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Wettermark B, Kalantaripour C, Forslund T, Hjemdahl P. Statin treatment for primary and secondary prevention in elderly patients-a cross-sectional study in Stockholm, Sweden. Eur J Clin Pharmacol 2024; 80:1571-1580. [PMID: 39012537 PMCID: PMC11393277 DOI: 10.1007/s00228-024-03724-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 06/24/2024] [Indexed: 07/17/2024]
Abstract
BACKGROUND Age is a major risk factor for atherosclerotic cardiovascular disease (CVD) and death, but there has been a debate about benefit-risk of statin treatment in the elderly with limited evidence on benefits for primary prevention, while there is strong evidence for its use in secondary prevention. AIM The aim of this study was to provide an overview of statin utilization in primary and secondary prevention for patients 75-84 years and ≥ 85 years in the Swedish capital Region Stockholm in 2019. METHODS This is a cross-sectional study based on the regional healthcare database VAL containing all diagnoses and dispensed prescription drugs for all 174,950 inhabitants ≥ 75 years old in the Stockholm Region. Prevalence and incidence were analyzed by sex, age, cardiovascular risk, substance, and the intensity of treatment. RESULTS A total of 35% of all individuals above the age of 75 in the region were treated with statins in 2019. The overall incidence in this age group was 31 patients per 1000 inhabitants. Men, individuals 75-84 compared to ≥ 85 years of age, and those with higher cardiovascular risk were treated to a greater extent. Simvastatin was used primarily by prevalent users and atorvastatin by incident users. The majority was treated with moderate-intensity dosages and fewer women received high intensity treatment. CONCLUSIONS Statins are widely prescribed in the elderly. Physicians seem to consider individual cardiovascular risk when deciding to initiate statin treatment for elderly patients, but here may still be some undertreatment among high-risk patients (especially women and elderly 85 + years) and some overtreatment among patients with low-risk for CVD.
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Affiliation(s)
- Björn Wettermark
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Box 580, 751 23, Uppsala, Sweden.
| | - Camelia Kalantaripour
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Box 580, 751 23, Uppsala, Sweden
| | - Tomas Forslund
- Academic Primary Health Care Centre, Stockholm Region, Stockholm, Sweden
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute and Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
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Zambon A, Liberopoulos E, Dovizio M, Veronesi C, Degli Esposti L, Pérez de Isla L. A real-world analysis of adherence, biochemical outcomes, and healthcare costs in patients treated with rosuvastatin/ezetimibe as single-pill combination vs. free combination in Italy. EUROPEAN HEART JOURNAL OPEN 2024; 4:oeae074. [PMID: 39310723 PMCID: PMC11416014 DOI: 10.1093/ehjopen/oeae074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Revised: 07/12/2024] [Accepted: 08/01/2024] [Indexed: 09/25/2024]
Abstract
Aims To compare medication adherence, lipid goal attainment, and healthcare costs between patients receiving a single-pill combination (SPC) vs. a free combination treatment (FCT) of rosuvastatin/ezetimibe (ROS/EZE) in Italy. Methods and results Administrative databases of healthcare entities covering ∼7 million individuals were used to identify adults prescribed with ROS/EZE as SPC or FCT between January 2018 and June 2020. Adherence was calculated as the proportion of days covered (PDC) after cohort balancing by propensity score matching. Patients with available LDL cholesterol testing were assessed for the proportion of those who at baseline were above lipid targets recommended by ESC/EAS Guidelines for their cardiovascular risk category and reached the target during follow-up. Among 25 886 patients on SPC and 7309 on FCT, adherent patients were more represented in SPC than FCT cohort (56.8 vs. 44.5%, P < 0.001), and this difference remained significant (P < 0.001) after stratification by cardiovascular risk (very high, high, and other). The proportion of patients reaching LDL cholesterol target at 1 year follow-up was significantly (P < 0.001) higher in SPC vs. FCT cohort: 35.4 vs. 23.8% for very high cardiovascular risk, 46.9 vs. 23.1% for high risk and 71.6 vs. 49.5% for other risk. Total healthcare costs per patient at 1 year follow-up were lower in SPC vs. FCT users (2337€ vs. 1890€, P < 0.001). In both cohorts, costs were mainly driven by drug expenses and hospitalizations. Conclusion This real-world analysis in dyslipidaemic patients found that treatment with ROS/EZE as SPC resulted in better adherence, higher chances of reaching lipid goals, and cost savings over FCT, in all cardiovascular risk categories.
