1
|
Bolden DM, Wogu AF, Peterson PN, Ross EG, Hogan SE, Matsushita K, Criqui MH, Allison M. Association between Statin use and Incident Peripheral Artery Disease According to Race, Age, and Presence of Depression in the Multi-Ethnic Study of Atherosclerosis. Ann Vasc Surg 2024; 102:160-171. [PMID: 38309426 PMCID: PMC10997470 DOI: 10.1016/j.avsg.2023.11.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 11/02/2023] [Accepted: 11/04/2023] [Indexed: 02/05/2024]
Abstract
BACKGROUND Peripheral artery disease (PAD) is associated with high morbidity and mortality and has been commonly described as a coronary heart disease equivalent. Statin medications are recommended for primary prevention of atherosclerotic cardiovascular disease (CVD) among other indications. Therefore, understanding the longitudinal relationship of incident PAD is necessary to inform future research on how to prevent the disease. Depression complicates CVD patients' ability to properly adhere to their medications, yet the effect of depression on the relationship between statin use and incident PAD is understudied. People with PAD have a higher incidence of depressive symptoms than people without PAD. Black American and Hispanic populations are disproportionately affected by both PAD and depression yet research on the modifying effect of either race or depression on the relationship between statin use and onset of PAD is minimal. While statin utilization is highest for ages 75-84 years, there is minimal evidence of favorable risk-benefit balance. Consequently, in this project, we examined the relationship between statin use and incident PAD and whether this relationship is modified by race/ethnicity, depressive symptoms, or age. METHODS We used data on participants from the Multi-Ethnic Study of Atherosclerosis from visit 1 (2000) through study visit 6 (2020) who had three separate measurements of the ankle-brachial index (ABI) taken at visit 1, visit 3, and visit 5. Incident PAD was defined as 1) incident lower extremity amputation or revascularization or 2) ABI less than 0.90 coupled with ABI decrease greater than 0.15 over the follow-up period. Statin use was noted on the study visit prior to incident PAD diagnosis while depressive symptoms were measured at exam 1, visit 3, and visit 5. Propensity score matching was implemented to create balance between the participants in the two treatment groups, that is, statin-treated and statin-untreated groups, to reduce the problem of confounding by indication. Propensity scores were calculated using multivariate logistic regression model to estimate the probability of receiving statin treatment. We used Cox proportional hazards regression to investigate the relationship between time-dependent statin use as well as other risk factors with incident PAD, overall and stratified by 1) race, 2) depression status, and 3) age. RESULTS A total of 4,210 participants were included in the final matched analytic cohort. There were 810 incident cases (19.3%) of PAD that occurred over an average (mean) of 11.3 years (SD = 5.7) of follow-up time. In the statin-treated group, and with an average follow-up time of 12.5 years (SD = 5.6), there were 281 cases (13.4%) of incident PAD with the average follow-up time of 10.1 years (SD = 5.5), whereas in the statin-untreated group, there were 531 cases (25.2%) (P < 0.001). Results demonstrate a lower risk of PAD event in the statin-treated group compared to the untreated group (hazard ratio [HR] = 0.45, 95% confidence interval [CI]: 0.33-0.62) over the span of 18.5 years. The interactions between 1) depression and 2) race with statin use for incident PAD were not significant. However, other risk factors which were significant included Black American race that had approximately 30% lower hazard of PAD compared to non-Hispanic White (HR = 0.70, 95% CI: 0.58-0.84); age-stratified models were also fitted, and stain use was still a significant treatment factor for ages 45-54 (HR = 0.45, 95% CI: 0.33-0.63), 55-64 (HR = 0.61, 95% CI: 0.46-0.79), and 65-74 years (HR = 0.61, 95% CI: 0.48-0.78) but not for ages 75-84 years. CONCLUSIONS Statin use was associated with a decreased risk of incident PAD for those under the age of 75 years. Neither race nor depression significantly modified the relationship between statin use and incident PAD; however, the risk of incident PAD was lower among Black Americans. These findings highlight that the benefit of statin may wane for those over the age of 75 years. Findings also suggest that statin use may not be compromised in those living with depression.
