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Muck MA, Fischer M, Hamerle M, Strack C, Holzhaeuer M, Pfeffer D, Hubauer U, Maier LS, Baessler A. Sex specific analysis of patients with and without reported statin intolerance referred to a specialized outpatient lipid clinic. Biol Sex Differ 2024; 15:67. [PMID: 39223591 PMCID: PMC11367976 DOI: 10.1186/s13293-024-00642-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2024] [Accepted: 08/19/2024] [Indexed: 09/04/2024] Open
Abstract
BACKGROUND Lowering LDL-cholesterol is a fundamental goal for both primary and secondary prevention of atherosclerotic cardiovascular diseases. Our study aims to analyse potential sex disparities regarding the tolerability and effectiveness of lipid-lowering therapy in patients with and without reported statin intolerance who are being treated at a lipid-outpatient clinic. METHODS From 2017 to 2022, n = 1062 patients (n = 612 men, n = 450 women) at high-risk were referred to our lipid-outpatient clinic because of difficulties in lipid control by primary healthcare providers. The main therapeutic objective was to optimize lipid-lowering therapy according to current treatment guidelines. RESULTS Patients presented with high LDL-C baseline levels (4.97 ± 1.81 mmol/l (192 ± 70 mg/dL) in men and 5.46 ± 2.04 mmol/l (211 ± 79 mg/dL) in women). Intolerance towards statins was reported more frequently by women (48.2%) than by men (38.9%, p = 0.004). LDL-C continuously decreased with individual treatment adjustments across follow-up visits. In total, treatment goals (LDL < 1.4 mmol/l (< 55 mg/dl) or < 1.8 mmol/l (< 70 mg/dl)) were accomplished in 75.8% of men and 55.5% of women after the last follow-up visit (p < 0.0001). In men, these data are almost identical in subjects with statin intolerance. In contrast, treatment goals were reached less frequently in women with statin intolerance compared to women tolerant to statin therapy. CONCLUSION Even if treated in a specialized lipid clinic, women are less likely to reach their target LDL-C than men, particularly when statin intolerant. Nevertheless, many patients with statin intolerance can be successfully treated using oral combination and PCSK9 inhibitor therapy. However, ongoing follow-up care to monitor progress and to adjust treatment plans is necessary to reach this goal.
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Affiliation(s)
- Maximilian A Muck
- Klinik und Poliklinik für Innere Medizin 2, University of Regensburg, Regensburg, Germany
| | - Marcus Fischer
- Klinik und Poliklinik für Innere Medizin 2, University of Regensburg, Regensburg, Germany
- Caritas Krankenhaus St. Lukas, Kelheim, 93309, Germany
| | - Michael Hamerle
- Klinik und Poliklinik für Innere Medizin 2, University of Regensburg, Regensburg, Germany
| | - Christina Strack
- Klinik und Poliklinik für Innere Medizin 2, University of Regensburg, Regensburg, Germany
| | - Maxime Holzhaeuer
- Klinik und Poliklinik für Innere Medizin 2, University of Regensburg, Regensburg, Germany
| | - Dennis Pfeffer
- Klinik und Poliklinik für Innere Medizin 2, University of Regensburg, Regensburg, Germany
| | - Ute Hubauer
- Klinik und Poliklinik für Innere Medizin 2, University of Regensburg, Regensburg, Germany
| | - Lars S Maier
- Klinik und Poliklinik für Innere Medizin 2, University of Regensburg, Regensburg, Germany
| | - Andrea Baessler
- Klinik und Poliklinik für Innere Medizin 2, University of Regensburg, Regensburg, Germany.
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Wei C, Yin W, He Z, Wu B. Reporting of Drug-Induced Myopathies Associated with the Combination of Statins and Daptomycin: A Disproportionality Analysis Using the US Food and Drug Administration Adverse Event Reporting System. J Clin Med 2023; 12:jcm12103548. [PMID: 37240654 DOI: 10.3390/jcm12103548] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 05/10/2023] [Accepted: 05/16/2023] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND Myopathy is one of the most common adverse reactions of daptomycin and statins. We aimed to evaluate the muscular toxicity of the combination therapy of daptomycin and statins in a large pharmacovigilance database. METHODS This was a retrospective disproportionality analysis based on real-world data. All cases reported between the first quarter of 2004 and the fourth quarter of 2022 where daptomycin and statins were reported were gathered from the US Food and Drug Administration Adverse Event Reporting System (FAERS) database. Disproportionality analyses were conducted by estimating the proportional reporting ratios (PRRs), reporting odds ratio (ROR), and information component (IC). RESULTS A total of 971,861 eligible cases were collected from the FAERS database. Data analysis showed that rosuvastatin (ROR: 124.39, 95% CI: 87.35-178.47), atorvastatin (ROR: 68.53, 95% CI: 51.93-90.43), and simvastatin (ROR: 94.83, 95% CI: 71.12-126.46) combined with daptomycin increased the reporting frequency of myopathy. Moreover, myopathy was reported more frequently with the 3-drug combination (ROR: 598.01, 95% CI: 231.81-1542.71). For rhabdomyolysis, the frequency of reports also increased when daptomycin was combined with rosuvastatin (ROR: 156.34, 95% CI: 96.21-254.05), simvastatin (ROR: 72.65, 95% CI: 47.36-111.44), and atorvastatin (ROR: 66.31, 95% CI: 44.06-99.81). CONCLUSIONS The combination of daptomycin and statins increased the association of myopathy and rhabdomyolysis, especially with rosuvastatin, simvastatin, and atorvastatin.