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Affiliation(s)
- Alberto Zambon
- Department of Medicine, University of Padua Medical School, 35128 Padova, Italy
| | - Evangelos Liberopoulos
- 1st Department of Propedeutic Medicine, School of Medicine, National and Kapodistrian University of Athens, 15772 Athens, Greece
| | - Melania Dovizio
- CliCon S.r.l., Società Benefit-Health Economics & Outcomes Research, 40138 Bologna, Italy
| | - Chiara Veronesi
- CliCon S.r.l., Società Benefit-Health Economics & Outcomes Research, 40138 Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit-Health Economics & Outcomes Research, 40138 Bologna, Italy
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Park D, Bea S, Bae JH, Lee H, Choe YJ, Shin JY, Kim H. PCSK9 Inhibitors and Infection-Related Adverse Events: A Pharmacovigilance Study Using the World Health Organization VigiBase. Drugs Real World Outcomes 2024; 11:465-475. [PMID: 38954190 PMCID: PMC11365897 DOI: 10.1007/s40801-024-00430-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2024] [Indexed: 07/04/2024] Open
Abstract
AIMS Protein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) are novel lipid-lowering agents used in patients with cardiovascular disease. Despite reassuring safety data from pivotal trials, increasing evidence from real-world studies suggests that PCSK9i increase the risk of bacterial and viral infections. Therefore, this study aimed to identify signals of infection-related adverse events (AEs) associated with PCSK9i. METHODS We performed an observational pharmacovigilance study using the World Health Organization's VigiBase, recorded up to December 2022. We included individual case safety reports (ICSRs) of PCSK9 inhibitors, alirocumab and evolocumab, and compared them with those of other drugs. Infection-related ICSRs were retrieved from the Medical Dictionary for Regulatory Activities System Organ Class 'infections and infestations.' RESULTS Among 114,293 reports (258,099 drug-AE pairs) related to PCSK9 inhibitors, 54% included female patients, 41% included patients aged ≥65 years, and 82% included patients who received evolocumab. Additionally, beyond AEs recognized by regulatory authorities, organ infections such as influenza (reporting odds ratio [ROR] 2.89, 95% confidence interval [CI] 2.74-3.05), gastric infections (ROR 2.47, 95% CI 1.63-3.75), and kidney infections (ROR 1.36, 95% CI 1.06-1.73) were observed. Sensitivity analysis indicated a heightened risk of infection-related AEs associated with PCSK9i regardless of the specific drug type. CONCLUSIONS In addition to the labelled respiratory infections, six infection-related symptoms in the gastrointestinal, urinary, and renal organs were identified. Our findings support the need for systematic surveillance of infections among PCSK9i users.
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Affiliation(s)
- Dahyun Park
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
| | - Sungho Bea
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Ji-Hwan Bae
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Hyesung Lee
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea
| | - Young June Choe
- Department of Paediatrics, Korea University Anam Hospital, Seoul, South Korea
| | - Ju-Young Shin
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea.
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea.
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Sciences and Technology, Sungkyunkwan University, Seoul, South Korea.
| | - Hoon Kim
- Department of Biohealth Regulatory Science, Sungkyunkwan University, Suwon, South Korea.
- School of Pharmacy, Sungkyunkwan University, 2066, Seobu-ro, Jangan-gu, Suwon, Gyeonggi-do, South Korea.
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Perez de Isla L, Liberopoulos E, Dovizio M, Veronesi C, Degli Esposti L, Zambon A. Differential Adherence to Free and Single-Pill Combination of Rosuvastatin/Ezetimibe: Findings from a Real-World Analysis in Italy. Adv Ther 2024; 41:3407-3418. [PMID: 38963586 PMCID: PMC11263226 DOI: 10.1007/s12325-024-02916-8] [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: 03/22/2024] [Accepted: 05/29/2024] [Indexed: 07/05/2024]
Abstract
INTRODUCTION Adherence to cardiovascular drug treatment can significantly benefit from a reduced pill burden, but data on this matter derived from real-life settings are currently scanty. This analysis assessed the possible changes in adherence in patients treated with rosuvastatin and ezetimibe (ROS/EZE) as free multi-pill combination who switched to ROS/EZE as single-pill combination in the setting of real clinical practice in Italy. METHODS A retrospective analysis was conducted on the administrative databases for a catchment area of about seven million health-assisted residents. Adults receiving ROS/EZE as a single-pill combination from January 2010 to June 2020 (followed up to 2021) were identified. The date of the first prescription of single-pill combination of ROS/EZE was considered as the index date. The analysis included the users of ROS/EZE as a free combination during the year before the index date. Baseline demographic and clinical characteristics were collected during the period of data availability prior to the index date. Adherence to therapy was evaluated as proportion of days covered (PDC), namely the percentage of days during which a patient had access to medication, in the 12-month interval preceding or following the index date (PDC < 25% non-adherence; PDC = 25-75% partial adherence; PDC > 75% adherence). RESULTS A total of 1219 patients (61.1% male, aged 66.2 ± 10.4 years) were included. Cardiovascular comorbidities were found in 83.3% of them, diabetes in 26.4%, and a combination of both in 16.2%. Single-pill combination of ROS/EZE was associated with a higher proportion of adherent patients compared to free-pill combination (75.2% vs 51.8%, p < 0.001). CONCLUSIONS This real-world analysis suggested that switching from a regimen based on separate pills to one based on a single-pill combination resulted in improved adherence to ROS/EZE therapy.
