1351
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Poli FE, Gulsin GS, McCann GP, Burton JO, Graham-Brown MP. The assessment of coronary artery disease in patients with end-stage renal disease. Clin Kidney J 2019; 12:721-734. [PMID: 31583096 PMCID: PMC6768295 DOI: 10.1093/ckj/sfz088] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Indexed: 02/06/2023] Open
Abstract
Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality among patients with end-stage renal disease (ESRD). Clustering of traditional atherosclerotic and non-traditional risk factors drive the excess rates of coronary and non-coronary CVD in patients with ESRD. Coronary artery disease (CAD) is a key disease process, present in ∼50% of the haemodialysis population ≥65 years of age. Patients with ESRD are more likely to be asymptomatic, posing a challenge to the correct identification of CAD, which is essential for appropriate risk stratification and management. Given the lack of randomized clinical trial evidence in this population, current practice is informed by observational data with a significant potential for bias. For this reason, the most appropriate approach to the investigation of CAD is the subject of considerable discussion, with practice patterns largely varying between different centres. Traditional imaging modalities are limited in their diagnostic accuracy and prognostic value for cardiac events and survival in patients with ESRD, demonstrated by the large number of adverse cardiac outcomes among patients with negative test results. This review focuses on the current understanding of CAD screening in the ESRD population, discussing the available evidence for the use of various imaging techniques to refine risk prediction, with an emphasis on their strengths and limitations.
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Affiliation(s)
- Federica E Poli
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Gaurav S Gulsin
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - Gerry P McCann
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
| | - James O Burton
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
- National Centre for Sport and Exercise Medicine, School of Sport, Exercise and Health Sciences, Loughborough University, Loughborough, UK
| | - Matthew P Graham-Brown
- Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Cardiovascular Biomedical Research Unit, Glenfield Hospital, Leicester, UK
- John Walls Renal Unit, University Hospitals Leicester NHS Trust, Leicester, UK
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1352
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Taylor R, Shrewsbury VA, Vincze L, Campbell L, Callister R, Park F, Schumacher T, Collins C, Hutchesson M. Be Healthe for Your Heart: Protocol for a Pilot Randomized Controlled Trial Evaluating a Web-Based Behavioral Intervention to Improve the Cardiovascular Health of Women With a History of Preeclampsia. Front Cardiovasc Med 2019; 6:144. [PMID: 31616675 PMCID: PMC6775183 DOI: 10.3389/fcvm.2019.00144] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Accepted: 09/05/2019] [Indexed: 01/07/2023] Open
Abstract
Background: Women with a history of preeclampsia are at greater risk of cardiovascular disease (CVD) related morbidity. Despite this knowledge, there is a lack of interventions available for women with a history of preeclampsia for the prevention of CVD. The aim of this pilot randomized controlled trial (RCT) is to determine the acceptability and preliminary efficacy of a web-based behavioral intervention targeted to women with a history of preeclampsia (Be Healthe for your Heart). Method: Australian women aged 18-45 years, with a recent history (≤4 years post diagnosis) of preeclampsia will be recruited for a 3-months, 2-arm parallel group pilot RCT. Participants will be randomized into 2 study arms: (1) Be Healthe for your Heart or; (2) Control, with assessments conducted at baseline, and after 3-months. Be Healthe for your Heart is an intervention delivered online via the program website, with weekly emails to support changes in modifiable CVD risk factors (excess body weight, physical inactivity, poor diet, and stress), using behavior change techniques (e.g., self-monitoring, goal setting). Intervention acceptability (satisfaction, usability, appropriateness, and usage) and impact on absolute full CVD 30-years risk score, CVD risk markers, and modifiable risk factors will be assessed. Discussion: No studies to date have evaluated acceptability and preliminary efficacy of a web-based intervention for the prevention of CVD in this high-risk population with preeclampsia. This pilot trial will inform development of a fully powered RCT if acceptability and preliminary efficacy are demonstrated.
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Affiliation(s)
- Rachael Taylor
- School of Health Sciences, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Vanessa A. Shrewsbury
- School of Health Sciences, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Lisa Vincze
- School of Allied Health Sciences, Griffith University, Gold Coast, QLD, Australia
| | - Linda Campbell
- School of Psychology, Faculty of Science, The University of Newcastle, Newcastle, NSW, Australia
| | - Robin Callister
- School of Biomedical Sciences and Pharmacy, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Felicity Park
- Department of Maternal Fetal Medicine, John Hunter Hospital, Newcastle, NSW, Australia
| | - Tracy Schumacher
- Department of Rural Health, Faculty of Health and Medicine, University of Newcastle, Tamworth, NSW, Australia
| | - Clare Collins
- School of Health Sciences, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
| | - Melinda Hutchesson
- School of Health Sciences, Priority Research Centre for Physical Activity and Nutrition, Faculty of Health and Medicine, The University of Newcastle, Newcastle, NSW, Australia
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1353
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Brown EA, Ward RC, Weeda E, Taber DJ, Axon RN, Gebregziabher M. Racial-Geographic Disparity in Lipid Management in Veterans with Type 2 Diabetes: A 10-Year Retrospective Cohort Study. Health Equity 2019; 3:472-479. [PMID: 31576377 PMCID: PMC6767165 DOI: 10.1089/heq.2019.0071] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Purpose: The prevalence of diabetes in U.S. veterans (20.5%) is nearly three times that of the general population. Minority veterans have higher rates of diabetes compared with their counterparts and urban/rural residence is also associated with uncontrolled cholesterol. However, the interplay between urban/rural residence and race/ethnicity on cholesterol control is unclear. Methods: Veterans Health Administration Corporate Data Warehouse and Centers for Medicare and Medicaid data were used to create unique dataset and perform longitudinal study of veterans with type 2 diabetes from 2006 to 2016. Logistic regression was used to model the association between low-density lipoprotein (LDL) control and the primary exposures (race/ethnicity and location of residence) after adjusting for all measured covariates, including the interaction between location of residence and race/ethnicity. Results: There was a significant interaction between race/ethnicity and rural residence. Rural non-Hispanic Black (NHB) veterans had higher odds for LDL >100 mg/dL (odds ratio [OR]=1.70, 95% confidence interval [CI] 1.50–1.60) and for LDL >70 mg/dL (OR=1.59, 95% CI 1.53–1.64) compared with urban non-Hispanic White (NHW) veterans. Similarly, compared with urban NHW, urban NHB veterans had higher odds of LDL >100 mg/dL (OR=1.45, 95% CI 1.43–1.47) and LDL >70 mg/dL (OR=1.36, 95% CI 1.34–1.38). Conclusion: This study highlights health disparities for veterans with type 2 diabetes. Future research is needed to evaluate interventions for mitigating these disparities in cholesterol management among veterans with diabetes.
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Affiliation(s)
- Elizabeth A Brown
- Department of Health Professions, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina
| | - Ralph C Ward
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.,Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
| | - Erin Weeda
- Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina.,Department of SCCP Clinical Pharmacy and Outcome Sciences-MUSC Campus, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina
| | - David J Taber
- Department of SCCP Clinical Pharmacy and Outcome Sciences-MUSC Campus, College of Pharmacy, Medical University of South Carolina, Charleston, South Carolina.,Department of Surgery and College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Robert Neal Axon
- Department of Surgery and College of Medicine, Medical University of South Carolina, Charleston, South Carolina.,Department of Medicine, College of Medicine, Medical University of South Carolina, Charleston, South Carolina
| | - Mulugeta Gebregziabher
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina.,Health Equity and Rural Outreach Innovation Center, Ralph H. Johnson Department of Veterans Affairs Medical Center, Charleston, South Carolina
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1354
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Ouchi Y, Sasaki J, Arai H, Yokote K, Harada K, Katayama Y, Urabe T, Uchida Y, Hayashi M, Yokota N, Nishida H, Otonari T, Arai T, Sakuma I, Sakabe K, Yamamoto M, Kobayashi T, Oikawa S, Yamashita S, Rakugi H, Imai T, Tanaka S, Ohashi Y, Kuwabara M, Ito H. Ezetimibe Lipid-Lowering Trial on Prevention of Atherosclerotic Cardiovascular Disease in 75 or Older (EWTOPIA 75). Circulation 2019; 140:992-1003. [DOI: 10.1161/circulationaha.118.039415] [Citation(s) in RCA: 76] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Background:
Evidence regarding the primary prevention of coronary artery disease events by low-density lipoprotein cholesterol (LDL-C) lowering therapy in older individuals, aged ≥75 years, is insufficient. This trial tested whether LDL-C–lowering therapy with ezetimibe is useful for the primary prevention of cardiovascular events in older patients.
Methods:
This multicenter, prospective, randomized, open-label, blinded end-point evaluation conducted at 363 medical institutions in Japan examined the preventive efficacy of ezetimibe for patients aged ≥75 years, with elevated LDL-C without history of coronary artery disease. Patients, who all received dietary counseling, were randomly assigned (1:1) to receive ezetimibe (10 mg once daily) versus usual care with randomization stratified by site, age, sex, and baseline LDL-C. The primary outcome was a composite of sudden cardiac death, myocardial infarction, coronary revascularization, or stroke.
Results:
Overall, 3796 patients were enrolled between May 2009 and December 2014, and 1898 each were randomly assigned to ezetimibe versus control. Median follow-up was 4.1 years. After exclusion of 182 ezetimibe patients and 203 control patients because of lack of appropriate informed consent and other protocol violations, 1716 (90.4%) and 1695 (89.3%) patients were included in the primary analysis, respectively. Ezetimibe reduced the incidence of the primary outcome (hazard ratio [HR], 0.66; 95% CI, 0.50–0.86;
P
=0.002). Regarding the secondary outcomes, the incidences of composite cardiac events (HR, 0.60; 95% CI, 0.37–0.98;
P
=0.039) and coronary revascularization (HR, 0.38; 95% CI, 0.18–0.79;
P
=0.007) were lower in the ezetimibe group than in the control group; however, there was no difference in the incidence of stroke, all-cause mortality, or adverse events between trial groups.
Conclusions:
LDL-C–lowering therapy with ezetimibe prevented cardiovascular events, suggesting the importance of LDL-C lowering for primary prevention in individuals aged ≥75 years with elevated LDL-C. Given the open-label nature of the trial, its premature termination and issues with follow-up, the magnitude of benefit observed should be interpreted with caution.
Clinical Registration:
URL:
https://www.umin.ac.jp
. Unique identifier: UMIN000001988.
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Affiliation(s)
| | - Jun Sasaki
- International University of Health and Welfare, Fukuoka, Japan (J.S.)
| | - Hidenori Arai
- National Center for Geriatrics and Gerontology, Obu, Japan (H.A.)
| | | | - Kazumasa Harada
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan (K.H., H.I.)
| | | | - Takao Urabe
- Juntendo University Urayasu Hospital, Urayasu, Japan (T.U.)
| | | | | | | | | | | | | | - Ichiro Sakuma
- Caress Sapporo Hokko Memorial Clinic, Sapporo, Japan (I.S.)
| | | | | | | | | | | | | | | | | | | | | | - Hideki Ito
- Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan (K.H., H.I.)
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1355
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Bittner V. Time to Rethink Prevention of Chronic Kidney Disease? J Am Coll Cardiol 2019; 74:1477-1479. [PMID: 31514950 DOI: 10.1016/j.jacc.2019.07.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Vera Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham, Alabama.
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1356
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Choi JY, Na JO. Pharmacological Strategies beyond Statins: Ezetimibe and PCSK9 Inhibitors. J Lipid Atheroscler 2019; 8:183-191. [PMID: 32821708 PMCID: PMC7379114 DOI: 10.12997/jla.2019.8.2.183] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/22/2019] [Accepted: 09/03/2019] [Indexed: 01/09/2023] Open
Abstract
Dyslipidemia, highly elevated, low-density lipoprotein (LDL) cholesterol, is a major cardiovascular risk factor. Statins have been proven to effectively reduce the risk of atherosclerotic cardiovascular disease (ASCVD) and are recommended as a first-line therapy for the primary and secondary prevention of ASCVD. However, statins may not be sufficient in decreasing LDL cholesterol levels and pose a significant on-treatment residual risk of major cardiovascular events (i.e., residual cholesterol risk) according to meta-analyses of statin trials. Current guidelines for cholesterol management to achieve additional LDL cholesterol reduction and reduce ASCVD risk recommend two hyperlipidemic agents besides statins. Use of ezetimibe, a cholesterol absorption inhibitor, leads to additional LCL cholesterol reduction and decreased ASCVD risk, when added to statin therapy, without raising significant safety concerns. Furthermore, in combination with a mild-to-moderate statin intensity, ezetimibe is used in situations of statin-associated adverse effects such as myalgia and the combination therapy is relatively safer. Monoclonal antibody of proprotein convertase subtilisin/kexin type 9 (PCSK9), alirocumab, and evolocumab, have been approved to lower LDL cholesterol level. While there are drawbacks to the use of PCSK9 inhibitors, including high cost and adverse events such as injection site reaction, they significantly decreased serum LDL cholesterol levels and thereby ASCVD risks when added to maximally tolerated statin therapy.
