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Zheng X, Tan L, Zhang Y. The impact of statin use on short-term and long-term mortality in patients with heart failure. Front Pharmacol 2024; 15:1397763. [PMID: 39391698 PMCID: PMC11464369 DOI: 10.3389/fphar.2024.1397763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Accepted: 09/13/2024] [Indexed: 10/12/2024] Open
Abstract
Background Heart failure (HF) is a complex disorder that has an association with increased morbidity and mortality rates globally. The association of statin use with mortality rate in individuals with HF remains unclear. Objectives To examine the association of statin use with the short-term and long-term all-cause mortality rate in critically ill individuals with HF. Methods We performed a retrospective cohort analysis based on the Medical Information Mart for Intensive Care (MIMIC)-IV database. The critically ill people with HF were assigned to a statin group and a non-statin group according to whether they had been treated with statin or not during hospitalization. The Kaplan-Meier (KM) method and Cox proportional hazard models were adopted to explore the link between statin administration and the 30-day, 90-day, as well as 1-year mortality rates. To ensure the robustness of the findings, a 1:1 nearest propensity-score matching (PSM) was also performed. Results The current research included 11,381 patients for the final analysis, with 7,561 in the statin group and 3,820 in the non-statin group. After multiple confounders were adjusted, we found that the Cox regression models revealed great beneficial effects of statin therapy on the 30-day, 90-day, as well as 1-year mortality rates among critically ill individuals with HF in the fully adjusted model. PSM also achieved consistent results. After PSM, the risk of mortality reduced by 23% for the 30-day mortality (HR = 0.77, 95%CI: 0.68-0.88, p < 0.001), 16% for the 90-day mortality rate (HR = 0.84, 95%CI: 0.75-0.93, p < 0.001), and 12% for the 1-year mortality rate (HR = 0.88, 95%CI: 0.81-0.97, p = 0.007). Patients treated with rosuvastatin had the greatest reduction in mortality rate. The 30-day, 90-day, and 1-year all-cause mortality rates were remarkably lower in patients who were treated with low-dose statins. Conclusion Our study unveiled that statin use was related to decreased short-term and long-term all-cause mortality rates in critically ill individuals with HF. Rosuvastatin was associated with the greatest reduction of all-cause mortality rates. Low-dose statins can significantly reduce short-term and long-term mortality, while high-dose statins are not significantly correlated with mortality. However, the results are not conclusive and should be interpreted with caution.
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Affiliation(s)
- Xiaoxue Zheng
- Department of Healthcare, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Long Tan
- Health Service Department, Guard Bureau of the General Office of the Central Committee of the Communist Party of China, Beijing, China
| | - Yu Zhang
- Department of Healthcare, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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Baig S, Mughal S, Murad Y, Virdee M, Jalal Z. Exploring the Perceptions and Behaviours of UK Prescribers Concerning Novel Lipid-Lowering Agent Prescriptions: A Qualitative Study. PHARMACY 2024; 12:104. [PMID: 39051388 PMCID: PMC11270282 DOI: 10.3390/pharmacy12040104] [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: 04/08/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/27/2024] Open
Abstract
Reducing low-density lipoprotein cholesterol levels lowers the risk of atherosclerotic cardiovascular disease. With the current and future portfolios of emerging lipid-lowering therapies included in various national and international guidelines, the objectives of this study were (i) to investigate the perceptions of UK prescribers', including doctors, pharmacists, and nurses, on current lipid management for cardiovascular diseases and prescriptions of novel lipid-lowering therapies, and (ii) to explore the challenges and facilitating factors of prescribing novel lipid-lowering therapies through qualitative interviews. Qualitative semi-structured interviews with twelve medical and non-medical prescribers were conducted, around 20-30 min in length. The interviews were audio-recorded and transcribed on an online platform. A thematic analysis was deployed. Four major themes emerged from the analysis: (1) prescribing barriers; (2) prescribing enablers; (3) inter-profession variability; and (4) health literacy. These themes highlighted the contrast between the need for optimal shared decision making and the various constraints in practice. Participants expressed their inexperience with novel lipid-lowering therapies and acknowledged the requirement and importance of these agents for primary cardiovascular disease prevention. Participants recognised confidence and competence as key drivers for prescribing therapies and welcomed further education and training to enhance their skillset. Patients' misconceptions towards current lipid-lowering therapies contributed to their refusal of newer agents, highlighting a requirement to improve patient education. Targeting communities through awareness campaigns was identified as a viable solution.
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Affiliation(s)
- Sarah Baig
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Birmingham B15 2TT, UK (Z.J.)
| | - Shahrauz Mughal
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Birmingham B15 2TT, UK (Z.J.)
| | - Yousuf Murad
- Worcestershire Acute Hospital Trust Woodrow Drive, Redditch B98 7UB, UK;
| | - Mandeep Virdee
- Royal Wolverhampton NHS Trust, Wolverhampton WV10 0QP, UK;
| | - Zahraa Jalal
- School of Pharmacy, Institute of Clinical Sciences, College of Medical and Dental Sciences, Birmingham B15 2TT, UK (Z.J.)
