and those without risk factors every 2 years. We will monitor participants in the community to reduce attrition and to track all-cause and disease-specific mortality. DISCUSSION Understanding the community burden of NCDs in resource-limited setting and testing effectiveness of community-based screening and management of NCDs will provide insights to develop national policy to address NCD burden in LMIC like Nepal.
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Affiliation(s)
- Gagan Neupane
- Health Foundation Nepal, Lalitpur, Nepal
- Shreegaun Primary Health Care Center, Dang, Nepal
| | - Sameer Acharya
- Health Foundation Nepal, Lalitpur, Nepal
- Shreegaun Primary Health Care Center, Dang, Nepal
| | - Manoj Bhattarai
- Health Foundation Nepal, Lalitpur, Nepal
- Department of Medicine/Nephrology, Kidney Specialists of the
Palm Beach, Palm Beach, Florida
| | - Ashish Upadhyay
- Health Foundation Nepal, Lalitpur, Nepal
- Section of Nephrology, Department of Medicine, Boston University
School of Medicine, Boston, Massachusetts
| | | | - Manoj Bhandari
- Health Foundation Nepal, Lalitpur, Nepal
- Department of Cardiology, Bronx Care Health System, New York,
New York
| | - Drona Pandeya
- Health Foundation Nepal, Lalitpur, Nepal
- Chemistry Department, Sonic Healthcare, Clinical Pathology
Laboratories, Austin, Texas
| | | | | | | | - Biraj Karmacharya
- Department of Community Programs, Dhulikhel Hospital Kathmandu
University Hospital, Kathmandu University School of Medical Sciences, Dhulikhel,
Nepal
- Sun Yat-sen Global Health Institute, Sun Yat-sen University,
Guangzhou, China
| | | | - John A Spertus
- Saint Luke’s Mid America Heart Institute, University of
Missouri, Kansas City, Missouri
| | - Dinesh Neupane
- Nepal Development Society, Chitwan, Nepal
- Welch Center for Prevention, Epidemiology and Clinical
Research, Johns Hopkins University, Baltimore, Maryland
| | - Lava Timsina
- Health Foundation Nepal, Lalitpur, Nepal
- Centers of Outcomes Research in Surgery, Department of Surgery,
Indiana University, Indianapolis, Indiana
| | - Yashashwi Pokharel
- Health Foundation Nepal, Lalitpur, Nepal
- America Nepal Medical Foundation, New York, USA
- Saint Luke’s Mid America Heart Institute, University of
Missouri Kansas City, Missouri
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1239
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Caring for Women After Hypertensive Pregnancies and Beyond: Implementation and Integration of a Postpartum Transition Clinic. Matern Child Health J 2020; 23:1459-1466. [PMID: 31257555 DOI: 10.1007/s10995-019-02768-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Purpose We developed a postpartum transition clinic to better support women after hypertensive pregnancy. Description Our program goals were (1) early postpartum hypertension medical management, (2) patient and provider education around CVD risk, (3) transition to primary care provider (PCP) and (4) a sustainable clinical model reimbursed by private and public insurances. We focused on women immediately postpartum in this analysis. Assessment Over the course of 5 years, a racially and socioeconomically diverse population of 412 immediately postpartum women received care for one, two or more appointments. Referral diagnoses included antepartum preeclampsia (PET) 51% (210/412), postpartum preeclampsia/hypertension (PP-PET) 22.3% (92/412), preeclampsia superimposed on chronic hypertension (siPET) 10.2% (42/412), chronic hypertension (cHTN) 8.8% (37/412), and gestational hypertension (gHTN) 7.8% (31/412). Almost half of women had 2-3 visits 47.3% (195/412) with no difference by diagnosis (p = 0.18). No show rates were consistently around 25%. Acquisition of home blood pressure monitors increased from 56.8% (44/94) to 93.8% (61/65) over the 5 years (p < 0.0001). Nearly half of patients seen had antihypertensive medication adjustments 48.3% (199/412). Of those patients scheduled, 86.8% (79/91) attended a nutrition consultation. For patients with PCPs within our system, 79.5% (105/132) kept their scheduled follow up PCP appointments. Conclusion We report a postpartum transition clinic after hypertensive pregnancy. In this diverse population, patients attended 2-3 visits, incorporated home blood pressure monitoring, adjusted antihypertensive medications and initiated prevention measures such as nutrition referrals and PCP follow-up. An internist salary was sustained through billings and collections from private and public insurance.
