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Mansfield BS, Mohamed F, Larouche M, Raal FJ. The Hurdle of Access to Emerging Therapies and Potential Solutions in the Management of Dyslipidemias. J Clin Med 2024; 13:4160. [PMID: 39064199 PMCID: PMC11277596 DOI: 10.3390/jcm13144160] [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: 06/12/2024] [Revised: 07/04/2024] [Accepted: 07/09/2024] [Indexed: 07/28/2024] Open
Abstract
This review explores the many barriers to accessing lipid-lowering therapies (LLTs) for the prevention and management of atherosclerotic cardiovascular disease (ASCVD). Geographical, knowledge, and regulatory barriers significantly impede access to LLTs, exacerbating disparities in healthcare infrastructure and affordability. We highlight the importance of policy reforms, including pricing regulations and reimbursement policies, for enhancing affordability and streamlining regulatory processes. Innovative funding models, such as value-based pricing and outcome-based payment arrangements, have been recommended to make novel LLTs more accessible. Public health interventions, including community-based programs and telemedicine, can be utilized to reach underserved populations and improve medication adherence. Education and advocacy initiatives led by patient advocacy groups and healthcare providers play a crucial role in raising awareness and empowering patients. Despite the barriers to access, novel LLTs present a big opportunity to reduce the burden of ASCVD, emphasizing the need for collaborative efforts among policymakers, healthcare providers, industry stakeholders, and patient advocacy groups to address these barriers to improve access to LLTs globally.
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Affiliation(s)
- Brett S. Mansfield
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Farzahna Mohamed
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
| | - Miriam Larouche
- Département de Médecine, Université de Montréal and ECOGENE-21, Montreal, QC H3T 1J4, Canada;
| | - Frederick J. Raal
- Department of Internal Medicine, University of the Witwatersrand, Johannesburg 2193, South Africa; (B.S.M.); (F.M.)
- Carbohydrate & Lipid Metabolism Research Unit, University of the Witwatersrand, Johannesburg 2193, South Africa
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2
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Pedro-Botet J, Climent E, Benaiges D, Llauradó G. [When to treat hypercholesterolaemia]. Med Clin (Barc) 2024; 162:238-243. [PMID: 37925276 DOI: 10.1016/j.medcli.2023.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/31/2023] [Accepted: 09/04/2023] [Indexed: 11/06/2023]
Affiliation(s)
- Juan Pedro-Botet
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España.
| | - Elisenda Climent
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Barcelona, España; Universidad Autónoma de Barcelona, Barcelona, España
| | - David Benaiges
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Barcelona, España; Departamento MELIS, Universidad Pompeu Fabra, Barcelona, España
| | - Gemma Llauradó
- Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Barcelona, España; Departamento MELIS, Universidad Pompeu Fabra, Barcelona, España
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Kohli-Lynch C, Thanassoulis G, Pencina M, Sehayek D, Pencina K, Moran A, Sniderman AD. The Causal-Benefit Model to Prevent Cardiovascular Events. JACC. ADVANCES 2024; 3:100825. [PMID: 38938840 PMCID: PMC11198721 DOI: 10.1016/j.jacadv.2023.100825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 11/02/2023] [Accepted: 11/28/2023] [Indexed: 06/29/2024]
Abstract
Selecting individuals for preventive lipid-lowering therapy is presently governed by the 10-year risk model. Once a prespecified level of cardiovascular disease risk is equaled or exceeded, individuals become eligible for preventive lipid-lowering therapy. A key limitation of this model is that only a small minority of individuals below the age of 65 years are eligible for therapy. However, just under one-half of all cardiovascular disease events occur below this age. Additionally, in many, the disease that caused their events after 65 years of age developed and progressed before 65 years of age. The causal-benefit model of prevention identifies individuals based both on their risk and the estimated benefit from lowering atherogenic apoB lipoprotein levels. Adopting the causal-benefit model would increase the number of younger subjects eligible for preventive treatment, would increase the total number of cardiovascular disease events prevented at virtually the same number to treat, and would be cost-effective.