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Affiliation(s)
- Jah Yeon Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
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1357
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Kazakov YI, Lukin IB, Sokolova NY, Ivanova OV, Bakulina AV. [Outcomes of revascularizing operations on lower-limb arteries in patients with critical ischaemia and multifocal atherosclerosis]. ANGIOLOGII︠A︡ I SOSUDISTAI︠A︡ KHIRURGII︠A︡ = ANGIOLOGY AND VASCULAR SURGERY 2019; 25:114-121. [PMID: 31503255 DOI: 10.33529/angio2019317] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The purpose of this study was to evaluate the amputation-free survival rate and predictors of major adverse cardiovascular events (extracardiac and cardiac mortality, non-fatal myocardial infarction, non-fatal stroke) in patients with atherosclerotic occlusive-stenotic lesions of the femoropopliteal-tibial segment and critical ischaemia. We analysed the results of treating a total of 122 patients with atherosclerotic lesions of the superficial femoral artery and lower limb critical ischaemia. Of these, 35 patients had no lesions of other arterial basins, 24 patients presented with a concomitant lesion of the carotid basin, 41 subjects had lesions of the coronary basin, and 22 had lesions of the coronary and carotid basins. The patients were subjected to either bypass graft operation (n=75) or endovascular intervention (n=47). The evaluated outcome measures were amputation-free survival and the frequency of major adverse cardiovascular events. The average duration of follow up amounted to 38.2±4.3 months. The carried out multivariate logistic regression analysis demonstrated that the factors associated with lower limb amputation and the development of major adverse cardiovascular events were as follows: a concomitant lesion of the coronary (p=0.044) and coronary-carotid (p<0.05) basins, a history of endured myocardial infarction (p=0.003), a C-reactive protein level not less than 17.0 mg/l (p<0.05) and the value of the apolipoprotein B/A1 ratio above 1.0 (p=0.004).
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Affiliation(s)
- Yu I Kazakov
- Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - I B Lukin
- Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - N Yu Sokolova
- Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - O V Ivanova
- Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
| | - A V Bakulina
- Department of Cardiovascular Surgery, Tver State Medical University of the RF Ministry of Public Health, Tver, Russia; Cardiac Surgery Department #2, Regional Clinical Hospital, Tver, Russia
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1358
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Kitzman DW, Upadhya B, Duncan P. Falls, Subclinical Cardiovascular Disease, and a Nonagenarian's Sage Advice. J Am Geriatr Soc 2019; 67:1774-1776. [PMID: 31493354 DOI: 10.1111/jgs.16042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 06/04/2019] [Indexed: 11/28/2022]
Affiliation(s)
- Dalane W Kitzman
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Bharathi Upadhya
- Department of Internal Medicine, Sections on Cardiovascular Medicine and Geriatrics, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Pamela Duncan
- Department of Neurology, Wake Forest School of Medicine, Winston-Salem, North Carolina
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1359
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Kelli HM, Mehta A, Tahhan AS, Liu C, Kim JH, Dong TA, Dhindsa DS, Ghazzal B, Choudhary MK, Sandesara PB, Hayek SS, Topel ML, Alkhoder AA, Martini MA, Sidoti A, Ko Y, Lewis TT, Vaccarino V, Sperling LS, Quyyumi AA. Low Educational Attainment is a Predictor of Adverse Outcomes in Patients With Coronary Artery Disease. J Am Heart Assoc 2019; 8:e013165. [PMID: 31476920 PMCID: PMC6755831 DOI: 10.1161/jaha.119.013165] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/15/2019] [Indexed: 01/03/2023]
Abstract
Background Educational attainment is an indicator of socioeconomic status and is inversely associated with coronary artery disease risk. Whether educational attainment level (EAL) among patients with coronary artery disease influences outcomes remains understudied. Methods and Results Patients undergoing cardiac catheterization had their highest EAL assessed using options of elementary/middle school, high school, college, or graduate education. Primary outcome was all-cause mortality and secondary outcomes were a composite of cardiovascular death/non-fatal myocardial infarction and non-fatal myocardial infarction during follow-up. Cox models adjusted for clinically relevant confounders were used to analyze the association of EAL with outcomes. Among 6318 patients (63.5 years, 63% men, 23% black) enrolled, 16%, 42%, 38%, and 4% had received graduate or higher, college, high school, and elementary/middle school education, respectively. During 4.2 median years of follow-up, there were 1066 all-cause deaths, 812 cardiovascular deaths/non-fatal myocardial infarction, and 276 non-fatal myocardial infarction. Compared with patients with graduate education, those in lower EAL categories (elementary/middle school, high school, or college education) had a higher risk of all-cause mortality (hazard ratios 1.52 [95% CI 1.11-2.09]; 1.43 [95% CI 1.17-1.73]; and 95% CI 1.26 [1.03-1.53], respectively). Similar findings were observed for secondary outcomes. Conclusions Low educational attainment is an independent predictor of adverse outcomes in patients undergoing angiographic coronary artery disease evaluation. The utility of incorporating EAL into risk assessment algorithms and the causal link between low EAL and adverse outcomes in this high-risk patient population need further investigation.
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Affiliation(s)
- Heval M. Kelli
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Anurag Mehta
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Ayman S. Tahhan
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Chang Liu
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGA
| | - Jeong Hwan Kim
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Tiffany A. Dong
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
- Department of MedicineEmory University School of MedicineAtlantaGA
| | - Devinder S. Dhindsa
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Bahjat Ghazzal
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Muaaz K. Choudhary
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Pratik B. Sandesara
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Salim S. Hayek
- Division of CardiologyDepartment of Internal MedicineUniversity of Michigan Medical SchoolAnn ArborMI
| | - Matthew L. Topel
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Ayman A. Alkhoder
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Mohamed A. Martini
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Arianna Sidoti
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Yi‐An Ko
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGA
| | - Tene T. Lewis
- Department of Biostatistics and BioinformaticsRollins School of Public HealthEmory UniversityAtlantaGA
| | - Viola Vaccarino
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Laurence S. Sperling
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
| | - Arshed A. Quyyumi
- Emory Clinical Cardiovascular Research InstituteDivision of CardiologyDepartment of MedicineEmory University School of MedicineAtlantaGA
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1360
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Coronary artery calcium scoring for individualized cardiovascular risk estimation in important patient subpopulations after the 2019 AHA/ACC primary prevention guidelines. Prog Cardiovasc Dis 2019; 62:423-430. [DOI: 10.1016/j.pcad.2019.10.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 12/13/2022]
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1361
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Hawley CE, Triantafylidis LK, Paik JM. The missing piece: Clinical pharmacists enhancing the interprofessional nephrology clinic model. J Am Pharm Assoc (2003) 2019; 59:727-735. [PMID: 31231002 PMCID: PMC8150925 DOI: 10.1016/j.japh.2019.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/13/2019] [Accepted: 05/14/2019] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To embed pharmacy residents in an interprofessional nephrology clinic to conduct medication reconciliation in targeted high-risk patients with nondialysis kidney disease. SETTING This pilot was a prospective quality improvement initiative conducted in an interprofessional outpatient nephrology clinic. PRACTICE DESCRIPTION The nephrology clinic team includes nephrology providers, a social worker, and a geriatrician. The team is responsible for the management of conditions such as nondialysis kidney disease, resistant hypertension, acute kidney injury, proteinuria, and nephropathy. EVALUATION Primary outcomes included the number and type of medication discrepancies and drug therapy problems identified. Secondary outcomes included the changes in care process directly resulting from the pharmacy residents' recommendations. The perceived value of the pharmacy residents to the interprofessional team was assessed through postintervention anonymous surveys and semistructured interviews. RESULTS The pharmacy residents conducted 118 visits for 87 unique patients (mean age 73 years, 97% male) with nondialysis kidney disease (89% stages III-V), polypharmacy (87% of patients taking > 10 medications), and a heavy comorbidity burden (85% hypertension, 80% dyslipidemia, 59% diabetes mellitus type II) from January to October 2017. Pharmacists identified 344 medication discrepancies and 301 drug therapy problems, resulting in 398 changes in care process. The most frequently identified discrepancies and drug therapy problems were the omission of an active medication from the medication list (86 of 344 discrepancies, 25%) and potentially inappropriate medications (106 of 301 drug therapy problems, 35%). Pharmacists recommended 228 medication changes, provided 76 adherence devices, facilitated 24 consults or referrals, and communicated with the primary care team on 70 occasions. The interprofessional team members all strongly agreed that patients and the team benefited from the pharmacists' involvement. CONCLUSION Pharmacy resident-led medication reconciliation resulted in the identification and resolution of medication discrepancies and drug therapy problems, leading to changes in the care process.
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Affiliation(s)
- Chelsea E. Hawley
- New England Geriatric Research, Education, and Clinical Center
- Department of Pharmacy, VA Boston Healthcare System, Boston, MA
| | | | - Julie M. Paik
- New England Geriatric Research, Education, and Clinical Center
- Renal Section, VA Boston Healthcare System
- Brigham and Women’s Hospital
- Department of Medicine, Harvard Medical School, Boston, MA
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1362
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Bittner V, Colantonio LD, Dai Y, Woodward M, Mefford MT, Rosenson RS, Muntner P, Monda KL, Kilgore ML, Jaeger BC, Levitan EB. Association of Region and Hospital and Patient Characteristics With Use of High-Intensity Statins After Myocardial Infarction Among Medicare Beneficiaries. JAMA Cardiol 2019; 4:865-872. [PMID: 31339519 PMCID: PMC6659160 DOI: 10.1001/jamacardio.2019.2481] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/31/2019] [Indexed: 01/14/2023]
Abstract
Importance High-intensity statin use after myocardial infarction (MI) varies by patient characteristics, but little is known about differences in use by hospital or region. Objective To explore the relative strength of associations of region and hospital and patient characteristics with high-intensity statin use after MI. Design, Setting, and Participants This retrospective cohort analysis used Medicare administrative claims and enrollment data to evaluate fee-for-service Medicare beneficiaries 66 years or older who were hospitalized for MI from January 1, 2011, through June 30, 2015, with a statin prescription claim within 30 days of discharge. Data were analyzed from January 4, 2017, through May 12, 2019. Exposures Beneficiary characteristics were abstracted from Medicare data. Hospital characteristics were obtained from the 2014 American Hospital Association Survey and Hospital Compare quality metrics. Nine regions were defined according to the US Census. Main Outcomes and Measures Intensity of the first statin claim after discharge characterized as high (atorvastatin calcium, 40-80 mg, or rosuvastatin calcium, 20-40 mg/d) vs low to moderate (all other statin types and doses). Trends in high-intensity statins were examined from 2011 through 2015. Associations of region and beneficiary and hospital characteristics with high-intensity statin use from January 1, 2014, to June 15, 2015, were examined using Poisson distribution mixed models. Results Among the 139 643 fee-for-service beneficiaries included (69 968 men [50.1%] and 69 675 women [49.9%]; mean [SD] age, 76.7 [7.5] years), high-intensity statin use overall increased from 23.4% in 2011 to 55.6% in 2015, but treatment gaps persisted across regions. In models considering region and beneficiary and hospital characteristics, region was the strongest correlate of high-intensity statin use, with 66% higher use in New England than in the West South Central region (risk ratio [RR], 1.66; 95% CI, 1.47-1.87). Hospital size of at least 500 beds (RR, 1.15; 95% CI, 1.07-1.23), medical school affiliation (RR, 1.11; 95% CI, 1.05-1.17), male sex (RR, 1.10; 95% CI, 1.07-1.13), and patient receipt of a stent (RR, 1.35; 95% CI, 1.31-1.39) were associated with greater high-intensity statin use. For-profit hospital ownership, patient age older than 75 years, prior coronary disease, and other comorbidities were associated with lower use. Conclusions and Relevance This study's findings suggest that geographic region is the strongest correlate of high-intensity statin use after MI, leading to large treatment disparities.
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Affiliation(s)
- Vera Bittner
- Division of Cardiovascular Disease, University of Alabama at Birmingham
| | | | - Yuling Dai
- Department of Epidemiology, University of Alabama at Birmingham
| | - Mark Woodward
- The George Institute for Global Health, University of New South Wales, Sydney, Australia
- The George Institute for Global Health, University of Oxford, Oxford, United Kingdom
- Department of Epidemiology, The Johns Hopkins University, Baltimore, Maryland
| | | | | | - Paul Muntner
- Department of Epidemiology, University of Alabama at Birmingham
| | - Keri L. Monda
- Center for Observational Research, Amgen, Inc, Thousand Oaks, California
| | - Meredith L. Kilgore
- Department of Health Care Organization and Policy, University of Alabama at Birmingham
| | - Byron C. Jaeger
- Department of Biostatistics, University of Alabama at Birmingham
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1364
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Annemans L, Stock JK, Chapman MJ. PCSK9 inhibition, atherosclerotic cardiovascular disease, and health economics: Challenges at the crossroads. J Clin Lipidol 2019; 13:714-720. [DOI: 10.1016/j.jacl.2019.07.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 07/14/2019] [Accepted: 07/16/2019] [Indexed: 12/22/2022]
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1365
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Dressel A, Schmidt B, Schmidt N, Laufs U, Fath F, Chapman MJ, Grammer TB, März W. Cost effectiveness of lifelong therapy with PCSK9 inhibitors for lowering cardiovascular events in patients with stable coronary artery disease: Insights from the Ludwigshafen Risk and Cardiovascular Health cohort. Vascul Pharmacol 2019; 120:106566. [DOI: 10.1016/j.vph.2019.106566] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2018] [Revised: 04/28/2019] [Accepted: 05/29/2019] [Indexed: 12/23/2022]
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1366
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Implications of cost-effectiveness analyses of lipid-lowering therapies: From the policy-maker's desk to the patient's bedside. Prog Cardiovasc Dis 2019; 62:406-413. [DOI: 10.1016/j.pcad.2019.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 10/23/2019] [Indexed: 12/19/2022]
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Bradley CK, Shrader P, Sanchez RJ, Peterson ED, Navar AM. The patient journey with proprotein convertase subtilisin/kexin type 9 inhibitors in community practice. J Clin Lipidol 2019; 13:725-734. [PMID: 31371271 PMCID: PMC7376543 DOI: 10.1016/j.jacl.2019.06.008] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/14/2019] [Accepted: 06/21/2019] [Indexed: 01/20/2023]
Abstract
BACKGROUND Trials have demonstrated that proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are effective as an adjunct to statin therapy, but access and cost issues have limited their use in community practice. OBJECTIVE The aim of the study was to better understand patients' experiences when trying to obtain, fill, and use PCSK9 inhibitor therapy in community practice. METHODS We conducted a patient survey to evaluate patient experiences with PCSK9 inhibitors including medication initiation, indication for treatment, insurance approval status, medication persistence, and reason for discontinuation. The survey was emailed to 4740 adults who used a patient access support program. RESULTS Overall, 1327 of 4740 adults completed the survey (28.0% response rate). Of those, 75.0% were aged >60 years, 52.8% were male, and 92.4% were White. At the time of PCSK9 inhibitor prescription, 70.2% were not on a statin (with 84.4% of those not on a statin reporting statin intolerance). Overall, 74.6% of patients found the drug approval process to be "somewhat" or "very" burdensome. Among n = 1216 patients who initiated treatment, 33.7% discontinued by the time of the survey, with 50.0% taking the drug for 1 to 6 months. Patient out-of-pocket costs were the leading reported reason for discontinuation. CONCLUSIONS Most PCSK9 inhibitor users in community practice were not on a statin, presumably because of statin intolerance. The drug approval process and costs continue to be strong reasons for lower initiation of PCSK9 agents, as well as higher discontinuation rates.
