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Wohlrab J, Kegel T, Große R, Eichner A. Handlungsempfehlungen zur Risikominimierung beim Einsatz von Januskinase-Inhibitoren zur Therapie chronisch-entzündlicher Hauterkrankungen. J Dtsch Dermatol Ges 2023; 21:845-852. [PMID: 37574686 DOI: 10.1111/ddg.15136_g] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/25/2023] [Indexed: 08/15/2023]
Abstract
ZusammenfassungDer Ausschuss für Risikobewertung (PRAC) der Europäischen Arzneimittelagentur (EMA) hat gemäß Artikel 20 der Verordnung (EG) Nr. 726/2004 die Sicherheit für Januskinase‐Inhibitoren für die Behandlung von Entzündungserkrankungen neu bewertet und von den bisherigen Hinweisen in den jeweiligen Fachinformationen der betreffenden Präparate abweichende Sicherheitsangaben formuliert. Diese beziehen sich arzneistoff‐ und indikationsübergreifend auf die Beachtung eines möglicherweise erhöhten Risikos für venöse thromboembolische oder schwere kardiovaskuläre Ereignisse, eine erhöhte Infektionsrate sowie eine Erhöhung der Prävalenz von Hautkrebs. Deshalb wird empfohlen, bei Patienten mit unabhängigen Risikofaktoren (Alter ab 65 Jahre, Raucher oder ehemalige Raucher, Patientinnen mit oraler Kontrazeption beziehungsweise Hormonersatztherapie sowie anderen Risikofaktoren) Januskinase‐Inhibitoren nur dann therapeutisch einzusetzen, wenn es keine geeigneten Behandlungsalternativen gibt. Um im klinischen Alltag eine pragmatische und sorgfältige Erfassung von Risikopatienten zu ermöglichen, wurde interdisziplinär eine Checkliste erarbeitet, die aus der Perspektive des Dermatologen als Arbeitsmittel geeignet ist.
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Affiliation(s)
- Johannes Wohlrab
- Universitätsklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
- Institut für angewandte Dermatopharmazie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Thomas Kegel
- Universitätsklinik für Innere Medizin IV (Hämatologie und Onkologie), Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Regina Große
- Universitätsklinik für Gynäkologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
| | - Adina Eichner
- Universitätsklinik für Dermatologie und Venerologie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
- Institut für angewandte Dermatopharmazie, Martin-Luther-Universität Halle-Wittenberg, Halle (Saale)
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Wohlrab J, Kegel T, Große R, Eichner A. Recommendations for risk minimization when using Janus kinase inhibitors for the treatment of chronic inflammatory skin diseases. J Dtsch Dermatol Ges 2023; 21:845-851. [PMID: 37345890 DOI: 10.1111/ddg.15136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Accepted: 04/25/2023] [Indexed: 06/23/2023]
Abstract
In accordance with article 20 of Regulation (EC) No 726/2004, the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) has re-evaluated the safety of Janus kinase inhibitors for the treatment of inflammatory diseases and formulated safety information deviating from the previous indications in the respective summary of product characteristics of the products concerned. These refer to the consideration of a possibly increased risk of venous thromboembolic or severe cardiovascular events, an increased infection rate and an increase in the prevalence of skin cancer across drugs and indications. Therefore, in patients with independent risk factors (age 65 years and older, smokers or former smokers, patients with oral contraception or hormone replacement therapy and other risk factors), it is recommended to use Janus kinase inhibitors therapeutically only if there are no suitable treatment alternatives. To facilitate a pragmatic and thorough detection of high-risk patients in everyday clinical practice, an interdisciplinary checklist was developed that is suitable as a working tool from the perspective of the dermatologist.