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Affiliation(s)
- Ciaran Kohli-Lynch
- Department of Preventive Medicine, Northwestern University, Chicago, Illinois, USA
| | - George Thanassoulis
- Department of Medicine, Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, McGill University Health Centre, Montreal, Quebec, Canada
| | - Michael Pencina
- Department of Medicine, Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, McGill University Health Centre, Montreal, Quebec, Canada
- Department of Biostatistics and Bioinformatics, Duke University School of Medicine, DCRI, Durham, North Carolina, USA
| | - Daniel Sehayek
- Department of Medicine, Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, McGill University Health Centre, Montreal, Quebec, Canada
| | - Karol Pencina
- Department of Medicine, Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, McGill University Health Centre, Montreal, Quebec, Canada
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Andrew Moran
- Division of General Medicine, Columbia University Medical Center, New York, New York, USA
| | - Allan D. Sniderman
- Department of Medicine, Mike and Valeria Rosenbloom Centre for Cardiovascular Prevention, McGill University Health Centre, Montreal, Quebec, Canada
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Zhang Y, Dron JS, Bellows BK, Khera AV, Liu J, Balte PP, Oelsner EC, Amr SS, Lebo MS, Nagy A, Peloso GM, Natarajan P, Rotter JI, Willer C, Boerwinkle E, Ballantyne CM, Lutsey PL, Fornage M, Lloyd-Jones DM, Hou L, Psaty BM, Bis JC, Floyd JS, Vasan RS, Heard-Costa NL, Carson AP, Hall ME, Rich SS, Guo X, Kazi DS, de Ferranti SD, Moran AE. Familial Hypercholesterolemia Variant and Cardiovascular Risk in Individuals With Elevated Cholesterol. JAMA Cardiol 2024; 9:263-271. [PMID: 38294787 PMCID: PMC10831623 DOI: 10.1001/jamacardio.2023.5366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 11/22/2023] [Indexed: 02/01/2024]
Abstract
Importance Familial hypercholesterolemia (FH) is a genetic disorder that often results in severely high low-density lipoprotein cholesterol (LDL-C) and high risk of premature coronary heart disease (CHD). However, the impact of FH variants on CHD risk among individuals with moderately elevated LDL-C is not well quantified. Objective To assess CHD risk associated with FH variants among individuals with moderately (130-189 mg/dL) and severely (≥190 mg/dL) elevated LDL-C and to quantify excess CHD deaths attributable to FH variants in US adults. Design, Setting, and Participants A total of 21 426 individuals without preexisting CHD from 6 US cohort studies (Atherosclerosis Risk in Communities study, Coronary Artery Risk Development in Young Adults study, Cardiovascular Health Study, Framingham Heart Study Offspring cohort, Jackson Heart Study, and Multi-Ethnic Study of Atherosclerosis) were included, 63 of whom had an FH variant. Data were collected from 1971 to 2018, and the median (IQR) follow-up was 18 (13-28) years. Data were analyzed from March to May 2023. Exposures LDL-C, cumulative past LDL-C, FH variant status. Main Outcomes and Measures Cox proportional hazards models estimated associations between FH variants and incident CHD. The Cardiovascular Disease Policy Model projected excess CHD deaths associated with FH variants in US adults. Results Of the 21 426 individuals without preexisting CHD (mean [SD] age 52.1 [15.5] years; 12 041 [56.2%] female), an FH variant was found in 22 individuals with moderately elevated LDL-C (0.3%) and in 33 individuals with severely elevated LDL-C (2.5%). The adjusted hazard ratios for incident CHD comparing those with and without FH variants were 2.9 (95% CI, 1.4-6.0) and 2.6 (95% CI, 1.4-4.9) among individuals with moderately and severely elevated LDL-C, respectively. The association between FH variants and CHD was slightly attenuated when further adjusting for baseline LDL-C level, whereas the association was no longer statistically significant after adjusting for cumulative past LDL-C exposure. Among US adults 20 years and older with no history of CHD and LDL-C 130 mg/dL or higher, more than 417 000 carry an FH variant and were projected to experience more than 12 000 excess CHD deaths in those with moderately elevated LDL-C and 15 000 in those with severely elevated LDL-C compared with individuals without an FH variant. Conclusions and Relevance In this pooled cohort study, the presence of FH variants was associated with a 2-fold higher CHD risk, even when LDL-C was only moderately elevated. The increased CHD risk appeared to be largely explained by the higher cumulative LDL-C exposure in individuals with an FH variant compared to those without. Further research is needed to assess the value of adding genetic testing to traditional phenotypic FH screening.