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Santos RD. EUROASPIRE V and uncontrolled risk factors in primary prevention: Atherosclerotic cardiovascular disease in the making. Eur J Prev Cardiol 2020; 28:380-382. [PMID: 33611497 DOI: 10.1177/2047487320915662] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Raul D Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Brazil
- Hospital Israelita Albert Einstein, Brazil
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1241
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Kaddoura R, Orabi B, Salam AM. PCSK9 Monoclonal Antibodies: An Overview. Heart Views 2020; 21:97-103. [PMID: 33014302 PMCID: PMC7507904 DOI: 10.4103/heartviews.heartviews_20_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 03/08/2020] [Indexed: 12/24/2022] Open
Abstract
PCSK9 monoclonal antibodies are novel lipid-lowering therapy that have been extensively studied in patients with hypercholesterolemia either as monotherapy or as an add-on to other LLTs. PCSK9 monoclonal antibodies have significantly reduced the low-density lipoprotein cholesterol (LDL-C) plasma level resulting in a better LDL-C goal attainment. The commercially available PCSK9 monoclonal antibodies, alirocumab and evolocumab, have demonstrated reductions in major adverse cardiovascular events such as myocardial infarction, stroke, unstable angina, and the need for coronary revascularization but not mortality. PCSK9 monoclonal antibodies have demonstrated a favorable safety profile. The most reported side effects are mild injection site with no causal relationship proven between the inhibition of PCSK9 and neurocognitive or glycemic adverse events. In this overview, the efficacy and safety of PCSK9 monoclonal antibodies in the treatment of primary and familial hypercholesterolemia will be discussed.
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Affiliation(s)
- Rasha Kaddoura
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Bassant Orabi
- Pharmacy Department, Heart Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amar M Salam
- Department of Cardiology, Al Khor Hospital, Hamad Medical Corporation, Doha, Qatar
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1242
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Wong ND. Evaluating Multisite Atherosclerosis and its Progression. J Am Coll Cardiol 2020; 75:1628-1630. [DOI: 10.1016/j.jacc.2020.02.047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2020] [Accepted: 02/24/2020] [Indexed: 11/25/2022]
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Dalton JE, Rothberg MB, Dawson NV, Krieger NI, Zidar DA, Perzynski AT. Failure of Traditional Risk Factors to Adequately Predict Cardiovascular Events in Older Populations. J Am Geriatr Soc 2020; 68:754-761. [PMID: 31958154 PMCID: PMC7156319 DOI: 10.1111/jgs.16329] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 11/19/2019] [Accepted: 11/28/2019] [Indexed: 01/10/2023]
Abstract
BACKGROUND Accurate assessment of atherosclerotic cardiovascular disease (ASCVD) risk across heterogeneous populations is needed for effective primary prevention. Little is known about the performance of standard cardiovascular risk factors in older adults. OBJECTIVE To evaluate the performance of the American College of Cardiology/American Heart Association Pooled Cohort Equations (PCE) risk model, as well as the underlying cardiovascular risk factors, among adults older than 65 years. DESIGN AND SETTING Retrospective cohort derived from a regional referral system's electronic medical records. PARTICIPANTS A total of 25 349 patients who were 65 years or older at study baseline (date of the first outpatient lipid panel taken between 2007 and 2010). MEASUREMENTS Exposures of interest were traditional cardiovascular risk factors, as defined by inclusion in the PCE model. The primary outcome was major ASCVD events, defined as a composite of myocardial infarctions, stroke, and cardiovascular death. RESULTS The PCE and internally estimated models produced similar risk distributions for white men aged 65 to 74 years. For all other groups, PCE predictions were generally lower than those of the internal models, particularly for African Americans. Discrimination of the PCE was poor for all age groups, with concordance index (95% confidence interval) estimates of 0.62 (0.60-0.64), 0.56 (0.54-0.57), and 0.52 (0.49-0.54) among patients aged 65 to 74, 75 to 84, and 85 years and older, respectively. Reestimating relationships within these age groups resulted in better calibration but negligible improvements in discrimination. Blood pressure, total cholesterol, and diabetes either were not associated at all or had inverse associations in the older age groups. CONCLUSION Traditional clinical risk factors for cardiovascular disease failed to accurately characterize risk in a contemporary population of Medicare-aged patients. Among those aged 85 years and older, some traditional risk factors were not associated with ASCVD events. Better risk models are needed to appropriately inform treatment decision making for the growing population of older adults. J Am Geriatr Soc 68:754-761, 2020.