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Affiliation(s)
- Johannes Wohlrab
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute for Applied Dermatopharmaceutics, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Thomas Kegel
- Department of Internal Medicine IV (Hematology and Oncology), Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Regina Große
- Deparment of Gynecology, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Adina Eichner
- Department of Dermatology and Venereology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
- Institute for Applied Dermatopharmaceutics, Martin-Luther University Halle-Wittenberg, Halle (Saale), Germany
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Mortensen MB, Nordestgaard BG. Guidelines versus trial-evidence for statin use in primary prevention: The Copenhagen General Population Study. Atherosclerosis 2021; 341:20-26. [PMID: 34959205 DOI: 10.1016/j.atherosclerosis.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 11/16/2021] [Accepted: 12/02/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND AIMS Guideline-recommended use of risk calculators to select for statin therapy in primary prevention has never been tested in a randomized controlled trial (RCT). We determined the extent to which guideline-based statin recommendations from the American College of Cardiology/American Heart Association (ACC/AHA), Canadian Cardiovascular Society(CCS), UK National Institute for Health and Care Excellence (NICE), and European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) is supported by available evidence from RCTs. METHODS 79,171 individuals from the Copenhagen General Population Study who were free of ASCVD and statin use at baseline were included. RCT evidence supporting guideline-recommended statin allocation and the estimated number needed to treat (NNT) to prevent one ASCVD event were assessed. RESULTS During 8.2 years of follow-up, 4031 ASCVD events occurred. Of individuals eligible for statin therapy with the ACC/AHA, CCS, NICE and ESC/EAS guidelines, 86%, 88%, 88% and 84% had direct RCT evidence of statin efficacy, respectively (guideline-positive&RCT-positive). This group represented 26-37% of all 79,171 individuals, while guideline-positive&RCT-negative individuals represented 5-7%, guideline-negative&RCT-positive individuals 28-39%, and guideline-negative&RCT-negative individuals represented 30-31%. The ASCVD events per 1000 person-years were 11.4-12.7 (guideline-positive&RCT-positive), 6.3-8.0 (guideline-positive&RCT-negative), 4.2-5.2 (guideline-negative&RCT-positive), and 2.3-2.5 (guideline-negative&RCT-negative), respectively, while the corresponding NNT to prevent one event in 10 years using high-intensity statin were 19-21, 30-32, 48-60, and 105-125, respectively. CONCLUSIONS The far majority of individuals eligible for guideline-recommended primary prevention with statins have direct RCT evidence supporting statin use. Allocating statins based on guideline-criteria is more efficient with lower NNT for preventing ASCVD events than allocating statin therapy based solely on RCT evidence.
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Affiliation(s)
- Martin Bødtker Mortensen
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark; The Department of Clinical Biochemistry and 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
| | - Børge Grønne Nordestgaard
- The Department of Clinical Biochemistry and 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.
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Pavlović J, Greenland P, Franco OH, Kavousi M, Ikram MK, Deckers JW, Ikram MA, Leening MJG. Recommendations and Associated Levels of Evidence for Statin Use in Primary Prevention of Cardiovascular Disease: A Comparison at Population Level of the American Heart Association/American College of Cardiology/Multisociety, US Preventive Services Task Force, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society Clinical Practice Guidelines. Circ Cardiovasc Qual Outcomes 2021; 14:e007183. [PMID: 34546786 DOI: 10.1161/circoutcomes.120.007183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Despite using identical evidence to support practice guidelines for lipid-lowering treatment in primary prevention of cardiovascular disease (CVD), it is unclear to what extent the 2018 American Heart Association/American College of Cardiology/Multisociety, 2016 US Preventive Services Task Force (USPSTF), 2020 Department of Veterans Affairs/Department of Defense, 2021 Canadian Cardiovascular Society, and 2019 European Society of Cardiology/European Atherosclerosis Society guidelines differ in grading and assigning levels of evidence and classes of recommendations (LOE/class) at a population level. METHODS We included 7262 participants, aged 45 to 75 years, without history of CVD from the prospective population-based Rotterdam Study. Per guideline, proportions of the population recommended statin therapy by LOE/class, sensitivity and specificity for CVD events, and numbers needed to treat at 10 years were calculated. RESULTS Mean age was 61.1 (SD 6.9) years; 58.2% were women. American Heart Association/American College of Cardiology/Multisociety, USPSTF, Department of Veterans Affairs/Department of Defense, Canadian Cardiovascular Society, and European Society of Cardiology/European Atherosclerosis Society strongly recommended statin initiation in respective 59.4%, 40.2%, 45.2%, 73.7%, and 42.1% of the eligible population based on high-quality evidence. Sensitivity for CVD events for treatment recommendations supported with strong LOE/class was 86.3% for American Heart Association/American College of Cardiology/Multisociety (IA or IB), 69.4% for USPSTF (USPSTF-B), 74.5% for Department of Veterans Affairs/Department of Defense (strong for), 93.3% for Canadian Cardiovascular Society (strong), and 66.6% for European Society of Cardiology/European Atherosclerosis Society (IA). Specificity was highest for the USPSTF at 45.3% and lowest for European Society of Cardiology/European Atherosclerosis Society at 10.0%. Estimated numbers needed to treat at 10 years for those with the strongest LOE/class were ranging from 20 to 26 for moderate-intensity and 12 to 16 for high-intensity statins. CONCLUSIONS Sensitivity, specificity, and numbers needed to treat at 10 years for assigned LOE/class varied greatly among 5 CVD prevention guidelines. The level of variability seems to be driven by differences in how the evidence is graded and translated into LOE/class underlying the treatment recommendations by different professional societies. Efforts towards harmonizing evidence grading systems for clinical guidelines in primary prevention of CVD may reduce ambiguity and reinforce updated evidence-based recommendations.