Collapse
Affiliation(s)
- Demetria M Bolden
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO.
| | - Adane F Wogu
- Department of Biostatistics and Informatics, Colorado School of Public Health, Aurora, CO
| | - Pamela N Peterson
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO; Division of Cardiology, Denver Health Medical Center, Denver, CO
| | - Elsie G Ross
- Division of Vascular Surgery, Department of Surgery, Stanford University School of Medicine, Palo Alto, CA
| | - Shea E Hogan
- Division of Cardiology, Department of Medicine, University of Colorado School of Medicine, Aurora, CO; Division of Cardiology, Denver Health Medical Center, Denver, CO
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD
| | - Michael H Criqui
- Department of Family Medicine, School of Medicine, University of California San Diego, San Diego, CA
| | - Matthew Allison
- Department of Family Medicine, School of Medicine, University of California San Diego, San Diego, CA
| |
Collapse
|
2
|
Sarzani R, Allevi M, Giulietti F, Sarnari S, Scorcella S, Di Agostini A, Turri P, Di Pentima C, Spannella F. Patient-reported muscle symptoms and their characterization in a hypertensive population eligible for statin therapy: An exploratory study. Nutr Metab Cardiovasc Dis 2024; 34:136-144. [PMID: 37798232 DOI: 10.1016/j.numecd.2023.08.011] [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: 01/18/2023] [Revised: 07/11/2023] [Accepted: 08/14/2023] [Indexed: 10/07/2023]
Abstract
BACKGROUND AND AIMS Statin-associated muscle symptoms (SAMS) are claimed to be frequent in clinical practice. We evaluated the prevalence and characteristics of patient-reported muscle symptoms (PRMS) attributed to drugs/nutraceuticals in hypertensive patients, focusing the attention on statin treatment. METHODS AND RESULTS Observational study on 390 consecutive outpatients. All patients were asked the following question: "Have you ever taken a drug/nutraceutical that you think gave you muscle symptoms?". Patients who answered "yes" were evaluated with a modified version of the SAMS-clinical index (SAMS-CI). Mean age: 60.5 ± 13.5 years (males 53.8%.). Patients who have ever taken a statin: 250. Patients who have never taken a statin: 140. Prevalence of PRMS (48.5% of the entire study population) did not differ between groups (p = 0.217). Only age, followed by number of drugs taken, was significantly associated with PRMS at multivariate analysis. A high prevalence of low scores to all the questions of "modified" SAMS-CI was found in both groups. Localization and pattern of PRMS did not differ between groups (p = 0.170). Timing of PRMS onset after starting the drug (p = 0.036) and timing of improvement after withdrawal (p = 0.002) were associated with statin therapy. CONCLUSION PRMS are highly prevalent among the hypertensive population and are believed to be drug-related, especially with aging and regardless of whether the drug taken is a statin or not. These findings are in line with the growing evidence that subjective muscle symptoms are often misattributed to statins, while they may more likely be related to the nocebo/drucebo effect or to other common undiagnosed conditions.
Collapse
Affiliation(s)
- Riccardo Sarzani
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy.
| | - Massimiliano Allevi
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | | | - Silvia Sarnari
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Samuele Scorcella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Angelica Di Agostini
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | - Paolo Turri
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| | | | - Francesco Spannella
- Internal Medicine and Geriatrics, IRCCS INRCA, Ancona, Italy; Department of Clinical and Molecular Sciences, University "Politecnica delle Marche", Ancona, Italy
| |
Collapse
|
3
|
Weisskopf MG, Levy J, Dickerson AS, Paganoni S, Leventer-Roberts M. Statin Medications and Amyotrophic Lateral Sclerosis Incidence and Mortality. Am J Epidemiol 2022; 191:1248-1257. [PMID: 35333291 PMCID: PMC9393061 DOI: 10.1093/aje/kwac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 01/26/2023] Open
Abstract
Studies of statins and amyotrophic lateral sclerosis (ALS) incidence and survival have had conflicting findings possibly related to difficulties with confounding by indication. We considered potency of statins used and duration of use to explore confounding by indication. Within the Clalit Health Services in Israel, we identified 948 ALS case patients from 2004 through 2017 and matched them with 1,000 control subjects each. Any statin use up to 3 years before ALS onset was not associated with ALS incidence but was associated with a reduced hazard ratio (HR) for death. Odds of ALS did not vary by statin potency, but use of only lower-potency statins was associated with longer survival (HR = 0.82, 95% CI: 0.68, 0.98), whereas the association with higher-potency statins was null compared with those case patients who did not use statins. However, duration of statin use appeared to account for these findings. Those who used statins only up to 3 years had longer survival (HR = 0.77, 95% CI: 0.61, 0.96) than did case patients who did not use statins, but those who used statins for >3 years did not. Although other explanations are possible, these findings could suggest a protective effect of statins on ALS survival that is partially masked by a worse prognosis from underlying reasons for taking statins that deserves further exploration.