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Affiliation(s)
- Chunyan Wei
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Wanhong Yin
- Department of Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Clinical Medical College, Sichuan University, Chengdu 610041, China
| | - Zhiyao He
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Bin Wu
- Department of Pharmacy, West China Hospital, Sichuan University, Chengdu 610041, China
- West China School of Pharmacy, Sichuan University, Chengdu 610041, China
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Vinciguerra C, Iacono S, Bevilacqua L, Landolfi A, Piscosquito G, Ginanneschi F, Schirò G, Di Stefano V, Brighina F, Barone P, Balistreri CR. Sex differences in neuromuscular disorders. Mech Ageing Dev 2023; 211:111793. [PMID: 36806604 DOI: 10.1016/j.mad.2023.111793] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/19/2023]
Abstract
The prevalence, onset, pathophysiology, and clinical course of many neuromuscular disorders (NMDs) may significantly differ between males and females. Some NMDs are more frequently observed in females, and characterized to show a higher grade of severity during or after the pregnancy. Meanwhile, others tend to have an earlier onset in males and exhibit a more variable progression. Prevalently, sex differences in NMDs have a familiar character given from genetic inheritance. However, they may also influence clinical presentation and disease severity of acquired NMD forms, and are represented by both hormonal and genetic factors. Consequently, to shed light on the distinctive role of biological factors in the different clinical phenotypes, we summarize in this review the sex related differences and their distinctive biological roles emerging from the current literature in both acquired and inherited NMDs.
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Affiliation(s)
- Claudia Vinciguerra
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy.
| | - Salvatore Iacono
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Liliana Bevilacqua
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Annamaria Landolfi
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Giuseppe Piscosquito
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Federica Ginanneschi
- Department of Medical, Surgical and Neurological Sciences, University of Siena, 53100 Siena, Italy
| | - Giuseppe Schirò
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Vincenzo Di Stefano
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Filippo Brighina
- Neurology Unit, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90127 Palermo, Italy
| | - Paolo Barone
- Neurology Unit, Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84131 Salerno, Italy
| | - Carmela Rita Balistreri
- Cellular and Molecular Laboratory, Department of Biomedicine, Neuroscience and Advanced Diagnostics (Bi.N.D.), University of Palermo, 90134 Palermo
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Marcellaud E, Jost J, Tchalla A, Magne J, Aboyans V. Statins in Primary Prevention in People Over 80 Years. Am J Cardiol 2023; 187:62-73. [PMID: 36459749 DOI: 10.1016/j.amjcard.2022.10.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2022] [Revised: 09/24/2022] [Accepted: 10/06/2022] [Indexed: 11/30/2022]
Abstract
In the much older population (≥80 years), the management of cardiovascular diseases requires specific research to avoid a plain transposition of medical practice from younger populations. Whether statins are useful in primary prevention in this population is not clear. The 3 intricate issues requiring attention are (1) the impact of hypercholesterolemia on mortality and major adverse cardiovascular events in subjects >80 years, (2) the efficacy of statins to prevent cardiovascular events at this age, and (3) the safety and tolerance of statins in this population. Three systematic reviews were performed using a search on EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, and Web of Science databases including publication until January 2021. Among the 7,617 references identified, 29 were finally retained. Regarding the first objective (16 studies, 121,250 participants), 7 studies (10,241 participants) did not find total cholesterol and low-density lipoprotein levels associated with an increased rate of major cardiovascular events in octogenarians. A total of 6 studies (14,493 participants) found increased levels associated with events, whereas 3 studies (96,516 participants) found the opposite, with increased risk of major adverse cardiovascular events with lower levels of cholesterol. In 8 studies (436,005 participants) addressing the efficacy of statins, most did not indicate a significant decrease in the rate of major cardiovascular events in these subjects. Finally, regarding tolerance (9 studies, 217,088 participants), the most important side effects in this population were muscular, hepatic, and gastrointestinal disorders. These events were more frequent than in the younger population. In conclusion, in the absence of convincing evidence, the benefit of statins in primary prevention for much older patients is not certain. Their prescription in this setting should only be considered case by case, taking into consideration physiological status, co-morbidities, level of risk, and expected life expectancy. Specific trials are mandatory.