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Affiliation(s)
- Jelena Pavlović
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Philip Greenland
- Department of Preventive Medicine, Northwestern University, Chicago, IL (P.G.)
| | - Oscar H Franco
- Institute of Social and Preventive Medicine, University of Bern, Switzerland (O.H.F.)
| | - Maryam Kavousi
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - M Kamran Ikram
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Neurology (M.K.I., M.A.I.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Jaap W Deckers
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Cardiology (J.W.D., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Neurology (M.K.I., M.A.I.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Radiology (M.A.I.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology (J.P., M.K., M.K.I., J.W.D., M.A.I., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands.,Department of Cardiology (J.W.D., M.J.G.L.), Erasmus MC - University Medical Center Rotterdam, the Netherlands
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Leening MJG. Who Benefits From Taking a Statin, and When?: On Fundamentally Restructuring Our Thinking Regarding Primary Prevention of Cardiovascular Disease. Circulation 2020; 142:838-840. [PMID: 32866062 DOI: 10.1161/circulationaha.120.048340] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Maarten J G Leening
- Departments of Epidemiology and Cardiology, Erasmus MC-University Medical Center Rotterdam, The Netherlands. Department of Clinical Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA
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Ikram MA, Brusselle G, Ghanbari M, Goedegebure A, Ikram MK, Kavousi M, Kieboom BCT, Klaver CCW, de Knegt RJ, Luik AI, Nijsten TEC, Peeters RP, van Rooij FJA, Stricker BH, Uitterlinden AG, Vernooij MW, Voortman T. Objectives, design and main findings until 2020 from the Rotterdam Study. Eur J Epidemiol 2020; 35:483-517. [PMID: 32367290 PMCID: PMC7250962 DOI: 10.1007/s10654-020-00640-5] [Citation(s) in RCA: 298] [Impact Index Per Article: 74.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 04/23/2020] [Indexed: 12/19/2022]
Abstract
The Rotterdam Study is an ongoing prospective cohort study that started in 1990 in the city of Rotterdam, The Netherlands. The study aims to unravel etiology, preclinical course, natural history and potential targets for intervention for chronic diseases in mid-life and late-life. The study focuses on cardiovascular, endocrine, hepatic, neurological, ophthalmic, psychiatric, dermatological, otolaryngological, locomotor, and respiratory diseases. As of 2008, 14,926 subjects aged 45 years or over comprise the Rotterdam Study cohort. Since 2016, the cohort is being expanded by persons aged 40 years and over. The findings of the Rotterdam Study have been presented in over 1700 research articles and reports. This article provides an update on the rationale and design of the study. It also presents a summary of the major findings from the preceding 3 years and outlines developments for the coming period.
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Affiliation(s)
- M Arfan Ikram
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.