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Affiliation(s)
- Leopoldo Perez de Isla
- Cardiology Department, Hospital Clínico San Carlos, Servicio de Cardiología, C/Profesor Martín Lagos s/n, 28040, Madrid, Spain.
| | - Evangelos Liberopoulos
- 1st Department of Propedeutic Medicine, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Melania Dovizio
- CliCon S.r.l., Società Benefit-Health, Economics and Outcomes Research, Bologna, Italy
| | - Chiara Veronesi
- CliCon S.r.l., Società Benefit-Health, Economics and Outcomes Research, Bologna, Italy
| | - Luca Degli Esposti
- CliCon S.r.l., Società Benefit-Health, Economics and Outcomes Research, Bologna, Italy
| | - Alberto Zambon
- Department of Medicine, University of Padua Medical School, Padua, Italy
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Peixoto C, Choudhri Y, Francoeur S, McCarthy LM, Fung C, Dowlatshahi D, Lemay G, Barry A, Goyal P, Pan J, Bjerre LM, Thompson W. Discontinuation versus continuation of statins: A systematic review. J Am Geriatr Soc 2024. [PMID: 39051828 DOI: 10.1111/jgs.19093] [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: 02/27/2024] [Revised: 05/23/2024] [Accepted: 06/27/2024] [Indexed: 07/27/2024]
Abstract
BACKGROUND Clinicians and patients often face a decision to continue or discontinue statins. We examined the impact of discontinuation of statins compared with continuation on clinical outcomes (all-cause mortality, cardiovascular [CV] mortality, CV events, and quality of life). METHODS We conducted a systematic review. Randomized controlled trials (RCTs), cohort studies, case-control studies, and quasi-randomized studies among people ≥18 years were eligible. We searched MEDLINE, Embase, and Cochrane Central Registry (inception to August 2023). Two independent reviewers performed screening and extracted data. Quality assessment was performed by one author and verified by another. We summarized results narratively, performed meta-analysis for a subset of studies, and used GRADE to assess certainty of evidence. We summarized findings in the subgroup of persons ≥75 years. RESULTS We retrieved 8369 titles/abstracts; 37 reports from 36 studies were eligible. This comprised 35 non-randomized studies (n = 1,708,684) and 1 RCT (n = 381). The 1 RCT was conducted among persons with life expectancy <1 year and showed there is probably no difference in 60-day mortality (risk difference = 3.5%, 90% CI -3.5 to 10.5) for statin discontinuation compared with continuation. Non-randomized studies varied in terms of population and setting, but consistently suggested that statin discontinuation might be associated with a relative increased risk of mortality (hazard ratio (HR) 1.92, 95% CI 1.52 to 2.44, nine studies), CV mortality (HR 1.63, 95% CI 1.27 to 2.10, five reports), and CV events (HR 1.31, 95% CI 1.23 to 1.39, eight reports). Findings in people ≥75 years were consistent with main results. There was a high degree of uncertainty in findings from non-randomized studies due to methodological limitations. CONCLUSIONS Statin discontinuation does not appear to affect short-term mortality near end-of-life based on one RCT. Outside of this population, findings from non-randomized studies consistently suggested statin discontinuation may be associated with worse outcomes, though this is uncertain.
