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Nova A, Fazia T, Bernardinelli L. Assessing Additive Interactions between Protective Factors Using Relative Risk Reduction Due to Interaction. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1053. [PMID: 39064482 PMCID: PMC11279276 DOI: 10.3390/medicina60071053] [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: 04/19/2024] [Revised: 06/22/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024]
Abstract
Background and Objectives: In the context of disease prevention, interaction on an additive scale is commonly assessed to determine synergistic effects between exposures. While the "Relative Excess Risk due to Interaction" represents the main measure of additive interaction between risk factors, in this study we aimed to extend this approach to assess additive interaction between factors known to prevent the event's occurrence, such as medical interventions and drugs. Materials and Methods: We introduced and described the "Relative Risk Reduction due to Interaction" (RRRI) as a key measure to assess additive interactions between preventive factors, such as therapeutic interventions and drug combinations. For RRRI values closer to 1, the combination of exposures has a greater impact on reducing the event risk due to their interaction. As a purely illustrative example, we re-evaluated a previous investigation of the synergistic effect between statins and blood pressure-lowering drugs in preventing major adverse cardiovascular events (MACE). Moreover, simulation studies were used to empirically evaluate the performance of a robust Poisson regression model to estimate RRRI across different scenarios. Results: In our example, the drug combination revealed a positive additive interaction in further reducing MACE risk (RRRI > 0), even if not statistically significant. This result is more straightforward to interpret as compared to the original one based on the RERI. Additionally, our simulations highlighted the importance of large sample sizes for detecting significant interaction effects. Conclusion: We recommend RRRI as the main measure to be considered when exploring additive interaction effects between protective exposures, such as the investigation of synergistic effects between drug combinations or preventive treatments.
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Affiliation(s)
- Andrea Nova
- Department of Brain and Behavioral Sciences, University of Pavia, 27100 Pavia, Italy; (T.F.); (L.B.)
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Li Y, Liu H, Shen C, Li J, Liu F, Huang K, Gu D, Li Y, Lu X. Association of genetic variants related to combined lipid-lowering and antihypertensive therapies with risk of cardiovascular disease: 2 × 2 factorial Mendelian randomization analyses. BMC Med 2024; 22:201. [PMID: 38764043 PMCID: PMC11103938 DOI: 10.1186/s12916-024-03407-x] [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: 10/13/2023] [Accepted: 04/25/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND Lipid-lowering drugs and antihypertensive drugs are commonly combined for cardiovascular disease (CVD). However, the relationship of combined medications with CVD remains controversial. We aimed to explore the associations of genetically proxied medications of lipid-lowering and antihypertensive drugs, either alone or both, with risk of CVD, other clinical and safety outcomes. METHODS We divided 423,821 individuals in the UK Biobank into 4 groups via median genetic scores for targets of lipid-lowering drugs and antihypertensive drugs: lower low-density lipoprotein cholesterol (LDL-C) mediated by targets of statins or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, lower systolic blood pressure (SBP) mediated by targets of β-blockers (BBs) or calcium channel blockers (CCBs), combined genetically lower LDL-C and SBP, and reference (genetically both higher LDL-C and SBP). Associations with risk of CVD and other clinical outcomes were explored among each group in factorial Mendelian randomization. RESULTS Independent and additive effects were observed between genetically proxied medications of lipid-lowering and antihypertensive drugs with CVD (including coronary artery disease, stroke, and peripheral artery diseases) and other clinical outcomes (ischemic stroke, hemorrhagic stroke, heart failure, diabetes mellitus, chronic kidney disease, and dementia) (P > 0.05 for interaction in all outcomes). Take the effect of PCSK9 inhibitors and BBs on CVD for instance: compared with the reference, PCSK9 group had a 4% lower risk of CVD (odds ratio [OR], 0.96; 95%CI, 0.94-0.99), and a 3% lower risk was observed in BBs group (OR, 0.97; 95%CI, 0.94-0.99), while combined both were associated with a 6% additively lower risk (OR, 0.94; 95%CI, 0.92-0.97; P = 0.87 for interaction). CONCLUSIONS Genetically proxied medications of combined lipid-lowering and antihypertensive drugs have an independent and additive effects on CVD, other clinical and safety outcomes, with implications for CVD clinical practice, subsequent trials as well as drug development of polypills.
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Affiliation(s)
- Ying Li
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Hongwei Liu
- Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University and Henan Cancer Hospital, Zhengzhou, 450008, China
| | - Chong Shen
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Research Units of Cohort Study On Cardiovascular Diseases and Cancers, Chinese Academy of Medical Sciences, Beijing, 100730, China
| | - Jianxin Li
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Fangchao Liu
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Keyong Huang
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, 100037, China
| | - Dongfeng Gu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, 100037, China
- School of Public Health and Emergency Management, Southern University of Science and Technology, Shenzhen, 518055, China
- School of Medicine, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Yun Li
- School of Public Health, North China University of Science and Technology, Tangshan, 063210, China.
| | - Xiangfeng Lu
- Department of Epidemiology, Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
- Department of Epidemiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100037, China.
- Key Laboratory of Cardiovascular Epidemiology, Chinese Academy of Medical Sciences, Beijing, 100037, China.