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Affiliation(s)
- Jarrod E. Dalton
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic
| | - Michael B. Rothberg
- Cleveland Clinic Lerner College of Medicine, Case Western Reserve University
- Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic
| | - Neal V. Dawson
- Department of Population and Quantitative Health Sciences, Case Western Reserve University
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth
| | - Nikolas I. Krieger
- Department of Quantitative Health Sciences, Lerner Research Institute, Cleveland Clinic
| | - David A. Zidar
- Harrington Heart and Vascular Institute, University Hospitals Cleveland Medical Center
- School of Medicine, Case Western Reserve University
| | - Adam T. Perzynski
- Center for Healthcare Research and Policy, Case Western Reserve University at MetroHealth
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Marx N, Rydén L, Brosius F, Ceriello A, Cheung M, Cosentino F, Green J, Kellerer M, Koob S, Kosiborod M, Nedungadi P, Rodbard HW, Vandvik PO, Standl E, Schnell O. Proceedings of the Guideline Workshop 2019 - Strategies for the optimization of guideline processes in diabetes, cardiovascular diseases and kidney diseases. Diabetes Res Clin Pract 2020; 162:108092. [PMID: 32109519 DOI: 10.1016/j.diabres.2020.108092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 02/24/2020] [Indexed: 12/21/2022]
Abstract
The Guideline Workshop 2019, held in October 2019 in Munich, Germany, had the purpose of facilitating discussion on strategies for optimization of guideline processes in diabetes amongst a group of representatives of renown national and international societies in the field of diabetes, cardiology, and nephrology. Results of this panel's discussions are presented in this manuscript and comprise a variety of suggestions for improving the quality and usability of guidelines, as well as to accelerate the development and responsiveness of guidelines to newly published, relevant data from clinical trials such as cardiovascular outcome trials in diabetes mellitus. These include, but are not limited to, recommendations to optimize presentation of content in guidelines, use of the GRADE-approach to rating the quality of evidence to harmonize guidelines, and utilization of digital health technologies to accelerate, streamline, and optimize communication on relevant data and development of clinical guidelines and necessary updates, while reducing costs. Recognizing that achieving alignment in guideline development among various medical organizations will be a long-term process, representatives from cross-sectional medical organizations relevant to cardio-renal metabolic disease and experts in guideline methodology will work together in the future. Among other activities, it is planned to continue the activity and organize a Guideline Workshop in 2020.
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Affiliation(s)
- Nikolaus Marx
- Department of Internal Medicine I, University Hospital Aachen, RWTH Aachen University, Pauwelsstraße 30, 52074 Aachen, Germany.
| | - Lars Rydén
- Department of Medicine K2, Karolinska Institute, Stockholm, Sweden.
| | - Frank Brosius
- University of Arizona College of Medicine, 1501 N. Campbell Ave, Tucson, AZ 85724-5022, USA.
| | - Antonio Ceriello
- IRCCS MultiMedica, Via Milanese 300, 20099 Sesto San Giovanni, MI, Italy.
| | - Michael Cheung
- KDIGO, Avenue Louise 65, Suite 11, 1050 Brussels, Belgium.
| | | | - Jennifer Green
- Duke University Medical Center, Duke Clinical Research Institute, 200 Morris St, DUMC Box 3850, Durham, NC 27715, USA.