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Affiliation(s)
- Yiyi Zhang
- Division of General Medicine, Columbia University, New York, New York
| | - Jacqueline S. Dron
- Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Center for Genomic Medicine, Massachusetts General Hospital, Boston
| | | | - Amit V. Khera
- Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Division of Cardiology, Brigham and Women’s Hospital, Boston, Massachusetts
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine, Mount Sinai, New York, New York
| | - Pallavi P. Balte
- Division of General Medicine, Columbia University, New York, New York
| | | | - Sami Samir Amr
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Personalized Medicine, Mass General Brigham, Cambridge, Massachusetts
| | - Matthew S. Lebo
- Department of Pathology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- Laboratory for Molecular Medicine, Personalized Medicine, Mass General Brigham, Cambridge, Massachusetts
| | - Anna Nagy
- Laboratory for Molecular Medicine, Personalized Medicine, Mass General Brigham, Cambridge, Massachusetts
| | - Gina M. Peloso
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
| | - Pradeep Natarajan
- Cardiovascular Disease Initiative, Broad Institute of Massachusetts Institute of Technology and Harvard, Cambridge
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Department of Medicine, Massachusetts General Hospital, Boston
| | - Jerome I. Rotter
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Cristen Willer
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Human Genetics, University of Michigan, Ann Arbor
- Department of Computational Medicine and Bioinformatics, University of Michigan, Ann Arbor
| | - Eric Boerwinkle
- Human Genetics Center, Department of Epidemiology, Human Genetics, and Environmental Sciences, School of Public Health, The University of Texas Health Science Center at Houston, Houston
| | | | - Pamela L. Lutsey
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Minneapolis
| | - Myriam Fornage
- The Brown Foundation Institute of Molecular Medicine, University of Texas Health Science Center at Houston
| | | | - Lifang Hou
- Northwestern University, Chicago, Illinois
| | - Bruce M. Psaty
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
- Department of Health Systems and Population Health, University of Washington, Seattle
| | - Joshua C. Bis
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
| | - James S. Floyd
- Cardiovascular Health Research Unit, Department of Medicine, University of Washington, Seattle
- Department of Epidemiology, University of Washington, Seattle
| | - Ramachandran S. Vasan
- The Framingham Heart Study, Framingham, Massachusetts
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts
| | - Nancy L. Heard-Costa
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, Massachusetts
| | - April P. Carson
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Michael E. Hall
- Department of Medicine, University of Mississippi Medical Center, Jackson
| | - Stephen S. Rich
- Center for Public Health Genomics, University of Virginia, Charlottesville
| | - Xiuqing Guo
- The Institute for Translational Genomics and Population Sciences, Department of Pediatrics, The Lundquist Institute for Biomedical Innovation at Harbor-UCLA Medical Center, Torrance, California
| | - Dhruv S. Kazi
- Department of Medicine, Harvard Medical School, Boston, Massachusetts
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Sarah D. de Ferranti
- Department of Cardiology, Boston Children’s Hospital, Boston, Massachusetts
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Andrew E. Moran
- Division of General Medicine, Columbia University, New York, New York
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5
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Morton JI, Marquina C, Lloyd M, Watts GF, Zoungas S, Liew D, Ademi Z. Lipid-Lowering Strategies for Primary Prevention of Coronary Heart Disease in the UK: A Cost-Effectiveness Analysis. PHARMACOECONOMICS 2024; 42:91-107. [PMID: 37606881 DOI: 10.1007/s40273-023-01306-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/20/2023] [Indexed: 08/23/2023]
Abstract
AIM We aimed to assess the cost effectiveness of four different lipid-lowering strategies for primary prevention of coronary heart disease initiated at ages 30, 40, 50, and 60 years from the UK National Health Service perspective. METHODS We developed a microsimulation model comparing the initiation of a lipid-lowering strategy to current standard of care (control). We included 458,692 participants of the UK Biobank study. The four lipid-lowering strategies were: (1) low/moderate-intensity statins; (2) high-intensity statins; (3) low/moderate-intensity statins and ezetimibe; and (4) inclisiran. The main outcome was the incremental cost-effectiveness ratio for each lipid-lowering strategy compared to the control, with 3.5% annual discounting using 2021 GBP (£); incremental cost-effectiveness ratios were compared to the UK willingness-to-pay threshold of £20,000-£30,000 per quality-adjusted life-year. RESULTS The most effective intervention, low/moderate-intensity statins and ezetimibe, was projected to lead to a gain in quality-adjusted life-years of 0.067 per person initiated at 30 and 0.026 at age 60 years. Initiating therapy at 40 years of age was the most cost effective for all lipid-lowering strategies, with incremental cost-effectiveness ratios of £2553 (95% uncertainty interval: 1270, 3969), £4511 (3138, 6401), £11,107 (8655, 14,508), and £1,406,296 (1,121,775, 1,796,281) per quality-adjusted life-year gained for strategies 1-4, respectively. Incremental cost-effectiveness ratios were lower for male individuals (vs female individuals) and for people with higher (vs lower) low-density lipoprotein-cholesterol. For example, low/moderate-intensity statin use initiated from age 40 years had an incremental cost-effectiveness ratio of £5891 (3822, 9348), £2174 (772, 4216), and was dominant (i.e. cost saving; -2,760, 350) in female individuals with a low-density lipoprotein-cholesterol of ≥ 3.0, ≥ 4.0 and ≥ 5.0 mmol/L, respectively. Inclisiran was not cost effective in any sub-group at its current price. CONCLUSIONS Low-density lipoprotein-cholesterol lowering from early ages is a more cost-effective strategy than late intervention and cost effectiveness increased with the increasing lifetime risk of coronary heart disease.
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Affiliation(s)
- Jedidiah I Morton
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Clara Marquina
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Melanie Lloyd
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia
| | - Gerald F Watts
- School of Medicine, Faculty of Health and Medical Sciences, University of Western Australia, Perth, WA, Australia
- Lipid Disorders Clinic, Cardiometabolic Service, Department of Cardiology, Royal Perth Hospital, Perth, WA, Australia
- Lipid Disorders Clinic, Cardiometabolic Service, Department of Internal Medicine, Royal Perth Hospital, Perth, WA, Australia
| | - Sophia Zoungas
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Danny Liew
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Zanfina Ademi
- Health Economics and Policy Evaluation Research (HEPER) Group, Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.