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Affiliation(s)
| | | | | | - Lisa M McCarthy
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
- Women's College Research Institute, Toronto, Ontario, Canada
- Bruyère Research Institute, Ottawa, Ontario, Canada
| | - Celeste Fung
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Dar Dowlatshahi
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - Geneviève Lemay
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Arden Barry
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Parag Goyal
- Program for the Care and Study of the Aging Heart, Department of Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Jeffrey Pan
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Lise M Bjerre
- Institut du Savoir Montfort, Ottawa, Ontario, Canada
- Department of Family Medicine, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Wade Thompson
- Department of Anesthesiology, Pharmacology, and Therapeutics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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Giacobbe F, Giannino G, Annone U, Morena A, Di Vita U, Carmagnola L, Nebiolo M, Rollo C, Ravetti E, Troncone M, Pancotti C, De Filippo O, Bruno F, Angelini F, Gaido L, Fariselli P, D'Ascenzo F, Giammaria M, De Ferrari GM. Impact of statin adherence and interruption within 6 months after ST-segment elevation myocardial infarction (STEMI): Results from the real-world regional registry FAST-STEMI. Int J Cardiol 2024; 405:131933. [PMID: 38437950 DOI: 10.1016/j.ijcard.2024.131933] [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: 09/30/2023] [Revised: 02/15/2024] [Accepted: 03/01/2024] [Indexed: 03/06/2024]
Abstract
BACKGROUND The impact of statin therapy on cardiovascular outcomes after ST-elevation acute myocardial infarction (STEMI) in real- world patients is understudied. AIMS To identify predictors of low adherence and discontinuation to statin therapy within 6 months after STEMI and to estimate their impact on cardiovascular outcomes at one year follow-up. METHODS We evaluated real-world adherence to statin therapy by comparing the number of bought tablets to the expected ones at 1 year follow-up through pharmacy registries. A total of 6043 STEMI patients admitted from 2012 to 2017 were enrolled in the FAST STEMI registry and followed up for 4,7 ± 1,6 years; 304 patients with intraprocedural and intrahospital deaths were excluded. The main outcomes evaluated were all-cause death, cardiovascular death, myocardial infarction, major and minor bleeding events, and ischemic stroke. The compliance cut-off chosen was 80% as mainly reported in literature. RESULTS From a total of 5744 patients, 418 (7,2%) patients interrupted statin therapy within 6 months after STEMI, whereas 3337 (58,1%) presented >80% adherence to statin therapy. Statin optimal adherence (>80%) resulted as protective factor towards both cardiovascular (0.1% vs 4.6%; AdjHR 0.025, 95%CI 0.008-0.079, p < 0.001) and all-cause mortality (0.3% vs 13.4%; Adj HR 0.032, 95%CI 0.018-0.059, p < 0.001) at 1 year follow-up. Further, a significant reduction of ischemic stroke incidence (1% vs 2.5%, p = 0.001) was seen in the optimal adherent group. Statin discontinuation within 6 months after STEMI showed an increase of both cardiovascular (5% vs 1.7%; AdjHR 2.23; 95%CI 1.37-3.65; p = 0,001) and all-cause mortality (14.8% vs 5.1%, AdjHR 2.32; 95%CI 1.73-3.11; p 〈0,001) at 1 year follow-up. After multivariate analysis age over 75 years old, known ischemic cardiopathy and female gender resulted as predictors of therapy discontinuation. Age over 75 years old, chronic kidney disease, previous atrial fibrillation, vasculopathy, known ischemic cardiopathy were found to be predictors of low statin adherence. CONCLUSIONS n our real-world registry low statin adherence and discontinuation therapy within 6 months after STEMI were independently associated to an increase of cardiovascular and all-cause mortality at 1 year follow-up. Low statin adherence led to higher rates of ischemic stroke.
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Affiliation(s)
- Federico Giacobbe
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
| | - Giuseppe Giannino
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
| | | | - Arianna Morena
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
| | - Umberto Di Vita
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
| | - Ludovica Carmagnola
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
| | - Marco Nebiolo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
| | - Cesare Rollo
- Department of Medical Sciences, University of Turin, Italy
| | - Emanuele Ravetti
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
| | - Mattia Troncone
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
| | | | - Ovidio De Filippo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy.