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Li X, Zhang W, Shu Y, Huo R, Zheng C, Qi Q, Fu P, Sun J, Wang Y, Wang Y, Lu J, Zhao X, Yin G, Wang Q, Hong J. Biparatopic anti-PCSK9 antibody enhances the LDL-uptake in HepG2 cells. Sci Rep 2024; 14:15331. [PMID: 38961200 PMCID: PMC11222478 DOI: 10.1038/s41598-024-66290-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 07/01/2024] [Indexed: 07/05/2024] Open
Abstract
Proprotein convertase subtilisin/kexin type 9 (PCSK9) has emerged as a promising therapeutic target to reduce lipids. In 2020, we reported a chimeric camelid-human heavy chain antibody VHH-B11-Fc targeting PCSK9. Recently, it was verified that VHH-B11 binds one linear epitope in the PCSK9 hinge region. To enhance its druggability, we have developed a novel biparatopic B11-H2-Fc Ab herein. Thereinto, surface plasmon resonance (SPR) confirmed the epitope differences in binding-PCSK9 among VHH-B11, VHH-H2 and the approved Repatha. Additionally, SPR revealed the B11-H2-Fc exhibits an avidity of approximately 0.036 nM for PCSK9, representing a considerable increase compared to VHH-B11-Fc (~ 0.69 nM). Moreover, we found the Repatha and B11-H2-Fc exhibited > 95% PCSK9 inhibition efficiency compared to approximately 48% for the VHH-Fc at 7.4 nM (P < 0.0005). Further, we verified its biological activity using the human hepatoma cells G2 model, where the B11-H2-Fc exhibited almost 100% efficiency in PCSK9 inhibition at only 0.75 μM. The immunoblotting results of low-density lipoprotein cholesterol (LDL-c) uptake assay also demonstrated the excellent performance of B11-H2-Fc on recovering the LDL-c receptor (LDLR), as strong as the Repatha (P > 0.05). These findings provide the first evidence of the efficacy of a novel Ab targeting PCSK9 in the field of lipid-lowering drugs.
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Affiliation(s)
- Xinyang Li
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China.
| | - Wei Zhang
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, 518055, Guangdong, China
| | - Yu Shu
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Rui Huo
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Chengyang Zheng
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Qi Qi
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Pengfei Fu
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Jie Sun
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Yuhuan Wang
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Yan Wang
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Juxu Lu
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Xiangjie Zhao
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China
| | - Guoyou Yin
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China.
| | - Qingqing Wang
- Employment and Business Startup Service Center, Henan University of Urban Construction, Ping Dingshan, 467036, China.
| | - Jun Hong
- College of Life Science and Engineering, Henan University of Urban Construction, Ping Dingshan, 467036, China.
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Su Q, Liu Y, Zhang G, Xu L, Wang M, Mei S, Garon G, Wu Y, Lv Q, Ma C. Efficacy and Safety of Single-Pill Combination of Rosuvastatin and Ezetimibe in Chinese Patients with Primary Hypercholesterolemia Inadequately Controlled by Statin Treatment (ROZEL): A Randomized, Double-Blind, Double Dummy, Active-Controlled Phase 3 Clinical Trial. Adv Ther 2023; 40:5285-5299. [PMID: 37770770 PMCID: PMC10611639 DOI: 10.1007/s12325-023-02666-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 08/23/2023] [Indexed: 09/30/2023]
Abstract
INTRODUCTION Many patients with primary hypercholesterolemia do not achieve their plasma low-density lipoprotein cholesterol (LDL-C) goals with statin alone under a recommended dose of statin (e.g., 10 mg rosuvastatin) in China. The objective of this phase III study was to evaluate the efficacy and safety of a new single-pill combination (SPC) of rosuvastatin 10 mg/ezetimibe 10 mg (R10/E10) in this population. METHODS This was a randomized, double-blind, double-dummy, active-controlled study in patients with primary hypercholesterolemia inadequately controlled with statin alone. The participants were randomized 1:1 to receive SPC R10/E10 or R10. The primary objective was to demonstrate the superiority of SPC R10/E10 vs. R10 in reducing the LDL-C levels after 8 weeks. RESULTS This trial randomized 305 participants to SPC R10/E10 (n = 153) and R10 (n = 152). The superiority of SPC R10/E10 over R10 was demonstrated with the least square (LS) mean difference of percent change in LDL-C from baseline to week 8: - 13.85% (95% confidence interval [CI] - 20.15% to - 7.56%, P < 0.0001). The proportion of participants who achieved the LDL-C target (< 2.6 mmol/l) at week 8 was larger with SPC R10/E10 (n = 80, 54.1%) than with R10 (n = 42, 29.2%) (Odds ratio = 2.80, 95% CI 1.70 to 4.61, P < 0.0001). No unexpected safety findings were reported. CONCLUSION The results suggest that SPC R10/E10 improve LDL-C reduction and goal achievement in Chinese patients with primary hypercholesterolemia not adequately controlled on statin therapy, without new safety findings. TRIAL REGISTRATION ClinicalTrials.gov (NCT04669041).