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Sundström J, Norhammar A, Karayiannides S, Bodegård J, Gustafsson S, Cars T, Eriksson Svensson M, Ärnlöv J. Are there lost opportunities in chronic kidney disease? A region-wide cohort study. BMJ Open 2024; 14:e074064. [PMID: 38643002 PMCID: PMC11033666 DOI: 10.1136/bmjopen-2023-074064] [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: 03/26/2023] [Accepted: 04/03/2024] [Indexed: 04/22/2024] Open
Abstract
OBJECTIVES Identify the windows of opportunity for the diagnosis of chronic kidney disease (CKD) and the prevention of its adverse outcomes and quantify the potential population gains of such prevention. DESIGN AND SETTING Observational, population-wide study of residents in the Stockholm and Skåne regions of Sweden between 1 January 2015 and 31 December 2020. PARTICIPANTS All patients who did not yet have a diagnosis of CKD in healthcare but had CKD according to laboratory measurements of CKD biomarkers available in electronic health records. OUTCOME MEASURES We assessed the proportions of the patient population that received a subsequent diagnosis of CKD in healthcare, that used guideline-directed pharmacological therapy (statins, renin-angiotensin aldosterone system inhibitors (RAASi) and/or sodium-glucose cotransporter-2 inhibitors (SGLT2i)) and that experienced adverse outcomes (all-cause mortality, cardiovascular mortality or major adverse cardiovascular events (MACE)). The potential to prevent adverse outcomes in CKD was assessed using simulations of guideline-directed pharmacological therapy in untreated subsets of the study population. RESULTS We identified 99 382 patients with undiagnosed CKD during the study period. Only 33% of those received a subsequent diagnosis of CKD in healthcare after 5 years. The proportion that used statins or RAASi was of similar size to the proportion that didn't, regardless of how advanced their CKD was. The use of SGLT2i was negligible. In simulations of optimal treatment, 22% of the 21 870 deaths, 27% of the 14 310 cardiovascular deaths and 39% of the 22 224 MACE could have been avoided if every patient who did not use an indicated medication for their laboratory-confirmed CKD was treated with guideline-directed pharmacological therapy for CKD. CONCLUSIONS While we noted underdiagnosis and undertreatment of CKD in this large contemporary population, we also identified a substantial realisable potential to improve CKD outcomes and reduce its burden by treating patients early with guideline-directed pharmacological therapy.
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Affiliation(s)
- Johan Sundström
- Department of Medical Sciences, Clinical Epidemiology, Uppsala University, Uppsala, Sweden
- The George Institute for Global Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Anna Norhammar
- Cardiology Unit, Department of Medicine, Karolinska Institutet, Solna, Stockholm, Sweden
- Capio S:t Görans Hospital, Stockholm, Sweden
| | - Stelios Karayiannides
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden
- Center for Diabetes, Academic Specialist Center, Region Stockholm, Stockholm, Sweden
| | - Johan Bodegård
- Cardiovascular, Renal and Metabolism, Medical Department, BioPharmaceuticals, AstraZeneca PLC, Oslo, Norway
| | | | | | - Maria Eriksson Svensson
- Department of Medical Sciences, Renal Medicine, Uppsala University, Uppsala, Sweden
- Uppsala Clinical Research Center, Uppsala, Sweden
| | - Johan Ärnlöv
- Division of Family Medicine, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
- School of Health and Social Studies, Dalarna University, Falun, Dalarna, Sweden
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Radhoe SP, Boersma E, Bertrand M, Remme W, Ferrari R, Fox K, MacMahon S, Chalmers J, Simoons ML, Brugts JJ. The Effects of a Perindopril-Based Regimen in Relation to Statin Use on the Outcomes of Patients with Vascular Disease: a Combined Analysis of the ADVANCE, EUROPA, and PROGRESS Trials. Cardiovasc Drugs Ther 2024; 38:131-139. [PMID: 36194352 PMCID: PMC10876738 DOI: 10.1007/s10557-022-07384-2] [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] [Accepted: 09/12/2022] [Indexed: 11/30/2022]
Abstract
PURPOSE To study the effects of a perindopril-based regimen on cardiovascular (CV) outcomes in patients with vascular disease in relation to background statin therapy. METHODS A pooled analysis of the randomized ADVANCE, EUROPA, and PROGRESS trials was performed to evaluate CV outcomes in 29,463 patients with vascular disease treated with perindopril-based regimens versus placebo. The primary endpoint was a composite of CV mortality, nonfatal myocardial infarction, and stroke. Multivariable Cox regression analyses were performed to assess the effects of a perindopril-based regimen versus placebo in relation to statin use. RESULTS At randomization, 39.5% of the overall combined study population used statins. After a mean follow-up of 4.0 years (SD 1.0), the cumulative event-free survival was highest in the statin/perindopril group and lowest in the no statin/placebo group (91.2% vs. 85.6%, respectively, log-rank p < 0.001). In statin users (adjusted hazard ratio [aHR] 0.87, 95% confidence interval [CI] 0.77-0.98) and non-statin users (aHR 0.80, 95% CI 0.74-0.87), a perindopril-based regimen was associated with a significantly lower risk of the primary endpoint when compared to placebo. The additional treatment effect appeared numerically greater in non-statin users, but the observed difference was statistically nonsignificant. CONCLUSION Our data suggest that the treatment benefits of a perindopril-based regimen in patients with vascular disease are independent of statin use.