Collapse
Affiliation(s)
- Marc G Weisskopf
- Correspondence to Marc Weisskopf, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue Building 1, Suite 1402, Boston, MA 02115 (e-mail: )
| | | | | | | | | |
Collapse
|
4
|
Duflot T, Tu L, Leuillier M, Messaoudi H, Groussard D, Feugray G, Azhar S, Thuillet R, Bauer F, Humbert M, Richard V, Guignabert C, Bellien J. Preventing the Increase in Lysophosphatidic Acids: A New Therapeutic Target in Pulmonary Hypertension? Metabolites 2021; 11:metabo11110784. [PMID: 34822442 PMCID: PMC8621392 DOI: 10.3390/metabo11110784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Accepted: 11/11/2021] [Indexed: 11/16/2022] Open
Abstract
Cardiovascular diseases (CVD) are the leading cause of premature death and disability in humans that are closely related to lipid metabolism and signaling. This study aimed to assess whether circulating lysophospholipids (LPL), lysophosphatidic acids (LPA) and monoacylglycerols (MAG) may be considered as potential therapeutic targets in CVD. For this objective, plasma levels of 22 compounds (13 LPL, 6 LPA and 3 MAG) were monitored by liquid chromatography coupled with tandem mass spectrometry (HPLC/MS2) in different rat models of CVD, i.e., angiotensin-II-induced hypertension (HTN), ischemic chronic heart failure (CHF) and sugen/hypoxia(SuHx)-induced pulmonary hypertension (PH). On one hand, there were modest changes on the monitored compounds in HTN (LPA 16:0, 18:1 and 20:4, LPC 16:1) and CHF (LPA 16:0, LPC 18:1 and LPE 16:0 and 18:0) models compared to control rats but these changes were no longer significant after multiple testing corrections. On the other hand, PH was associated with important changes in plasma LPA with a significant increase in LPA 16:0, 18:1, 18:2, 20:4 and 22:6 species. A deleterious impact of LPA was confirmed on cultured human pulmonary smooth muscle cells (PA-SMCs) with an increase in their proliferation. Finally, plasma level of LPA(16:0) was positively associated with the increase in pulmonary artery systolic pressure in patients with cardiac dysfunction. This study demonstrates that circulating LPA may contribute to the pathophysiology of PH. Additional experiments are needed to assess whether the modulation of LPA signaling in PH may be of interest.
Collapse
Affiliation(s)
- Thomas Duflot
- UNIROUEN, INSERM U1096, CHU Rouen, Department of Pharmacology, Normandie University, F-76000 Rouen, France; (V.R.); (J.B.)
- Correspondence: ; Tel.: +33-2-32-88-84-91
| | - Ly Tu
- INSERM UMR_S 999, Hôpital Marie Lannelongue, F-92350 Le Plessis-Robinson, France; (L.T.); (R.T.); (M.H.); (C.G.)
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, F-92290 Châtenay-Malabry, France
| | - Matthieu Leuillier
- UNIROUEN, INSERM U1096, Normandie University, F-76000 Rouen, France; (M.L.); (H.M.); (D.G.); (S.A.)
| | - Hind Messaoudi
- UNIROUEN, INSERM U1096, Normandie University, F-76000 Rouen, France; (M.L.); (H.M.); (D.G.); (S.A.)
| | - Déborah Groussard
- UNIROUEN, INSERM U1096, Normandie University, F-76000 Rouen, France; (M.L.); (H.M.); (D.G.); (S.A.)
| | - Guillaume Feugray
- UNIROUEN, INSERM U1096, CHU Rouen, Department of General Biochemistry, Normandie University, F-76000 Rouen, France;
| | - Saïda Azhar
- UNIROUEN, INSERM U1096, Normandie University, F-76000 Rouen, France; (M.L.); (H.M.); (D.G.); (S.A.)
| | - Raphaël Thuillet
- INSERM UMR_S 999, Hôpital Marie Lannelongue, F-92350 Le Plessis-Robinson, France; (L.T.); (R.T.); (M.H.); (C.G.)