| | - Guy Brusselle
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Mohsen Ghanbari
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André Goedegebure
- Department of Otorhinolaryngology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M Kamran Ikram
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Neurology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Brenda C T Kieboom
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Caroline C W Klaver
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Ophthalmology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robert J de Knegt
- Department of Gastroenterology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Annemarie I Luik
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Robin P Peeters
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Frank J A van Rooij
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - Bruno H Stricker
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Meike W Vernooij
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Trudy Voortman
- Department of Epidemiology, Erasmus University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands
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Alameddine R, Seifeddine S, Ishak H, Antoun J. Improving statin prescription through the involvement of nurses in the provision of ASCVD score: a quality improvement initiative in primary care. Postgrad Med 2020; 132:479-484. [PMID: 32276565 DOI: 10.1080/00325481.2020.1755146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVES This study compares two methods of providing CVD risk score on the percentage of appropriate statin therapy for primary prevention of CVD in family medicine clinics, according to the American Heart Association guidelines. METHODS Participants were non-diabetic patients aged 40 to 75 with a recently ordered low-density lipoprotein (LDL) level, not on statin therapy and free of CVD. The first intervention is passive with a display of the score on the EMR in the vital signs section and lasted for three months. The second intervention is collaborative where the nurses calculate the risk score and displayed it to the physician along with therapy recommendations. Electronic health records were reviewed to randomly select medical charts of eligible patients. RESULTS 162 charts were randomly selected out of 547 eligible charts and included in the analysis, including 60 charts for the baseline group. Among moderate-risk patients, the percentage of appropriate statin initiation was 0% at baseline and after intervention 1; yet it increased to (33.3% [7.5-70.1, 95% CI]) after intervention 2. Among high risk patients, percentage of appropriate statin initiation was 9.1% [0.1-41.3, 95% CI], 11.1% [1.4, 34.7, 95% CI] and 28.6% [8.4, 58.1, 95% CI] during baseline, intervention 1 and intervention 2, respectively. CONCLUSION The provision of the CVD risk score alone as clinical decision support is not enough to improve statin initiation for primary prevention. The nurse collaboration can improve guideline-concordant statin initiation.
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Affiliation(s)
- Reina Alameddine
- Department of Family Medicine, American University of Beirut , Beirut, Lebanon
| | - Suzan Seifeddine
- Department of Family Medicine, American University of Beirut , Beirut, Lebanon
| | - Hala Ishak
- Department of Family Medicine, American University of Beirut , Beirut, Lebanon
| | - Jumana Antoun
- Department of Family Medicine, American University of Beirut , Beirut, Lebanon
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Pavlović J, Kavousi M, Ikram MA, Leening MJG. Updated treatment thresholds in the 2019 ESC/EAS dyslipidaemia guidelines substantially expand indications for statin use for primary prevention at population level: Results from the Rotterdam Study. Atherosclerosis 2020; 299:64-66. [PMID: 32169303 DOI: 10.1016/j.atherosclerosis.2020.02.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Accepted: 02/25/2020] [Indexed: 01/01/2023]
Affiliation(s)
- Jelena Pavlović
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maryam Kavousi
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Neurology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Radiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Maarten J G Leening
- Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
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Khunti K, Jung H, Dans AL, Held C, Dagenais GR, Yusuf S, Lonn E. Statin Use in Primary Prevention: A Simple Trial-Based Approach Compared With Guideline-Recommended Risk Algorithms for Selection of Eligible Patients. Can J Cardiol 2019; 35:644-652. [PMID: 31030865 DOI: 10.1016/j.cjca.2019.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 03/12/2019] [Accepted: 03/12/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Cardiovascular disease risk assessment tools help identify individuals likely to benefit from preventative therapies. In this study we compared outcomes using the American College of Cardiology/American Heart Association (ACC/AHA) risk algorithm and the Framingham Risk Score (FRS) tool in the Heart Outcomes Prevention Evaluation (HOPE)-3 study. METHODS We compared outcomes using the ACC/AHA algorithm and the FRS with those seen in HOPE-3, which randomized participants to 10 mg rosuvastatin or placebo. The first coprimary outcome was the composite of death from cardiovascular causes, nonfatal myocardial infarction, or nonfatal stroke; second coprimary outcome additionally included heart failure, cardiac arrest, and revascularization. RESULTS Relative risks using risk scores were similar to those observed in the HOPE-3. Hazards ratios for the first coprimary outcome according to risk categories of ≤ 10%, 10%-20%, and ≥ 20% using the ACC/AHA algorithm were 0.82 (95% confidence interval [CI], 0.53-1.28), 0.72 (95% CI, 0.53-0.96), and 0.72 (95% CI, 0.55-0.93), and absolute risk reduction (ARR) of 0.18%, 1.33%, and 1.85%, respectively, over a median of 5.6 years. Corresponding results using the FRS were 0.69 (95% CI, 0.36-1.35), 0.73 (95% CI, 0.52-1.01), and 0.75 (95% CI, 0.60- 0.94); and ARR of 1.32%, 0.61%, and 1.43%. Hazard ratios for the second coprimary outcome were 0.77 (95% CI, 0.51-1.14), 0.73 (95% CI, 0.56-0.95), and 0.74 (95% CI, 0.58-0.94); and ARR of 0.36%, 1.49%, and 1.85%, using the ACC/AHA algorithm and 0.76 (95% CI, 0.41-1.41), 0.70 (95% CI, 0.52-0.95), and 0.76 (95% CI, 0.62-0.94); and ARR of 1.08%, 0.83%, and 1.56% using the FRS. CONCLUSIONS The pragmatic HOPE-3 trial approach identifies in an ethnically diverse primary prevention population individuals at intermediate risk who benefit from statin therapy using simple clinical characteristics without the need for complex, currently used risk assessment tools.