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Affiliation(s)
- Elodie Marcellaud
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, U1094 Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France; Unit of Clinical Pharmacy, Division of Hospital Pharmacy, Limoges Hospital Center, Limoges, France.
| | - Jeremy Jost
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, U1094 Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France; Unit of Clinical Pharmacy, Division of Hospital Pharmacy, Limoges Hospital Center, Limoges, France
| | - Achille Tchalla
- Division of Geriatrics, Limoges Hospital Center, Limoges, France; VIESANTE, UR 24134 Ageing Frailty Prevention e-Health, OmegaHealth Institute, University of Limoges, Limoges, France
| | - Julien Magne
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, U1094 Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France; Division of Cardiology, Limoges Hospital Center, Limoges, France
| | - Victor Aboyans
- Inserm U1094, IRD U270, University of Limoges, CHU Limoges, EpiMaCT - Epidemiology of Chronic Diseases in Tropical Zone, U1094 Institute of Epidemiology and Tropical Neurology, Omega Health, Limoges, France; Division of Cardiology, Limoges Hospital Center, Limoges, France
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5
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Carland C, Hansra B, Parsons C, Lyubarova R, Khandelwal A. Adequate enrollment of women in cardiovascular drug trials and the need for sex-specific assessment and reporting. AMERICAN HEART JOURNAL PLUS : CARDIOLOGY RESEARCH AND PRACTICE 2022; 17:100155. [PMID: 38559887 PMCID: PMC10978324 DOI: 10.1016/j.ahjo.2022.100155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 06/09/2022] [Accepted: 06/14/2022] [Indexed: 04/04/2024]
Abstract
Cardiovascular disease (CVD) is the leading cause of death for women in the United States and globally. There is an abundance of evidence-based trials evaluating the efficacy of drug therapies to reduce morbidity and mortality in CVD. Additionally, there are well-established influences of sex, through a variety of mechanisms, on pharmacologic treatments in CVD. Despite this, the majority of drug trials are not powered to evaluate sex-specific outcomes, and much of the data that exists is gathered post hoc and through meta-analysis. The FDA established a committee in 1993 to increase the enrollment of women in clinical trials to improve this situation. Several authors, reviewing committees, and professional societies have highlighted the importance of sex-specific analysis and reporting. Despite these statements, there has not been a major improvement in representation or reporting. There are ongoing efforts to assess trial design, female representation on steering committees, and clinical trial processes to improve the representation of women. This review will describe the pharmacologic basis for the need for sex-specific assessment of cardiovascular drug therapies. It will also review the sex-specific reporting of landmark drug trials in hypertension, coronary artery disease (CAD), hyperlipidemia, and heart failure (HF). In reporting enrollment of women, several therapeutic areas like antihypertensives and newer anticoagulation trials fare better than therapeutics for HF and acute coronary syndromes. Further, drug trials and cardiometabolic or lifestyle intervention trials had a higher percentage of female participants than the device or procedural trials.