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Affiliation(s)
- Qiaoli Su
- Department of Cardiology, West China Hospital of Sichuan University, Chengdu, China
| | - Ying Liu
- Department of Cardiology, The People's Hospital of Liaoning Province, Shengyang, China
| | - Guogang Zhang
- Department of Cardiology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Li Xu
- Department of Cardiology, Pu Ren Hospital of Wu Han City, Wuhan, China
| | | | | | | | - Yanzhen Wu
- Sanofi Research and Development, Beijing, China
| | - Qiang Lv
- Department of Cardiology, Beijing Anzhen Hopital, Capital Medical University, NO. 2 Anzhen Road, District Chaoyang, Beijing, 100029, China.
| | - Changsheng Ma
- Department of Cardiology, Beijing Anzhen Hopital, Capital Medical University, NO. 2 Anzhen Road, District Chaoyang, Beijing, 100029, China
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Wang GHM, Morris E, Vouri SM, Keshwani S, Schmidt S, Pepine CJ, Smith SM. Modifiable statin characteristics associated with potential statin-related prescribing cascades. Pharmacotherapy 2023; 43:1307-1316. [PMID: 37771303 DOI: 10.1002/phar.2883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/11/2023] [Accepted: 09/07/2023] [Indexed: 09/30/2023]
Abstract
STUDY OBJECTIVE Clinicians may prescribe new medications (marker drug) to treat statin-related (index drug) adverse events, constituting a prescribing cascade. We aimed to identify modifiable statin characteristics (intensity and individual statin agents) associated with lower risk of prescribing cascades to inform clinical decisions in the presence of statin-related adverse events. DESIGN A secondary analysis based on our previous work, a high-throughput sequence symmetry analysis screening for potential statin-related prescribing cascades. DATA SOURCE MarketScan Commercial and Medicare Supplemental Insurance claims databases between 2005 and 2019. PATIENTS Adults who initiated a statin between 2007 and 2018, and who were continuously enrolled in the same healthcare plan for at least 720 days before and 360 days after statin initiation. INTERVENTION Among the previously identified 57 potential prescribing cascades, 42 statin-marker class dyad with a sample size of ≥ 500 were assessed in this study. MEASUREMENTS We measured patients' baseline characteristics within -360 days of statin initiation and reported by modifiable statin characteristics. We also performed logistic regression and reported the adjusted odds ratios (aOR) with 95% confidence intervals (CI) of modifiable statin characteristics after adjusting for baseline characteristics. MAIN RESULTS We identified 1,307,867 statin initiators who met the study criteria (21% elderly, 52% female). Compared with patients initiating low-intensity statins, those initiating moderate- or high-intensity statins had significantly greater odds to develop 29 (69%) prescribing cascades, including antidiabetic drugs such as dipeptidyl peptidase 4 (DPP-4) inhibitors (aOR 1.22; 95% CI, 1.11-1.35) and glucagon-like peptide-1 (GLP-1) analogs (aOR 1.31; 95% CI, 1.16-1.47), and opioids (aOR 1.18; 95% CI, 1.13-1.23). Individual statin agent selection also had a differential effect on 34 (81%) of the prescribing cascades. For example, compared with simvastatin initiators, the probability of initiating osmotically acting laxatives was significantly higher for lovastatin initiators (aOR 1.09; 95% CI, 1.03-1.15) and significantly lower in atorvastatin initiators (aOR 0.92; 95% CI, 0.89-0.94). CONCLUSION Compared with low-intensity statins, high-intensity statins are associated with increased risk in many potential prescribing cascades, while the choice of individual statin agents affects the risk of prescribing cascades bidirectionally.
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Affiliation(s)
- Grace Hsin-Min Wang
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Earl Morris
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Scott M Vouri
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
| | - Shailina Keshwani
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
| | - Stephan Schmidt
- Department of Pharmaceutics, College of Pharmacy, University of Florida, Orlando, Florida, USA
| | - Carl J Pepine
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
| | - Steven M Smith
- Department of Pharmaceutical Outcomes & Policy, University of Florida College of Pharmacy, Gainesville, Florida, USA
- Center for Drug Evaluation and Safety, University of Florida, Gainesville, Florida, USA
- Division of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, Florida, USA
- Center for Integrative Cardiovascular and Metabolic Disease, University of Florida, Gainesville, Florida, USA
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Barrios V, Pintó X, Escobar C, Varona JF, Gámez JM. Real-World Attainment of Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Cardiovascular Disease Treated with High-Intensity Statins: The TERESA Study. J Clin Med 2023; 12:3187. [PMID: 37176627 PMCID: PMC10179558 DOI: 10.3390/jcm12093187] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Despite steady improvements in cardiovascular disease (CVD) prevention, a scarce proportion of patients achieve the recommended LDL-C goals, even under high-intensity lipid-lowering therapy (LLT). Our study aimed to evaluate the attainment rate of LDL-C targets recommended by the 2019 European guidelines, and to characterize potential factors associated with LDL-C goal achievement and change patterns in LLT. We conducted a retrospective, observational study on patients treated with high-intensity atorvastatin or rosuvastatin ± ezetimibe at cardiology and internal medicine clinics across Spain. It included 1570 evaluable patients (median age: 62 years; established CVD: 77.5% [myocardial infarction: 34.3%]; and 85.8% at very high cardiovascular risk). Rosuvastatin ± ezetimibe was the LLT in 52.2% of patients, and atorvastatin ± ezetimibe in 47.8%. LLT had been modified in 36.8% of patients (side effects: 10%), being the most common switch from atorvastatin- to rosuvastatin-based treatment (77.2%). The risk-based LDL-C goal attainment rate was 31.1%, with 78.2% high-risk and 71.7% very high-risk patients not achieving the recommended LDL-C targets. Established CVD and familial hypercholesterolemia were significantly associated with the non-achievement of LDL-C goals. Although having limitations, this study shows that the guideline-recommended LDL-C goal attainment rate is still suboptimal despite using high-intensity statin therapy in a real-world setting in Spain.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, University Hospital Ramón y Cajal, Alcalá University, 28034 Madrid, Spain