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Affiliation(s)
- Corey K Bradley
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Peter Shrader
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Robert J Sanchez
- Medical Affairs, Regeneron Pharmaceuticals, Inc, Tarrytown, NY, USA
| | - Eric D Peterson
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Ann Marie Navar
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
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Koskinas KC, Windecker S, Pedrazzini G, Mueller C, Cook S, Matter CM, Muller O, Häner J, Gencer B, Crljenica C, Amini P, Deckarm O, Iglesias JF, Räber L, Heg D, Mach F. Evolocumab for Early Reduction of LDL Cholesterol Levels in Patients With Acute Coronary Syndromes (EVOPACS). J Am Coll Cardiol 2019; 74:2452-2462. [PMID: 31479722 DOI: 10.1016/j.jacc.2019.08.010] [Citation(s) in RCA: 127] [Impact Index Per Article: 25.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 08/09/2019] [Accepted: 08/12/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although guidelines recommend in-hospital initiation of high-intensity statin therapy in patients with acute coronary syndromes (ACS), low-density lipoprotein cholesterol (LDL-C) target levels are frequently not attained. Evolocumab, a rapidly acting, potent LDL-C-lowering drug, has not been studied in the acute phase of ACS. OBJECTIVES The purpose of this study was to assess the feasibility, safety, and LDL-C-lowering efficacy of evolocumab initiated during the in-hospital phase of ACS. METHODS The authors conducted an investigator-initiated, randomized, double-blind, placebo-controlled trial involving 308 patients hospitalized for ACS with elevated LDL-C levels (≥1.8 mmol/l on high-intensity statin for at least 4 weeks; ≥2.3 mmol/l on low- or moderate-intensity statin; or ≥3.2 mmol/l on no stable dose of statin). Patients were randomly assigned 1:1 to receive subcutaneous evolocumab 420 mg or matching placebo, administered in-hospital and after 4 weeks, on top of atorvastatin 40 mg. The primary endpoint was percentage change in calculated LDL-C from baseline to 8 weeks. RESULTS Most patients (78.2%) had not been on previous statin treatment. Mean LDL-C levels decreased from 3.61 to 0.79 mmol/l at week 8 in the evolocumab group, and from 3.42 to 2.06 mmol/l in the placebo group; the difference in mean percentage change from baseline was -40.7% (95% confidence interval: -45.2 to -36.2; p < 0.001). LDL-C levels <1.8 mmol/l were achieved at week 8 by 95.7% of patients in the evolocumab group versus 37.6% in the placebo group. Adverse events and centrally adjudicated cardiovascular events were similar in both groups. CONCLUSIONS In this first randomized trial assessing a PCSK9 antibody in the very high-risk setting of ACS, evolocumab added to high-intensity statin therapy was well tolerated and resulted in substantial reduction in LDL-C levels, rendering >95% of patients within currently recommended target levels. (EVOlocumab for Early Reduction of LDL-cholesterol Levels in Patients With Acute Coronary Syndromes [EVOPACS]; NCT03287609).
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Affiliation(s)
- Konstantinos C Koskinas
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland.
| | | | - Christian Mueller
- Department of Cardiology, University Hospital Basel, Basel, Switzerland
| | - Stéphane Cook
- Department of Cardiology, Fribourg Hospital and University, Fribourg, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
| | - Olivier Muller
- Service of Cardiology, Lausanne University Hospital, Lausanne, Switzerland
| | - Jonas Häner
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Baris Gencer
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | | | | | - Olga Deckarm
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Juan F Iglesias
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
| | - Lorenz Räber
- Department of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
| | - Dik Heg
- CTU Bern, University of Bern, Bern, Switzerland
| | - François Mach
- Department of Cardiology, Geneva University Hospital, Geneva, Switzerland
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1369
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Schwartzbard AZ, Ahmad A. Use of Inflammatory Biomarkers to Predict the Clinical Benefit of Ezetimibe: A Clinical Perspective. J Am Coll Cardiol 2019; 74:1069-1070. [PMID: 31439216 DOI: 10.1016/j.jacc.2019.06.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 06/19/2019] [Accepted: 06/25/2019] [Indexed: 10/26/2022]
Affiliation(s)
- Arthur Z Schwartzbard
- Division of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University Medical Center, New York, New York.
| | - Amier Ahmad
- Division of Cardiology and Center for the Prevention of Cardiovascular Disease, Department of Medicine, New York University Medical Center, New York, New York
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1370
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Chen S, Wu H, Yang T, Li B, Hu Y, Sun H. Does Early Graft Patency Benefit from Perioperative Statin Therapy? A Propensity Score-Matched Study of Patients Undergoing Off-Pump Coronary Artery Bypass Surgery. Cardiovasc Ther 2019; 2019:1582183. [PMID: 31772605 PMCID: PMC6739783 DOI: 10.1155/2019/1582183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 07/01/2019] [Accepted: 07/21/2019] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Decreased graft patency after off-pump coronary artery bypass grafting (OPCAB) leads to substantial increases in cardiac events. However, there is paucity of data on efficacy and safety of perioperative statin therapy for OPCAB populations. METHODS 582 patients undergoing OPCAB in a single-institution database (October 1, 2009-September 30, 2012) were stratified by perioperative continuation of statin therapy (CS group, n=398) or not (DS group, n=184). Inverse probability weighted propensity adjustment was used to account for treatment assignment bias, resulting in a well-matched cohort. Primary outcomes were graft patency at an average of five days after operation and in-hospital mortality. Secondary outcomes included intraoperative blood loss, liver, and renal functions. RESULTS No in-hospital death occurred in this study. Early graft patency rates after OPCAB were 98.4% (1255 of 1275 grafts) in the CS group and 98.0% (583 of 595 grafts, P=0.486) in the DS group. Secondary outcomes showed a reduction in blood loss during operation (438.53 mL versus 480.47 mL, P=0.01). Continuation of statin therapy is associated with alanine transaminase (ALT) elevation (49.67 U/L versus 34.52 U/L, P<0.001), as well as aspartate transaminase (33.54 U/L versus 28.10 U/L, P<0.001). Abnormal ALT elevation was observed in 8.9% of the CS group and 3.1% in DS (odds ratio 3.06, 95% confidence interval, 1.77 to 5.29, P<0.001). There was no significant difference in estimated glomerular filtration rate (76.28 mL/min/1.73m2 versus 76.13 mL/min/1.73m2, P=0.90). Subgroup analyses suggested that graft occlusion was less common in CS than in DS group among smoking patients (odds ratio 0.41, 95% confidence interval, 0.20 to 0.86, P=0.026). CONCLUSIONS Perioperative continuation of statin therapy did not improve early graft patency in OPCAB patients. A lower risk of graft occlusion was observed among smoking patients. Continuous statin use correlated with liver function elevation (Clinical Trials.gov number, NCT01268917).
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Affiliation(s)
- Shanglin Chen
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Hengchao Wu
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Tao Yang
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Baotong Li
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Yuanyu Hu
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
| | - Hansong Sun
- Department of Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China
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1371
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Hawley CE, Roefaro J, Forman DE, Orkaby AR. Statins for Primary Prevention in Those Aged 70 Years and Older: A Critical Review of Recent Cholesterol Guidelines. Drugs Aging 2019; 36:687-699. [PMID: 31049807 PMCID: PMC7245614 DOI: 10.1007/s40266-019-00673-w] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The risk of atherosclerotic cardiovascular disease rises with age and remains the leading cause of death in older adults. Evidence for the use of statins for primary prevention in older adults is limited, despite the possibility that this population may derive significant clinical benefit given its increased cardiovascular risk. Until publication of the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the Management of Blood Cholesterol, and the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, guidelines for statin prescription in older adults remained unchanged despite new evidence of possible benefit in older adults. In this review, we present key updates in the 2018 and 2019 guidelines and the evidence informing these updates. We compare the discordant recommendations of the seven major North American and European guidelines on cholesterol management released in the past 5 years and highlight gaps in the literature regarding primary prevention of cardiovascular disease in older adults. As most cardiovascular events in older adults are nonfatal, we ask how clinicians should weigh the risks and benefits of continuing a statin for primary prevention in older adults. We also reframe the concept of deprescribing of statins in the older population, using the Geriatrics 5Ms framework: Mind, Mobility, Medications, Multi-complexity, and what Matters Most to older adults. A recent call from the National Institute on Aging for a statin trial focusing on older adults extends from similar concerns.
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Affiliation(s)
- Chelsea E. Hawley
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Pharmacy Department, VA Boston Healthcare System, Boston, MA, USA
| | - John Roefaro
- Pharmacy Department, VA Boston Healthcare System, Boston, MA, USA
| | - Daniel E. Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
- Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ariela R. Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA
- Division of Aging, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
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1372
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Virani SS, Akeroyd JM, Smith SC, Al-Mallah M, Maddox TM, Morris PB, Petersen LA, Ballantyne CM, Grundy SM, Stone NJ. Very High-Risk ASCVD and Eligibility for Nonstatin Therapies Based on the 2018 AHA/ACC Cholesterol Guidelines. J Am Coll Cardiol 2019; 74:712-714. [DOI: 10.1016/j.jacc.2019.05.051] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/23/2019] [Accepted: 05/26/2019] [Indexed: 11/30/2022]
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1373
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Qamar A, Giugliano RP, Bohula EA, Park JG, Jarolim P, Murphy SA, Blazing MA, Califf RM, Cannon CP, Braunwald E, Morrow DA. Biomarkers and Clinical Cardiovascular Outcomes With Ezetimibe in the IMPROVE-IT Trial. J Am Coll Cardiol 2019; 74:1057-1068. [DOI: 10.1016/j.jacc.2019.06.038] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Revised: 06/03/2019] [Accepted: 06/13/2019] [Indexed: 10/26/2022]
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1374
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Ballantyne CM, Laufs U, Ray KK, Leiter LA, Bays HE, Goldberg AC, Stroes ES, MacDougall D, Zhao X, Catapano AL. Bempedoic acid plus ezetimibe fixed-dose combination in patients with hypercholesterolemia and high CVD risk treated with maximally tolerated statin therapy. Eur J Prev Cardiol 2019; 27:593-603. [PMID: 31357887 PMCID: PMC7153222 DOI: 10.1177/2047487319864671] [Citation(s) in RCA: 201] [Impact Index Per Article: 40.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Aims The aim of this study was to evaluate the low-density lipoprotein cholesterol lowering efficacy and safety of a bempedoic acid 180 mg and ezetimibe 10 mg fixed-dose combination in patients with hypercholesterolemia and a high risk of cardiovascular disease receiving maximally tolerated statin therapy. Methods This phase 3, double-blind clinical trial enrolled adult patients at high risk of cardiovascular disease due to atherosclerotic cardiovascular disease, heterozygous familial hypercholesterolemia, or multiple cardiovascular disease risk factors. Patients were randomly assigned (2:2:2:1) to treatment with the fixed-dose combination, bempedoic acid 180 mg, ezetimibe 10 mg or placebo added to stable background statin therapy for 12 weeks. The primary efficacy endpoint was the percentage change from baseline to week 12 in low-density lipoprotein cholesterol. Results Among the 301 patients included in the primary analysis, the mean baseline low-density lipoprotein cholesterol level was 3.87 mmol/L (149.8 mg/dL). At week 12, the fixed-dose combination lowered low-density lipoprotein cholesterol (–36.2%) significantly more than placebo (1.8% (placebo-corrected difference –38.0%); P < 0.001), ezetimibe alone (–23.2%; P < 0.001) or bempedoic acid alone (–17.2%; P < 0.001). The fixed-dose combination lowered low-density lipoprotein cholesterol levels similarly across subgroups, including patients receiving high-intensity, other-intensity or no statin therapy. Improvements with the fixed-dose combination were also observed in secondary efficacy endpoints, including high-sensitivity C-reactive protein. In this trial, fixed-dose combination treatment had a generally similar safety profile compared with bempedoic acid, ezetimibe or placebo. Conclusion The bempedoic acid and ezetimibe fixed-dose combination significantly lowered low-density lipoprotein cholesterol versus placebo or other oral monotherapies and had a favourable safety profile when added to maximally tolerated statin therapy in patients with hypercholesterolemia and high cardiovascular disease risk. Trial Registration ClinicalTrials.gov identifier: NCT03337308.