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Bryan AS, Moran AE, Mobley CM, Derington CG, Rodgers A, Zhang Y, Fontil V, Shea S, Bellows BK. Cost-effectiveness analysis of initial treatment with single-pill combination antihypertensive medications. J Hum Hypertens 2023; 37:985-992. [PMID: 36792728 PMCID: PMC10425570 DOI: 10.1038/s41371-023-00811-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 02/17/2023]
Abstract
Hypertension guidelines recommend initiating treatment with single pill combination (SPC) antihypertensive medications, but SPCs are used by only one-third of treated hypertensive US adults. This analysis estimated the cost-effectiveness of initial treatment with SPC dual antihypertensive medications compared with usual care monotherapy in hypertensive US adults.The validated BP Control Model-Cardiovascular Disease (CVD) Policy Model simulated initial SPC dual therapy (two half-standard doses in a single pill) compared with initial usual care monotherapy (half-standard dose when baseline systolic BP < 20 mmHg above goal and one standard dose when ≥20 mmHg above goal). Secondary analyses examined equivalent dose monotherapy (one standard dose) and equivalent dose dual therapy as separate pills (two half-standard doses). The primary outcomes were direct healthcare costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio (ICER) over 10 years from a US healthcare sector perspective.At 10 years, initial dual drug SPC was projected to yield 0.028 (95%UI 0.008 to 0.051) more QALYs at no greater cost ($73, 95%UI -$1 983 to $1 629) than usual care monotherapy. In secondary analysis, SPC dual therapy was cost-effective vs. equivalent dose monotherapy (ICER $8 000/QALY gained) and equivalent dose dual therapy as separate pills (ICER $57 000/QALY gained). At average drug prices, initiating antihypertensive treatment with SPC dual therapy is more effective at no greater cost than usual care initial monotherapy and has the potential to improve BP control rates and reduce the burden of CVD in the US.
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7
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Xu X, Wang Z, Huang R, Guo Y, Xiong Z, Zhuang X, Liao X. Remnant Cholesterol in Young Adulthood Is Associated With Left Ventricular Remodeling and Dysfunction in Middle Age: The CARDIA Study. Circ Cardiovasc Imaging 2023; 16:e015589. [PMID: 37988449 PMCID: PMC10659242 DOI: 10.1161/circimaging.123.015589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 10/12/2023] [Indexed: 11/23/2023]
Abstract
BACKGROUND Recent studies have shown that remnant cholesterol (RC) is associated with incident heart failure; however, its association with left ventricular (LV) structure and function is unclear. We aimed to evaluate the association between RC levels in young adulthood and LV structure and function in middle age. METHODS We included 3321 participants from the CARDIA study (Coronary Artery Risk Development in Young Adults) at baseline. RC was calculated as total cholesterol minus high-density lipoprotein cholesterol minus calculated low-density lipoprotein cholesterol, and the RC trajectories that followed a similar pattern of change over time were identified using the latent class growth mixture model. LV structure and function were assessed using echocardiography at CARDIA study year 25. Multivariable linear regression models were performed to assess the associations of both baseline and trajectories of RC levels with LV structure and function. RESULTS Among 3321 participants, the mean age was 24.99±3.62 years: 1450 (43.90%) were male, and 1561 (47.00%) were Black. After multivariate adjustment, higher baseline RC (per SD in log-transformed) was associated with higher LV mass index (β=1.29; P=0.004), worse global longitudinal strain (β=0.19; P<0.001), worse global circumferential strain (β=0.16; P=0.014), lower septal e' (β=-0.26; P<0.001), lower lateral e' (β=-0.18; P=0.003), and higher E/e' (β=0.15; P=0.003). Three RC trajectories were identified during follow-up: low increasing (42.4%), moderate increasing (45.5%), and high increasing (12.1%). Similarly, compared with the low-increasing group, the high-increasing RC trajectory group was related to higher LV mass index, worse global longitudinal strain, lower septal e', lower lateral e', and higher E/e'. CONCLUSIONS Elevated RC levels in young adulthood were related to adverse LV structural and functional alterations in midlife. Long-term trajectories of RC levels during young adulthood help identify individuals at a higher risk for adverse LV remodeling and dysfunction. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifier: NCT00005130.
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Affiliation(s)
- Xinghao Xu
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Zhaoyan Wang
- Department of Cardiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China (Z.W.)
| | - Rihua Huang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Yue Guo
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Zhenyu Xiong
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Xiaodong Zhuang
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
| | - Xinxue Liao
- Department of Cardiology, the First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
- NHC Key Laboratory of Assisted Circulation, Sun Yat-Sen University, Guangzhou, China. (X.X., R.H., Y.G., Z.X., X.Z., X.L.)