| | - Xavier Pintó
- Lipid and Vascular Risk Unit, Department of Internal Medicine, University Hospital of Bellvitge-Idibell-UB-CiberObn, 08907 L’Hospitalet de Llobregat, Spain;
| | - Carlos Escobar
- Department of Cardiology, University Hospital La Paz, 28046 Madrid, Spain;
| | - Jose F. Varona
- Department of Internal Medicine, University Hospital HM Monteprincipe, HM Hospitales, 28660 Madrid, Spain;
| | - José M. Gámez
- Department of Cardiology, University Hospital Son Llàtzer, 07198 Palma, Spain;
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN CB 12/03/30038), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Liu T, Zuo R, Wang J, Huangtao Z, Wang B, Sun L, Wang S, Li B, Zhu Z, Pan Y. Cardiovascular disease preventive effects of aspirin combined with different statins in the United States general population. Sci Rep 2023; 13:4585. [PMID: 36941404 PMCID: PMC10027662 DOI: 10.1038/s41598-023-31739-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Accepted: 03/16/2023] [Indexed: 03/23/2023] Open
Abstract
The purpose of this study was to explore the use of aspirin in conjunction with various statins for cardiovascular disease (CVD) prevention in the general population of the United States (U.S.). A total of 3778 people from the National Health and Nutrition Examination Surveys from 2011 to 2018 were included in our analysis. After adjusting for sociodemographic and common cardiovascular risk factors, we used multivariable logistic regression analysis to determine aspirin should be combined with which type of statin for better CVD preventive effects. Subgroup analyses were carried out subsequently. In comparison to the aspirin use alone, the odds ratios with 95% confidence intervals for CVD were 0.43 (0.33, 0.57), 0.69 (0.42, 1.13), 0.44 (0.31, 0.62), 0.34 (0.23, 0.50) and 0.64 (0.49, 0.84) for the combination use of aspirin and atorvastatin, lovastatin, pravastatin, rosuvastatin as well as simvastatin, respectively, in the fully-adjusted model. Aspirin combined with rosuvastatin was more effective in the prevention of individual CVD, including congestive heart failure, coronary heart disease, angina pectoris and heart attack, than aspirin combined with other statins. In conclusion, statins combined with aspirin have a clear advantage over aspirin alone in preventing CVD. In addition, when various sex, age, and fitness levels were considered, as well as with and without diabetes mellitus, the combination usage of aspirin and rosuvastatin had the greatest CVD preventive effects than aspirin coupled with other statins.
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Affiliation(s)
- Tao Liu
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Ronghua Zuo
- Department of Anesthesiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, Jiangsu, China
| | - Jia Wang
- Department of Nephrology, The Affiliated Hospital of Xuzhou Medical University, Xuzhou, 221000, Jiangsu, China
| | - Zixuan Huangtao
- School of Clinical Medicine, Hainan Medical University, Haikou, 57119, Hainan, China
| | - Bing Wang
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Lifang Sun
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Shasha Wang
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Baoyin Li
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Zhijian Zhu
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China
| | - Yesheng Pan
- Department of Cardiology, Jinshan Branch of Shanghai Sixth People's Hospital, Shanghai, 201500, China.
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Lee YJ, Cho JY, You SC, Lee YH, Yun KH, Cho YH, Shin WY, Im SW, Kang WC, Park Y, Lee SY, Lee SJ, Hong SJ, Ahn CM, Kim BK, Ko YG, Choi D, Hong MK, Jang Y, Kim JS. Moderate-intensity statin with ezetimibe vs. high-intensity statin in patients with diabetes and atherosclerotic cardiovascular disease in the RACING trial. Eur Heart J 2023; 44:972-983. [PMID: 36529993 DOI: 10.1093/eurheartj/ehac709] [Citation(s) in RCA: 17] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 10/15/2022] [Accepted: 11/17/2022] [Indexed: 12/23/2022] Open
Abstract
AIMS This study evaluated the effect of moderate-intensity statin with ezetimibe combination therapy vs. high-intensity statin monotherapy among patients with diabetes mellitus (DM) and atherosclerotic cardiovascular disease (ASCVD). METHODS AND RESULTS This was a pre-specified, stratified subgroup analysis of the DM cohort in the RACING trial. The primary outcome was a 3-year composite of cardiovascular death, major cardiovascular events, or non-fatal stroke. Among total patients, 1398 (37.0%) had DM at baseline. The incidence of the primary outcome was 10.0% and 11.3% among patients with DM randomized to ezetimibe combination therapy vs. high-intensity statin monotherapy (hazard ratio: 0.89; 95% confidence interval: 0.64-1.22; P = 0.460). Intolerance-related discontinuation or dose reduction of the study drug was observed in 5.2% and 8.7% of patients in each group, respectively (P = 0.014). LDL cholesterol levels <70 mg/dL at 1, 2, and 3 years were observed in 81.0%, 83.1%, and 79.9% of patients in the ezetimibe combination therapy group, and 64.1%, 70.2%, and 66.8% of patients in the high-intensity statin monotherapy group (all P < 0.001). In the total population, no significant interactions were found between DM status and therapy regarding primary outcome, intolerance-related discontinuation or dose reduction, and the proportion of patients with LDL cholesterol levels <70 mg/dL. CONCLUSION Ezetimibe combination therapy effects observed in the RACING trial population are preserved among patients with DM. This study supports moderate-intensity statin with ezetimibe combination therapy as a suitable alternative to high-intensity statins if the latter cannot be tolerated, or further reduction in LDL cholesterol is required among patients with DM and ASCVD. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, Identifier:NCT03044665.