| | - Francesco Bruno
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy
| | | | | | - Fabrizio D'Ascenzo
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
| | | | - Gaetano Maria De Ferrari
- Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza, Turin, Italy; Department of Medical Sciences, University of Turin, Italy
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Yang J, Zhou J, Liu H, Hao J, Hu S, Zhang P, Wu H, Gao Y, Tang W. Blood lipid levels mediating the effects of sex hormone-binding globulin on coronary heart disease: Mendelian randomization and mediation analysis. Sci Rep 2024; 14:11993. [PMID: 38796576 PMCID: PMC11127952 DOI: 10.1038/s41598-024-62695-8] [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: 02/10/2024] [Accepted: 05/20/2024] [Indexed: 05/28/2024] Open
Abstract
Observational studies indicate that serum sex hormone-binding globulin (SHBG) levels are inversely correlated with blood lipid levels and coronary heart disease (CHD) risk. Given that dyslipidemia is an established risk factor for CHD, we aim to employ Mendelian randomization (MR) in conjunction with mediation analysis to confirm the mediating role of blood lipid levels in the association between SHBG and CHD. First, we assessed the causality between serum SHBG levels and five cardiovascular diseases using univariable MR. The results revealed causality between SHBG levels and reduced risk of CHD, myocardial infarction, as well as hypertension. Specifically, the most significant reduction was observed in CHD risk, with an odds ratio of 0.73 (95% CI 0.63-0.86) for each one-standard-deviation increase in SHBG. The summary-level data of serum SHBG levels and CHD are derived from a sex-specific genome-wide association study (GWAS) conducted by UK Biobank (sample size = 368,929) and a large-scale GWAS meta-analysis (60,801 cases and 123,504 controls), respectively. Subsequently, we further investigated the mediating role of blood lipid level in the association between SHBG and CHD. Mediation analysis clarified the mediation proportions for four mediators: high cholesterol (48%), very low-density lipoprotein cholesterol (25.1%), low-density lipoprotein cholesterol (18.5%), and triglycerides (44.3%). Summary-level data for each mediator were sourced from the UK Biobank and publicly available GWAS. The above results confirm negative causality between serum SHBG levels and the risk of CHD, myocardial infarction, and hypertension, with the causal effect on reducing CHD risk largely mediated by the improvement of blood lipid profiles.
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Affiliation(s)
- Juntao Yang
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
- Department of Cardiology, Shaoxing People's Hospital, 568 Zhongxing North Road, Shaoxing, 312000, Zhejiang, China
| | - Jiedong Zhou
- Department of Cardiology, Shaoxing People's Hospital, 568 Zhongxing North Road, Shaoxing, 312000, Zhejiang, China
| | - Hanxuan Liu
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
| | - Jinjin Hao
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Songqing Hu
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Peipei Zhang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, Zhejiang, China
| | - Haowei Wu
- School of Medicine, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yefei Gao
- School of Medicine, Shaoxing University, Shaoxing, Zhejiang, China
| | - Weiliang Tang
- Department of Cardiology, Shaoxing People's Hospital, 568 Zhongxing North Road, Shaoxing, 312000, Zhejiang, China.
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8
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Treciokiene I, Daukintyte K, Hjemdahl P, Wettermark B. Trends in statin utilization and ischemic heart disease mortality in Lithuania and Sweden, 2000-2020. Ups J Med Sci 2024; 129:10412. [PMID: 38863727 PMCID: PMC11165250 DOI: 10.48101/ujms.v129.10412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 03/26/2024] [Accepted: 03/31/2024] [Indexed: 06/13/2024] Open
Abstract
Aims To compare statin utilization and ischemic heart disease (IHD) mortality trends in Lithuania and Sweden and to assess correlations between the total utilization of statins and IHD mortality. Methods An ecological study assessing time trends in statin utilization (DDDs per 1000 inhabitants per day; DDD/TID) and IHD mortality in Lithuania and Sweden between 2000 and 2020. Statin utilization data in Lithuania were wholesale trade data, and Swedish data were drugs dispensed at pharmacies. IHD mortality data were extracted from national databases as rates per 100 000 inhabitants. Associations between statin utilization and IHD mortality in Lithuania and Sweden were examined using Spearman's rank and Pearson's correlation coefficients, respectively. Results Statin utilization increased from 16.8 to 135.8 DDD/TID in Sweden and from 0.2 to 61.8 DDD/TID in Lithuania between 2000 and 2020. Medium intensity was the most common statin dosage in Lithuania, while Sweden used more high intensity than moderate-intensity statins from 2017. IHD mortality in Lithuania remained high between 2000 and 2020 (from 359.1 to 508.8 deaths per 100 000 population), while it decreased markedly in Sweden (from 226.87 to 88.7 deaths per 100 000 population). IHD mortality and statin utilization were inversely correlated in Sweden (r = -0.993, P < 0.001), while a positive correlation was found in Lithuania (rs = 0.871, P < 0.001). Conclusion Despite the growing statin utilization in both countries, Lithuania recorded a slight increase in IHD mortality rates unlike the situation in Sweden. This indicates room for improvement in the management of modifiable cardiovascular risk factors in Lithuania including how statins are prescribed and used in clinical practice.