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, F-92290 Châtenay-Malabry, France
| | - Fabrice Bauer
- UNIROUEN, INSERM U1096, CHU Rouen, Department of Cardiology, Normandie University, F-76000 Rouen, France;
| | - Marc Humbert
- INSERM UMR_S 999, Hôpital Marie Lannelongue, F-92350 Le Plessis-Robinson, France; (L.T.); (R.T.); (M.H.); (C.G.)
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, F-92290 Châtenay-Malabry, France
| | - Vincent Richard
- UNIROUEN, INSERM U1096, CHU Rouen, Department of Pharmacology, Normandie University, F-76000 Rouen, France; (V.R.); (J.B.)
| | - Christophe Guignabert
- INSERM UMR_S 999, Hôpital Marie Lannelongue, F-92350 Le Plessis-Robinson, France; (L.T.); (R.T.); (M.H.); (C.G.)
- School of Medicine, Université Paris-Saclay, Le Kremlin-Bicêtre, F-92290 Châtenay-Malabry, France
| | - Jérémy Bellien
- UNIROUEN, INSERM U1096, CHU Rouen, Department of Pharmacology, Normandie University, F-76000 Rouen, France; (V.R.); (J.B.)
| |
Collapse
|
5
|
Abstract
OBJECTIVE To estimate relative risk (RR) of statin-associated musculoskeletal symptoms by statin therapy intensity. SETTING Network meta-analysis assessing multicentre randomised controlled trials (RCTs) across several countries. PARTICIPANTS PubMed, Web of Science, Cochrane database and ClinicalTrials.gov were searched through January 2021 for doubled-blinded RCTs testing the effect of statin therapy on lipids with at least 1000 participants and 2 years of intended treatment. Two coders assessed articles for final inclusion, quality and outcomes. Treatment intensity was categorised according to American Heart Association definitions. OUTCOMES Pairwise and network meta-analysis (NMA) estimated RR and risk difference with random effects modelling. Heterogeneity was evaluated with the I2 statistic. Outcomes included muscle symptoms (any, myalgia and attrition due to muscle symptoms), rhabdomyolysis and elevated creatine kinase (CK) (>10 × upper limit of normal). RESULTS Of 2919 RCTs, 24 (n=152 461) met inclusion criteria. NMA results indicated risk was significantly greater for high compared with moderate intensity statin therapy for any muscle problem (RR=1.04, 95% CI 1.00 to 1.07; I2=0%), myalgia (RR=1.04, 95% CI 1.00 to 1.08; I2=0%, number needed to harm (NNH)=173), attrition due to muscle problems (RR=1.37, 95% CI 1.09 to 1.73, I2=0%, NNH=218) and elevated CK (RR=4.69, 95% CI 2.50 to 8.80; I2=7%, NNH=527). Risk also was significantly higher for high intensity compared with placebo for any muscle problem (RR=1.05, 95% CI 1.01 to 1.09, I2=0%), myalgia (RR=1.13, 95% CI 1.05 to 1.23; I2=0%, NNH=182), attrition due to muscle problems (RR=1.55, 95% CI 1.15 to 2.08, I2=0%, NNH=187) and elevated CK (RR=5.37, 95% CI 2.48 to 11.61; I2=7%, NNH=589). Due to inconsistency of results across sensitivity analyses, estimates were inconclusive for rhabdomyolysis and CK. There were no significant differences in risk between moderate intensity therapy and placebo for all outcomes. CONCLUSIONS For approximately each 200 patients on high intensity statins, one additional patient may experience myalgia or discontinue therapy due to muscle problems compared with moderate intensity therapy. TRIAL REGISTRATION NUMBER CRD42019112758.