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Affiliation(s)
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Germany
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, UK
| | - Lawrence A Leiter
- Division of Endocrinology and Metabolism, St Michael's Hospital, Canada
| | - Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, USA
| | | | - Erik Sg Stroes
- Department of Vascular Medicine, Academic Medical Centre, The Netherlands
| | | | - Xin Zhao
- Esperion Therapeutics, Inc., USA
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan and Multimedica IRCCS, Italy
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1375
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Moon SJ, Jeon JY, Jang K, Yu KS, Lim Y, Kim MG. Pharmacokinetic interactions between telmisartan/amlodipine and rosuvastatin after multiple oral administrations in healthy Korean male subjects. Drug Des Devel Ther 2019; 13:2533-2542. [PMID: 31440035 PMCID: PMC6667348 DOI: 10.2147/dddt.s210364] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 06/12/2019] [Indexed: 12/16/2022] Open
Abstract
PURPOSE Hypertension and dyslipidemia are major risk factors for cardiovascular diseases, and reduction of cardiovascular risks can be achieved by combining antihypertensive therapy with statins. The objective of this study was to evaluate the pharmacokinetic interaction between telmisartan/amlodipine fixed dose combination and rosuvastatin in healthy Korean male volunteers. PATIENTS AND METHODS An open-label, two-cohort, multiple-dose, single-sequence crossover study was conducted in healthy male subjects. In Cohort 1, the subjects were administered one tablet of telmisartan/amlodipine 80 mg/5 mg once daily for 14 days with or without one tablet of rosuvastatin 20 mg once daily. In Cohort 2, the subjects were administered one tablet of rosuvastatin 20 mg once daily for 14 days with or without one tablet of telmisartan/amlodipine 80 mg/5 mg once daily. Serial blood samples were collected up to 24 hrs post-dose on the 9th and 14th days in Cohort 1 and on the 5th and 14th days in Cohort 2. Plasma drug concentrations were measured by liquid chromatography/tandem mass spectrometry. Pharmacokinetic parameters, including maximum plasma concentration at steady state (Cmax,ss) and area under the plasma concentration versus time curve over dosing interval (AUCτ,ss), were determined by non-compartmental analysis. The geometric least-square mean (GLSM) ratios and associated 90% confidence intervals (CIs) of log-transformed Cmax,ss and AUCτ,ss for separate or concurrent therapy were calculated to evaluate pharmacokinetic interactions. RESULTS Thirty-eight subjects from Cohort 1 and nineteen subjects from Cohort 2 completed the study. The GLSM ratios and 90% CIs of Cmax,ss and AUCτ,ss, were 0.9829 (0.8334-1.1590) and 1.0003 (0.9342-1.0710) for telmisartan; 0.9908 (0.9602-1.0223) and 1.0081 (0.9758-1.0413) for amlodipine; and 2.2762 (2.0113-2.5758) and 1.3261 (1.2385-1.4198) for rosuvastatin, respectively. CONCLUSION The pharmacokinetic parameters of telmisartan/amlodipine, but not rosuvastatin, met the pharmacokinetic equivalent criteria. The increase in systemic exposure to rosuvastatin caused by telmisartan/amlodipine co-administration would not be clinically significant in practice. Nevertheless, an appropriately designed two-sequence crossover study is needed to confirm the results of this study.
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Affiliation(s)
- Seol Ju Moon
- Center for Clinical Pharmacology, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Ji-Young Jeon
- Center for Clinical Pharmacology, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Kyungho Jang
- Center for Clinical Pharmacology, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea
| | - Kyung-Sang Yu
- Department of Clinical Pharmacology and Therapeutics, Seoul National University College of Medicine and Hospital, Seoul, Republic of Korea
| | - Yeji Lim
- Yuhan Research Institute, Yuhan Corporation, Seoul, Republic of Korea
| | - Min-Gul Kim
- Center for Clinical Pharmacology, Biomedical Research Institute, Chonbuk National University Hospital, Jeonju, Republic of Korea
- Research Institute of Clinical Medicine of Chonbuk National University
, Jeonju, Republic of Korea
- Department of Pharmacology, School of Medicine, Chonbuk National University, Jeonju, Republic of Korea
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1376
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Zhang Y, Vittinghoff E, Pletcher MJ, Allen NB, Zeki Al Hazzouri A, Yaffe K, Balte PP, Alonso A, Newman AB, Ives DG, Rana JS, Lloyd-Jones D, Vasan RS, Bibbins-Domingo K, Gooding HC, de Ferranti SD, Oelsner EC, Moran AE. Associations of Blood Pressure and Cholesterol Levels During Young Adulthood With Later Cardiovascular Events. J Am Coll Cardiol 2019; 74:330-341. [PMID: 31319915 PMCID: PMC6764095 DOI: 10.1016/j.jacc.2019.03.529] [Citation(s) in RCA: 139] [Impact Index Per Article: 27.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 03/07/2019] [Accepted: 03/24/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Blood pressure (BP) and cholesterol are major modifiable risk factors for cardiovascular disease (CVD), but effects of exposures during young adulthood on later life CVD risk have not been well quantified. OBJECTIVE The authors sought to evaluate the independent associations between young adult exposures to risk factors and later life CVD risk, accounting for later life exposures. METHODS The authors pooled data from 6 U.S. cohorts with observations spanning the life course from young adulthood to later life, and imputed risk factor trajectories for low-density lipoprotein (LDL) and high-density lipoprotein cholesterols, systolic and diastolic BP starting from age 18 years for every participant. Time-weighted average exposures to each risk factor during young (age 18 to 39 years) and later adulthood (age ≥40 years) were calculated and linked to subsequent risks of coronary heart disease (CHD), heart failure (HF), or stroke. RESULTS A total of 36,030 participants were included. During a median follow-up of 17 years, there were 4,570 CHD, 5,119 HF, and 2,862 stroke events. When young and later adult risk factors were considered jointly in the model, young adult LDL ≥100 mg/dl (compared with <100 mg/dl) was associated with a 64% increased risk for CHD, independent of later adult exposures. Similarly, young adult SBP ≥130 mm Hg (compared with <120 mm Hg) was associated with a 37% increased risk for HF, and young adult DBP ≥80 mm Hg (compared with <80 mm Hg) was associated with a 21% increased risk. CONCLUSIONS Cumulative young adult exposures to elevated systolic BP, diastolic BP and LDL were associated with increased CVD risks in later life, independent of later adult exposures.
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Affiliation(s)
- Yiyi Zhang
- Division of General Medicine, Columbia University, New York, New York
| | - Eric Vittinghoff
- Department of Epidemiology and Biostatistics, School of Medicine, University of California-San Francisco, San Francisco, California
| | - Mark J Pletcher
- Department of Epidemiology and Biostatistics, School of Medicine, University of California-San Francisco, San Francisco, California
| | - Norrina B Allen
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Adina Zeki Al Hazzouri
- Division of Epidemiology and Population Health Sciences, Department of Public Health Sciences, University of Miami, Miami, Florida
| | - Kristine Yaffe
- Departments of Psychiatry, Neurology, and Epidemiology, University of California-San Francisco, San Francisco, California
| | - Pallavi P Balte
- Division of General Medicine, Columbia University, New York, New York
| | - Alvaro Alonso
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Anne B Newman
- Departments of Epidemiology, Medicine and Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Diane G Ives
- Center for Aging and Population Health, Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jamal S Rana
- Divisions of Cardiology and Research, Kaiser Permanente Northern California, Oakland, California
| | - Donald Lloyd-Jones
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois
| | - Ramachandran S Vasan
- Department of Internal Medicine, Boston Medical Center, Boston University School of Medicine, Boston, Massachusetts; Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts; The Boston University and the National Heart, Lung, and Blood Institute's Framingham Heart Study, Framingham, Massachusetts
| | - Kirsten Bibbins-Domingo
- Department of Epidemiology and Biostatistics, School of Medicine, University of California-San Francisco, San Francisco, California
| | - Holly C Gooding
- Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | | | - Andrew E Moran
- Division of General Medicine, Columbia University, New York, New York.
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1377
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Impact of Lipid-Lowering Therapy on Mortality According to the Baseline Non-HDL Cholesterol Level: A Meta-Analysis. High Blood Press Cardiovasc Prev 2019; 26:263-272. [PMID: 31313082 DOI: 10.1007/s40292-019-00330-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 07/11/2019] [Indexed: 12/24/2022] Open
Abstract
INTRODUCTION Previous report showed that more intensive lipid-lowering therapy was associated with less mortality when baseline LDL-C levels were > 100 mg/dL. Non-HDL-C is a better predictor of cardiovascular risk than simpler LDL-C. AIM The objective of this meta-analysis was to define the impact of lipid-lowering therapy on the reduction of total and cardiovascular mortality by different baseline levels of non-HDL-C. METHODS We performed a meta-analysis including randomized, controlled clinical trials of lipid-lowering therapy, reporting mortality with a minimum of 6 months of follow-up, searching in PubMed/Medline, EMBASE and Cochrane Clinical Trials databases. The random-effects model and meta-regression were performed. RESULTS Twenty nine trials of lipid-lowering drugs, including 233,027 patients, were considered eligible for the analyses. According to the baseline non-HDL-C level, the results on cardiovascular mortality were: (1) ≥ 190 mg/dL: OR 0.63 (95% CI 0.53-0.76); (2) 160-189 mg/dL: OR 0.82 (95% CI 0.75-0.89); (3) 130-159 mg/dL: OR 0.71 (95% CI 0.52-0.98); (4) < 130 mg/dL: OR 0.95 (95% CI 0.87-1.05). When evaluating mortality from any cause, the results were the following: (1) ≥ 190 mg/dL: OR 0.70 (95% CI 0.61-0.82); (2) 160-189 mg/dL: OR 0.91 (95% CI 0.83-0.98); (3) 130-159 mg/dL; OR 0.88 (95% CI 0.77-1.00); (4) < 130 mg/dL: OR 0.98 (95% CI 0.91-1.06). The meta-regression analysis showed a significant association between baseline non-HDL-C and mortality. CONCLUSIONS In these meta-analyses, lipid-lowering therapy was associated with reduction in the risk of all-cause and cardiovascular mortality when baseline non-HDL-C levels were above than 130 mg/dL.
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1378
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Hai JJ, Wong YK, Wong CK, Un KC, Chan PH, Siu CW, Yiu KH, Lau CP, Tse HF. Prognostic implications of statin intolerance in stable coronary artery disease patients with different levels of high-sensitive troponin. BMC Cardiovasc Disord 2019; 19:168. [PMID: 31307391 PMCID: PMC6633694 DOI: 10.1186/s12872-019-1152-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 07/08/2019] [Indexed: 12/27/2022] Open
Abstract
Background The prognostic implication of statin in tolerance (SI) in those with stable CAD remains unclear. We hypothesized that SI is of higher prognostic significance in stable CAD patients with elevated high-sensitive cardiac troponin I (hs-cTnI). Methods A total of 952 stable CAD patients from the prospective Hong Kong CAD study who had complete clinical data, biomarker measurements and who were prescribed statin therapy were studied. Results We identified 13 (1.4%) and 125 (13.1%) patients with complete and partial SI, respectively. At baseline, patients with SI were more likely to have diabetes mellitus and a higher hs-cTnI level, but no difference in LDL-C level compared with those without SI. After 51 months of follow-up, patients with SI had a higher mean LDL-C level than those without SI. A total of 148 (15.5%) patients developed major adverse cardiovascular events (MACEs). Both SI (HR 1.52, 95% CI 1.06–2.19, P = 0.02) and elevated hs-cTnI (HR 3.18, 95% CI 2.07–4.89, P < 0.01) were independent predictors of a MACE in patients with stable CAD. When stratified by hs-cTnI level, SI independently predicted MACE-free survival only in those with elevated hs-cTnI (HR 1.51, 95% CI 1.01–2.24, P = 0.04). Conclusions SI independently predicted MACE in patients with stable CAD and high hs-cTnI, but not in those with low hs-cTnI. Hs-cTnI may be used to stratify stable CAD patients who have SI for intensive lipid-lowering therapy using non-statin agents. Electronic supplementary material The online version of this article (10.1186/s12872-019-1152-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Jo-Jo Hai
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Yuen-Kwun Wong
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Chun-Ka Wong
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Ka-Chun Un
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Pak-Hei Chan
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Chung-Wah Siu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Kai-Hang Yiu
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China.,Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Chu-Pak Lau
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China
| | - Hung-Fat Tse
- Cardiology Division, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Hong Kong, China. .,Division of Cardiology, Department of Medicine, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China. .,The University of Hong Kong-Shenzhen Institute of Research and Innovation, Shenzhen, China. .,Hong Kong-Guangdong Joint Laboratory on Stem Cell and Regenerative Medicine, the University of Hong Kong, Hong Kong, China.