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Affiliation(s)
- Kamlesh Khunti
- Leicester Diabetes Centre, Leicester General Hospital, Leicester, United Kingdom.
| | - Hyejung Jung
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Antonio L Dans
- College of Medicine, University of the Philippines, Manila, Philippines
| | - Claes Held
- Department of Medical Sciences, Cardiology, Uppsala Clinical Research Centre, Uppsala, Sweden
| | - Gilles R Dagenais
- Institut Universitaire de Cardiologie et Pneumologie de Québec, Université Laval, Québec, Quebec City, Canada
| | - Salim Yusuf
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Medicine and Population Health Research Institute, Hamilton Health Sciences General Site, McMaster University, Hamilton, Ontario, Canada
| | - Eva Lonn
- Population Health Research Institute, Hamilton Health Sciences, McMaster University, Hamilton, Ontario, Canada; Department of Medicine and Population Health Research Institute, Hamilton Health Sciences General Site, McMaster University, Hamilton, Ontario, Canada
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Han X, Fox DS, Chu M, Dougherty JS, McCombs J. Primary Prevention Using Cholesterol-Lowering Medications in Patients Meeting New Treatment Guidelines: A Retrospective Cohort Analysis. J Manag Care Spec Pharm 2019; 24:1078-1085. [PMID: 30362921 PMCID: PMC10397869 DOI: 10.18553/jmcp.2018.24.11.1078] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The American College of Cardiology and American Heart Association (ACC/AHA) issued new cholesterol treatment guidelines in 2013. Two of the groups designated for primary prevention were analyzed: patients with a low-density lipoprotein cholesterol (LDL-C) level ≥ 190 mg per dL and diabetic patients aged 40-75 years. OBJECTIVE To estimate the effects of primary prevention as specified in the 2013 guidelines on cardiovascular event risk and cost. METHODS Primary prevention patients were identified using laboratory and diagnostic data for Humana members from 2007 to 2013. Potential study patients were classified into 3 risk groups: elevated LDL-C, diabetes, and elevated LDL-C and diabetes. Patients receiving cholesterol-lowering medications before their index date were excluded. Eligible patients were divided into 2 treatment groups: (1) primary prevention patients who initiated treatment before experiencing any cardiovascular disease (CVD)-related event, and (2) patients who either did not initiate treatment until after experiencing a CVD event or never initiated treatment. The associations between initiating cholesterol-lowering medications for primary prevention and the risk for acute myocardial infarction, stroke, coronary angioplasty, or coronary artery bypass graft surgery were estimated using Cox proportional hazards models. The effect of primary prevention on health care costs was estimated using generalized linear models. RESULTS 91,066 patients met study selection criteria. Primary prevention rates were the lowest in diabetic patients (35%), who were newly designated for treatment in the 2013 guidelines. Primary prevention rates were higher for patients designated for treatment under earlier guidelines: 65% for patients with elevated LDL-C and 78% for the combined LDL-C and diabetes group. Primary prevention treatment was associated with significant reductions in cardiovascular event risk (up to 37%) and lower total all-cause costs (by $673) in the first post-index year. CONCLUSIONS Initiating cholesterol-lowering medications for primary prevention, as specified in the ACC/AHA 2013 guidelines, for patients with high LDL-C and diabetes is associated with reduced CVD event risks and lower health care costs. DISCLOSURES No outside funding supported this study. Han received fellowship support from the Pharmaceutical Research and Manufacturers Association Foundation (PhRMA) during the conduct of this study. Dougherty is employed by PhRMA. The authors have nothing to disclose.