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Affiliation(s)
- S P Radhoe
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands.
| | - E Boersma
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | | | - W Remme
- STICARES Cardiovascular Research Institute, Rhoon, the Netherlands
| | - R Ferrari
- Department of Cardiology, University of Ferrara, Ferrara, Italy
| | - K Fox
- NHLI, Imperial College and Royal Brompton Hospital, London, UK
| | - S MacMahon
- The George Institute for Global Health, The University of NSW, Sydney, NSW, Australia
| | - J Chalmers
- The George Institute for Global Health, The University of NSW, Sydney, NSW, Australia
| | - M L Simoons
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
| | - J J Brugts
- Department of Cardiology, Thorax Center, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015GD, the Netherlands
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Liu HT, Deng NH, Wu ZF, Zhou ZY, Tian Z, Liu XY, Wang YX, Zheng HY, Ou YS, Jiang ZS. Statin's role on blood pressure levels: Meta-analysis based on randomized controlled trials. J Clin Hypertens (Greenwich) 2023; 25:238-250. [PMID: 36799888 PMCID: PMC9994171 DOI: 10.1111/jch.14645] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2022] [Revised: 01/21/2023] [Accepted: 01/26/2023] [Indexed: 02/18/2023]
Abstract
Statins have been proven to be effective in minimizing the risk of cardiovascular adverse events, however, their effect on BP variability is debatable with respect to their significance and their use as a potential anti-hypertensive. Using a meta-analysis approach, the aim of this study was to explore whether certain statins have the potential to lower blood pressure (BP). For the period 2002-2022, Scopus, PubMed, Web of Science, and the Cochrane Central Register of Controlled Trials databases were searched for the studies that examined the effect of statins on blood pressure in normotensive or hypertensive individuals. Randomized controlled clinical trials that investigated this effect were included based on our inclusion criteria. Our primary outcomes were changes in systolic and diastolic blood pressure (DBP). The final analysis of the study included 49 RCTs involving 45 173 participants randomized to receive either statins or placebo. Among the two groups, the total weighted mean difference (WMD) for systolic blood pressure (ΔSBP) was -1.42 (95% CI: -2.38, -0.46; p = .004) and diastolic blood pressure (ΔDBP) was 0.82 (95% CI: -1.28, -0.36; p = .0005). Despite various studies suggesting the efficacy of statins in blood pressure lowering to be significant and non-significant both, we observed a decrease in SBP and DBP both, although the change was not as large and could be considered significant. A large multicenter, multi-ethnic, large sample pool size, and a long period follow-up study is still required to assert these claims.
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Affiliation(s)
- Hui Ting Liu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Nian Hua Deng
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Ze Fan Wu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Zhan Yang Zhou
- Department of Cardiology, Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, Beijing, PR China
| | - Zhen Tian
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Xi Yan Liu
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Yan Xia Wang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Hong Yu Zheng
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
| | - Yang Shao Ou
- The Second Hospital, University of South China, Hengyang, Hunan, PR China
| | - Zhi Sheng Jiang
- Institute of Cardiovascular Disease, Key Laboratory for Arteriosclerosis of Hunan Province, Hengyang Medical College, University of South China, Hengyang, Hunan, PR China
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Poli A, Catapano AL, Corsini A, Manzato E, Werba JP, Catena G, Cetin I, Cicero AFG, Cignarella A, Colivicchi F, Consoli A, Landi F, Lucarelli M, Manfellotto D, Marrocco W, Parretti D, Perrone Filardi P, Pirillo A, Sesti G, Volpe M, Marangoni F. LDL-cholesterol control in the primary prevention of cardiovascular diseases: An expert opinion for clinicians and health professionals. Nutr Metab Cardiovasc Dis 2023; 33:245-257. [PMID: 36566123 DOI: 10.1016/j.numecd.2022.10.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Accepted: 10/04/2022] [Indexed: 11/29/2022]
Abstract
AIMS Although adequate clinical management of patients with hypercholesterolemia without a history of known cardiovascular disease is essential for prevention, these subjects are often disregarded. Furthermore, the scientific literature on primary cardiovascular prevention is not as rich as that on secondary prevention; finally, physicians often lack adequate tools for the effective management of subjects in primary prevention and have to face some unsolved relevant issues. This document aims to discuss and review the evidence available on this topic and provide practical guidance. DATA SYNTHESIS Available algorithms and risk charts represent the main tool for the assessment of cardiovascular risk in patients in primary prevention. The accuracy of such an estimate can be substantially improved considering the potential contribution of some additional risk factors (C-reactive protein, lipoprotein(a), family history of cardiovascular disease) and conditions (environmental pollution, sleep quality, socioeconomic status, educational level) whose impact on the cardiovascular risk has been better understood in recent years. The availability of non-invasive procedures to evaluate subclinical atherosclerosis may help to identify subjects needing an earlier intervention. Unveiling the presence of these conditions will improve cardiovascular risk estimation, granting a more appropriate intervention. CONCLUSIONS The accurate assessment of cardiovascular risk in subjects in primary prevention with the use of algorithms and risk charts together with the evaluation of additional factors will allow physicians to approach each patient with personalized strategies, which should translate into an increased adherence to therapy and, as a consequence, a reduced cardiovascular risk.