| | - Monika Kellerer
- Marienhospital Stuttgart, Böheimstraße 37, 70199 Stuttgart, Germany.
| | - Susan Koob
- PCNA National Office, 613 Williamson Street, Suite 200, Madison, WI 53703, USA.
| | - Mikhail Kosiborod
- Saint Luke's Mid America Heart Institute and University of Missouri-Kansas City, 4401 Wornall Rd, Kansas City, MO 64111, USA; The George Institute for Global Health and University of New South Wales, Sydney, Australia.
| | - Prashant Nedungadi
- American Heart Association, 7272 Greenville Avenue, Dallas, TX 75082, USA.
| | - Helena W Rodbard
- Endocrine and Metabolic Consultants, 3200 Tower Oaks Blvd., Suite 250, Rockville, MD 20852, USA.
| | - Per Olav Vandvik
- Institute of Health and Society, University of Oslo, Oslo, Norway
| | - Eberhard Standl
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, 85764 Neuherberg, Munich, Germany.
| | - Oliver Schnell
- Forschergruppe Diabetes e. V., Ingolstaedter Landstraße 1, 85764 Neuherberg, Munich, Germany.
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1245
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Seo WK, Hosseini MB, Bang OY, Liebeskind DS. Recent updates in dyslipidemia management: perspectives in stroke-specific situation. PRECISION AND FUTURE MEDICINE 2020. [DOI: 10.23838/pfm.2020.00009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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1246
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Boccara F, Kumar PN, Caramelli B, Calmy A, López JAG, Bray S, Cyrille M, Rosenson RS. Evolocumab in HIV-Infected Patients With Dyslipidemia: Primary Results of the Randomized, Double-Blind BEIJERINCK Study. J Am Coll Cardiol 2020; 75:2570-2584. [PMID: 32234462 DOI: 10.1016/j.jacc.2020.03.025] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/16/2020] [Accepted: 03/17/2020] [Indexed: 01/06/2023]
Abstract
BACKGROUND People living with human immunodeficiency virus (PLHIV) are at increased risk of atherosclerotic cardiovascular disease (ASCVD) and are prone to statin-related adverse events from drug-drug interactions with certain antiretroviral regimens. OBJECTIVES This study sought to evaluate the efficacy and safety of evolocumab in dyslipidemic PLHIV. METHODS BEIJERINCK (EvolocumaB Effect on LDL-C Lowering in SubJEcts with Human Immunodeficiency VirRus and INcreased Cardiovascular RisK) is a randomized, double-blind, multinational trial comparing monthly subcutaneous evolocumab 420 mg with placebo in PLHIV with hypercholesterolemia/mixed dyslipidemia taking maximally-tolerated statin therapy. The primary endpoint was the percent change (baseline to week 24) in low-density lipoprotein cholesterol (LDL-C); secondary endpoints included achievement of LDL-C <70 mg/dl and percent change in other plasma lipid and lipoprotein levels. Treatment-emergent adverse events were also examined. RESULTS A total of 464 patients were analyzed (mean age of 56.4 years, 82.5% male, mean duration with HIV of 17.4 years). ASCVD was documented in 35.6% of patients, and statin intolerance/contraindications to statin use were present in 20.7% of patients. Evolocumab reduced LDL-C by 56.9% (95% confidence interval: 61.6% to 52.3%) from baseline to week 24 versus placebo. An LDL-C level of <70 mg/dl was achieved in 73.3% of patients in the evolocumab group versus 7.9% in the placebo group. Evolocumab also significantly reduced other atherogenic lipid levels, including non-high-density lipoprotein cholesterol, apolipoprotein B, and lipoprotein(a) (all p < 0.0001). Evolocumab was well tolerated, and treatment-emergent adverse events patient incidence was similar among evolocumab and placebo groups. CONCLUSIONS Evolocumab was safe and significantly reduced lipid levels in dyslipidemic PLHIV on maximally-tolerated statin therapy. Evolocumab is an effective therapy for lowering atherogenic lipoproteins in PLHIV with high cardiovascular risk. (Safety, Tolerability & Efficacy on LDL-C of Evolocumab in Subjects With HIV & Hyperlipidemia/Mixed Dyslipidemia; NCT02833844).