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Affiliation(s)
- Indre Treciokiene
- Pharmacy and Pharmacology Centre, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Kamile Daukintyte
- Pharmacy and Pharmacology Centre, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology Unit, Karolinska Institute and Clinical Pharmacology, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Pharmacy and Pharmacology Centre, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Department of Pharmacy, Faculty of Pharmacy, Uppsala University, Uppsala, Sweden
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Bentzel S, Ljungman C, Hjerpe P, Schiöler L, Manhem K, Bengtsson Boström K, Kahan T, Mourtzinis G. Long-term secondary prevention and outcome following acute coronary syndrome: real-world results from the Swedish Primary Care Cardiovascular Database. Eur J Prev Cardiol 2024; 31:812-821. [PMID: 38135289 DOI: 10.1093/eurjpc/zwad389] [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: 10/15/2023] [Revised: 12/01/2023] [Accepted: 12/11/2023] [Indexed: 12/24/2023]
Abstract
AIMS Most studies of treatment adherence after acute coronary syndrome (ACS) are based on prescribed drugs and lack long-term follow-up or consecutive data on risk factor control. We studied the long-term treatment adherence, risk factor control, and its association to recurrent ACS and death. METHODS AND RESULTS We retrospectively included 3765 patients (mean age 75 years, 40% women) with incident ACS from 1 January 2006 until 31 December 2010 from the Swedish Primary Care Cardiovascular Database of Skaraborg. All patients were followed until 31 December 2014 or death. We recorded blood pressure (BP), low-density lipoprotein cholesterol (LDL-C), recurrent ACS, and death. We used data on dispensed drugs to calculate the proportion of days covered for secondary prevention medications. Cox regressions were used to analyse the association of achieved BP and LDL-C to recurrent ACS and death. The median follow-up time was 4.8 years. The proportion of patients that reached BP of <140/90 mm Hg was 58% at Year 1 and 66% at Year 8. 65% of the patients reached LDL-C of <2.5 mmol/L at Year 1 and 56% at Year 8; however, adherence to statins varied from 43% to 60%. Only 62% of the patients had yearly measured BP, and only 28% yearly measured LDL-C. Systolic BP was not associated with a higher risk of recurrent ACS or death. Low-density lipoprotein cholesterol of 3.0 mmol/L was associated with a higher risk of recurrent ACS {hazard ratio [HR] 1.19 [95% confidence interval (CI) 1.00-1.40]} and death HR [1.26 (95% CI 1.08-1.47)] compared with an LDL-C of 1.8 mmol/L. CONCLUSION This observational long-term real-world study demonstrates low drug adherence and potential for improvement of risk factors after ACS. Furthermore, the study confirms that uncontrolled LDL-C is associated with adverse outcome even in this older population.
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Affiliation(s)
- Sara Bentzel
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B Wallenberglab/SU, 413 45, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Blå stråket 3, 413 46, Gothenburg, Sweden
| | - Charlotta Ljungman
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B Wallenberglab/SU, 413 45, Gothenburg, Sweden
- Department of Cardiology, Sahlgrenska University Hospital, Blå stråket 3, 413 46, Gothenburg, Sweden
| | - Per Hjerpe
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Linus Schiöler
- Occupational and Environmental Medicine, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Karin Manhem
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kristina Bengtsson Boström
- School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Regionhälsan R&D Centre, Skaraborg Primary Care, Skövde, Sweden
| | - Thomas Kahan
- Division of Cardiovascular Medicine, Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Georgios Mourtzinis
- Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Blå stråket 5B Wallenberglab/SU, 413 45, Gothenburg, Sweden
- Department of Medicine and Emergency Mölndal, Sahlgrenska University Hospital, Mölndal, Sweden
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10
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Mazhar F, Hjemdahl P, Sjölander A, Kahan T, Jernberg T, Carrero JJ. Intensity of and adherence to lipid-lowering therapy as predictors of goal attainment and major adverse cardiovascular events in primary prevention. Am Heart J 2024; 269:118-130. [PMID: 38109988 DOI: 10.1016/j.ahj.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2023] [Revised: 11/25/2023] [Accepted: 12/10/2023] [Indexed: 12/20/2023]
Abstract