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Affiliation(s)
- Yong-Joon Lee
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Jae Young Cho
- Department of Cardiovascular Medicine, Wonkwang University Hospital, Muwang-ro 895, Iksan 54538, Korea
| | - Seng Chan You
- Department of Biomedical Systems Informatics, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Yong-Ho Lee
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Kyeong Ho Yun
- Department of Cardiovascular Medicine, Wonkwang University Hospital, Muwang-ro 895, Iksan 54538, Korea
| | - Yun-Hyeong Cho
- Department of Cardiology, Hanyang University College of Medicine, Hwasu-ro 14 beon-gil 55, Goyang 10475, Korea
| | - Won-Yong Shin
- Department of Cardiology, Soonchunhyang University Cheonan Hospital, Suncheonhyang 6-gil 31, Cheonan 31151, Korea
| | - Sang Wook Im
- Department of Cardiology, CHA University College of Medicine, Yatap-ro 59, Seongnam 13496, Korea
| | - Woong Chol Kang
- Department of Cardiology, Gachon University College of Medicine, Namdong-daero 774 beon-gil 21, Incheon 21565, Korea
| | - Yongwhi Park
- Department of Cardiology, Gyeongsang National University Changwon Hospital, Samjeongja-ro 11, Changwon 51472, Korea
| | - Sung Yoon Lee
- Department of Cardiology, Inje University Ilsan Paik Hospital, Juhwa-ro 170, Ilsan 10380, Korea
| | - Seung-Jun Lee
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Sung-Jin Hong
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Chul-Min Ahn
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Young-Guk Ko
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Donghoon Choi
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Myeong-Ki Hong
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
| | - Yangsoo Jang
- Department of Cardiology, CHA University College of Medicine, Yatap-ro 59, Seongnam 13496, Korea
| | - Jung-Sun Kim
- Division of Cardiology, Severance Hospital, Yonsei University College of Medicine, Yonsei-ro 50-1, Seoul 03722, Korea
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Gallo G, Sarzani R, Cicero AFG, Genovese S, Pirro M, Gallelli L, Faggiano A, Volpe M. An Expert Opinion on the Role of the Rosuvastatin/Amlodipine Single Pill Fixed Dose Combination in Cardiovascular Prevention. High Blood Press Cardiovasc Prev 2023; 30:83-91. [PMID: 37020154 PMCID: PMC10089988 DOI: 10.1007/s40292-023-00570-9] [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: 02/21/2023] [Accepted: 03/13/2023] [Indexed: 04/07/2023] Open
Abstract
Current cardiovascular disease prevention strategies are based on the management of cardiovascular risk as a continuum, redefining the therapeutic goals for each individual based on the estimated global risk profile. Given the frequent clustering of the principal cardiovascular risk factors, such as hypertension, diabetes and dyslipidaemia, in the same individual, patients are required to take multiple drugs to achieve therapeutic targets. The adoption of single pill fixed dose combinations may contribute to achieve better control of blood pressure and cholesterol compared to the separate administration of the individual drugs, mostly due to better adherence related to therapeutic simplicities. This paper reports the outcomes of an Expert multidisciplinary Roundtable. In particular, the rational and potential clinical use of the single pill fixed dose combination "Rosuvastatin-Amlodipine" for the management of concomitant hypertension/hypercholesterolemia in different clinical fields are discussed. This Expert Opinion also illustrates the importance of an early and effective management of total cardiovascular risk, highlights the substantial benefits of combining blood pressure and lipid-lowering treatments in a single-pill fixed dose combination and attempts to identify and overcome the barriers to the implementation in clinical practice of the fixed dose combinations with dual targets. This Expert Panel identifies and proposes the categories of patients who may benefit the most from this fixed dose combination.
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Affiliation(s)
- Giovanna Gallo
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Riccardo Sarzani
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS INRCA, Ancona, Italy
- Department of Clinical and Molecular Sciences, University 'Politecnica delle Marche', Ancona, Italy
| | - Arrigo Francesco Giuseppe Cicero
- Hypertension and Cardiovascular Risk Research Unit, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
- IRCCS AOU Policlinico di S. Orsola, Bologna, Italy
| | - Stefano Genovese
- Endocrine and Metabolic Diseases Unit IRCCS Centro Cardiologico Monzino, 20138, Milan, Italy
| | - Matteo Pirro
- Unit of Internal Medicine, Department of Medicine and Surgery, University of Perugia, Perugia, Italy
| | - Luca Gallelli
- Department of Health Sciences, Campus "Salvatore Venuta", University of Catanzaro "Magna Græcia", 88100, Catanzaro, Italy
| | - Andrea Faggiano
- Cardiovascular Unit, Internal Medicine Department, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, University of Milan, Milan, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy.