Collapse
Affiliation(s)
- John W Davis
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| | - Susan C Weller
- Department of Preventive Medicine and Population Health, University of Texas Medical Branch at Galveston, Galveston, Texas, USA
- Department of Family Medicine, The University of Texas Medical Branch at Galveston, Galveston, Texas, USA
| |
Collapse
|
6
|
Youens D, Doust J, Robinson S, Moorin R. Regularity and Continuity of GP Contacts and Use of Statins Amongst People at Risk of Cardiovascular Events. J Gen Intern Med 2021; 36:1656-1665. [PMID: 33655384 PMCID: PMC8175539 DOI: 10.1007/s11606-021-06638-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/25/2021] [Indexed: 01/13/2023]
Abstract
BACKGROUND Regularity and continuity of general practitioner (GP) contacts are associated with reduced hospitalisation. Opportunities for improved medication management are cited as a potential cause. OBJECTIVE Determine associations between continuity and regularity of primary care and statin use amongst individuals at risk of cardiovascular disease (CVD) outcomes. DESIGN Observational cohort study using self-report and administrative data from 267,153 participants of the Sax Institute's 45 and Up Study conducted in New South Wales, Australia. from 2006 to 2009. Medicare Benefits Schedule (MBS) and Pharmaceutical Benefits Scheme (PBS) data, from Services Australia, were linked to survey, hospital and death data by the NSW Centre for Health Record Linkage. PARTICIPANTS The 45 and Up Study participants at risk of CVD outcomes based on self-report and administrative data, divided into existing users and potential users based on dispensing records through the exposure period. MAIN MEASURES The Continuity of Care index (COC), measuring whether patients see the same GP, and an index assessing whether GP visits are on a regular basis, measured from July 2011 to June 2012. Amongst potential users, statin initiation from July 2012 to June 2013 was assessed using logistic regression; amongst existing users, adherence was assessed from July 2012 to June 2015 using Cox regression (non-adherence being 30 days without statins). KEY RESULTS Amongst 29,420 potential users, the most regular quintile had 1.22 times the odds of initiating statin (95%CI 1.11-1.34), while the high continuity group had an odds ratio of 1.12 (95%CI 1.02-1.24). Amongst 30,408 existing users, the most regular quintile had 0.82 the hazard of non-adherence (95%CI 0.78-0.87); the high continuity group had a hazard ratio of 0.89 (95%CI 0.84-0.94). CONCLUSIONS Regularity and continuity of care impact on medication management. It is possible that this mediates impacts on hospitalisation. Where there is a risk of unobserved confounding, potential causal pathways should be investigated.
Collapse
Affiliation(s)
- David Youens
- Health Systems and Data Analytics, School of Public Health, Curtin University, Perth, Australia.
- , Perth, Australia.
| | - Jenny Doust
- School of Public Health, The University of Queensland, Brisbane, Australia
- Institute for Evidence-Based Healthcare, Faculty of Health Sciences & Medicine, Bond University, Gold Coast, Australia
| | - Suzanne Robinson
- Health Systems and Data Analytics, School of Public Health, Curtin University, Perth, Australia
| | - Rachael Moorin
- Health Systems and Data Analytics, School of Public Health, Curtin University, Perth, Australia
- School of Population & Global Health, The University of Western Australia, Perth, Australia
| |
Collapse
|
7
|
Damiani I, Corsini A, Bellosta S. Potential statin drug interactions in elderly patients: a review. Expert Opin Drug Metab Toxicol 2020; 16:1133-1145. [DOI: 10.1080/17425255.2020.1822324] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Isabella Damiani
- Department of Pharmacological and Biomolecular Sciences, Università Degli Studi Di Milano, Milan, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences, Università Degli Studi Di Milano, Milan, Italy
- IRCCS MultiMedica, Milan, Italy
| | - Stefano Bellosta
- Department of Pharmacological and Biomolecular Sciences, Università Degli Studi Di Milano, Milan, Italy
| |
Collapse
|
8
|
Baik SH, McDonald CJ. Independent effects of 15 commonly prescribed drugs on all-cause mortality among US elderly patients with type 2 diabetes mellitus. BMJ Open Diabetes Res Care 2020; 8:8/1/e000940. [PMID: 32341050 PMCID: PMC7202731 DOI: 10.1136/bmjdrc-2019-000940] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Revised: 02/28/2020] [Accepted: 03/21/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Most patients with type 2 diabetes mellitus (T2DM) also have hypertension and hyperlipidemia. Consequently, they are taking medications for all three conditions concurrently and the effect of one drug could be confounded with that of another. This study aimed to determine the independent effects of 15 commonly prescribed medications for three conditions on the risk of