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Affiliation(s)
- Franck Boccara
- AP-HP, Hôpitaux de l'Est Parisien, Hôpital Saint-Antoine, Department of Cardiology, Sorbonne Université-INSERM UMR S_938, Centre de Recherche Saint-Antoine, Paris, France.
| | - Princy N Kumar
- Division of Infectious Diseases and Travel Medicine, Georgetown University School of Medicine, Washington, DC
| | - Bruno Caramelli
- Interdisciplinary Medicine in Cardiology Unit, InCor, University of São Paulo, São Paulo, Brazil
| | - Alexandra Calmy
- HIV/AIDS Unit, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland
| | | | - Sarah Bray
- Global Development, Amgen Inc., Thousand Oaks, California
| | | | - Robert S Rosenson
- Cardiometabolics Unit, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York, New York
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1247
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Kim KJ, Yoon J, Won KH, Lim SW, Chae IH, Lee SY, Kim SW, Kim HS. Assessment of the Efficacy of Lowering LDL Cholesterol with Rosuvastatin 10 mg in Four Korean Statin Benefit Groups as per ACC/AHA Guidelines (NewStaR4G). J Clin Med 2020; 9:jcm9040916. [PMID: 32230818 PMCID: PMC7230727 DOI: 10.3390/jcm9040916] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/24/2020] [Accepted: 03/25/2020] [Indexed: 01/14/2023] Open
Abstract
The American College of Cardiology and American Heart Association (ACC/AHA) guidelines identified four statin benefit groups on the basis of atherosclerotic cardiovascular disease risk reduction and proposed statin therapy by evidence-based intensity. Although these guidelines used randomized controlled trials with hard outcomes as exclusive evidence for its recommendations, a limited number of studies conducted in Asian countries makes its application of treatment strategy, intensity, and statin doses uncertain in these population. This prospective, multicenter study aimed to evaluate the efficacy of rosuvastatin 10 mg in the four statin benefit groups requiring high- or moderate-intensity statin therapy according to the ACC/AHA guidelines in the Korean population. The primary endpoint was percentage reduction in low-density lipoprotein (LDL) cholesterol. Secondary endpoints were percentage reduction in other lipids and achievement of ≥50% reduction in LDL cholesterol. Rosuvastatin 10 mg lowered LDL cholesterol by 61.4 mg/dL, a 44.9% decrease from baseline after eight weeks. Reduction of LDL cholesterol ≥50% was achieved in 46.3% of patients. Rosuvastatin 10 mg was generally well tolerated. In the Korean population, rosuvastatin 10 mg was favorable and tolerant in lowering LDL cholesterol in the four statin benefit groups requiring high- or moderate-intensity statin therapy according to the ACC/AHA guidelines.