- IRCCS San Raffaele Roma, Rome, Italy.
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Jaam M, Al-Naimi HN, Haddad MM, Abushanab D, Al-Badriyeh D. Comparative efficacy and safety among high-intensity statins. Systematic Review and Meta-Analysis. J Comp Eff Res 2023; 12:e220163. [PMID: 36847307 PMCID: PMC10288954 DOI: 10.57264/cer-2022-0163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 12/05/2022] [Indexed: 03/01/2023] Open
Abstract
Aim: To summarize the evidence in terms of efficacy and safety of head-to-head studies of high-intensity statins regardless of the underlying population. Materials & methods: A systematic review and meta-analysis was conducted to summarize the effect sizes in randomized controlled trials and cohort studies that compared high-intensity statins. Results: Based on 44 articles, similar effectiveness was observed across the statins in reducing LDL levels from baseline. All statins were observed to have similar adverse drug reactions (ADRs), although higher dosages were associated with more ADRs. Based on a pooled quantitative analysis of atorvastatin 80 mg versus rosuvastatin 40 mg, rosuvastatin was statistically more effective in reducing LDL. Conclusion: This review further confirms that high-intensity statins reduce LDL by ≥50%, favoring rosuvastatin over atorvastatin. Additional data are needed to confirm the clinical significance on cardiovascular outcomes using real-world studies.
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Affiliation(s)
- Myriam Jaam
- College of Pharmacy, QU Health, Qatar University, Doha, 2713, Qatar
| | | | | | - Dina Abushanab
- Drug Information Department, Hamad Medical Corporation, Doha, 3050, Qatar
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, 3052, Australia
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11
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Makarevičius G, Rinkūnienė E, Badarienė J. National Trends in Statin Use in Lithuania from 2010 to 2021. Medicina (B Aires) 2022; 59:medicina59010037. [PMID: 36676661 PMCID: PMC9864999 DOI: 10.3390/medicina59010037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 11/28/2022] [Accepted: 12/17/2022] [Indexed: 12/28/2022] Open
Abstract
Objective: In Lithuania, no comprehensive national research on statin utilization and trends has yet been undertaken. Nonetheless, this knowledge is critical for the healthcare system to identify key areas for development. We aimed to analyze trends in statin utilization in Lithuania from the past 12 years considering changes in reimbursement policies and the publication of updated international CVD prevention guidelines. Methods: We performed a retrospective, descriptive study of statin utilization in Lithuania from 2010 to 2021. The data were obtained from PharmaZOOM LT, an independent software supplier with nationwide coverage on pharmaceutical market data. The data coverage was 95%. We used anatomical therapeutic chemical (ATC) classification for data extraction and calculated defined daily doses (DDDs) according to the ATC/DDD Toolkit of World Health Organization according to statin dose in a pill. Results: Statin use increased overall from 8.28 DDD/TID in 2010 to 96.06 DDD/TID in 2021. The annual growth rate in sales of statin DDD/TID was 22.28%. The increase was mostly due to the increase in moderate- and high-intensity statins. The increases coincided with changes in reimbursement policy or the publication of international guidelines. Polypill use in Lithuania began steadily increasing after 2016 and reached 19.37% of the total DDD/TID of statins in 2021. Conclusions: The use of statins has increased dramatically in Lithuania over the last decade. Changes in statin reimbursement regulations in the country, as well as worldwide cardiovascular preventive recommendations aiming at lower LDL-C objectives, fueled the progress.
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Affiliation(s)
- Gytis Makarevičius
- Centre for Neurology, Vilnius University, LT-03101 Vilnius, Lithuania
- Correspondence: (G.M.); (J.B.)
| | - Egidija Rinkūnienė
- Clinic of Cardiac and Vascular Diseases, Medical Faculty, Vilnius University, LT-03101 Vilnius, Lithuania
| | - Jolita Badarienė
- Clinic of Cardiac and Vascular Diseases, Medical Faculty, Vilnius University, LT-03101 Vilnius, Lithuania
- Correspondence: (G.M.); (J.B.)