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1379
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Vallejo-Vaz AJ, Ray KK, Ginsberg HN, Davidson MH, Eckel RH, Lee LV, Bessac L, Pordy R, Letierce A, Cannon CP. Associations between lower levels of low-density lipoprotein cholesterol and cardiovascular events in very high-risk patients: Pooled analysis of nine ODYSSEY trials of alirocumab versus control. Atherosclerosis 2019; 288:85-93. [PMID: 31349086 DOI: 10.1016/j.atherosclerosis.2019.07.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2019] [Revised: 06/26/2019] [Accepted: 07/10/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND AIMS Guidelines recommend high-intensity statins for patients with atherosclerotic cardiovascular disease (ASCVD). Subgroups with comorbidities that increase cardiovascular risk, such as diabetes mellitus (DM), chronic kidney disease (CKD) or polyvascular disease (PoVD), may derive greater absolute benefit from addition of non-statin therapies. We assessed the relationship between lower low-density lipoprotein cholesterol (LDL-C) and major adverse cardiovascular events (MACE) risk reduction during alirocumab phase III ODYSSEY trials among these subgroups. METHODS Patient data were pooled from nine trials comparing alirocumab with control (placebo/ezetimibe), predominantly on background maximally tolerated statin. Patients with baseline ASCVD were stratified into subgroups with DM, CKD or PoVD, or without comorbidities, and between-group relative and absolute benefits were compared. RESULTS Among 3505 patients with ASCVD, 1573 had no comorbidities, 981 had DM, 660 had CKD and 943 had PoVD, with overlap between comorbidities; mean baseline LDL-C levels were 119 (ASCVD overall), 123, 117, 114 and 113 mg/dL, respectively. Overall, each 39 mg/dL lower on-study LDL-C was associated with a 25% lower MACE risk, hazard ratio 0.75 (95% confidence interval, 0.62-0.90, p = 0.0023), with a similar lower risk observed in each very high-risk subgroup (DM, CKD or PoVD; 30-35%) but not in the subgroup without these comorbidities (9%). Absolute benefits were greater for very high-risk subgroups; lowering LDL-C from 120 to 40 mg/dL would result in 2.76-4.35 fewer MACE/100 patient-years versus 0.3 for no comorbidities. CONCLUSIONS Among patients with ASCVD and mean baseline LDL-C >100 mg/dL, patients with DM, CKD or PoVD appeared to derive greater absolute cardiovascular benefits from further LDL-C reduction than those without.
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Affiliation(s)
- Antonio J Vallejo-Vaz
- Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, UK.
| | - Kausik K Ray
- Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, UK
| | | | - Michael H Davidson
- Department of Medicine, University of Chicago Medicine, Chicago, IL, USA
| | - Robert H Eckel
- University of Colorado, Anschutz Medical Campus, Aurora, CO, USA
| | | | | | - Robert Pordy
- Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA
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1380
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Abstract
Introduction: Spontaneous coronary artery dissection (SCAD) is an increasingly appreciated cause of acute myocardial infarction (AMI) and sudden cardiac death most often affecting young to middle-aged women with few conventional cardiovascular risk factors. Areas covered: A literature search was performed using MedLine, PubMed, and Google Scholar (dating to 04/30/2019). Authors review the key clinical features of SCAD and highlight what is known regarding its pathophysiology and associated factors. The relationship between SCAD and other systemic vasculopathies, notably fibromuscular dysplasia (FMD) is also discussed. Authors also mention the management of acute SCAD along with considerations for long term follow-up such as chest pain syndrome, extracoronary vasculopathy screening, and recurrent SCAD. Expert opinion: Our understanding regarding the association of SCAD and other arteriopathies such as FMD is anticipated to grow. In addition, progress is likely to be made in our efforts to predict recurrent SCAD risk and define potential preventative strategies, possibly through the incorporation of adjunctive imaging.
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Affiliation(s)
- Nicholas Y Tan
- a Department of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA
| | - Marysia S Tweet
- a Department of Cardiovascular Diseases , Mayo Clinic , Rochester , MN , USA
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1381
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Devaraj S, Jialal I. The Cholesterol Guidelines and the Clinical Laboratory. Am J Clin Pathol 2019; 152:120-121. [PMID: 31188419 DOI: 10.1093/ajcp/aqz049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Sridevi Devaraj
- Texas Children's Hospital, Houston.,Baylor College of Medicine, Houston, TX
| | - Ishwarlal Jialal
- California Northstate University, Elk Grove.,Veterans Affairs Medical Center, Mather, CA
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1382
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Ma C, Gurol ME, Huang Z, Lichtenstein AH, Wang X, Wang Y, Neumann S, Wu S, Gao X. Low-density lipoprotein cholesterol and risk of intracerebral hemorrhage: A prospective study. Neurology 2019; 93:e445-e457. [PMID: 31266905 DOI: 10.1212/wnl.0000000000007853] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 03/13/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVE To prospectively examine the association between low-density lipoprotein (LDL) cholesterol (LDL-C) concentrations and intracerebral hemorrhage (ICH) risk. METHODS The current cohort study included 96,043 participants (mean age 51.3 years) who were free of stroke, myocardial infarction, and cancer at baseline (2006). Serum LDL-C concentrations were assessed in 2006, 2008, 2010, and 2012. Cumulative average LDL-C concentrations were calculated from all available LDL-C data during that period. Incident ICH was confirmed by review of medical records. RESULTS We identified 753 incident ICH cases during 9 years of follow-up. The ICH risk was similar among participants with LDL concentrations of 70 to 99 mg/dL and those with LDL-C concentrations ≥100 mg/dL. In contrast, participants with LDL-C concentrations <70 mg/dL had a significantly higher risk of developing ICH than those with LDL-C concentrations of 70 to 99 mg/dL; adjusted hazard ratios were 1.65 (95% confidence interval [CI] 1.32-2.05) for LDL-C concentrations of 50 to 69 mg/dL and 2.69 (95% CI 2.03-3.57) for LDL-C concentrations <50 mg/dL. CONCLUSIONS We observed a significant association between lower LDL-C and higher risk of ICH when LDL-C was <70 mg/dL, and the association became nonsignificant when LDL-C ≥70 mg/dL. These data can help determination of the ideal LDL range in patients who are at increased risk of both atherosclerotic disease and hemorrhagic stroke and guide planning of future lipid-lowering studies.
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Affiliation(s)
- Chaoran Ma
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - M Edip Gurol
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Zhe Huang
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Alice H Lichtenstein
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Xiuyan Wang
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Yuzhen Wang
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Samantha Neumann
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA
| | - Shouling Wu
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA.
| | - Xiang Gao
- From the Department of Nutritional Sciences (C.M.), Eberly College of Science (S.N.), and Department of Nutritional Sciences (X.G.), Pennsylvania State University, University Park; Hemorrhagic Stroke Research Program (M.E.G.), Massachusetts General Hospital and Harvard Medical School, Boston; Departments of Cardiology (Z.H., S.W.) and Neurology (X.W., Y.W.), Kailuan General Hospital, Tangshan, China; and Jean Mayer USDA Human Nutrition Research Center on Aging (A.H.L.), Tufts University, Boston, MA.
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1383
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Fonarow GC, van Hout B, Villa G, Arellano J, Lindgren P. Updated Cost-effectiveness Analysis of Evolocumab in Patients With Very High-risk Atherosclerotic Cardiovascular Disease. JAMA Cardiol 2019; 4:691-695. [PMID: 31166576 PMCID: PMC6551584 DOI: 10.1001/jamacardio.2019.1647] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/10/2019] [Indexed: 01/14/2023]
Abstract
Importance In October 2018, evolocumab was made available at a reduced annual list price of $5850 in the United States. This 60% reduction was aimed at improving patient access by lowering patient copays. Shortly thereafter, the 2018 American College of Cardiology/American Heart Association cholesterol management guideline was released. An updated cost-effectiveness analysis of evolocumab in the United States may be therefore of interest to payers and prescribers. Objective To present an updated cost-effectiveness analysis of evolocumab added to standard background therapy compared with standard background therapy alone in patients with very high-risk atherosclerotic cardiovascular disease, reflecting the 2018 ACC/AHA guideline definition and using the new evolocumab list price. Design, Setting, and Participants This study used the Markov model originally used in a previous study by Fonarow et al in 2017. A US societal perspective was considered, and a range of baseline cardiovascular event rates were modeled to reflect varying risk profiles in clinical practice within patients with very high-risk atherosclerotic cardiovascular disease. Exposures Addition of evolocumab to standard background therapy, including maximally tolerated statin therapy (ie, the maximum intensity of statin therapy a patient can safely receive), with or without ezetimibe. Main Outcomes and Measures Major cardiovascular events (myocardial infarction, ischemic stroke, and cardiovascular death), costs, quality-adjusted life-years, and incremental cost-effectiveness ratios. Results Evolocumab was associated with both increased costs and improved outcomes when added to standard background therapy. Incremental costs ranged from $22 228 to $3411, depending on the varying level of risk within the defined population. Incremental quality-adjusted life years ranged from 0.39 to 0.44. Incremental cost-effectiveness ratios ranged from $56 655 to $7667 per quality-adjusted life-year gained. For a range of baseline cardiovascular event rates in patients with very high-risk atherosclerotic cardiovascular disease, incremental cost-effectiveness ratios were below the generally accepted willingness-to-pay thresholds. Moreover, the ratios were below the threshold of $50 000 per quality-adjusted life-years gained for any baseline rate of 6.9 or more events per 100 patient-years. Conclusions and Relevance At its current list price, the addition of evolocumab to standard background therapy meets accepted cost-effectiveness thresholds across a range of baseline cardiovascular event rates in patients with very high-risk atherosclerotic cardiovascular disease as defined by the 2018 ACC/AHA guideline.
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Affiliation(s)
- Gregg C. Fonarow
- Division of Cardiology, David Geffen School of Medicine, University of California, Los Angeles Medical Center, Los Angeles
- Section Editor, JAMA Cardiology
| | - Ben van Hout
- ScHARR School for Health and Related Research, University of Sheffield, Sheffield, England
| | | | | | - Peter Lindgren
- The Swedish Institute for Health Economics, Lund, Sweden
- Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Stockholm, Sweden
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1384
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Cainzos-Achirica M, Fedeli U, Sattar N, Agyemang C, Jenum AK, McEvoy JW, Murphy JD, Brotons C, Elosua R, Bilal U, Kanaya AM, Kandula NR, Martinez-Amezcua P, Comin-Colet J, Pinto X. Epidemiology, risk factors, and opportunities for prevention of cardiovascular disease in individuals of South Asian ethnicity living in Europe. Atherosclerosis 2019; 286:105-113. [PMID: 31128454 PMCID: PMC8299475 DOI: 10.1016/j.atherosclerosis.2019.05.014] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 01/22/2023]
Abstract
South Asian (SA) individuals represent a large, growing population in a number of European countries. These individuals, particularly first-generation SA immigrants, are at higher risk of developing type 2 diabetes, atherogenic dyslipidaemia, and coronary heart disease than most other racial/ethnic groups living in Europe. SAs also have an increased risk of stroke compared to European-born individuals. Despite a large body of conclusive evidence, SA-specific cardiovascular health promotion and preventive interventions are currently scarce in most European countries, as well as at the European Union level. In this narrative review, we aim to increase awareness among clinicians and healthcare authorities of the public health importance of cardiovascular disease among SAs living in Europe, as well as the need for tailored interventions targeting this group - particularly, in countries where SA immigration is a recent phenomenon. To this purpose, we review key studies on the epidemiology and risk factors of cardiovascular disease in SAs living in the United Kingdom, Italy, Spain, Denmark, Norway, Sweden, and other European countries. Building on these, we discuss potential opportunities for multi-level, targeted, tailored cardiovascular prevention strategies. Because lifestyle interventions often face important cultural barriers in SAs, particularly for first-generation immigrants; we also discuss features that may help maximise the effectiveness of those interventions. Finally, we evaluate knowledge gaps, currently available risk stratification tools such as QRISK-3, and future directions in this important field.