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Affiliation(s)
- Andrea Poli
- NFI - Nutrition Foundation of Italy, Milan, Italy.
| | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy; Center for the Study of Dyslipidaemias, IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy
| | - Enzo Manzato
- Department of Medicine, University of Padova, Padova, Italy; SISA - Italian Society for the Study of Atherosclerosis, Italy
| | - José Pablo Werba
- Unit of Atherosclerosis Prevention, Monzino Cardiology Center, IRCCS, Milan, Italy
| | | | - Irene Cetin
- Department of Woman, Mother and Neonate Hospital Buzzi, Milan, University of Milan, Italy; SIGO - Italian Society of Gynecology and Obstetrics, Italy
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, IRCCS AOU di Bologna, Bologna, Italy; SINut - Italian Nutraceutical Society, Italy
| | - Andrea Cignarella
- Department of Medicine, University of Padova, Padova, Italy; Italian Research Center for Gender Health and Medicine, Italy
| | - Furio Colivicchi
- Division of Clinical Cardiology, San Filippo Neri Hospital, Rome, Italy; ANMCO - Italian National Association of Hospital Cardiologists, Italy
| | - Agostino Consoli
- Department of Medicine and Aging Sciences, University G. D'Annunzio, Chieti, Italy; SID - Italian Society of Diabetology, Italy
| | - Francesco Landi
- Fondazione Policlinico Universitario A. Gemelli IRCSS, Rome, Italy; SIGG - Italian Society of Gerontology and Geriatrics, Italy
| | - Maurizio Lucarelli
- SNaMID - National Society of Medical Education in General Practice, Italy
| | - Dario Manfellotto
- Department of Internal Medicine, Fatebenefratelli Hospital, Isola Tiberina, Rome, Italy; FADOI - Federation of Associations of Hospital Internists, Italy
| | - Walter Marrocco
- SIMPeSV and FIMMG - Italian Society of Preventive and Lifestyle Medicine and Italian Federation of General Practitioners, Italy
| | | | - Pasquale Perrone Filardi
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy; SIC - Italian Society of Cardiology, Italy
| | - Angela Pirillo
- Center for the Study of Dyslipidaemias, IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy; Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, Italy
| | - Giorgio Sesti
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Rome, Italy; SIMI - Italian Society of Internal Medicine, Italy
| | - Massimo Volpe
- Department of Clinical and Molecular Medicine, Sapienza University of Rome, Italy; SIPREC - Italian Society for Cardiovascular Prevention, Italy
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Shinohara K, Ikeda S, Enzan N, Matsushima S, Tohyama T, Funakoshi K, Kishimoto J, Itoh H, Komuro I, Tsutsui H. Efficacy of intensive lipid-lowering therapy with statins stratified by blood pressure levels in patients with type 2 diabetes mellitus and retinopathy: Insight from the EMPATHY study. Hypertens Res 2021; 44:1606-1616. [PMID: 34526672 DOI: 10.1038/s41440-021-00734-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 07/06/2021] [Accepted: 07/25/2021] [Indexed: 02/07/2023]
Abstract
Intensive lipid-lowering therapy is recommended in individuals exhibiting type 2 diabetes mellitus (T2DM) with microvascular complications (as high-risk patients), even without known cardiovascular disease (CVD). However, evidence is insufficient to stratify the patients who would benefit from intensive therapy among them. Hypertension is a major risk factor, and uncontrolled blood pressure (BP) is associated with increased CVD risk. We evaluated the efficacy of intensive vs. standard statin therapy for primary CVD prevention among T2DM patients with retinopathy stratified by BP levels. We used the dataset from the EMPATHY study, which compared intensive statin therapy targeting low-density lipoprotein cholesterol (LDL-C) levels of <70 mg/dL and standard therapy targeting LDL-C levels ranging from ≥100 to <120 mg/dL in T2DM patients with retinopathy without known CVD. A total of 4980 patients were divided into BP ≥ 130/80 mmHg (systolic BP ≥ 130 mmHg and/or diastolic BP ≥ 80 mmHg, n = 3335) and BP < 130/80 mmHg (n = 1645) subgroups by baseline BP levels. During the median follow-up of 36.8 months, 281 CVD events were observed. Consistent with previous studies, CVD events occurred more frequently in the BP ≥ 130/80 mmHg subgroup than in the BP < 130/80 mmHg subgroup (P < 0.001). In the BP ≥ 130/80 mmHg subgroup, intensive statin therapy was associated with lower CVD risk (HR 0.70, P = 0.015) than standard therapy after adjustment. No such association was observed in the BP < 130/80 mmHg subgroup. The interaction between BP subgroup and statin therapy was significant. In conclusion, intensive statin therapy targeting LDL-C < 70 mg/dL provided benefits in primary CVD prevention when compared with standard therapy among T2DM patients with retinopathy and BP ≥ 130/80 mmHg.