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12
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Kakavand H, Aghakouchakzadeh M, Shahi A, Virani SS, Dixon DL, Van Tassell BW, Talasaz AH. A stepwise approach to prescribing novel lipid-lowering medications. J Clin Lipidol 2022; 16:822-832. [DOI: 10.1016/j.jacl.2022.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 10/05/2022] [Indexed: 11/05/2022]
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13
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Kadappu P, Jonnagaddala J, Liaw ST, Cochran BJ, Rye KA, Ong KL. Statin Prescription Patterns and Associations with Subclinical Inflammation. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58081096. [PMID: 36013563 PMCID: PMC9414401 DOI: 10.3390/medicina58081096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 08/04/2022] [Accepted: 08/11/2022] [Indexed: 11/30/2022]
Abstract
Background and Objectives: Statins have been extensively utilised in atherosclerotic cardiovascular disease (ASCVD) prevention and can inhibit inflammation. However, the association between statin therapy, subclinical inflammation and associated health outcomes is poorly understood in the primary care setting. Materials and Methods: Primary care electronic health record (EHR) data from the electronic Practice-Based Research Network (ePBRN) from 2012−2019 was used to assess statin usage and adherence in South-Western Sydney (SWS), Australia. Independent determinants of elevated C-reactive protein (CRP) were determined. The relationship between baseline CRP levels and hospitalisation rates at 12 months was investigated. Results: The prevalence of lipid-lowering medications was 14.0% in all adults and 44.6% in the elderly (≥65 years). The prevalence increased from 2012 to 2019 despite a drop in statin use between 2013−2015. A total of 55% of individuals had good adherence (>80%). Hydrophilic statin use and higher intensity statin therapy were associated with elevated CRP levels. However, elevated CRP levels were not associated with all-cause or ASCVD hospitalisations after adjusting for confounders. Conclusions: The prevalence and adherence patterns associated with lipid-lowering medications highlighted the elevated ASCVD-related burden in the SWS population, especially when compared with the Australian general population. Patients in SWS may benefit from enhanced screening protocols, targeted health literacy and promotion campaigns, and timely incorporation of evidence into ASCVD clinical guidelines. This study, which used EHR data, did not support the use of CRP as an independent marker of future short-term hospitalisations.
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Affiliation(s)
- Preetham Kadappu
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Jitendra Jonnagaddala
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Siaw-Teng Liaw
- School of Population Health, University of New South Wales, Sydney, NSW 2052, Australia
| | - Blake J. Cochran
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Kerry-Anne Rye
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
| | - Kwok Leung Ong
- School of Medical Sciences, University of New South Wales, Sydney, NSW 2052, Australia
- Correspondence: ; Tel.: +61-2-9385-2156
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Efficacy of Rosuvastatin Combined with rt-PA Intravenous Thrombolytic Therapy for Elderly Acute Ischemic Stroke Patients. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:9403693. [PMID: 35756414 PMCID: PMC9217586 DOI: 10.1155/2022/9403693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/07/2022] [Accepted: 05/23/2022] [Indexed: 11/17/2022]
Abstract
Background Acute ischemic stroke (AIS) is a fatal and disabling disease. Given the unsatisfactory results by current treatment strategies, optimizing the treatment of AIS is still an urgent problem to be solved. Objective To determine the therapeutic efficacy of rosuvastatin (ROS) combined with thrombolytic therapy using recombinant tissue plasminogen activator (rt-PA) on senile AIS patients and analyze its effects on serum inflammatory responses and neurological function. Methods A retrospective study was conducted on 150 senile AIS patients who visited the Longmen County People's Hospital between January 2019 and June 2021. Of them, 100 cases treated by ROS combined with rt-PA intravenous thrombolytic therapy (ivTT) were set as the observation group and the rest 50 cases receiving rt-PA alone were included in the control group. Intergroup comparisons were conducted with respect to the following parameters: neurological function (National Institutes of Health Stroke Scale, NIHSS; Scandinavian Stroke Scale, SSS), serum neuron-specific enolase (NSE) and high-sensitivity C-reactive protein (hs-CRP), therapeutic efficacy, incidence of adverse reactions, and patient satisfaction. Results The observation group had lower NIHSS and SSS scores and serum NSE and hs-CRP than the control group. In addition, the observation group was found with a higher overall response rate, higher patient satisfaction, and fewer adverse reactions. Conclusion ROS combined with rt-PA ivTT can better enhance the therapeutic efficacy of elderly patients with AIS, improve their neurological function, and reduce serum inflammatory responses.
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Vitiello A, Ferrara F. Plausible Positive Effects of Statins in COVID-19 Patient. Cardiovasc Toxicol 2021; 21:781-789. [PMID: 34255300 PMCID: PMC8275916 DOI: 10.1007/s12012-021-09674-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 07/07/2021] [Indexed: 01/08/2023]
Abstract
Since the onset of the global COVID-19 pandemic, there has been much discussion about the advantages and disadvantages of ongoing chronic drug therapies in SARS-CoV-2-positive patients. These discussions include also statins treatment. The statins are among the most widely used drugs in the global population. Statins aim to lower cholesterol, which is essential for many biological processes but can lead to heart disease if levels are too high; however, also the pleiotropic effects of statins are well known. So could the anti-inflammatory or the potential antiviral effects of statins be helpful in avoiding extreme inflammation and severity in COVID-19? To date, there are conflicting opinions on the effects of statins in the course of COVID-19 infection. The aim of this article is to describe the molecular and pharmacological basis of the pleiotropic effects of statins that could be more involved in the fight against COVID-19 infection and to investigate the current epidemiological evidence in the literature on the current and important topic.
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Affiliation(s)
- Antonio Vitiello
- Clinical Pharmacologist, Pharmaceutical Department, Usl Umbria 1, A.Migliorati street, 06132, Perugia, Italy
| | - Francesco Ferrara
- Hospital Pharmacist Manager, Pharmaceutical Department, Usl Umbria 1, A.Migliorati street, 06132, Perugia, Italy.