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Pirillo A, Casula M, Catapano AL. European guidelines for the treatment of dyslipidaemias: New concepts and future challenges. Pharmacol Res 2023; 196:106936. [PMID: 37739143 DOI: 10.1016/j.phrs.2023.106936] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 09/20/2023] [Accepted: 09/20/2023] [Indexed: 09/24/2023]
Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the leading cause of mortality and morbidity worldwide. Low-density lipoprotein cholesterol (LDL-C) is one of the most important causal factors for ASCVD. Based on the evidence of the clinical benefits of lowering LDL-C, the current 2019 European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) guidelines provide guidance for optimal management of people with dyslipidaemia. These guidelines include new and revised concepts, with a general tightening of LDL-C goals to be achieved, especially for patients at high and very high cardiovascular risk, based on the results of clinical trials of the recently approved drugs for the treatment of hypercholesterolaemia. However, some issues are still open for discussion. Among others, the concept of lifetime exposure to elevated LDL-C levels will probably drive the pharmacological approach and future guidelines. In addition, other factors such as non-HDL-C, apolipoprotein B, and lipoprotein(a) are becoming increasingly important in determining cardiovascular risk. Finally, there is the question of whether combination therapy should be used as the first step to maximise the effectiveness of the pharmacological approach, avoiding the stepwise approach, which is likely to have a detrimental effect on adherence. Given the ever-changing landscape and the availability of new drugs targeting other important lipids, future guidelines will need to consider all these issues.
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Affiliation(s)
- Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Manuela Casula
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
| | - Alberico L Catapano
- Epidemiology and Preventive Pharmacology Service (SEFAP), Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy.
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9
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Bryant KB, Rao AS, Cohen LP, DanDan N, Kronish IM, Barai N, Fontil V, Zhang Y, Moran AE, Bellows BK. Effectiveness and Cost-Effectiveness of Team-Based Care for Hypertension: A Meta-Analysis and Simulation Study. Hypertension 2023; 80:1199-1208. [PMID: 36883454 PMCID: PMC10987007 DOI: 10.1161/hypertensionaha.122.20292] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/16/2023] [Indexed: 03/09/2023]
Abstract
BACKGROUND Team-based care (TBC), a team of ≥2 healthcare professionals working collaboratively toward a shared clinical goal, is a recommended strategy to manage blood pressure (BP). However, the most effective and cost-effective TBC strategy is unknown. METHODS A meta-analysis of clinical trials in US adults (aged ≥20 years) with uncontrolled hypertension (≥140/90 mm Hg) was performed to estimate the systolic BP reduction for TBC strategies versus usual care at 12 months. TBC strategies were stratified by the inclusion of a nonphysician team member who could titrate antihypertensive medications. The validated BP Control Model-Cardiovascular Disease Policy Model was used to project the expected BP reductions out to 10 years and simulate cardiovascular disease events, direct healthcare costs, quality-adjusted life years, and cost-effectiveness of TBC with physician and nonphysician titration. RESULTS Among 19 studies comprising 5993 participants, the 12-month systolic BP change versus usual care was -5.0 (95% CI, -7.9 to -2.2) mm Hg for TBC with physician titration and -10.5 (-16.2 to -4.8) mm Hg for TBC with nonphysician titration. Relative to usual care at 10 years, TBC with nonphysician titration was estimated to cost $95 (95% uncertainty interval, -$563 to $664) more per patient and gain 0.022 (0.003-0.042) quality-adjusted life years, costing $4400/quality-adjusted life year gained. TBC with physician titration was estimated to cost more and gain fewer quality-adjusted life years than TBC with nonphysician titration. CONCLUSIONS TBC with nonphysician titration yields superior hypertension outcomes compared with other strategies and is a cost-effective way to reduce hypertension-related morbidity and mortality in the United States.