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Affiliation(s)
- Keisuke Shinohara
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan. .,Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan.
| | - Shota Ikeda
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Nobuyuki Enzan
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shouji Matsushima
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Takeshi Tohyama
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Kouta Funakoshi
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan.,Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Junji Kishimoto
- Center for Clinical and Translational Research, Kyushu University Hospital, Fukuoka, Japan
| | - Hiroshi Itoh
- Department of Endocrinology, Metabolism and Nephrology, Keio University School of Medicine, Tokyo, Japan
| | - Issei Komuro
- Department of Cardiovascular Medicine, The University of Tokyo Graduate School of Medicine, Tokyo, Japan
| | - Hiroyuki Tsutsui
- Department of Cardiovascular Medicine, Faculty of Medical Sciences, Kyushu University, Fukuoka, Japan
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Isaac JA, Ekere KE, Ezekiel E, Galadima IH, Abdulahi R, Samali A. Compressional Physics of Binary Mixture of Dried Andrographis paniculata and Moringa oleifera Leaves. BORNEO JOURNAL OF PHARMACY 2021. [DOI: 10.33084/bjop.v4i4.2544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Traditionally, the leafy part of Andrographis paniculata and Moringa oleifera have been widely reported to manage hypertension. Investigation of its pharmacological actions justifies its use. As part of formulation studies to standardize them, this study focused on their compaction and compression properties. Compacts equivalent to 250 mg of A. paniculata and M. oleifera were produced by compressing powders and granules at various compression pressure. Results show that M. oleifera met the WHO limit for ash values. Relative density values for granulated batches were higher, while their moisture content values were lower when compared to those of direct compression. The result from Heckel plots shows that batches deform mainly by plastic flow. For Kawakita plots, values of 1/b show that batches containing microcrystalline cellulose were less cohesive. The plot of tensile strength signifies that granulated batches achieved maximum crushing strength faster at low pressure. Formulations containing maize starch were shown to have higher percent porosity, and granulated batches gave higher values for apparent density-pressure relationship and lower friability values. Tablets produced by the wet granulation method showed better compression and compaction properties than those formulated by direct compression.
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Affiliation(s)
| | | | - Ekeh Ezekiel
- National Institute for Pharmaceutical Research and Development
| | | | | | - Ayuba Samali
- National Institute for Pharmaceutical Research and Development
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9
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Lee S, Yang S, Chang MJ. Antihypertensive effects of rosuvastatin in patients with hypertension and dyslipidemia: A systemic review and meta-analysis of randomized studies. PLoS One 2021; 16:e0260391. [PMID: 34818350 PMCID: PMC8612562 DOI: 10.1371/journal.pone.0260391] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 11/09/2021] [Indexed: 11/18/2022] Open
Abstract
Some studies have suggested the antihypertensive effects of statins, a class of lipid-lowering agents, particularly in patients with hypertension. However, the evidence for the role of statins in blood pressure (BP) lowering is controversial, and no meta-analysis of rosuvastatin therapy has been conducted to assess its BP-lowering effects. Therefore, the aim of this meta-analysis of randomized controlled trials (RCTs) was to investigate the effects of rosuvastatin on systolic blood pressure (SBP) and diastolic blood pressure (DBP) in patients with hypertension. We systematically searched the electronic databases MEDLINE, EMBASE, and Cochrane Library to identify RCTs in which patients were assigned to groups of rosuvastatin plus antihypertensive agents vs. antihypertensive agents. The three authors independently selected the studies, extracted data, and assessed methodological quality. We included five RCTs in this meta-analysis with 288 patients treated with rosuvastatin and 219 patients without rosuvastatin. The mean DBP in the rosuvastatin group was significantly lower than that in the non-rosuvastatin group by -2.12 mmHg (95% confidence interval (CI) -3.72 to -0.52; Pfixed-effects model = 0.009; I2 = 0%, Pheterogeneity = 0.97). Rosuvastatin treatment also lowered the mean SBP compared with the non-rosuvastatin treatment by -2.27 mmHg, but not significantly (95% CI - 4.75 to 0.25; Pfixed-effects model = 0.08; I2 = 0%, Pheterogeneity = 0.82). In this study, we reviewed the antihypertensive effects of rosuvastatin in patients with hypertension and dyslipidemia. We demonstrated a modest significant reduction of DBP and a trend toward a lowered SBP in patients with hypertension with rosuvastatin therapy. Rosuvastatin could be beneficial to control hypertension and, consequently, contribute toward reducing the risk of cardiovascular events in patients with hypertension and dyslipidemia.
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Affiliation(s)
- Sungjae Lee
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea
| | - Seungwon Yang
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Science, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
| | - Min Jung Chang
- Department of Pharmaceutical Medicine and Regulatory Sciences, Colleges of Medicine and Pharmacy, Yonsei University, Incheon, Republic of Korea
- Department of Pharmacy and Yonsei Institute of Pharmaceutical Science, College of Pharmacy, Yonsei University, Incheon, Republic of Korea
- Department of Industrial Pharmaceutical Science, Yonsei University, Incheon, Republic of Korea
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10
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Zhu J, Liu Y, Zhang Y, Li D. Attribute Supervised Probabilistic Dependent Matrix Tri-Factorization Model for the Prediction of Adverse Drug-Drug Interaction. IEEE J Biomed Health Inform 2021; 25:2820-2832. [PMID: 33373310 DOI: 10.1109/jbhi.2020.3048059] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Adverse drug-drug interaction (ADDI) becomes a significant threat to public health. Despite the detection of ADDIs is experimentally implemented in the early development phase of drug design, many potential ADDIs are still clinically explored by accidents, leading to a large number of morbidity and mortality. Several computational models are designed for ADDI prediction. However, they take no consideration of drug dependency, although many drugs usually produce synergistic effects and own highly mutual dependency in treatments, which contains underlying information about ADDIs and benefits ADDI prediction. In this paper, we design a dependent network to model the drug dependency and propose an attribute supervised learning model Probabilistic Dependent Matrix Tri-Factorization (PDMTF) for ADDI prediction. In particular, PDMTF incorporates two drug attributes, molecular structure and side effect, and their correlation to model the adverse interactions among drugs. The dependent network is represented by a dependent matrix, which is first formulated by the row precision matrix of the predicted attribute matrices and then regularized by the molecular structure similarities among drugs. Meanwhile, an efficient alternating algorithm is designed for solving the optimization problem of PDMTF. Experiments demonstrate the superior performance of the proposed model when compared with eight baselines and its two variants.