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Affiliation(s)
- Xue Han
- 1 Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - D Steven Fox
- 1 Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
| | - Michelle Chu
- 2 Titus Family Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, Los Angeles
| | - J Samantha Dougherty
- 3 Policy and Research Department, Pharmaceutical Research and Manufacturers of America, Washington, DC
| | - Jeffrey McCombs
- 1 Department of Pharmaceutical and Health Economics, School of Pharmacy, Leonard Schaeffer Center for Health Policy and Economics, University of Southern California, Los Angeles
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Leening MJG, Ikram MA. Primary prevention of cardiovascular disease: The past, present, and future of blood pressure- and cholesterol-lowering treatments. PLoS Med 2018; 15:e1002539. [PMID: 29558473 PMCID: PMC5860691 DOI: 10.1371/journal.pmed.1002539] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
In a Perspective, M. Afran Ikram and Maarten Leening discuss the evolving approaches to determining cardiovascular risk.
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Affiliation(s)
- Maarten J. G. Leening
- Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Cardiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts, United States of America
| | - M. Arfan Ikram
- Department of Epidemiology, Erasmus MC – University Medical Center Rotterdam, Rotterdam, the Netherlands
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Mortensen MB, Falk E, Li D, Nasir K, Blaha MJ, Sandfort V, Rodriguez CJ, Ouyang P, Budoff M. Statin Trials, Cardiovascular Events, and Coronary Artery Calcification: Implications for a Trial-Based Approach to Statin Therapy in MESA. JACC Cardiovasc Imaging 2018; 11:221-230. [PMID: 28624395 PMCID: PMC5723240 DOI: 10.1016/j.jcmg.2017.01.029] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Revised: 01/18/2017] [Accepted: 01/25/2017] [Indexed: 12/30/2022]
Abstract
OBJECTIVES This study sought to determine whether coronary artery calcium (CAC) could be used to optimize statin allocation among individuals for whom trial-based evidence supports efficacy of statin therapy. BACKGROUND Recently, allocation of statins was proposed for primary prevention of atherosclerotic cardiovascular disease (ASCVD) based on proven efficacy from randomized controlled trials (RCTs) of statin therapy, a so-called trial-based approach. METHODS The study used data from MESA (Multi-Ethnic Study of Atherosclerosis) with 5,600 men and women, 45 to 84 years of age, and free of clinical ASCVD, lipid-lowering therapy, or missing information for risk factors at baseline examination. RESULTS During 10 years' follow-up, 354 ASCVD and 219 hard coronary heart disease (CHD) events occurred. Based on enrollment criteria for 7 RCTs of statin therapy in primary prevention, 73% of MESA participants (91% of those >55 years of age) were eligible for statin therapy according to a trial-based approach. Among those individuals, CAC = 0 was common (44%) and was associated with low rates of ASCVD and CHD (3.9 and 1.7, respectively, per 1,000 person-years). There was a graded increase in event rates with increasing CAC score, and in individuals with CAC >100 (27% of participants) the rates of ASCVD and CHD were 18.9 and 12.7, respectively. Consequently, the estimated number needed to treat (NNT) in 10 years to prevent 1 event varied greatly according to CAC score. For ASCVD events, the NNT was 87 for CAC = 0 and 19 for CAC >100. For CHD events, the NNT was 197 for CAC = 0 and 28 for CAC >100. CONCLUSIONS Most MESA participants qualified for trial-based primary prevention with statins. Among the individuals for whom trial-based evidence supports efficacy of statin therapy, CAC = 0 and CAC >100 were common and associated with low and high cardiovascular risks, respectively. This information may guide shared decision making aimed at targeting evidence-based statins to those who are likely to benefit the most.