BACKGROUND The effectiveness of lipid-lowering therapy (LLT) for primary prevention of atherosclerotic cardiovascular disease (ASCVD) in routine care may depend on treatment intensity and adherence. METHODS Observational study of adults with newly initiated LLT for primary prevention of ASCVD in Stockholm, Sweden, during 2017-2021. Study exposures were LLT adherence [proportion of days covered (PDC)], LLT intensity (expected reduction of LDL cholesterol), and the combined measure of adherence and intensity. At each LLT fill, adherence and intensity were calculated during the previous 12 months, and the patients estimated ASCVD risk was categorized. Study outcomes were major adverse cardiovascular events (MACE) and LDL-C goal attainment. RESULTS Thirty-six thousand two hundred eighty-three individuals (mean age 63 years, 47% women, median follow-up 2 years), with a baseline low-moderate (40%), high (49%), and very-high (11%) ASCVD risk started LLT. Increases in LLT adherence, intensity, or adherence-adjusted intensity of 10% over 1 year were associated with lower risks of MACE (with hazard ratios of 0.95 [95% CI, 0.93-0.98]; 0.93 [0.86-1.00]; and 0.90 [0.85-0.95], respectively) and higher odds of attaining LDL goals. Patients with good adherence (≥80%) had similar risks of MACE and similar odds ratios for LDL-C goal attainment with low-moderate and high-intensity LLT. Treatment discontinuation was associated with increased MACE risk. The relative and absolute benefits of good adherence were greatest in patients with very high ASCVD risk. CONCLUSION In routine-care primary prevention, better adherence to LLT was associated with a lower risk of MACE across all treatment intensities. Improving adherence is especially important among patients with very high ASCVD risk.
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Affiliation(s)
- Faizan Mazhar
- Department of Medical Epidemiology and Biostatistics, Campus Solna, Karolinska Institutet, Stockholm, Sweden.
| | - Paul Hjemdahl
- Department of Medicine Solna, Clinical Epidemiology Unit/Clinical Pharmacology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - Arvid Sjölander
- Department of Medical Epidemiology and Biostatistics, Campus Solna, Karolinska Institutet, Stockholm, Sweden
| | - Thomas Kahan
- Department of Clinical Sciences, Karolinska Institutet, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Tomas Jernberg
- Department of Clinical Sciences, Karolinska Institutet, Division of Cardiovascular Medicine, Danderyd Hospital, Stockholm, Sweden
| | - Juan Jesus Carrero
- Department of Medical Epidemiology and Biostatistics, Campus Solna, Karolinska Institutet, Stockholm, Sweden; Division of Nephrology, Department of Clinical Sciences, Danderyd Hospital, Danderyd, Sweden
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11
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Martin SS, Aday AW, Almarzooq ZI, Anderson CAM, Arora P, Avery CL, Baker-Smith CM, Barone Gibbs B, Beaton AZ, Boehme AK, Commodore-Mensah Y, Currie ME, Elkind MSV, Evenson KR, Generoso G, Heard DG, Hiremath S, Johansen MC, Kalani R, Kazi DS, Ko D, Liu J, Magnani JW, Michos ED, Mussolino ME, Navaneethan SD, Parikh NI, Perman SM, Poudel R, Rezk-Hanna M, Roth GA, Shah NS, St-Onge MP, Thacker EL, Tsao CW, Urbut SM, Van Spall HGC, Voeks JH, Wang NY, Wong ND, Wong SS, Yaffe K, Palaniappan LP. 2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association. Circulation 2024; 149:e347-e913. [PMID: 38264914 DOI: 10.1161/cir.0000000000001209] [Citation(s) in RCA: 182] [Impact Index Per Article: 182.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2024]
Abstract
BACKGROUND The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year's worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year's edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.
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12
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Schonck WAM, Stroes ESG, Hovingh GK, Reeskamp LF. Long-Term Efficacy and Tolerability of PCSK9 Targeted Therapy: A Review of the Literature. Drugs 2024; 84:165-178. [PMID: 38267805 PMCID: PMC10981656 DOI: 10.1007/s40265-024-01995-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/08/2024] [Indexed: 01/26/2024]
Abstract
Increased plasma levels of low-density lipoprotein cholesterol (LDL-C) are causally associated with atherosclerotic cardiovascular disease (ASCVD), and statins that lower LDL-C have been the cornerstone of ASCVD prevention for decades. However, guideline-recommended LDL-C targets are not achieved in about 60% of statin users. Proprotein convertase subtilisin/kexin type 9 (PCSK9)-targeted therapy effectively lowers LDL-C levels and has been shown to reduce ASCVD risk. A growing body of scientific and clinical evidence shows that PCSK9-targeted therapy offers an excellent safety and tolerability profile with a low incidence of side effects in the short term. In this review, we present and discuss the current clinical and scientific evidence pertaining to the long-term efficacy and tolerability of PCSK9-targeted therapy.