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Affiliation(s)
- Miguel Cainzos-Achirica
- Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; School of Medicine and Health Sciences, Universitat Internacional de Catalunya, Sant Cugat Del Vallès, Barcelona, Spain.
| | - Ugo Fedeli
- Department of Epidemiology, Azienda Zero, Veneto Region, Italy
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, Scotland, UK
| | - Charles Agyemang
- Department of Public Health, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - Anne K Jenum
- General Practice Research Unit (AFE), Department of General Practice, University of Oslo, Institute of Health and Society, Norway
| | - John W McEvoy
- Johns Hopkins Ciccarone Center for the Prevention of Cardiovascular Disease, Johns Hopkins Medical Institutions, Baltimore, MD, USA; National University of Ireland and National Institute for Preventive Cardiology, Galway, Ireland; Division of Cardiology, Department of Medicine, Saolta University Healthcare Group, University College Hospital Galway, Galway, Ireland
| | - Jack D Murphy
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carlos Brotons
- Casernes Primary Care Center, Àmbit D'Atenció Primària Barcelona Ciutat, Barcelona, Spain
| | - Roberto Elosua
- Cardiovascular Epidemiology and Genetics, Mar Institute of Medical Research, Barcelona, Spain; Biomedical Research Network in Cardiovascular Diseases (CIBERCV), Barcelona, Spain; School of Medicine, Universitat de Vic-Central de Catalunya, Vic, Spain
| | - Usama Bilal
- Urban Health Collaborative, Drexel Dornsife School of Public Health, Philadelphia, PA, USA
| | | | - Namratha R Kandula
- Northwestern University, Departments of Medicine and Preventive Medicine, Chicago, IL, USA
| | - Pablo Martinez-Amezcua
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Josep Comin-Colet
- Department of Cardiology, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Bellvitge Biomedical Research Institute (IDIBELL), L'Hospitalet de Llobregat, Barcelona, Spain; School of Medicine, University of Barcelona, Barcelona, Spain
| | - Xavier Pinto
- School of Medicine, University of Barcelona, Barcelona, Spain; Cardiovascular Risk Unit, Department of Internal Medicine, Bellvitge University Hospital, L'Hospitalet de Llobregat, Barcelona, Spain; Biomedical Research Network in Obesity and Nutrition (CIBEROBN), Instituto de Salud Carlos III, Madrid, Spain
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1385
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Mora S, Chang CL, Moorthy MV, Sever PS. Association of Nonfasting vs Fasting Lipid Levels With Risk of Major Coronary Events in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm. JAMA Intern Med 2019; 179:898-905. [PMID: 31135812 PMCID: PMC6547106 DOI: 10.1001/jamainternmed.2019.0392] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2018] [Accepted: 02/03/2019] [Indexed: 01/25/2023]
Abstract
Importance Recent guidelines have recommended nonfasting for routine testing of lipid levels based on comparisons of nonfasting and fasting populations. However, no previous study has examined the association of cardiovascular outcomes with fasting vs nonfasting lipid levels measured in the same individuals. Objective To compare the association of nonfasting and fasting lipid levels with prospectively ascertained coronary and vascular outcomes and to evaluate whether a strategy of using nonfasting instead of fasting lipid level measurement would result in misclassification of risk for individuals undergoing evaluation for initiation of statin therapy. Design, Setting, and Participants This post hoc prospective follow-up of a randomized clinical trial included 8270 of 10 305 participants from the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA) with nonfasting and fasting lipid levels measured 4 weeks apart (including 6855 participants with no prior vascular disease) (median follow-up, 3.3 years; interquartile range, 2.8-3.6 years). Data were collected from February 1, 1998, to December 31, 2002, and analyzed from February 1, 2016, to November 30, 2018. Multivariable Cox models, adjusted for cardiovascular risk factors, were calculated for 40-mg/dL (1-mmol/L) higher values of nonfasting and fasting lipids. Main Outcomes and Measures The trial's primary end point consisted of major coronary events (nonfatal myocardial infarction [MI] and fatal coronary heart disease [212 events]). Secondary analyses examined atherosclerotic cardiovascular disease (ASCVD) events (including MI, stroke, and ASCVD death [351 events]). Results Among the 8270 participants (82.1% male; mean [SD] age, 63.4 [8.5] years), nonfasting samples had modestly higher triglyceride levels and similar cholesterol levels compared to fasting samples. Associations of nonfasting lipid levels with coronary events were similar to those for fasting lipid levels. For example, adjusted hazard ratios (HRs) per 40-mg/dL of low-density lipoprotein cholesterol were 1.32 (95% CI, 1.08-1.61; P = .007) for nonfasting levels and 1.28 (95% CI, 1.07-1.55; P = .008) for fasting levels. For the primary prevention group, adjusted HRs were 1.42 (95% CI, 1.13-1.78; P = .003) for nonfasting levels and 1.37 (95% CI, 1.11-1.69; P = .003) for fasting levels. Results were consistent by randomized treatment arm (atorvastatin calcium, 10 mg/d, or placebo) and similar for ASCVD events. Concordance of fasting and nonfasting lipid levels for classifying participants into appropriate ASCVD risk categories was high (94.8%). Conclusions and Relevance Measurement of nonfasting and fasting lipid levels yields similar results in the same individuals for association with incident coronary and ASCVD events. These results suggest that routine measurement of nonfasting lipid levels may help facilitate ASCVD risk screening and treatment, including consideration of when to initiate statin therapy.
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Affiliation(s)
- Samia Mora
- Center for Lipid Metabolomics, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Division of Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - C. Lan Chang
- National Heart and Lung Institute, Imperial College, London, United Kingdom
| | - M. Vinayaga Moorthy
- Center for Lipid Metabolomics, Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Peter S. Sever
- National Heart and Lung Institute, Imperial College, London, United Kingdom
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1386
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Ikezaki H, Fisher VA, Lim E, Ai M, Liu CT, Adrienne Cupples L, Nakajima K, Asztalos BF, Furusyo N, Schaefer EJ. Direct Versus Calculated LDL Cholesterol and C-Reactive Protein in Cardiovascular Disease Risk Assessment in the Framingham Offspring Study. Clin Chem 2019; 65:1102-1114. [PMID: 31239251 DOI: 10.1373/clinchem.2019.304600] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 05/22/2019] [Indexed: 01/09/2023]
Abstract
BACKGROUND Increases in circulating LDL cholesterol (LDL-C) and high-sensitivity C-reactive protein (hsCRP) concentrations are significant risk factors for cardiovascular disease (CVD). We assessed direct LDL-C and hsCRP concentrations compared to standard risk factors in the Framingham Offspring Study. METHODS We used stored frozen plasma samples (-80 °C) obtained after an overnight fast from 3147 male and female participants (mean age, 58 years) free of CVD at cycle 6 of the Framingham Offspring Study. Overall, 677 participants (21.5%) had a CVD end point over a median of 16.0 years of follow-up. Total cholesterol (TC), triglyceride (TG), HDL cholesterol (HDL-C), direct LDL-C (Denka Seiken and Kyowa Medex methods), and hsCRP (Dade Behring method) concentrations were measured by automated analysis. LDL-C was also calculated by both the Friedewald and Martin methods. RESULTS Considering all CVD outcomes on univariate analysis, significant factors included standard risk factors (age, hypertension, HDL-C, hypertension treatment, sex, diabetes, smoking, and TC concentration) and nonstandard risk factors (non-HDL-C, direct LDL-C and calculated LDL-C, TG, and hsCRP concentrations). On multivariate analysis, only the Denka Seiken direct LDL-C and the Dade Behring hsCRP were still significant on Cox regression analysis and improved the net risk reclassification index, but with modest effects. Discordance analysis confirmed the benefit of the Denka Seiken direct LDL-C method for prospective hard CVD endpoints (new-onset myocardial infarction, stroke, and/or CVD death). CONCLUSIONS Our data indicate that the Denka Seiken direct LDL-C and Dade Behring hsCRP measurements add significant, but modest, information about CVD risk, compared to standard risk factors and/or calculated LDL-C.
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Affiliation(s)
- Hiroaki Ikezaki
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, Boston, MA.,Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Virginia A Fisher
- Department of Biostatistics, Boston University School of Public Health, Boston, MA.,the Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA
| | - Elise Lim
- Department of Biostatistics, Boston University School of Public Health, Boston, MA.,the Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA
| | - Masumi Ai
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, Boston, MA.,Department of Insured Medical Care Management, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Ching-Ti Liu
- Department of Biostatistics, Boston University School of Public Health, Boston, MA.,the Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA
| | - L Adrienne Cupples
- Department of Biostatistics, Boston University School of Public Health, Boston, MA.,the Framingham Heart Study, National Heart, Lung, and Blood Institute, Framingham, MA
| | - Katsuyuki Nakajima
- Department of Biochemistry, Gunma University, Maebashi, Japan.,Department of Clinical Chemistry, Gunma University, Maebashi, Japan
| | - Bela F Asztalos
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, Boston, MA
| | - Norihiro Furusyo
- Department of General Internal Medicine, Kyushu University Hospital, Fukuoka, Japan
| | - Ernst J Schaefer
- Cardiovascular Nutrition Laboratory, Jean Mayer USDA Human Nutrition Research Center on Aging at Tufts University and Tufts University School of Medicine, Boston, MA; .,Clinical Affairs Department, Boston Heart Diagnostics, Framingham, MA
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1387
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Del Pinto R, Grassi D, Properzi G, Desideri G, Ferri C. Low Density Lipoprotein (LDL) Cholesterol as a Causal Role for Atherosclerotic Disease: Potential Role of PCSK9 Inhibitors. High Blood Press Cardiovasc Prev 2019; 26:199-207. [PMID: 31236902 DOI: 10.1007/s40292-019-00323-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/18/2019] [Indexed: 02/07/2023] Open
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9)-related discoveries of the turn of the century have translated into substantial novelty in dyslipidemia treatment in the last 5 years. With chronic preventable atherosclerotic cardiovascular diseases (ASCVD) representing an epidemic of morbidity and mortality worldwide, low-density lipoprotein cholesterol (LDL-c) reduction represents a public health priority. By overcoming two major statin-related issues, namely intolerance and ineffectiveness, PCSK9 inhibitors have offered a safe and effective option in selected clinical settings where LDL-c reduction is required. Herein, we recapitulate recent findings, clinical applications, and ASCVD prevention potential of PCSK9 inhibition, with focus on anti-PCSK9 monoclonal antibodies, evolocumab and alirocumab.
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Affiliation(s)
- Rita Del Pinto
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, Building Delta 6, L'Aquila, Italy.
| | - Davide Grassi
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, Building Delta 6, L'Aquila, Italy
| | - Giuliana Properzi
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, Building Delta 6, L'Aquila, Italy
| | - Giovambattista Desideri
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, Building Delta 6, L'Aquila, Italy
| | - Claudio Ferri
- Department of Life, Health and Environmental Sciences, San Salvatore Hospital, University of L'Aquila, Building Delta 6, L'Aquila, Italy
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1388
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Emerging Role of Coronary Computed Tomography Angiography in Lipid-Lowering Therapy: a Bridge to Image-Guided Personalized Medicine. Curr Cardiol Rep 2019; 21:72. [DOI: 10.1007/s11886-019-1170-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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1389
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Abstract
PURPOSE OF REVIEW Low-density lipoprotein cholesterol (LDL-C) is one major cause of cardiovascular disease (CVD). In this review, we discuss current developments in the understanding of LDL-C as lifelong risk factor, treatment targets, and emerging approaches to reduce cardiovascular risk by lowering LDL-C. RECENT FINDINGS Recent evidence underscores the importance of LDL-C lowering in CVD prevention by mechanisms that increase the hepatic clearance of apolipoprotein B-containing lipoproteins from the plasma. Mendelian randomization studies provided evidence on both safety and efficacy of lower LDL-C in the long term. For young individuals, metrics other than 10-year CVD risk are required. Despite this evidence, LDL-C treatment target attainment is poor. Novel approaches are therefore needed. These include individualized strategies and new LDL-C-lowering pharmaceuticals. Early, long-term treatment with LDL-C-lowering therapies has the potential to markedly reduce CVD incidence and progression. Future research should aim to identify patient characteristics that enable physicians to tailor therapy to each individual patient.
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1390
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Lipid-lowering agents for the treatment of hyperlipidemia in patients with chronic kidney disease and end-stage renal disease on dialysis: a review. DRUGS & THERAPY PERSPECTIVES 2019. [DOI: 10.1007/s40267-019-00646-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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1391
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Tanaka S, Diallo D, Delbosc S, Genève C, Zappella N, Yong-Sang J, Patche J, Harrois A, Hamada S, Denamur E, Montravers P, Duranteau J, Meilhac O. High-density lipoprotein (HDL) particle size and concentration changes in septic shock patients. Ann Intensive Care 2019; 9:68. [PMID: 31197574 PMCID: PMC6565796 DOI: 10.1186/s13613-019-0541-8] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Accepted: 05/30/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Sepsis is associated with systemic inflammation that may impact lipoprotein function. In particular, high-density lipoproteins (HDLs) that display pleiotropic protective roles may be dysfunctional in septic conditions. The aim of this study was to evaluate the HDL profile and the inflammatory context in septic shock patients admitted to our intensive care unit (ICU). METHODS In this study, 20 septic shock patients and 20 controls (ICU patients without septic shock) were included. Plasma samples were collected on days 1, 2 and 7. Total cholesterol and lipoprotein concentrations were determined. HDL profiles were obtained using the Lipoprint® System (non-denaturing electrophoresis). Quantification of pro-inflammatory cytokines (interleukin 1b, 6 and 8), cell-free DNA and lipopolysaccharide-binding protein was also performed. RESULTS HDL concentration was statistically lower in septic shock patients than in controls. At days 1 and 2, septic patients had significantly more large-sized HDL than control patients. Patients recovered a normal lipid profile at day 7. CONCLUSIONS Our results emphasize that HDL levels are dramatically decreased in the acute phase of septic shock and that there is a shift toward large HDL particles, which may reflect a major dysfunction of these lipoproteins. Further mechanistic studies are required to explore this shift observed during sepsis.