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Affiliation(s)
| | - Aditi S. Rao
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Laura P. Cohen
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Nadine DanDan
- New York-Presbyterian Hospital, Columbia University Medical Center, New York, NY
| | - Ian M. Kronish
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Nikita Barai
- Icahn School of Medicine, Mount Sinai, New York, NY
| | - Valy Fontil
- Grossman School of Medicine, New York University, New York, NY
| | - Yiyi Zhang
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Andrew E. Moran
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
| | - Brandon K. Bellows
- Vagelos College of Physician and Surgeons, Columbia University, New York, NY
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10
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Marquina C, Morton J, Zomer E, Talic S, Lybrand S, Thomson D, Liew D, Ademi Z. Lost Therapeutic Benefit of Delayed Low-Density Lipoprotein Cholesterol Control in Statin-Treated Patients and Cost-Effectiveness Analysis of Lipid-Lowering Intensification. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:498-507. [PMID: 36442832 DOI: 10.1016/j.jval.2022.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Revised: 10/23/2022] [Accepted: 11/07/2022] [Indexed: 05/06/2023]
Abstract
OBJECTIVES Attainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in statin-treated patients remains suboptimal. We quantified the health economic impact of delayed lipid-lowering intensification from an Australian healthcare and societal perspective. METHODS A lifetime Markov cohort model (n = 1000) estimating the impact on coronary heart disease (CHD) of intensifying lipid-lowering treatment in statin-treated patients with uncontrolled LDL-C, at moderate to high risk of CHD with no delay or after a 5-year delay, compared with standard of care (no intensification), starting at age 40 years. Intensification was tested with high-intensity statins or statins + ezetimibe. LDL-C levels were extracted from a primary care cohort. CHD risk was estimated using the pooled cohort equation. The effect of cumulative exposure to LDL-C on CHD risk was derived from Mendelian randomization data. Outcomes included CHD events, quality-adjusted life-years (QALYs), healthcare and productivity costs, and incremental cost-effectiveness ratios (ICERs). All outcomes were discounted annually by 5%. RESULTS Over the lifetime horizon, compared with standard of care, achieving LDL-C control with no delay with high-intensity statins prevented 29 CHD events and yielded 30 extra QALYs (ICERs AU$13 205/QALY) versus 22 CHD events and 16 QALYs (ICER AU$20 270/QALY) with a 5-year delay. For statins + ezetimibe, no delay prevented 53 CHD events and gave 45 extra QALYs (ICER AU$37 271/QALY) versus 40 CHD events and 29 QALYs (ICER of AU$44 218/QALY) after a 5-year delay. CONCLUSIONS Delaying attainment of LDL-C goals translates into lost therapeutic benefit and a waste of resources. Urgent policies are needed to improve LDL-C goal attainment in statin-treated patients.
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Affiliation(s)
- Clara Marquina
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Jedidiah Morton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Ella Zomer
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Stella Talic
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | | | - Danny Liew
- Adelaide Medical School, University of Adelaide, Adelaide, SA, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia; School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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11
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Lou Z, Yi SS, Pomeranz J, Suss R, Russo R, Rummo PE, Eom H, Liu J, Zhang Y, Moran AE, Bellows BK, Kong N, Li Y. The Health and Economic Impact of Using a Sugar Sweetened Beverage Tax to Fund Fruit and Vegetable Subsidies in New York City: A Modeling Study. J Urban Health 2023; 100:51-62. [PMID: 36550343 PMCID: PMC9918717 DOI: 10.1007/s11524-022-00699-3] [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] [Accepted: 11/07/2022] [Indexed: 12/24/2022]
Abstract
Low fruit and vegetable (FV) intake and high sugar-sweetened beverage (SSB) consumption are independently associated with an increased risk of developing cardiovascular disease (CVD). Many people in New York City (NYC) have low FV intake and high SSB consumption, partly due to high cost of fresh FVs and low cost of and easy access to SSBs. A potential implementation of an SSB tax and an FV subsidy program could result in substantial public health and economic benefits. We used a validated microsimulation model for predicting CVD events to estimate the health impact and cost-effectiveness of SSB taxes, FV subsidies, and funding FV subsidies with an SSB tax in NYC. Population demographics and health profiles were estimated using data from the NYC Health and Nutrition Examination Survey. Policy effects and price elasticity were derived from recent meta-analyses. We found that funding FV subsidies with an SSB tax was projected to be the most cost-effective policy from the healthcare sector perspective. From the societal perspective, the most cost-effective policy was SSB taxes. All policy scenarios could prevent more CVD events and save more healthcare costs among men compared to women, and among Black vs. White adults. Public health practitioners and policymakers may want to consider adopting this combination of policy actions, while weighing feasibility considerations and other unintended consequences.
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Affiliation(s)
- Zhouyang Lou
- School of Industrial Engineering, Purdue University, West Lafayette, IN, USA
| | - Stella S Yi
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jennifer Pomeranz
- Department of Public Health Policy and Management, School of Global Public Health, New York University, New York, NY, USA
| | - Rachel Suss
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Rienna Russo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
- Department of Epidemiology, Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA
| | - Pasquale E Rummo
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Heesun Eom
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Junxiu Liu
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Yiyi Zhang
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Andrew E Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Brandon K Bellows
- Division of General Medicine, Columbia University Irving Medical Center, New York, NY, USA.
| | - Nan Kong
- Weldon School of Biomedical Engineering, Purdue University, West Lafayette, IN, USA.