all-cause mortality among elderly patients with T2DM. RESEARCH DESIGN AND METHODS A cohort of 360 437 elderly patients with T2DM from 2007 to 2016 US Medicare data was traced along with cumulative uses of 8 diabetes, 6 hypertension and 1 hyperlipidemia drugs. The relative risk of all-cause mortality for each study drug was estimated using an extended Cox regression analysis adjusting for the concurrent use of other study drugs. RESULTS Compared with the no use of each study medication, mortality risk declined with use of 3 diabetes drugs, sodium-glucose cotransporter-2 inhibitors (HR=0.73; 95% CI 0.64 to 0.84), glucagon-like peptide-1 receptor agonists (HR=0.75; 95% CI 0.70 to 0.80) and dipeptidyl peptidase-4 inhibitors (HR=0.94; 95% CI 0.91 to 0.98), the use of 3 blood pressure medications, diuretics (HR=0.89; 95% CI 0.87 to 0.92), angiotensin receptor blockers (HR=0.86; 95% CI 0.84 to 0.89), ACE inhibitors (HR=0.98; 95% CI 0.95 to 1.01) as well as statins (HR=0.83; 95% CI 0.80 to 0.85). It increased moderately with insulin (HR=1.55; 95% CI 1.51 to 1.59), sulfonylureas (HR=1.16; 95% CI 1.13 to 1.20), a small inconsistent amount with metformin (HR=1.05), beta-blockers (HR=1.07), dihydropyridine calcium-channel blockers (HR=0.99) and non-dihydropyridine calcium-channel blockers (HR=1.05). The use of thiazolidinedione had no effect. CONCLUSION Among older patients with diabetes, mortality risk decreased importantly with three new diabetes drugs, 3 blood pressure drugs and statins. It increased moderately with sulfonylurea and insulin. Studies of aggressive use of new T2DM drugs instead of sulfonylureas and insulin are needed. Our statin results empirically validate two national guidelines for using statins in older patients with diabetes. However, 23% of study patients never took a statin, suggesting missed opportunities for prevention.
Collapse
Affiliation(s)
- Seo H Baik
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, Maryland, USA
| | - Clement J McDonald
- Lister Hill National Center for Biomedical Communications, National Library of Medicine, Bethesda, Maryland, USA
| |
Collapse
|
9
|
Drapkina OM, Samorodskaya IV, Larina VN. [Guidelines for the Diagnosis and Management of Chronic Coronary Syndromes in Primary Health Care - the Issue of Acceptability for the Russian Federation]. ACTA ACUST UNITED AC 2020; 60:130-136. [PMID: 32394867 DOI: 10.18087/cardio.2020.4.n1000] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 02/17/2020] [Indexed: 11/18/2022]
Abstract
In 2019, the European Society for Cardiology (ESC) published guidelines with a new term, "chronic coronary syndromes" (CCS). These guidelines presented 6 clinical scenarios, which are most common in outpatient practice. The diagnostic approach described in these guidelines shifts from the standardization to the rationality of individualized solutions on using various diagnostic methods. The diagnostic approach suggested in the ESC guidelines requires extensive medical discussion and consensus because this will definitely entail a) further increase in indexes that reflect the morbidity of ischemic heart disease (IHD) due to unconfirmed diagnoses and b) administration of unreasoned therapy. This article presents statements of the guidelines, which cannot be automatically transmitted to the existing medical practice and should be discussed and adjusted by experts of the Russian Society of Cardiology.
Collapse
Affiliation(s)
- O M Drapkina
- National Medical Research Centre for Preventive Medicine, Ministry of Health of Russia
| | - I V Samorodskaya
- National Medical Research Centre for Preventive Medicine, Ministry of Health of Russia
| | - V N Larina
- Pirogov National Research Medical University, Ministry of Health of Russia
| |
Collapse
|
10
|
Amraotkar AR, Singh S, Desai R. Adding a US Perspective for Stroke Risk in Noncompliant Older Adults. J Am Geriatr Soc 2019; 67:2664-2665. [DOI: 10.1111/jgs.16169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Accepted: 07/20/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Alok R. Amraotkar
- Division of Cardiovascular MedicineUniversity of Louisville School of Medicine Louisville Kentucky
- Diabetes and Obesity CenterUniversity of Louisville School of Medicine Louisville Kentucky
| | - Sandeep Singh
- Department of Clinical EpidemiologyBiostatistics and Bioinformatics, Academic Medical Center Amsterdam The Netherlands
| | - Rupak Desai
- Division of CardiologyAtlanta Veterans Affairs (VA) Medical Center Decatur Georgia
| |
Collapse
|
11
|
Eilat‐Tsanani S, Schonmann Y. Reply to: Adding a US Perspective for Stroke Risk in Noncompliant Older Adults. J Am Geriatr Soc 2019; 67:2665-2666. [DOI: 10.1111/jgs.16172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 08/19/2019] [Indexed: 11/26/2022]
Affiliation(s)
| | - Yochai Schonmann
- Department of Family Medicine, Sackler School of MedicineTel Aviv University Tel Aviv Israel
| |
Collapse
|