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11
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Hageman SHJ, Dorresteijn JAN, Bots ML, Asselbergs FW, Westerink J, van der Meulen MP, Mosterd A, Visseren FLJ, Asselbergs FW, Nathoe HM, de Borst GJ, Bots ML, Geerlings MI, Emmelot MH, de Jong PA, Leiner T, Lely AT, van der Kaaij NP, Kappelle LJ, Ruigrok YM, Verhaar MC, Visseren FLJ, Westerink J. Residual cardiovascular risk reduction guided by lifetime benefit estimation in patients with symptomatic atherosclerotic disease: effectiveness and cost-effectiveness. Eur J Prev Cardiol 2021; 29:635-644. [PMID: 34009323 DOI: 10.1093/eurjpc/zwab028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 12/07/2020] [Indexed: 12/22/2022]
Abstract
AIMS To determine the (cost)-effectiveness of blood pressure lowering, lipid-lowering, and antithrombotic therapy guided by predicted lifetime benefit compared to risk factor levels in patients with symptomatic atherosclerotic disease. METHODS AND RESULTS For all patients with symptomatic atherosclerotic disease in the UCC-SMART cohort (1996-2018; n = 7697) two treatment strategies were compared. The lifetime benefit-guided strategy was based on individual estimation of gain in cardiovascular disease (CVD)-free life with the SMART-REACH model. In the risk factor-based strategy, all patients were treated the following: low-density lipoprotein cholesterol (LDL-c) < 1.8 mmol/L, systolic blood pressure <140 mmHg, and antithrombotic medication. Outcomes were evaluated for the total cohort using a microsimulation model. Effectiveness was evaluated as total gain in CVD-free life and events avoided, cost-effectiveness as incremental cost-effectivity ratio (ICER). In comparison to baseline treatment, treatment according to lifetime benefit would lead to an increase of 24 243 CVD-free life years [95% confidence interval (CI) 19 980-29 909] and would avoid 940 (95% CI 742-1140) events in the next 10 years. For risk-factor based treatment, this would be an increase of 18 564 CVD-free life years (95% CI 14 225-20 456) and decrease of 857 (95% CI 661-1057) events. The ICER of lifetime benefit-based treatment with a treatment threshold of ≥1 year additional CVD-free life per therapy was €15 092/QALY gained and of risk factor-based treatment €9933/QALY gained. In a direct comparison, lifetime benefit-based treatment compared to risk factor-based treatment results in 1871 additional QALYs for the price of €36 538/QALY gained. CONCLUSION Residual risk reduction guided by lifetime benefit estimation results in more CVD-free life years and more CVD events avoided compared to the conventional risk factor-based strategy. Lifetime benefit-based treatment is an effective and potentially cost-effective strategy for reducing residual CVD risk in patients with clinical manifest vascular disease.
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Affiliation(s)
- Steven H J Hageman
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Jannick A N Dorresteijn
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Michiel L Bots
- Julius Center for Health Sciences and Primary Care, Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Folkert W Asselbergs
- Department of Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Westerink
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
| | - Miriam P van der Meulen
- Julius Center for Health Sciences and Primary Care, Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands
| | - Arend Mosterd
- Julius Center for Health Sciences and Primary Care, Utrecht, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.,Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
| | - Frank L J Visseren
- Department of Vascular Medicine, University Medical Center Utrecht, PO Box 85500, 3508 GA Utrecht, The Netherlands
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12
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Estudio farmacodinámico del policomprimido cardiovascular: ¿existe algún tipo de interacción entre los monocomponentes? Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2019.11.021] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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13
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Wang Y, Jiang L, Feng SJ, Tang XY, Kuang ZM. Effect of Combined Statin and Antihypertensive Therapy in Patients with Hypertension: A Systematic Review and Meta-Analysis. Cardiology 2020; 145:802-812. [PMID: 33113537 DOI: 10.1159/000508280] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 04/26/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This meta-analysis aimed to explore the preventive effects of combined statin and antihypertensive therapy on major cardiovascular outcomes in patients with hypertension. METHODS PubMed, Embase, and the Cochrane Library databases and reference lists of published studies were systematically searched throughout October 9, 2019. Studies designed as randomized controlled trials and investigating the effects of combined statin and antihypertensive therapy versus antihypertensive therapy alone were included. Data abstraction and quality of included studies were assessed by 2 independent authors. The summary results were calculated using relative risks (RRs) with 95% CIs employing a random-effects model. RESULTS A total of 8 randomized controlled trials including 38,618 patients were finally enrolled. The summary RRs indicated that the combined therapy significantly reduced the risk of major adverse cardiovascular events compared with antihypertensive therapy alone (RR 0.79; 95% CI 0.71-0.88; p < 0.001). Furthermore, the patients in the combined therapy group also experienced less myocardial infarction (RR 0.67; 95% CI 0.53-0.84; p = 0.001) and stroke risks (RR 0.82; 95% CI 0.72-0.94; p = 0.005), while no significant difference was observed between combined therapy and antihypertensive therapy alone regarding cardiac death (RR 0.96; 95% CI 0.84-1.08; p = 0.465) and all-cause mortality (RR 0.95; 95% CI 0.86-1.04; p = 0.277). CONCLUSION These findings suggested that combined statin and antihypertensive therapy was associated with more cardiovascular benefits compared with antihypertensive therapy alone.