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Affiliation(s)
| | - Erling Falk
- Department of Cardiology, Aarhus University Hospital, Aarhus, Denmark
| | - Dong Li
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, University of California Los Angeles, Torrance, California
| | - Khurram Nasir
- Center for Healthcare Advancement and Outcomes, Baptist Health South Florida, Miami, Florida; Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Florida; The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Michael J Blaha
- The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, Maryland
| | - Veit Sandfort
- Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland
| | - Carlos Jose Rodriguez
- Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Pamela Ouyang
- The John Hopkins University School of Medicine, Baltimore, Maryland
| | - Matthew Budoff
- Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, University of California Los Angeles, Torrance, California
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Pavlović J, Greenland P, Deckers JW, Kavousi M, Hofman A, Ikram MA, Franco OH, Leening MJ. Assessing gaps in cholesterol treatment guidelines for primary prevention of cardiovascular disease based on available randomised clinical trial evidence: The Rotterdam Study. Eur J Prev Cardiol 2017; 25:420-431. [PMID: 29171772 PMCID: PMC5818030 DOI: 10.1177/2047487317743352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background The purpose of this study was to determine how American College of Cardiology/American Heart Association (ACC/AHA) 2013 and European Society of Cardiology 2016 guidelines for the primary prevention of atherosclerotic cardiovascular disease (CVD) compare in reflecting the totality of accrued randomised clinical trial evidence for statin treatment at population level. Methods From 1997–2008, 7279 participants aged 45–75 years, free of atherosclerotic cardiovascular disease, from the population-based Rotterdam Study were included. For each participant, we compared eligibility for each one of 11 randomised clinical trials on statin use in primary prevention of CVD, with recommendations on lipid-lowering therapy from the ACC/AHA and European Society of Cardiology (ESC) guidelines. Atherosclerotic cardiovascular disease incidence and cardiovascular disease mortality rates were calculated. Results The proportion of participants eligible for each trial ranged from 0.4% for ALLHAT-LLT to 30.8% for MEGA. The likelihood of being recommended for lipid-lowering treatment was lowest for those eligible for low-to-intermediate risk RCTs (HOPE-3, MEGA, and JUPITER), and highest for high-risk individuals with diabetes (MRC/BHF HPS, CARDS, and ASPEN) or elderly PROSPER. Eligibility for an increasing number of randomised clinical trials correlated with a greater likelihood of being recommended lipid-lowering treatment by either guideline (p < 0.001 for both guidelines). Conclusion Compared to RCTs done in high risk populations, randomised clinical trials targeting low-to-intermediate risk populations are less well-reflected in the ACC/AHA, and even less so in the ESC guideline recommendations. Importantly, the low-to-intermediate risk population targeted by HOPE-3, the most recent randomised clinical trial in this field, is not well-captured by the current European prevention guidelines and should be specifically considered in future iterations of the guidelines.
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Affiliation(s)
- Jelena Pavlović
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Philip Greenland
- 2 Department of Preventive Medicine, Feinberg School of Medicine, Northwestern University, USA
| | - Jaap W Deckers
- 3 Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Maryam Kavousi
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Albert Hofman
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,4 Department of Epidemiology, Harvard T.H. Chan School of Public Health, USA
| | - M Arfan Ikram
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,5 Department of Neurology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,6 Department of Radiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Oscar H Franco
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands
| | - Maarten Jg Leening
- 1 Department of Epidemiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,3 Department of Cardiology, Erasmus MC - University Medical Center Rotterdam, the Netherlands.,4 Department of Epidemiology, Harvard T.H. Chan School of Public Health, USA
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Mortensen MB, Budoff M, Li D, Nasir K, Blaha MJ, Sandfort V, Jose Rodriguez C, Ouyang P, Falk E. High-Quality Statin Trials Support the 2013 American College of Cardiology/American Heart Association Cholesterol Guidelines After the HOPE-3 Trial (Heart Outcomes Prevention Evaluation-3): MESA (The Multiethnic Study of Atherosclerosis). Circulation 2017; 136:1863-1865. [PMID: 28634218 PMCID: PMC5845782 DOI: 10.1161/circulationaha.117.029381] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Martin Bødtker Mortensen
- From Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M., E.F.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.B., D.L.); Center for Healthcare Advancement & Outcomes Baptisk Health South Florida, Miami (K.N.); Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami (K.N.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and John Hopkins University School of Medicine, Baltimore, MD (P.O.).
| | - Matthew Budoff
- From Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M., E.F.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.B., D.L.); Center for Healthcare Advancement & Outcomes Baptisk Health South Florida, Miami (K.N.); Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami (K.N.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and John Hopkins University School of Medicine, Baltimore, MD (P.O.)
| | - Dong Li
- From Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M., E.F.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.B., D.L.); Center for Healthcare Advancement & Outcomes Baptisk Health South Florida, Miami (K.N.); Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami (K.N.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and John Hopkins University School of Medicine, Baltimore, MD (P.O.)
| | - Khurram Nasir
- From Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M., E.F.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.B., D.L.); Center for Healthcare Advancement & Outcomes Baptisk Health South Florida, Miami (K.N.); Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami (K.N.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and John Hopkins University School of Medicine, Baltimore, MD (P.O.)
| | - Michael J Blaha
- From Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M., E.F.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.B., D.L.); Center for Healthcare Advancement & Outcomes Baptisk Health South Florida, Miami (K.N.); Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami (K.N.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and John Hopkins University School of Medicine, Baltimore, MD (P.O.)