| | - Yan Li
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
- School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
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12
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The role of noninvasive scoring systems for predicting cardiovascular disease risk in patients with nonalcoholic fatty liver disease: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol 2022; 34:1277-1284. [PMID: 36317774 DOI: 10.1097/meg.0000000000002462] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
BACKGROUNDS Cardiovascular disease (CVD) is suggested as a leading cause of death among patients with nonalcoholic fatty liver disease (NAFLD). The aim of this work was to clarify the role of noninvasive scoring systems (NSSs) in predicting CVD risk among this population. METHODS The PubMed, Web of Science, and Cochrane databases were searched until 23 March 2022. Meta-analysis was performed for three most commonly used NSS separately, that is, fibrosis-4 index (FIB-4), NAFLD fibrosis score (NFS), and AST/platelet ratio index (APRI). RESULTS Totally, nine studies including 155 382 patients with NAFLD were enrolled. Patients with NAFLD had a higher risk of CVD with increasing FIB-4 score (1.94, 1.52-2.46), the association remained significant after adjustment for age, sex, body mass index, hypertension, and diabetes (2.44, 1.85-3.22). Similarly, a higher risk of CVD was also observed in patients with increasing NFS (2.17, 1.58-2.98) and APRI scores (1.36, 1.04-1.79) in the unadjusted model. However, in the adjusted model, the association was significant only for NFS (3.83, 1.40-10.43), but not for APRI (1.41, 0.79-2.51). Additionally, the increment in CVD risk was most noticeable in subgroup of FIB > 2.67 vs. FIB ≤ 1.3 (6.52, 3.07-13.86) and subgroup of NFS > 0.676 vs. NFS ≤ -1.455 (16.88, 5.68-50.23). All subgroup analyses showed significant associations between FIB-4, NFS, and risk of CVD. Sensitivity analyses did not modify these results. CONCLUSIONS FIB-4 and NFS might be useful in identifying those who are at higher risk of CVD among patients with NAFLD. However, APRI was not recommended for this use.
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13
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Eradicating Atherosclerosis: Should We Start Statins at Younger Ages and at Lower LDL-Cs. Curr Cardiol Rep 2022; 24:1397-1406. [PMID: 36006590 PMCID: PMC10021628 DOI: 10.1007/s11886-022-01760-y] [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] [Accepted: 07/29/2022] [Indexed: 11/03/2022]
Abstract
PURPOSE OF REVIEW Given the increasing burden of cardiovascular disease, we review the literature for earlier initiation of statin therapy at younger ages and lower low-density lipoprotein cholesterol (LDL-C) levels, with the goal of preventing the development of atherosclerosis prior to clinical events. RECENT FINDINGS There is a rising prevalence of dyslipidemia among younger adults. Although guidelines offer recommendations for adults over 40, there is little guidance for the management of younger adults with moderately elevated LDL-C levels. Earlier and more aggressive statin use may slow progression, or even halt atherosclerosis, and may likewise be beneficial and cost-effective on a population level. Further research is needed to define the exact age and LDL-C level at which to start statin therapy. Until then, more detailed risk stratification with lab testing and imaging should be used to identify younger adults at the highest risk.
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14
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Severe Mental Illness and Cardiovascular Disease: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 80:918-933. [PMID: 36007991 DOI: 10.1016/j.jacc.2022.06.017] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 06/08/2022] [Accepted: 06/21/2022] [Indexed: 11/23/2022]
Abstract
People with severe mental illness, consisting of schizophrenia, bipolar disorder, and major depression, have a high burden of modifiable cardiovascular risk behaviors and conditions and have a cardiovascular mortality rate twice that of the general population. People with acute and chronic cardiovascular disease are at a higher risk of developing mental health symptoms and disease. There is emerging evidence for shared etiological factors between severe mental illness and cardiovascular disease that includes biological, genetic, and behavioral mechanisms. This state-of-the art review will describe the relationship between severe mental illness and cardiovascular disease, explore the factors that lead to poor cardiovascular outcomes in people with severe mental illness, propose strategies to improve the cardiovascular health of people with severe mental illness, and present areas for future research focus.
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15
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Aguiar C. Low-density lipoprotein cholesterol lowering in the comfort zone and the benefits of stepping out. Rev Port Cardiol 2022; 41:689-691. [DOI: 10.1016/j.repc.2022.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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16
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Redel-Traub G, Smilowitz NR, Xia Y, Berger JS. Systematic review and meta-regression on the duration of LDL-C lowering and major adverse cardiovascular events. Vasc Med 2022; 27:375-376. [PMID: 35603756 DOI: 10.1177/1358863x221098459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Gabriel Redel-Traub
- Department of Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | - Nathaniel R Smilowitz
- Department of Medicine, Leon H Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, USA.,Department of Medicine, Division of Cardiology, Veterans Affairs New York Harbor Health Care System, New York, NY, USA
| | - Yuhe Xia
- Department of Population Health, New York University Grossman School of Medicine, New York, NY, USA
| | - Jeffrey S Berger
- Department of Medicine, Leon H Charney Division of Cardiology, New York University Grossman School of Medicine, New York, NY, USA
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17
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Witting C, Devareddy A, Rodriguez F. Review of Lipid-Lowering Therapy in Women from Reproductive to Postmenopausal Years. Rev Cardiovasc Med 2022; 23:183. [PMID: 38031574 PMCID: PMC10686310 DOI: 10.31083/j.rcm2305183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/08/2022] [Accepted: 03/15/2022] [Indexed: 12/01/2023] Open
Abstract
Although cardiovascular disease is the leading cause of death in women, cardiovascular risk factors remain underrecognized and undertreated. Hyperlipidemia is one of the leading modifiable risk factors for CVD. Statins are the mainstay of lipid lowering therapy (LLT), with additional agents such as ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors as additive or alternative therapies. Clinical trials have demonstrated that these LLTs are equally efficacious in lipid lowering and cardiovascular risk reduction in women as they are in men. Although the data on statin teratogenicity is evolving, in times of pregnancy or attempted pregnancy, most lipid-lowering agents are generally avoided due to lack of high-quality safety data. This leads to limited treatment options in pregnant women with hyperlipidemia or cardiovascular disease. During the perimenopausal period, the mainstay of lipid management remains consistent with guidelines across all ages. Hormone replacement therapy for cardiovascular risk reduction is not recommended. Future research is warranted to target sex-based disparities in LLT initiation and persistence across the life course.