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Affiliation(s)
- Sébastien Tanaka
- INSERM, UMR 1188 Diabète athérothombose Réunion Océan Indien (DéTROI), Université de La Réunion, 2 Rue Maxime Rivière, 97491 Sainte Clotilde, La Réunion, France
- AP-HP, Service d’Anesthésie-Réanimation, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Dévy Diallo
- Inserm U1148, Laboratory for Vascular, Translational Science Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France
| | - Sandrine Delbosc
- Inserm U1148, Laboratory for Vascular, Translational Science Bichat Hospital, 46 Rue Henri Huchard, 75018 Paris, France
| | - Claire Genève
- AP-HP, Service d’Anesthésie-Réanimation, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Nathalie Zappella
- AP-HP, Service d’Anesthésie-Réanimation, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
| | - Jennyfer Yong-Sang
- INSERM, UMR 1188 Diabète athérothombose Réunion Océan Indien (DéTROI), Université de La Réunion, 2 Rue Maxime Rivière, 97491 Sainte Clotilde, La Réunion, France
| | - Jessica Patche
- INSERM, UMR 1188 Diabète athérothombose Réunion Océan Indien (DéTROI), Université de La Réunion, 2 Rue Maxime Rivière, 97491 Sainte Clotilde, La Réunion, France
| | - Anatole Harrois
- AP-HP, Service d’Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
- Laboratoire d’étude de la Microcirculation, «Bio-CANVAS: Biomarkers in CardioNeuroVascular DISEASES» UMRS 942, Paris, France
| | - Sophie Hamada
- AP-HP, Service d’Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - Erick Denamur
- UMR1137 IAME, Inserm, Laboratoire de Génétique Moléculaire, Université Paris Diderot and AP-HP, Hôpital Bichat, Paris, France
| | - Philippe Montravers
- AP-HP, Service d’Anesthésie-Réanimation, CHU Bichat-Claude Bernard, 46 Rue Henri Huchard, 75018 Paris, France
- Inserm UMR1152, Physiopathologie et Epidémiologie des Maladies Respiratoires, Paris, France
| | - Jacques Duranteau
- AP-HP, Service d’Anesthésie-Réanimation, Hôpitaux Universitaires Paris-Sud, Université Paris-Sud, Hôpital de Bicêtre, 78 Rue du Général Leclerc, 94270 Le Kremlin-Bicêtre, France
- Laboratoire d’étude de la Microcirculation, «Bio-CANVAS: Biomarkers in CardioNeuroVascular DISEASES» UMRS 942, Paris, France
| | - Olivier Meilhac
- INSERM, UMR 1188 Diabète athérothombose Réunion Océan Indien (DéTROI), Université de La Réunion, 2 Rue Maxime Rivière, 97491 Sainte Clotilde, La Réunion, France
- CHU de La Réunion, Saint-Denis, France
- INSERM U1188 Diabète athérothrombose Thérapies Réunion Océan Indien (DéTROI), Université de La Réunion au CYROI, 2, Rue Maxime Rivière, 97490 Sainte Clotilde, La Réunion, France
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1392
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Eggink E, Moll van Charante EP, van Gool WA, Richard E. A Population Perspective on Prevention of Dementia. J Clin Med 2019; 8:E834. [PMID: 31212802 PMCID: PMC6617301 DOI: 10.3390/jcm8060834] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/06/2019] [Accepted: 06/09/2019] [Indexed: 01/21/2023] Open
Abstract
The global number of people living with dementia is expected to increase to 130 million in 2050. Based on extensive evidence from observational studies, it is estimated that about 30% of dementia cases may be attributable to potentially modifiable risk factors. This suggests that interventions targeting these factors could perhaps delay or prevent the onset of dementia. Since the vast majority of people with dementia live in low- and middle-income countries, such interventions should preferably be easy and affordable to implement across a wide range of health care systems. However, to date, results from dementia prevention trials do not provide convincing evidence that treatment of these risk factors reduces the risk of dementia. The current paper aims to give an overview of available evidence for the potential for dementia prevention. In particular, we discuss methodological issues that might complicate the development of effective prevention interventions and explore the opportunities and challenges for future dementia prevention research. Currently, several ongoing and planned trials are testing the effect of multi-domain interventions on dementia risk in high-risk populations. It is desirable that future dementia strategies also target the wider population, through interventions on the individual, community, and population level, in order to constrain the growing prevalence of dementia worldwide.
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Affiliation(s)
- Esmé Eggink
- Department of General Practice, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Eric P Moll van Charante
- Department of General Practice, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Willem A van Gool
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
| | - Edo Richard
- Department of Neurology, Amsterdam University Medical Center, University of Amsterdam, Meibergdreef 15, 1105 AZ Amsterdam, The Netherlands.
- Department of Neurology, Donders Institute for Brain, Behaviour and Cognition, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA Nijmegen, The Netherlands.
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1393
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Khoong EC, Karliner L, Lo L, Stebbins M, Robinson A, Pathak S, Santoyo-Olsson J, Scherzer R, Peralta CA. A Pragmatic Cluster Randomized Trial of an Electronic Clinical Decision Support System to Improve Chronic Kidney Disease Management in Primary Care: Design, Rationale, and Implementation Experience. JMIR Res Protoc 2019; 8:e14022. [PMID: 31199334 PMCID: PMC6594214 DOI: 10.2196/14022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 05/03/2019] [Accepted: 05/05/2019] [Indexed: 02/06/2023] Open
Abstract
Background The diagnosis of chronic kidney disease (CKD) is based on laboratory results easily extracted from electronic health records; therefore, CKD identification and management is an ideal area for targeted electronic decision support efforts. Early CKD management frequently occurs in primary care settings where primary care providers (PCPs) may not implement all the best practices to prevent CKD-related complications. Few previous studies have employed randomized trials to assess a CKD electronic clinical decision support system (eCDSS) that provided recommendations to PCPs tailored to each patient based on laboratory results. Objective The aim of this study was to report the trial design and implementation experience of a CKD eCDSS in primary care. Methods This was a 3-arm pragmatic cluster-randomized trial at an academic general internal medicine practice. Eligible patients had 2 previous estimated-glomerular-filtration-rates by serum creatinine (eGFRCr) <60 mL/min/1.73m2 at least 90 days apart. Randomization occurred at the PCP level. For patients of PCPs in either of the 2 intervention arms, the research team ordered triple-marker testing (serum creatinine, serum cystatin-c, and urine albumin-creatinine-ratio) at the beginning of the study period, to be completed when acquiring labs for regular clinical care. The eCDSS launched for PCPs and patients in the intervention arms during a regular PCP visit subsequent to completing the triple-marker testing. The eCDSS delivered individualized guidance on cardiovascular risk-reduction, potassium and proteinuria management, and patient education. Patients in the eCDSS+ arm also received a pharmacist phone call to reinforce CKD-related education. The primary clinical outcome is blood pressure change from baseline at 6 months after the end of the trial, and the main secondary outcome is provider awareness of CKD diagnosis. We also collected process, patient-centered, and implementation outcomes. Results A multidisciplinary team (primary care internist, nephrologists, pharmacist, and informaticist) designed the eCDSS to integrate into the current clinical workflow. All 81 PCPs contacted agreed to participate and were randomized. Of 995 patients initially eligible by eGFRCr, 413 were excluded per protocol and 58 opted out or withdrew, resulting in 524 patient participants (188 usual care; 165 eCDSS; and 171 eCDSS+). During the 12-month intervention period, 53.0% (178/336) of intervention patient participants completed triple-marker labs. Among these, 138/178 (77.5%) had a PCP appointment after the triple-marker labs resulted; the eCDSS was opened for 73.9% (102/138), with orders or education signed for 81.4% (83/102). Conclusions Successful integration of an eCDSS into primary care workflows and high eCDSS utilization rates at eligible visits suggest this tailored electronic approach is feasible and has the potential to improve guideline-concordant CKD care. Trial Registration ClinicalTrials.gov NCT02925962; https://clinicaltrials.gov/ct2/show/NCT02925962 (Archived by WebCite at http://www.webcitation.org/78qpx1mjR) International Registered Report Identifier (IRRID) DERR1-10.2196/14022
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Affiliation(s)
- Elaine C Khoong
- Division of General Internal Medicine at Zuckerberg San Francisco General Hospital, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Leah Karliner
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, United States
| | - Lowell Lo
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Marilyn Stebbins
- School of Pharmacy, University of California San Francisco, San Francisco, CA, United States
| | - Andrew Robinson
- University of California San Francisco, San Francisco, CA, United States
| | - Sarita Pathak
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Multiethnic Health Equity Research Center, University of California San Francisco, San Francisco, CA, United States
| | - Jasmine Santoyo-Olsson
- Division of General Internal Medicine, Department of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Rebecca Scherzer
- Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA, United States
| | - Carmen A Peralta
- Division of Nephrology, Department of Medicine, University of California San Francisco, San Francisco, CA, United States.,Kidney Health Research Collaborative, San Francisco Veterans Affairs Medical Center, University of California San Francisco, San Francisco, CA, United States.,Cricket Health, San Francisco, CA, United States
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1394
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Rosoff DB, Charlet K, Jung J, Lee J, Muench C, Luo A, Longley M, Mauro KL, Lohoff FW. Association of High-Intensity Binge Drinking With Lipid and Liver Function Enzyme Levels. JAMA Netw Open 2019; 2:e195844. [PMID: 31199452 PMCID: PMC6575145 DOI: 10.1001/jamanetworkopen.2019.5844] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/01/2019] [Indexed: 12/20/2022] Open
Abstract
Importance The prevalence of high-intensity binge drinking (HIBD), defined as consuming 2 or more times the binge threshold defined by the National Institute on Alcohol Abuse and Alcoholism (NIAAA), is rapidly increasing in the United States. While the relationship between alcohol consumption and lipid and liver function enzyme (LFT) biomarkers has been previously examined, the associations of HIBD with those biomarkers remain unknown. Objective To examine associations of HIBD with lipid and LFT levels in a cross-sectional sample enriched with participants who engage in HIBD. Design, Setting, and Participants Cross-sectional study using data from the NIAAA clinical sample collected from March 3, 2005, to August 21, 2017, with participants recruited for either the NIAAA screening protocols or inpatient alcohol treatment program. For this study, participants were stratified by self-reported alcohol consumption into 4 sex-specific binge levels: nonbinge and 1, 2, and 3 or more times the binge threshold (levels I, II, and III). Multivariable analyses examined the odds of clinically high levels of lipids and LFTs across binge levels. Analyses were performed from December 3, 2018, to January 30, 2019. Main Outcomes and Measures Serum levels of high-density lipoprotein cholesterol (HDL-C), low-density lipoprotein cholesterol, total cholesterol, triglycerides, alanine aminotransferase, aspartate aminotransferase, and γ-glutamyltransferase. Results A total of 2065 participants underwent protocol screening; 1519 with data available on alcohol consumption, body mass index, lipid levels, and LFT levels were included in the final analyses. Mean (SD) age was 39.7 (12.1) years; mean (SD) body mass index was 26.6 (5.1); 978 (64.4%) were male; 718 (47.3%) were white; and 578 (31.1%) consumed alcohol at the nonbinge level, 321 (21.2%) at level I, 239 (15.7%) at level II, and 318 (25.1%) at level III. High-intensity binge drinking was associated with 2- to 8-fold increased odds for clinically high levels of HDL-C, total cholesterol, triglycerides, and all LFTs (eg, for HDL-C: level III odds ratio [OR], 8.65; 95% CI, 4.75-15.77 and for γ-glutamyltransferase: level III OR, 8.21; 95% CI, 5.90-11.43). Increased HIBD frequency (days consuming at levels II and III) was associated with increased odds for clinically high levels of HDL-C, total cholesterol, and all LFTs (per unit increase in days consuming at the respective binge level) (eg, for HDL-C: level II OR, 1.025; 95% CI, 1.014-1.036 and level III OR, 1.033; 95% CI, 1.019-1.047 and for γ-glutamyltransferase: level II OR, 1.028; 95% CI, 1.019-1.037 and level III OR, 1.033; 95% CI, 1.019-1.047). Conclusions and Relevance High-impact binge drinking was significantly associated with increased odds for clinically high levels of lipids and LFTs. Given that HIBD is increasingly common among US adults, targeted interventions aimed at reducing HIBD may have important health benefits.
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Affiliation(s)
- Daniel B. Rosoff
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Katrin Charlet
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
- Department of Psychiatry and Psychotherapy, Charite–Universitaetsmedizin Berlin, Berlin, Germany
| | - Jeesun Jung
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Jisoo Lee
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Christine Muench
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Audrey Luo
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Martha Longley
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Kelsey L. Mauro
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
| | - Falk W. Lohoff
- Section on Clinical Genomics and Experimental Therapeutics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Bethesda, Maryland
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1395
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Fruchart JC, Santos RD, Aguilar-Salinas C, Aikawa M, Al Rasadi K, Amarenco P, Barter PJ, Ceska R, Corsini A, Després JP, Duriez P, Eckel RH, Ezhov MV, Farnier M, Ginsberg HN, Hermans MP, Ishibashi S, Karpe F, Kodama T, Koenig W, Krempf M, Lim S, Lorenzatti AJ, McPherson R, Nuñez-Cortes JM, Nordestgaard BG, Ogawa H, Packard CJ, Plutzky J, Ponte-Negretti CI, Pradhan A, Ray KK, Reiner Ž, Ridker PM, Ruscica M, Sadikot S, Shimano H, Sritara P, Stock JK, Su TC, Susekov AV, Tartar A, Taskinen MR, Tenenbaum A, Tokgözoğlu LS, Tomlinson B, Tybjærg-Hansen A, Valensi P, Vrablík M, Wahli W, Watts GF, Yamashita S, Yokote K, Zambon A, Libby P. The selective peroxisome proliferator-activated receptor alpha modulator (SPPARMα) paradigm: conceptual framework and therapeutic potential : A consensus statement from the International Atherosclerosis Society (IAS) and the Residual Risk Reduction Initiative (R3i) Foundation. Cardiovasc Diabetol 2019; 18:71. [PMID: 31164165 PMCID: PMC6549355 DOI: 10.1186/s12933-019-0864-7] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 04/29/2019] [Indexed: 12/12/2022] Open
Abstract
In the era of precision medicine, treatments that target specific modifiable characteristics of high-risk patients have the potential to lower further the residual risk of atherosclerotic cardiovascular events. Correction of atherogenic dyslipidemia, however, remains a major unmet clinical need. Elevated plasma triglycerides, with or without low levels of high-density lipoprotein cholesterol (HDL-C), offer a key modifiable component of this common dyslipidemia, especially in insulin resistant conditions such as type 2 diabetes mellitus. The development of selective peroxisome proliferator-activated receptor alpha modulators (SPPARMα) offers an approach to address this treatment gap. This Joint Consensus Panel appraised evidence for the first SPPARMα agonist and concluded that this agent represents a novel therapeutic class, distinct from fibrates, based on pharmacological activity, and, importantly, a safe hepatic and renal profile. The ongoing PROMINENT cardiovascular outcomes trial is testing in 10,000 patients with type 2 diabetes mellitus, elevated triglycerides, and low levels of HDL-C whether treatment with this SPPARMα agonist safely reduces residual cardiovascular risk.