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Affiliation(s)
- Ying Wang
- The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang, China.,Department of Hypertension, Beijing Anzhen Hospital of Capital Medical University, Beijing, China
| | - Long Jiang
- Department of Cardiology, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Shu-Jun Feng
- Hunan Province Key Laboratory of Tumor Cellular and Molecular Pathology, Cancer Research Institute, Hengyang School of Medicine, University of South China, Hengyang, China
| | - Xin-Ying Tang
- Department of Cardiology, Hospital of Chenzhou Affiliated to University of South China, Chenzhou, China
| | - Ze-Min Kuang
- Department of Hypertension, Beijing Anzhen Hospital of Capital Medical University, Beijing, China,
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Redfern J, Coorey G, Mulley J, Scaria A, Neubeck L, Hafiz N, Pitt C, Weir K, Forbes J, Parker S, Bampi F, Coenen A, Enright G, Wong A, Nguyen T, Harris M, Zwar N, Chow CK, Rodgers A, Heeley E, Panaretto K, Lau A, Hayman N, Usherwood T, Peiris D. A digital health intervention for cardiovascular disease management in primary care (CONNECT) randomized controlled trial. NPJ Digit Med 2020; 3:117. [PMID: 32964140 PMCID: PMC7484809 DOI: 10.1038/s41746-020-00325-z] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/14/2020] [Indexed: 12/31/2022] Open
Abstract
Digital health applications (apps) have the potential to improve health behaviors and outcomes. We aimed to examine the effectiveness of a consumer web-based app linked to primary care electronic health records (EHRs). CONNECT was a multicenter randomized controlled trial involving patients with or at risk of cardiovascular disease (CVD) recruited from primary care (Clinical Trial registration ACTRN12613000715774). Intervention participants received an interactive app which was pre-populated and refreshed with EHR risk factor data, diagnoses and, medications. Interactive risk calculators, motivational messages and lifestyle goal tracking were also included. Control group received usual health care. Primary outcome was adherence to guideline-recommended medications (≥80% of days covered for blood pressure (BP) and statin medications). Secondary outcomes included attainment of risk factor targets and eHealth literacy. In total, 934 patients were recruited; mean age 67.6 (±8.1) years. At 12 months, the proportion with >80% days covered with recommended medicines was low overall and there was no difference between the groups (32.8% vs. 29.9%; relative risk [RR] 1.07 [95% CI, 0.88-1.20] p = 0.49). There was borderline improvement in the proportion meeting BP and LDL targets in intervention vs. control (17.1% vs. 12.1% RR 1.40 [95% CI, 0.97-2.03] p = 0.07). The intervention was associated with increased attainment of physical activity targets (87.0% intervention vs. 79.7% control, p = 0.02) and e-health literacy scores (72.6% intervention vs. 64.0% control, p = 0.02). In conclusion, a consumer app integrated with primary health care EHRs was not effective in increasing medication adherence. Borderline improvements in risk factors and modest behavior changes were observed.