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Affiliation(s)
- Corinne Carland
- Department of Medicine, University of Pennsylvania, United States of America
| | - Barinder Hansra
- Division of Cardiology and Department of Critical Care Medicine, UPMC, United States of America
| | - Cody Parsons
- Cardiovascular Health, Stanford Health Care, United States of America
| | - Radmila Lyubarova
- Division of Cardiology, Albany Medical College, United States of America
| | - Abha Khandelwal
- Division of Cardiology, Stanford School of Medicine, United States of America
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Abed W, Abujbara M, Batieha A, Ajlouni K. Statin Induced Myopathy Among Patients Attending the National Center for Diabetes, endocrinology, & genetics. Ann Med Surg (Lond) 2022; 74:103304. [PMID: 35145672 PMCID: PMC8818528 DOI: 10.1016/j.amsu.2022.103304] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 01/17/2022] [Accepted: 01/23/2022] [Indexed: 11/22/2022] Open
Abstract
Background and objectives myopathy is a major side effect of statins that leads to statin intolerance and discontinuation. In this prospective cohort study, the main objective was to estimate the incidence of myopathy in patients receiving statins. In addition, we identified some risk factors associated with statin induced myopathy. Methods A prospective cohort study was conducted at the National Center for Diabetes, Endocrinology and Genetics [NCDEG] in Jordan from October 1, 2018 to January 31, 2021. All subjects who initiated statin therapy followed up during that period. Data was collected at time 0 (baseline), 3, 6, 9, and 12 months after enrollment. Demographic and clinical data were collected from medical records. Muscular symptoms were collected by conducting face-to-face interviews to all patients using a pre-structured questionnaire. Results The overall incidence of myopathy among patients taking statins was 27.8%, 31.4% in males and 22.6% in females, the incidence of myopathy was higher in older people, being highest in patients ≥60 years (34%). Bivariate analyses showed no significant association between myopathy and hypothyroidism, diabetes or medications that are known to interact with statins. The incidence of myopathy was highest with Simvastatin 40 mg (50%) and lowest with Fluvastatin XL 80 mg (8%) and Rosuvastatin 10 mg (10.8%). Conclusions The overall incidence of myopathy in patients taking statins was 27.8%. Myopathy was directly related to dose and type of statin used. The use of Fluvastatin XL 80 mg and Rosuvastatin 10 mg showed less incidence of myopathy compared with other statins. Myopathy is the most common adverse effect associated with statins therapy. In this prospective cohort study, we estimated the incidence of myopathy among 400 subjects received statin therapy over 1 year follow-up. The overall incidence of myopathy among patients received statins was 27.8%. The incidence of myopathy was highest with Simvastatin 40 mg (50%) and lowest with Fluvastatin XL 80 mg (8%) and Rosuvastatin 10 mg (10.8%). The relatively high rate of statin induced myopathy in our population may point to the importance of genetic factors.
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Affiliation(s)
- Waddah Abed
- Department of Endocrinology, The National Center (Institute) for Diabetes, Endocrinology, and Genetics, The University of Jordan, Amman, Jordan
| | - Mousa Abujbara
- Department of Endocrinology, The National Center (Institute) for Diabetes, Endocrinology, and Genetics, The University of Jordan, Amman, Jordan
| | - Anwar Batieha
- Department of Public Health, Jordan University of Science and Technology (JUST), Irbid, Jordan
| | - Kamel Ajlouni
- Department of Endocrinology, The National Center (Institute) for Diabetes, Endocrinology, and Genetics, The University of Jordan, Amman, Jordan
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7
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Rønning M, Hjellvik V, Sakshaug S, Blix HS, Midtvedt K, Reisæter AV, Holdaas H, Åsberg A. Use of Statins in Kidney Transplant Recipients in Norway. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031370. [PMID: 35162389 PMCID: PMC8835204 DOI: 10.3390/ijerph19031370] [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: 11/29/2021] [Revised: 01/14/2022] [Accepted: 01/20/2022] [Indexed: 11/16/2022]
Abstract
Kidney transplant recipients (KTRs) experience increased risk of cardiovascular disease. Guidelines recommend HMG-CoA reductase inhibitor (statin) therapy when tolerated. We aimed to study changes in the prescription of statins and patients’ adherence to treatment over time. A population-based observational study utilizing linked data from the Norwegian Renal Registry (national coverage of 99.9%) and the Norwegian Prescription Database was performed. Data from a total of 2250 first KTRs were included (mean age—54 years, 69% men). Dispensed prescriptions of statins and immunosuppressants for the period 2004–2016 for all first KTRs engrafted in the period 2005–2015 were analyzed. Seventy-two percent received statins the first year after kidney transplantation and the proportion increased with age. The proportion receiving a statin varied according to the time frame of transplantation (77% in 2005–2010 vs. 66% in 2012–2015). Among new users of statins, 82% of the patients were adherent both the second and third year after kidney transplantation, while the corresponding figure for those already receiving statins before transplantation was 97%. Statin continuation rates in KTRs were high. In conclusion, our findings show a slightly lower overall proportion of patients receiving statins after kidney transplants than the national target level of 80%. The proportion of statin users increased with the age of the KTRs but showed a decreasing trend as time progressed.
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Affiliation(s)
- Marit Rønning
- Department of Drug Statistics, Norwegian Institute of Public Health, 0213 Oslo, Norway; (M.R.); (S.S.)
| | - Vidar Hjellvik
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, 0213 Oslo, Norway;
| | - Solveig Sakshaug
- Department of Drug Statistics, Norwegian Institute of Public Health, 0213 Oslo, Norway; (M.R.); (S.S.)
| | - Hege Salvesen Blix
- Department of Drug Statistics, Norwegian Institute of Public Health, 0213 Oslo, Norway; (M.R.); (S.S.)
- Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway;
- Correspondence:
| | - Karsten Midtvedt
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (K.M.); (A.V.R.); (H.H.)
| | - Anna Varberg Reisæter
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (K.M.); (A.V.R.); (H.H.)
- Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway
| | - Hallvard Holdaas
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (K.M.); (A.V.R.); (H.H.)
| | - Anders Åsberg
- Department of Pharmacy, The Faculty of Mathematics and Natural Sciences, University of Oslo, 0316 Oslo, Norway;
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway; (K.M.); (A.V.R.); (H.H.)
- Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, 0424 Oslo, Norway
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Peterson KA, Kaur G, Gianos E, Mookherjee S, Poli KA, Sidhu MS, Lyubarova R. Challenges in Optimizing Lipid Management in Women. Cardiovasc Drugs Ther 2021; 36:1197-1220. [PMID: 34661802 DOI: 10.1007/s10557-021-07273-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 11/28/2022]
Abstract
While there are physiologic differences in lipid metabolism in men and women, pharmacologic therapy is very effective in both with similar management strategies recommended in the current guidelines for the management of dyslipidemia. Despite similar guidelines for treatment, studies have shown that women have worse control of dyslipidemia than their male counterparts. This may stem from multiple contributing factors including underestimation of cardiovascular disease risk in women, decreased prescription and utilization of lipid-lowering therapies, decreased medication adherence, and higher risk of statin intolerance, all of which may contribute to lower attainment of lipid targets. Furthermore, heart disease is the leading cause of mortality in women, with heart disease noted an average of 7-10 years later than in men. This has historically led to the misperception that women are protected from heart disease and can be treated less aggressively. In fact, traditional risk factors for atherosclerotic cardiovascular disease often impact risk in women to a greater extent than they do in men. Unique risk factors such as pregnancy-related disorders also contribute to the level of risk and therefore warrant consideration in risk stratification. This review summarizes the efficacy of contemporary lipid-lowering therapies in women versus men and discusses the challenges that arise with lipid management in women along with potential ways to tackle these obstacles.
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Affiliation(s)
- Kellsey A Peterson
- Division of Cardiology, Department of Medicine, Albany Medical College and Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Gurleen Kaur
- Division of Cardiology, Department of Medicine, Albany Medical College and Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Eugenia Gianos
- Department of Cardiology, Lenox Hill Hospital, Northwell Health, New York, NY, USA
- Donald and Barbara Zucker School of Medicine, Hempstead, NY, USA
| | - Sulagna Mookherjee
- Division of Cardiology, Department of Medicine, Albany Medical College and Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Kim A Poli
- Division of Cardiology, Department of Medicine, Albany Medical College and Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Mandeep S Sidhu
- Division of Cardiology, Department of Medicine, Albany Medical College and Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA
| | - Radmila Lyubarova
- Division of Cardiology, Department of Medicine, Albany Medical College and Albany Medical Center, 47 New Scotland Ave, Albany, NY, 12208, USA.
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Zhu Y, Chiang C, Wang L, Brock G, Milks MW, Cao W, Zhang P, Zeng D, Donneyong M, Li L. A multistate transition model for statin-induced myopathy and statin discontinuation. CPT Pharmacometrics Syst Pharmacol 2021; 10:1236-1244. [PMID: 34562311 PMCID: PMC8520747 DOI: 10.1002/psp4.12691] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 05/10/2021] [Accepted: 07/07/2021] [Indexed: 12/12/2022] Open
Abstract
The overarching goal of this study was to simultaneously model the dynamic relationships among statin exposure, statin discontinuation, and potentially statin-related myopathic outcomes. We extracted data from the Indiana Network of Patient Care for 134,815 patients who received statin therapy between January 4, 2004, and December 31, 2008. All individuals began statin treatment, some discontinued statin use, and some experienced myopathy and/or rhabdomyolysis while taking the drug or after discontinuation. We developed a militate model to characterize 12 transition probabilities among six different states defined by use or discontinuation of statin and its associated myopathy or rhabdomyolysis. We found that discontinuation of statin therapy was common and frequently early, with 44.4% of patients discontinuing therapy after 1 month, and discontinuation is a strong indicator for statin-induced myopathy (risk ratio, 10.8; p < 0.05). Women more likely than men (p < 0.05) and patients aged 65 years and older had a higher risk than those aged younger than 65 years to discontinue statin use or experience myopathy. In conclusion, we introduce an innovative multistate model that allows clear depiction of the relationship between statin discontinuation and statin-induced myopathy. For the first time, we have successfully demonstrated and quantified the relative risk of myopathy between patients who continued and discontinued statin therapy. Age and sex were two strong risk factors for both statin discontinuation and incident myopathy.