| | - Veit Sandfort
- From Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M., E.F.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.B., D.L.); Center for Healthcare Advancement & Outcomes Baptisk Health South Florida, Miami (K.N.); Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami (K.N.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and John Hopkins University School of Medicine, Baltimore, MD (P.O.)
| | - Carlos Jose Rodriguez
- From Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M., E.F.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.B., D.L.); Center for Healthcare Advancement & Outcomes Baptisk Health South Florida, Miami (K.N.); Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami (K.N.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and John Hopkins University School of Medicine, Baltimore, MD (P.O.)
| | - Pamela Ouyang
- From Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M., E.F.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.B., D.L.); Center for Healthcare Advancement & Outcomes Baptisk Health South Florida, Miami (K.N.); Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami (K.N.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and John Hopkins University School of Medicine, Baltimore, MD (P.O.)
| | - Erling Falk
- From Department of Cardiology, Aarhus University Hospital, Denmark (M.B.M., E.F.); Division of Cardiology, Los Angeles Biomedical Research Institute at Harbor-UCLA, Torrance, CA (M.B., D.L.); Center for Healthcare Advancement & Outcomes Baptisk Health South Florida, Miami (K.N.); Department of Epidemiology, Robert Stempel College of Public Health and Department of Medicine, Herbert Wertheim College of Medicine, Florida International University, Miami (K.N.); The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Baltimore, MD (M.J.B.); Radiology and Imaging Sciences, National Institutes of Health, Bethesda, MD (V.S.); Division of Public Health Sciences, Department of Epidemiology and Prevention, Wake Forest School of Medicine, Winston-Salem, NC (C.J.R.); and John Hopkins University School of Medicine, Baltimore, MD (P.O.)
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Statins and Cardiovascular Health: Controversy, Consensus, and Clinical Judgment. J Cardiovasc Nurs 2017; 32:90-92. [PMID: 28178028 DOI: 10.1097/jcn.0000000000000394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Khavandi M, Duarte F, Ginsberg HN, Reyes-Soffer G. Treatment of Dyslipidemias to Prevent Cardiovascular Disease in Patients with Type 2 Diabetes. Curr Cardiol Rep 2017; 19:7. [PMID: 28132397 PMCID: PMC5503120 DOI: 10.1007/s11886-017-0818-1] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW Current preventive and treatment guidelines for type 2 diabetes have failed to decrease the incidence of comorbidities, such as dyslipidemia and ultimately heart disease. The goal of this review is to describe the physiological and metabolic lipid alterations that develop in patients with type 2 diabetes mellitus. Questions addressed include the differences in lipid and lipoprotein metabolism that characterize the dyslipidemia of insulin resistance and type 2 diabetes mellitus. We also examine the relevance of the new AHA/ADA treatment guidelines to dyslipidemic individuals. RECENT FINDINGS In this review, we provide an update on the pathophysiology of diabetic dyslipidemia, including the role of several apolipoproteins such as apoC-III. We also point to new studies and new agents for the treatment of individuals with type 2 diabetes mellitus who need lipid therapies. Type 2 diabetes mellitus causes cardiovascular disease via several pathways, including dyslipidemia characterized by increased plasma levels of apoB-lipoproteins and triglycerides, and low plasma concentrations of HDL cholesterol. Treatments to normalize the dyslipidemia and reduce the risk for cardiovascular events include the following: lifestyle and medication, particularly statins, and if necessary, ezetimibe, to significantly lower LDL cholesterol. Other treatments, more focused on triglycerides and HDL cholesterol, are less well supported by randomized clinical trials and should be used on an individual basis. Newer agents, particularly the PCSK9 inhibitors, show a great promise for even greater lowering of LDL cholesterol, but we await the results of ongoing clinical trials.
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Affiliation(s)
- Maryam Khavandi
- College of Physicians and Surgeons, Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH-10-305, New York, NY, 10032, USA
| | - Francisco Duarte
- College of Physicians and Surgeons, Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH-10-305, New York, NY, 10032, USA
| | - Henry N Ginsberg
- College of Physicians and Surgeons, Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH-10-305, New York, NY, 10032, USA
| | - Gissette Reyes-Soffer
- College of Physicians and Surgeons, Department of Medicine, Division of Preventive Medicine and Nutrition, Columbia University Medical Center, 622 West 168th Street, PH-10-305, New York, NY, 10032, USA.
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