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Affiliation(s)
- Celeste Witting
- Stanford University School of Medicine, Stanford, CA 94305, USA
| | | | - Fatima Rodriguez
- Stanford University School of Medicine, Stanford, CA 94305, USA
- Division of Cardiovascular Medicine, Stanford Healthcare, Stanford, CA 94305, USA
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18
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Feingold KR, Chait A. Approach to patients with elevated low-density lipoprotein cholesterol levels. Best Pract Res Clin Endocrinol Metab 2022; 37:101658. [PMID: 35487874 DOI: 10.1016/j.beem.2022.101658] [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] [Indexed: 11/27/2022]
Abstract
Elevated low-density lipoprotein cholesterol (LDL-C) levels increase the risk of atherosclerotic cardiovascular disease (ASCVD) and lowering LDL-C levels reduces the risk of ASCVD. In patients with elevated LDL-C levels it is important to consider whether lifestyle, other medical conditions, medications, or genetic factors could be causing or contributing to the elevation. There are guidelines from various organizations outlining the approach to lowering LDL-C levels but while these guidelines agree on many issues there are numerous areas where recommendations are discordant. In this review, we outline several principles that will help in deciding who and how to treat patients with elevated LDL-C levels. Specifically, we discuss evidence indicating that the sooner one initiates therapy the better and the greater the reduction in LDL-C the better. Additionally, the higher the LDL-C level and the higher the risk of ASCVD, the greater the benefits of treatment. Using these principles will help in making decisions regarding the treatment of LDL-C levels.
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Affiliation(s)
| | - Alan Chait
- Division of Metabolism, Endocrinology and Nutrition, University of Washington, Seattle, WA, USA.
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19
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Kohli-Lynch CN, Lewsey J, Boyd KA, French DD, Jordan N, Moran AE, Sattar N, Preiss D, Briggs AH. Beyond Ten-Year Risk: A Cost-Effectiveness Analysis of Statins for the Primary Prevention of Cardiovascular Disease. Circulation 2022; 145:1312-1323. [PMID: 35249370 PMCID: PMC9022692 DOI: 10.1161/circulationaha.121.057631] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022]
Abstract
Cholesterol guidelines typically prioritize primary prevention statin therapy on the basis of 10-year risk of cardiovascular disease. The advent of generic pricing may justify expansion of statin eligibility. Moreover, 10-year risk may not be the optimal approach for statin prioritization. We estimated the cost-effectiveness of expanding preventive statin eligibility and evaluated novel approaches to prioritization from a Scottish health sector perspective.
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Affiliation(s)
- Ciaran N Kohli-Lynch
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois; Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - James Lewsey
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - Kathleen A Boyd
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom
| | - Dustin D French
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois; Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Chicago, Illinois; Department of Ophthalmology and Medical Social Science, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Neil Jordan
- Center for Health Services and Outcomes Research, Northwestern University, Chicago, Illinois; Center of Innovation for Complex Chronic Healthcare, Hines VA Hospital, Hines, Chicago, Illinois; Departments of Psychiatry & Behavioral Sciences and Preventive Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Andrew E Moran
- Division of General Medicine, Columbia University Irving Medical Center, New York City, New York
| | - Naveed Sattar
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - David Preiss
- Medical Research Council Population Health Research Unit, Clinical Trial Service Unit and Epidemiological Studies Unit, Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Andrew H Briggs
- Health Economics and Health Technology Assessment, University of Glasgow, Glasgow, United Kingdom; Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, United Kingdom
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20
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Heidenreich PA, Clarke SL, Maron DJ. Time to Relax the 40-Year Age Threshold for Pharmacologic Cholesterol Lowering. J Am Coll Cardiol 2021; 78:1965-1967. [PMID: 34763773 DOI: 10.1016/j.jacc.2021.08.072] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 08/30/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Paul A Heidenreich
- VA Palo Alto Health Care system, Palo Alto, California, USA; Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA.
| | - Shoa L Clarke
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA. https://twitter.com/ShoaClarke
| | - David J Maron
- Department of Medicine, Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, USA; Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, California, USA
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