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Affiliation(s)
- Yuxi Zhu
- Division of BiostatisticsCollege of Public HealthThe Ohio State UniversityColumbusOhioUSA
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Chien‐Wei Chiang
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Lei Wang
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Guy Brock
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - M. Wesley Milks
- Department of Internal MedicineCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Weidan Cao
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
| | - Pengyue Zhang
- BiostatisticsSchool of MedicineIndiana UniversityIndianapolisIndianaUSA
| | - Donglin Zeng
- Department of BiostatisticsUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
| | - Macarius Donneyong
- Division of Pharmacy Practice and ScienceCollege of PharmacyThe Ohio State UniversityColumbusOhioUSA
| | - Lang Li
- Department of Biomedical InformaticsCollege of MedicineThe Ohio State UniversityColumbusOhioUSA
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Mueller AM, Liakoni E, Schneider C, Burkard T, Jick SS, Krähenbühl S, Meier CR, Spoendlin J. The Risk of Muscular Events Among New Users of Hydrophilic and Lipophilic Statins: an Observational Cohort Study. J Gen Intern Med 2021; 36:2639-2647. [PMID: 33751411 PMCID: PMC8390626 DOI: 10.1007/s11606-021-06651-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Accepted: 02/02/2021] [Indexed: 12/21/2022]
Abstract
BACKGROUND Statins are effective lipid-lowering drugs for the prevention of cardiovascular disease, but muscular adverse events can limit their use. Hydrophilic statins (pravastatin, rosuvastatin) may cause less muscular events than lipophilic statins (e.g. simvastatin, atorvastatin) due to lower passive diffusion into muscle cells. OBJECTIVE To compare the risk of muscular events between statins at comparable lipid-lowering doses and to evaluate if hydrophilic statins are associated with a lower muscular risk than lipophilic statins. DESIGN/SETTING Propensity score-matched cohort study using data from the United Kingdom-based Clinical Practice Research Datalink (CPRD) GOLD. PATIENTS New statin users. Cohort 1: pravastatin 20-40 mg (hydrophilic) vs simvastatin 10-20 mg (lipophilic), cohort 2: rosuvastatin 5-40 mg (hydrophilic) vs atorvastatin 10-80 mg (lipophilic), and cohort 3: simvastatin 40-80 mg vs atorvastatin 10-20 mg. MAIN MEASURES The outcome was a first record of a muscular event (myopathy, myalgia, myositis, rhabdomyolysis) during a maximum follow-up of 1 year. KEY RESULTS The propensity score-matched cohorts consisted of 1) 9,703, 2) 7,032, and 3) 37,743 pairs of statin users. Comparing the risk of muscular events between low-intensity pravastatin vs low-intensity simvastatin yielded a HR of 0.86 (95% CI 0.64-1.16). In the comparison of moderate- to high-intensity rosuvastatin vs equivalent doses of atorvastatin, we observed a HR of 1.17 (95% CI 0.88-1.56). Moderate- to high-intensity simvastatin was associated with a HR of 1.33 (95% CI 1.16-1.53), when compared with atorvastatin at equivalent doses. LIMITATIONS We could not conduct other pairwise comparisons of statins due to small sample size. In the absence of a uniform definition on the comparability of statin doses, the applied dose ratios may not fully match with all literature sources. CONCLUSIONS Our results do not suggest a systematically lower risk of muscular events for hydrophilic statins when compared to lipophilic statins at comparable lipid-lowering doses.
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Affiliation(s)
- Alexandra M Mueller
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Evangelia Liakoni
- Clinical Pharmacology and Toxicology, Department of General Internal Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Cornelia Schneider
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Theresa Burkard
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
| | - Susan S Jick
- Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.,Boston University School of Public Health, Boston, MA, USA
| | - Stephan Krähenbühl
- Division of Clinical Pharmacology and Toxicology, University Hospital Basel, Basel, Switzerland.,Department of Biomedicine, University of Basel, Basel, Switzerland
| | - Christoph R Meier
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland. .,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland. .,Boston Collaborative Drug Surveillance Program, Lexington, MA, USA.