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Affiliation(s)
- Julie Redfern
- Faculty of Medicine and Health, The University of Sydney, Westmead Applied Research Centre, Sydney, NSW Australia
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Genevieve Coorey
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
- Faculty of Medicine and Health, School of Public Health, University of Sydney, Sydney, NSW Australia
| | - John Mulley
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Anish Scaria
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Lis Neubeck
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Nashid Hafiz
- Faculty of Medicine and Health, The University of Sydney, Westmead Applied Research Centre, Sydney, NSW Australia
| | - Chris Pitt
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Kristie Weir
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Joanna Forbes
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Sharon Parker
- School of Health and Social Care, Edinburgh Napier University, Edinburgh, Scotland
| | - Fiona Bampi
- Fiona Bampi - Cancer Australia, Australian Government, Sydney, Australia
| | - Alison Coenen
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Gemma Enright
- Faculty of Medicine and Health, The University of Sydney, Westmead Applied Research Centre, Sydney, NSW Australia
| | - Annette Wong
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW Australia
| | - Theresa Nguyen
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Mark Harris
- Centre for Primary Health Care and Equity, UNSW, Sydney, NSW Australia
| | - Nick Zwar
- Faculty of Health Sciences & Medicine, Bond University, Gold Coast, QLD Australia
- School of Public Health and Community Medicine, UNSW, Sydney, Australia
| | - Clara K. Chow
- Faculty of Medicine and Health, The University of Sydney, Westmead Applied Research Centre, Sydney, NSW Australia
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Anthony Rodgers
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Emma Heeley
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
| | - Katie Panaretto
- Centre for Chronic Disease, The University of Queensland, Brisbane, QLD Australia
| | - Annie Lau
- Australian Institute of Health Innovation, Macquarie University, Sydney, NSW Australia
| | | | - Tim Usherwood
- Faculty of Medicine and Health, The University of Sydney, Westmead Applied Research Centre, Sydney, NSW Australia
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
- Department of General Practice, Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, NSW Australia
| | - David Peiris
- The George Institute for Global Health, UNSW, Sydney, NSW Australia
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González-Juanatey JR, Tamargo J, Torres F, Weisser B, Oudovenko N. Pharmacodynamic study of the cardiovascular polypill. Is there any interaction among the monocomponents? REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 74:51-58. [PMID: 31983653 DOI: 10.1016/j.rec.2019.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 11/27/2019] [Indexed: 01/01/2023]
Abstract
INTRODUCTION AND OBJECTIVES To compare the pharmacodynamics of the CNIC polypill (atorvastatin 40mg/ramipril 10mg/aspirin 100mg) in terms of low-density lipoprotein cholesterol (LDL-C) and systolic blood pressure (SBP), with the corresponding reference products (atorvastatin and ramipril). METHODS This was a multicenter, randomized, open-label, and parallel 3-arm study comparing the effect of the CNIC polypill vs ramipril 10mg and atorvastatin 40mg on SBP and LDL-C. The coprimary endpoints were differences in the adjusted mean 24-hour SBP (using ambulatory BP measurement) and LDL-C during the study period estimated using an ANCOVA model. RESULTS Of the 241 patients included in the per protocol population, 84 received the CNIC polypill (group A), 84 atorvastatin (group B), and 73 ramipril (group C). SBP decreased from 139.3±12.5 to 133.2±12.9mmHg in group A and from 138.1±11.9 to 134.0±12.8mmHg in group C (baseline adjusted mean difference for the decrease in SBP was 1.77mmHg (90%CI, -0.5 to 4.0) in favor of group A, without reaching statistical significance. LDL-C was reduced by 33.9±21.6 and 29.2±25.8mg/dL in groups A and B, respectively (baseline adjusted mean difference for the decrease in LDL-C was 7.0% (90%CI, 1.5-12.4), a significantly greater decrease with the polypill). The 3 treatments were well tolerated. CONCLUSIONS The results of this study rule out a negative effect on blood pressure of the interaction between the components of the CNIC polypill. The reduction in LDL-C was greater in the CNIC polypill group, suggesting a synergistic effect of the components.
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Affiliation(s)
- José R González-Juanatey
- Servicio de Cardiología, Hospital Clínico Universitario de Santiago de Compostela, CIBERCV; IDIS, Santiago de Compostela, A Coruña, Spain
| | - Juan Tamargo
- Departamento de Farmacología, Escuela de Medicina, Universidad Complutense, Fundación Gregorio Marañón, CIBERCV, Madrid, Spain
| | - Ferran Torres
- Unidad de Bioestadística, IDIBAPS, Hospital Clínic de Barcelona, Facultat de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Burkhard Weisser
- Institut für Sportwissenschaft, Christian-Albrechts-Universität zu Kiel, Kiel, Germany
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Does Co-administration of Antihypertensive Drugs and Statins Alter Their Efficacy and Safety? A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Cardiovasc Pharmacol 2019; 73:352-358. [DOI: 10.1097/fjc.0000000000000671] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Sufficient Cause Interaction for Time-to-event Outcomes. Epidemiology 2019; 30:189-196. [PMID: 30608244 DOI: 10.1097/ede.0000000000000958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Methods to assess sufficient cause interactions are well developed for binary outcomes. We extend these methods to handle time-to-event outcomes, which occur frequently in medicine and epidemiology. Based on theory for marginal structural models in continuous time, we show how to assess sufficient cause interaction nonparametrically, allowing for censoring and competing risks. We apply the method to study interaction between intensive blood pressure therapy and statin treatment on all-cause mortality.
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Abstract
Between the 1930s and 50s, evolutionary biologists developed a successful theory of why organisms age, firmly rooted in population genetic principles. By the 1980s the evolution of aging had a secure experimental basis. Since the force of selection declines with age, aging evolves due to mutation accumulation or a benefit to fitness early in life. Here we review major insights and challenges that have emerged over the last 35 years: selection does not always necessarily decline with age; higher extrinsic (i.e., environmentally caused) mortality does not always accelerate aging; conserved pathways control aging rate; senescence patterns are more diverse than previously thought; aging is not universal; trade-offs involving lifespan can be 'broken'; aging might be 'druggable'; and human life expectancy continues to rise but compressing late-life morbidity remains a pressing challenge.
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Affiliation(s)
- Thomas Flatt
- Department of Biology, University of Fribourg, Chemin du Musée 10, CH-1700, Fribourg, Switzerland
| | - Linda Partridge
- Max Planck Institute for Biology of Aging, Joseph-Stelzmann-Strasse 9b, D-50931, Cologne, Germany.
- Institute for Healthy Aging and GEE, University College London, Darwin Building, Gower Street, London, WC1E6BT, UK.
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