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Xu M, Demuyakor A, Hu S, Liu H, Zhao C, Chen T, Qin Y, Xu Y, Feng X, Zeng M, Weng Z, Gao Z, Hou J, Jia H, Zhang S, Yu B. Is the effect of atorvastatin 60 mg on stabilization of lipid-rich plaque equivalent to that of rosuvastatin 10 mg? A serial optical coherence tomography combined with intravascular ultrasound imaging. Catheter Cardiovasc Interv 2021; 97 Suppl 2:1097-1107. [PMID: 33864710 DOI: 10.1002/ccd.29654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 03/14/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES This study aimed to compare the effect of atorvastatin 60 (AT60) mg to that of rosuvastatin 10 (RT10) mg on the morphological changes in lipid-rich plaques (LRPs) and plaque volume, using serial optical coherence tomography (OCT) and intravascular ultrasound imaging (IVUS). BACKGROUND Intensive lipid lowering therapy by statin provides more clinical benefit compared to that of moderate lipid lowering therapy. METHODS Fifty patients who underwent OCT and IVUS at baseline, 6, and 12 months were grouped by statin therapy into the AT60 mg (n = 27) and RT10 mg (n = 23) groups. The relationships between absolute and percentage changes in biomarkers and fibrous cap thickness (FCT) during follow-up were investigated using a simple regression analysis. RESULTS At 6 months, the mean low-density lipoprotein cholesterol level reduced from 113.5 to 65.5 mg/dl (AT60 mg group) and 100.2 to 72.2 mg/dl (RT10 mg groups). A continuous increase in FCT from baseline to 12 months was observed in both groups (p < .001, p < .001, respectively). Mean lipid arc significantly decreased in both AT60 mg (189.0 ± 55.9°, 170.9 ± 60.2°, 155.6 ± 50.6°, p < .001) and RT10 mg (160.0 ± 45.6°, 151.2 ± 48.5°, 141.1 ± 52.9°, p = .010) groups. Plaque burden did not change significantly in both groups. CONCLUSIONS Lipid-lowering therapy effect with AT60 mg was equivalent to that of RT10 mg in terms of change in plaque morphology. AT60 mg showed more intensive low-density lipid cholesterol level reduction compared to RT10 mg while RT10 mg was effective in increasing the high-density lipid cholesterol level. Both statin therapies could effectively stabilize LRPs.
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Affiliation(s)
- Maoen Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Abigail Demuyakor
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Sining Hu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Huimin Liu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Chen Zhao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Tao Chen
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yuhan Qin
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Yishuo Xu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Xue Feng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ming Zeng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Ziqian Weng
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Zhanqun Gao
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Jingbo Hou
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Haibo Jia
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Shuo Zhang
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
| | - Bo Yu
- Department of Cardiology, The Second Affiliated Hospital of Harbin Medical University, The Key Laboratory of Myocardial Ischemia, Chinese Ministry of Education, Harbin, China
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Kumar B, Shah MAA, Kumar R, Kumar J, Memon A. Comparison of Atorvastatin and Rosuvastatin in Reduction of Inflammatory Biomarkers in Patients with Acute Coronary Syndrome. Cureus 2019; 11:e4898. [PMID: 31423377 PMCID: PMC6689481 DOI: 10.7759/cureus.4898] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Introduction High-sensitivity C-reactive protein (hs-CRP) has emerged to be a very useful and reliable clinical marker of primary as well as secondary cardiovascular morbidity and mortality. Elevated hs-CRP contributes to underlying atherogenesis and worsens disease prognosis. Along with their lipid-lowering properties, statins also contribute to the alleviation of micro-inflammation and reduces pro-inflammatory markers. The aim of this study is to compare the effects of rosuvastatin and atorvastatin in lowering hs-CRP levels in statin-naive patients admitted with acute coronary syndrome (ACS). Methods In this prospective, open-label randomized trial, group A was given rosuvastatin 40 mg daily and group B was given atorvastatin 20 mg daily along with standard post-ACS therapy. Lipid profile (mg/dL), hs-CRP (mg/L) and erythrocyte sedimentation rate (ESR) (mm/Hr) were recorded and measured as the baseline (before starting therapy) and then again after four weeks. The data were analyzed using SPSS for Windows version 22.0 (IBM Corp., Armonk, NY). Results With four weeks of treatment, both group A and B showed statistically significant reduction in serum hs-CRP levels (p<0.0001). In group A, there was a mean 51% decrease in hs-CRP levels, and in group B, a 35% reduction was seen. Group A showed markedly low hs-CRP levels than group B after four weeks of therapy (18.46 ± 6.35 vs. 24.67 ± 8.45) (p<0.0001). Group A showed mean 16% decrease in ESR levels as compared to 14% decrease in group B. Group A showed lower ESR levels than group B after four weeks of therapy (19.59 ± 11.83 vs. 20.52 ± 12.13) (p<0.0001). Conclusion Rosuvastatin showed a 50% decrease and atorvastatin showed a 35% reduction in serum hs-CRP levels in statin-naive ACS patients. Rosuvastatin has a more effective role in reducing micro-inflammation in ACS patients.
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Affiliation(s)
- Besham Kumar
- Internal Medicine, Jinnah Postgraduate Medical Center, Karachi, PAK
| | | | - Rajesh Kumar
- Internal Medicine, Liaquat University of Medical and Health Sciences, Hyderabad, PAK
| | - Jai Kumar
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
| | - Aurangzeb Memon
- Internal Medicine, Liaquat University of Medical and Health Sciences, Jamshoro, PAK
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