| | - Julia Spoendlin
- Basel Pharmacoepidemiology Unit, Division of Clinical Pharmacy and Epidemiology, Department of Pharmaceutical Sciences, University of Basel, Basel, Switzerland.,Hospital Pharmacy, University Hospital Basel, Basel, Switzerland
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Webb AJ, McManus D, Rouse GE, Vonderheyde R, Topal JE. Implications for medication dosing for transgender patients: A review of the literature and recommendations for pharmacists. Am J Health Syst Pharm 2020; 77:427-433. [PMID: 32012216 DOI: 10.1093/ajhp/zxz355] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
PURPOSE Transgender patients face considerable healthcare disparities. Improved means of recognizing transgender patients and understanding their medical needs is important to provide optimal care. The electronic medical record (EMR) of our health system allows for differentiation of gender identity, legal sex, and sex at birth. With EMR recognition of transgender patients, a recommendation for estimating creatinine clearance (CLcr) and ideal body weight (IBW) was needed to standardize medication dosing. SUMMARY The literature was reviewed for evidence on the effect of gender-affirming hormone therapy on serum creatinine concentration and lean body mass. Findings informed a recommendation for drug dosing based on CLcr and IBW in transgender patients. Four studies that reported the effect of hormone therapy on biometric laboratory values were found. Three studies reported that values of transgender patients more closely resembled the standard values of their gender identity vs sex at birth after hormone therapy; 1 study reported a range of values that more closely resembled those associated with sex at birth while still overlapping with values associated with gender identity. Consequently, it was recommended that pharmacists dose medications based on CLcr and IBW calculations consistent with gender identity after a patient has been on hormone therapy for 6 months or longer. CONCLUSION Providing optimal care to transgender patients includes considering the effect of gender-affirming hormone therapy on overall physiology. Consistently using the appropriate CLcr and IBW calculations for each patient ensures safe and effective care. Additional studies are needed to confirm the effect of hormone therapy on renal clearance and lean body mass.
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Affiliation(s)
- Andrew J Webb
- Department of Pharmacy, School of Health Sciences, Mayo Clinic, Rochester, MN
| | - Dayna McManus
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT
| | - Ginger E Rouse
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT
| | - Robyn Vonderheyde
- Information Technology Services, Yale New Haven Health System, New Haven, CT
| | - Jeffrey E Topal
- Department of Pharmacy Services, Yale New Haven Hospital, New Haven, CT.,Department of Internal Medicine, Section of Infectious Diseases, Yale School of Medicine, New Haven, CT
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12
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Nikolic D, Banach M, Chianetta R, Luzzu LM, Pantea Stoian A, Diaconu CC, Citarrella R, Montalto G, Rizzo M. An overview of statin-induced myopathy and perspectives for the future. Expert Opin Drug Saf 2020; 19:601-615. [PMID: 32233708 DOI: 10.1080/14740338.2020.1747431] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction: Statins remain the most commonly prescribed lipid-lowering drug class for the treatment of atherosclerotic cardiovascular disease. Their well-recognized side effects are known as statin-associated muscle symptom (SAMS). Some advances in this field have been made in recent years, but the understanding of the mechanisms has lagged. Investigating the specific role of the anti-HMGCR autoantibody, pharmacokinetic genetic variants, characterization of the known phenotypes of statin toxicity, in relation to clinical markers of disease, is of high importance.Areas covered: We summarized currently available findings (on PubMed) related to SAMS and discussed the therapeutic approaches, risk factors, drug interactions, potential novel systems, algorithms and biomarkers for SAMS detection. CoQ10 supplementation has been suggested as a complementary approach to manage SAMS, while vitamin D levels may be useful for both the diagnosis and management.Expert Opinion/Commentary: Further studies might help to understand the easiest way to diagnose SAMS, suitable prevention and an effective non-statin therapy. This review sheds new light on the future directions in both research and clinical practice, which will help with rapid risk assessment, identification of the SAMS risk factors in order to decrease the incidence of statins' adverse effects, and the most effective therapy.
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Affiliation(s)
- Dragana Nikolic
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,BELSS, Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Maciej Banach
- Department of Hypertension, Medical University of Lodz, Lodz, Poland
| | - Roberta Chianetta
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy.,BELSS, Euro-Mediterranean Institute of Science and Technology (IEMEST), Palermo, Italy
| | - Luca Marco Luzzu
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Anca Pantea Stoian
- Department of Diabetes, Nutrition and Metabolic Diseases, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Camelia Cristina Diaconu
- Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, Bucharest, Romania.,Department of Internal Medicine, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | - Roberto Citarrella
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Giuseppe Montalto
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
| | - Manfredi Rizzo
- Department of Health Promotion Sciences Maternal and Infantile Care, Internal Medicine and Medical Specialties (PROMISE), University of Palermo, Palermo, Italy
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Abstract
OBJECTIVE Statins are a class of drugs that competitively bind to the active site of HMG-CoA reductase enzyme, thereby inhibiting the initial steps in cholesterol synthesis. Originally approved for use in lowering serum cholesterol, a risk factor for developing atherosclerosis and coronary heart disease, statins have subsequently been noted to have myriad extrahepatic effects, including potential effects on cognition, diabetes, breast cancer, bone, and muscle. This narrative review assesses the current state of the science regarding the risks and benefits of statin therapy in women to identify areas where additional research is needed. METHODS Basic and clinical studies were identified by searching PubMed with particular attention to inclusion of female animals, women, randomized controlled trials, and sex-specific analyses. RESULTS Statin therapy is generally recommended to reduce the risk of cardiovascular disease. None of the current clinical guidelines, however, offer sex-specific recommendations for women due to lack of understanding of sex differences and underlying mechanisms of disease processes. In addition, conclusions regarding efficacy of treatments do not consider lipid solubility for the drug, dosing, duration of treatment, interactions with estrogen, or comorbidities. Pleiotropic effects of statins are often derived from secondary analysis of studies with cardiovascular events as primary outcomes. CONCLUSIONS Many of the trials that have established the efficacy and safety of statins were conducted predominantly or entirely in men, with results extrapolated to women. Additional research is needed to guide clinical recommendations specific to women. : Video Summary:http://links.lww.com/MENO/A462.