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Affiliation(s)
- Kyung-Jin Kim
- Division of Cardiology, Department of Internal Medicine, Ewha Womans University Medical Center, Ewha Womans University School of Medicine, Seoul 07985, Korea
| | - Junghan Yoon
- Division of Cardiology, Department of Internal Medicine, Yonsei University, Wonju Severance Christian Hospital, Wonju 26426, Korea
| | - Kyung Heon Won
- Division of Cardiology, Department of Internal Medicine, Seoul Medical Center, Seoul 02053, Korea
| | - Sang-Wook Lim
- Bundang Cha Hospital Cardiovascular Center, Seongnam 13496, Korea
| | - In-Ho Chae
- Seoul National University Bundang Hospital, Seoul National University School of Medicine, Seongnam 13620, Korea
| | - Sung Yun Lee
- Inje University Ilsan Paik Hospital Cardiology, Goyang 10380, Korea
| | - Sang-Wook Kim
- Heart Research Institute Chung-ang University Hospital, Seoul 06973, Korea
| | - Hyo-Soo Kim
- Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul National University College of Medicine, Seoul 03080, Korea
- Correspondence: or
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1248
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Efficacy and Safety of High-intensity Statins in Patients With Acute Myocardial Infarction: An Asian Perspective. Can J Cardiol 2020; 36:886-892. [PMID: 32204951 DOI: 10.1016/j.cjca.2019.10.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Revised: 10/11/2019] [Accepted: 10/16/2019] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND The 2013 American College of Cardiology/American Heart Association cholesterol guideline recommends high-intensity statin (HIS) in patients with atherosclerotic cardiovascular disease, but little is known about the efficacy and safety of HIS in Asian ethnicity. We assessed the effects of HIS in Taiwanese with acute myocardial infarction (AMI). METHODS Consecutive patients admitted for new AMI between January 2010 and December 2013 without prior statin use were enrolled from the Taiwan National Health Insurance Research Database. Patients were grouped based on the intensity of statin they took after discharge. The primary endpoint was the composite outcome of all-cause mortality, recurrent myocardial infarction, and stroke. We also compared the incidences of severe hepatitis and myopathy that need admission between HIS and non-HIS groups. We used propensity score analysis to match covariates between groups and Cox proportional hazards models with adjustment to estimate the risks of clinical outcomes. RESULTS After 1:4 propensity score match, there were 4402 patients in the HIS group and 17,608 patients in the non-HIS group. After follow-up for 3 years, 668 patients (15.2%) in the HIS group and 2749 (15.6%) in the non-HIS group had the primary composite endpoint. Cox proportional-hazards analyses showed that HIS did not further reduce composite endpoint (adjusted hazard ratio, 0.975; 95% confidence interval, 0.896-1.062); however, HIS patients had a lower risk of ischemic stroke at 3-year follow-up. Regarding safety, HIS did not increase hospitalization rates for severe hepatitis and myopathy. CONCLUSIONS Patients with AMI in Taiwan with HIS had similar clinical outcomes to those with non-HIS. Using HIS for the effective reduction of low-density lipoprotein cholesterol is safe in Taiwan.
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1249
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Kar S. Elevated Lipoprotein A in South Asians and the Associated Risk of Cardiovascular Disease: A Systematic Review. Curr Probl Cardiol 2020; 46:100581. [PMID: 32295712 DOI: 10.1016/j.cpcardiol.2020.100581] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2020] [Accepted: 03/11/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND South Asians have a premature risk of cardiovascular disease and increased lipoprotein A which enhances their risk. METHODS This systematic review evaluates the role of elevated lipoprotein A in cardiovascular disease risk for South Asians. It discusses the pathophysiology, clinical studies, and treatment of elevated lipoprotein A using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method. RESULTS A total of 72 articles was incorporated which consisted of clinical studies, case-control and cohort studies, meta-analysis, reviews, and editorials. Cardiovascular disease and myocardial infarction occurs prematurely in South Asians, which is further enhanced with an elevated lipoprotein A. CONCLUSIONS South Asians with an elevated lipoprotein A have an increased risk of coronary artery disease so they should have early enactment of lifestyle modification and aggressive medical management.
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1250
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Nelson AJ, Nicholls SJ. Translating evidence from clinical trials of omega-3 fatty acids to clinical practice. Future Cardiol 2020; 16:343-350. [PMID: 32180456 DOI: 10.2217/fca-2019-0031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The REDUCE-IT (Reduction of Cardiovascular Events with Icosapent Ethyl-Intervention Trial) study recently demonstrated that administration of high doses of omega-3 fatty acids confers cardiovascular benefit in high-risk patients with the modest hypertriglyceridemia. This provided optimism for a therapeutic area that has challenged the field of cardiovascular prevention for 2 decades. However, it raises a number of questions including understanding the mechanism underscoring this benefit, how best to use these therapies and whether similar results will be observed with alternative omega-3 fatty acid preparations. Contemporary clinical trials of omega-3 fatty acids and their attempt to prevent cardiovascular events will be reviewed.
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Affiliation(s)
| | - Stephen J Nicholls
- Monash Cardiovascular Research Centre, Monash University, Melbourne, Victoria, Australia
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