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Affiliation(s)
| | - Raul D. Santos
- Hospital Israelita Albert Einstein, and Lipid Clinic, Heart Institute (InCor) University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Carlos Aguilar-Salinas
- Unidad de Investigacion de Enfermedades Metabolicas, Department of Endocrinolgy and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
- Tecnologico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Masanori Aikawa
- Center for Interdisciplinary Cardiovascular Sciences and Center for Excellence in Vascular Biology, Division of Cardiovascular Medicine and Channing Division of Network Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Khalid Al Rasadi
- Department of Clinical Biochemistry, Sultan Qaboos University Hospital, Muscat, Oman
| | - Pierre Amarenco
- Department of Neurology and Stroke Center, Paris-Diderot-Sorbonne University, Paris, France
| | - Philip J. Barter
- Lipid Research Group, School of Medical Sciences, University of New South Wales, Sydney, NSW Australia
| | - Richard Ceska
- IIIrd Dept Int. Med, Center for Preventive Cardiology, 3rd Internal Medicine Clinic, University General Hospital and Charles University, Prague, Czech Republic
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Jean-Pierre Després
- Centre de recherche sur les soins et les services de première ligne-Université Laval du CIUSSS de la Capitale-Nationale, Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC Canada
| | - Patrick Duriez
- INSERM, CHU Lille, U1171-Degenerative & Vascular Cognitive Disorders, University of Lille, Faculty of Pharmacy, University of Lille, UDSL, Lille, France
| | - Robert H. Eckel
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO USA
| | - Marat V. Ezhov
- Laboratory of Lipid Disorders, National Cardiology Research Center, Moscow, Russian Federation
| | - Michel Farnier
- Lipid Clinic, Point Médical and Department of Cardiology, CHU Dijon-Bourgogne, Dijon, France
| | - Henry N. Ginsberg
- Columbia University Vagelos College of Physicians and Surgeons, New York, USA
| | - Michel P. Hermans
- Division of Endocrinology and Nutrition, Cliniques Universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Shun Ishibashi
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Jichi Medical University, Shimotsuke, Japan
| | - Fredrik Karpe
- OCDEM, University of Oxford and the NIHR Oxford Biomedical Research Centre, OUH Foundation Trust, Churchill Hospital, Oxford, UK
| | - Tatsuhiko Kodama
- Laboratory for System Biology and Medicine Research Center for Advanced Science and Technology, The University of Tokyo, Tokyo, Japan
| | - Wolfgang Koenig
- Deutsches Herzzentrum München, Technische Universitat München, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance, Munich, Germany
- Institute of Epidemiology and Medical Biometry, University of Ulm, Ulm, Germany
| | - Michel Krempf
- Mass Spectrometry Core facility of West Human Nutrition Research Center (CRNHO), Hotel Dieu Hospital, Nantes, France
- Inra, UMR 1280, Physiologie des Adaptations Nutritionnelles, Nantes, France
- Department of Endocrinology, Metabolic diseases and Nutrition, G and R Laennec Hospital, Nantes, France
| | - Soo Lim
- Department of Internal Medicine, Seoul National University Bundang Hospital and Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Alberto J. Lorenzatti
- DAMIC Medical Institute/Rusculleda Foundation for Research, Córdoba, Argentina
- Cardiology Department, Córdoba Hospital, Córdoba, Argentina
| | - Ruth McPherson
- Ruddy Canadian Cardiovascular Genetics Centre, University of Ottawa Heart Institute, Ottawa, Canada
| | - Jesus Millan Nuñez-Cortes
- Internal Medicine, Lipids Unit, Gregorio Marañón University Hospital, Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
- Instituto de Investigaciones Sanitarias Gregorio Marañón, Madrid, Spain
| | - Børge G. Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Hisao Ogawa
- National Cerebral and Cardiovascular Center, Suita, Osaka Japan
| | - Chris J. Packard
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Jorge Plutzky
- Cardiovascular Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Carlos I. Ponte-Negretti
- Unidad de Prevención Cardiometabólica Cardiocob. Servicio de Cardiología Hospital el Pino Santiago de Chile, Sociedad Inter Americana de Cardiología SIAC Chairman Cardiovascular Prevention Comite, Santiago de Chile, Chile
| | - Aruna Pradhan
- Division of Cardiovascular Medicine, VA Boston Medical Center, Boston, MA USA
- Division of Preventive Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Kausik K. Ray
- Imperial Centre for Cardiovascular Disease Prevention, Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Željko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, Zagreb University, Kispaticeva 12, Zagreb, Croatia
| | - Paul M. Ridker
- Division of Cardiovascular Medicine and Center for Cardiovascular Disease Prevention, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università Degli Studi di Milano, Milan, Italy
| | - Shaukat Sadikot
- Department of Endocrinology/Diabetology, Jaslok Hospital and Research Centre, Mumbai, India
| | - Hitoshi Shimano
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine, University of Tsukuba, Ibaraki, 305-8575 Japan
| | - Piyamitr Sritara
- Department of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Jane K. Stock
- R3i Foundation, Picassoplatz 8, 4010 Basel, Switzerland
| | - Ta-Chen Su
- Departments of Internal Medicine and Environmental and Occupational Medicine, National Taiwan University; Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan
| | - Andrey V. Susekov
- Faculty of Clinical Pharmacology and Therapeutics, Academy for Postgraduate Continuous Medical Education, Moscow, Russian Federation
| | | | - Marja-Riitta Taskinen
- Research Program for Clinical and Molecular Metabolism, Faculty of Medicine, University of Helsinki and Clinical Research Institute, HUCH Ltd., Helsinki, Finland
| | - Alexander Tenenbaum
- Sackler Faculty of Medicine, Tel Aviv University, 6997801 Tel Aviv, Israel
- Cardiac Rehabilitation Institute, Sheba Medical Center, 5265601 Tel Hashomer, Israel
| | - Lale S. Tokgözoğlu
- Department of Cardiology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Brian Tomlinson
- Department of Medicine & Theraputics, The Chinese University of Hong Kong, Hong Kong, Hong Kong
| | - Anne Tybjærg-Hansen
- Department of Clinical Biochemistry, Rigshospitalet; Copenhagen University Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Herlev, Denmark
| | - Paul Valensi
- Department of Endocrinology, Diabetology and Nutrition, Jean-Verdier Hospital (AP-HP), Paris 13 University, Sorbonne Paris Cité, CRNH-IdF, CINFO, 93140 Bondy, France
| | - Michal Vrablík
- 3rd Department of Medicine, 1st Faculty of Medicine of Charles University and General University Hospital in Prague, Prague, Czech Republic
| | - Walter Wahli
- Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, Clinical Sciences Building, 11 Mandalay Road, Singapore, 308232 Singapore
- Center for Integrative Genomics, Université de Lausanne, Le Génopode, CH-1015 Lausanne, Switzerland
- Institut National de La Recherche Agronomique (INRA), UMR1331 ToxAlim, Toulouse, France
| | - Gerald F. Watts
- Lipid Disorders Clinic, Department of Cardiology, Royal Perth Hospital, School of Medicine, University of Western Australia, Perth, Australia
| | - Shizuya Yamashita
- Rinku General Medical Center, Izumisano, Osaka Japan
- Department of Community Medicine, Osaka University Graduate School of Medicine, Suita, Osaka Japan
- Department of Cardiovascular Medicine, Osaka University Graduate School of Medicine, Suita, Osaka Japan
| | - Koutaro Yokote
- Department of Endocrinology, Hematology and Gerontology, Clinical Cell Biology and Medicine, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Alberto Zambon
- Department of Medicine-DIMED, University of Padua, Padua, Italy
| | - Peter Libby
- Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA USA
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1396
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Alarfaj SJ, Perez A, Unger NR. Statin Use and the Point Prevalence of Antibiotics in Ambulatory Patients with Diabetes in the National Health and Nutrition Examination Survey (NHANES) 2003-2012. Antibiotics (Basel) 2019; 8:E64. [PMID: 31137765 PMCID: PMC6627739 DOI: 10.3390/antibiotics8020064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/26/2019] [Accepted: 04/08/2019] [Indexed: 11/16/2022] Open
Abstract
In patients with diabetes, the risk of infections is increased, hypothesized to be due to alterations in the immune system, among other changes. The pleotropic effects of statins have been investigated to assess their role in reducing the risk of infection and infection-related outcomes with varying results. The aim of this study is to determine if the use of statins is associated with a decrease in the point prevalence of oral antibiotic use in ambulatory patients with diabetes. Using data from the National Health and Nutrition Examination Survey (NHANES) from 2003 to 2012, all adult patients diagnosed with diabetes were analyzed. Patients were grouped into those who were prescribed statins and those who were not. Oral antibiotic use between the two groups was compared. Data were standardized to national estimates. A total of 3240 patients with diabetes were identified, with 1575 statin users and 1665 non-statin users. After controlling for baseline socio-demographic and clinical variables, the overall point prevalence of oral antibiotic use in diabetes population was 3.5% with no difference between statin users and non-statin users (2.9% vs. 4%, p = 0.116). Based on the results of this study, the use of statins in patients with diabetes was not associated with a reduction in the point prevalence of antibiotic use.
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Affiliation(s)
- Sumaiah J Alarfaj
- Department of Pharmaceutical Practice, Princess Nourah bint Abdulrahman University College of Pharmacy, Riyadh 11671, Saudi Arabia.
| | - Alexandra Perez
- Department of Sociobehavioral and Administrative Pharmacy, Nova Southeastern University College of Pharmacy, Davie, FL 33328, USA.
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1397
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Varghese T, Lundberg G. Lipids in Women: Management in Cardiovascular Disease Prevention and Special Subgroups. CURRENT CARDIOVASCULAR RISK REPORTS 2019. [DOI: 10.1007/s12170-019-0615-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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1398
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Ascaso JF, Civeira F, Guijarro C, López Miranda J, Masana L, Mostaza JM, Pedro-Botet J, Pintó X, Valdivielso P. Indications of PCSK9 inhibitors in clinical practice. Recommendations of the Spanish Sociey of Arteriosclerosis (SEA), 2019. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 31:128-139. [PMID: 31130361 DOI: 10.1016/j.arteri.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023]
Abstract
A group of experts convened by the Spanish Society of Arteriosclerosis (SEA) has been in charge of updating the SEA document on the indications of PCSK9 inhibitors (PCSK9i) in clinical practice that was published in 2016. This update is justified by the fact that the data from clinical trials carried out on a large scale with PCSK9i have shown that in addition to their high potency to lower atherogenic cholesterol, they reduce the risk of atherosclerotic cardiovascular disease, both in patients with stable disease, and with recent disease, and with a high degree of security. This update provides the recommendations and level of evidence for the prescription of iPCSK9 in patients with homozygous and heterozygous familial hypercholesterolemia, with atherosclerotic cardiovascular disease, and in primary prevention in patients with very high cardiovascular risk. These recommendations have been established taking into account the concentration of LDL-C, the clinical situation of the patient, the additional risk factors and the cost-effectiveness of their use.
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Affiliation(s)
| | - Fernando Civeira
- Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, España
| | - Carlos Guijarro
- Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - José López Miranda
- Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, CIBEROBN, Córdoba, España
| | - Luis Masana
- Hospital Universitario de Reus, Universidad Rovira y Virgili, IISPV, CIBERDEM, Reus, Tarragona, España
| | | | - Juan Pedro-Botet
- Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Hospital Universitario de Bellvitge-Idibell, Universidad de Barcelona, CIBEROBN, Hospitalet de Llobregat, Barcelona, España.
| | - Pedro Valdivielso
- Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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1399
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Fujihara Y, Nakamura T, Horikoshi T, Obata JE, Fujioka D, Watanabe Y, Watanabe K, Kugiyama K. Remnant Lipoproteins Are Residual Risk Factor for Future Cardiovascular Events in Patients With Stable Coronary Artery Disease and On-Statin Low-Density Lipoprotein Cholesterol Levels <70 mg/dL. Circ J 2019; 83:1302-1308. [DOI: 10.1253/circj.cj-19-0047] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yuki Fujihara
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Takamitsu Nakamura
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Takeo Horikoshi
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Jun-ei Obata
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Daisuke Fujioka
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Yosuke Watanabe
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Kazuhiro Watanabe
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
| | - Kiyotaka Kugiyama
- Department of Internal Medicine II, University of Yamanashi, Faculty of Medicine
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1400
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