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Affiliation(s)
- Stephanie S. Faubion
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
| | - Ekta Kapoor
- Center for Women’s Health, Mayo Clinic, Rochester, MN
- Division of General Internal Medicine, Mayo Clinic, Rochester, MN
- Division of Endocrinology, Diabetes, Metabolism and Nutrition, Mayo Clinic, Rochester, MN
| | - Ann M. Moyer
- Department of Pathology and Laboratory Medicine, Mayo Clinic, Rochester, MN
| | - Howard N. Hodis
- Atherosclerosis Research Unit, Departments of Medicine and Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Virginia M. Miller
- Departments of Surgery and Physiology & Biomedical Engineering, Women’s Health Research Center, Mayo Clinic, Rochester, MN
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Bergström H, Brånvall E, Helde-Frankling M, Björkhem-Bergman L. Differences in discontinuation of statin treatment in women and men with advanced cancer disease. Biol Sex Differ 2018; 9:47. [PMID: 30342545 PMCID: PMC6196002 DOI: 10.1186/s13293-018-0207-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 10/11/2018] [Indexed: 11/30/2022] Open
Abstract
Background Statins are often discontinued in patients with advanced cancer since the net effect of treatment is considered negative. However, guidelines concerning discontinuation of statin treatment are lacking. The aim of this study was to investigate any differences in time of discontinuation of statin treatment between men and women with advanced cancer disease. Methods Medical records from 195 deceased palliative cancer patients from a previous study cohort were reviewed. Patients treated with statins 2 years before death were identified as “statin users.” The time of discontinuation of statin therapy was identified and correlated to time of death. Only patients that had incurable cancer disease at time of statin discontinuation were included in the analysis. Results Fifty-four patients were identified as statin users, 29 women and 25 men. The average time span between discontinuation of statin treatment and time of death was significantly longer in women than in men, 10 months compared to 4 months (p < 0.01), with a range of 1–24 months among women and 1–12 months for men. All patients died due to their cancer disease. More men than women had a history of stroke or cardiac infarction (p = 0.02). There were no differences in age, socioeconomic factors, or survival time from study inclusion between men and women. There was no difference in self-assessed quality of life (QoL) between statin users who had discontinued statin treatment and those who are still on treatment. Men generally assessed their QoL lower than women in this study (p = 0.03). Conclusion Statin treatment was discontinued earlier in women than in men in patients with advanced cancer. The data suggest that statins may be discontinued earlier in men as well, since earlier discontinuation did not affect cardiovascular mortality.
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Affiliation(s)
- Helena Bergström
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo floor 7, SE-141 83, Huddinge, Sweden
| | - Elsa Brånvall
- Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Bergtallsvägen 12, SE-125 59, Älvsjö, Sweden.,Division of Clinical Epidemiology, Department of Medicine Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden
| | - Maria Helde-Frankling
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo floor 7, SE-141 83, Huddinge, Sweden.,Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Bergtallsvägen 12, SE-125 59, Älvsjö, Sweden
| | - Linda Björkhem-Bergman
- Department of Neurobiology, Care Sciences and Society (NVS), Division of Clinical Geriatrics, Karolinska Institutet, Blickagången 16, Neo floor 7, SE-141 83, Huddinge, Sweden. .,Palliative Home Care and Hospice Ward, ASIH Stockholm Södra, Bergtallsvägen 12, SE-125 59, Älvsjö, Sweden.
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15
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Irwin JC, Khalesi S, Fenning AS, Vella RK. The effect of lipophilicity and dose on the frequency of statin-associated muscle symptoms: A systematic review and meta-analysis. Pharmacol Res 2018; 128:264-273. [DOI: 10.1016/j.phrs.2017.09.013] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 09/19/2017] [Accepted: 09/20/2017] [Indexed: 10/18/2022]
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