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Affiliation(s)
- Willemijn A M Schonck
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - Erik S G Stroes
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
| | - G Kees Hovingh
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands
- Global Chief Medical Office, Novo Nordisk, Copenhagen, Denmark
| | - Laurens F Reeskamp
- Department of Vascular Medicine, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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13
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García-Peña ÁA, Pineda-Posada M, Páez-Canro C, Cruz C, Samacá-Samacá D. Analysis of the evolocumab (Repatha®) patient support program for patients with cardiovascular disease in Colombia. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2023; 35:280-289. [PMID: 37277296 DOI: 10.1016/j.arteri.2023.04.005] [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: 02/09/2023] [Revised: 04/13/2023] [Accepted: 04/25/2023] [Indexed: 06/07/2023]
Abstract
BACKGROUND Cardiovascular diseases are considered the leading cause of death globally. This study describes the demographic characteristics, treatment patterns, self-reported compliance and persistence, and to explore variables related to non-adherence of patients enrolled in the cardiovascular patient support program (PSP) for evolocumab treatment in Colombia. METHODS This retrospective observational of the data registry of patients who entered the evolocumab PSP program. RESULTS The analysis included 930 patients enrolled in the PSP (2017-2021). Mean age was 65.1 (SD±13.1) and49.1% patients were female. The mean compliance rate to evolocumab treatment was 70.5% (SD±21.8). A total of 367 patients (40.5%) reported compliance higher than 80%. Persistence analysis included 739 patients (81.5%) where 87.8% of these patients were considered persistent to treatment. A total of 871 patients (93.7%) reported the occurrence of at least one adverse event during the follow-up period (mostly non-serious). CONCLUSION This is the first real-life study describing patient characteristics, compliance and continuity of treatment for dyslipidemia in a patient support program in Colombia. The overall adherence found was higher than 70%; similar to findings reported in other real-life studies with iPCSK9. However, the reasons for low compliance were different, highlighting the high number of administrative and medical reasons for suspension or abandonment of treatment with evolocumab.
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Affiliation(s)
| | | | | | - César Cruz
- Amgen Biotecnológica SAS, Bogotá, Colombia
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14
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Lee HC, Cheng WC, Ma WL, Lin YH, Shin SJ, Lin YH. Association of lipid composition and unsaturated fatty acids of VLDL with atrial remodeling in metabolic syndrome. Sci Rep 2023; 13:6575. [PMID: 37085694 PMCID: PMC10121655 DOI: 10.1038/s41598-023-33757-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 04/18/2023] [Indexed: 04/23/2023] Open
Abstract
Subjects with metabolic syndrome (MetS) commonly have atrial remodeling, which indicates a risk for atrial fibrillation. This study determined MetS-related changes in lipid components in very-low-density lipoprotein (VLDL), which has been shown to cause atrial remodeling, the effect of statins on these changes, and the correlation between atrial remodeling and VLDL lipid compositions. Blood samples were collected from 12 non-MetS and 27 sex- and age-matched MetS subjects. Fourteen patients with MetS (MetS-off statin) discontinued statin therapy 14 days before the study, while the remaining 13 remained on it (MetS-on statin). The VLDLs were isolated and processed for mass-based lipid profiling. Lipidomic analyses were performed and associated with atrial remodeling markers measured using standard echocardiography and electrocardiography. Compared with the VLDL components of the non-MetS group, glucosyl/galactosyl ceramide, lyso-phosphatidylcholine, lyso-phosphatidylethanolamine, and triglycerides were enriched in the MetS-off statin group. Statin therapy attenuated all abnormally abundant lipid classes in MetS, except for triglycerides. In addition, lyso-phosphatidylcholine, lyso-phosphatidylethanolamine, and triglycerides were significantly correlated with atrial dilatation, and the latter two were also correlated with the PR interval. Enrichment of double bonds, which indicate unsaturated fatty acids, was also significantly correlated with atrial remodeling and P-wave duration. This study suggests that the pathological lipid payload of MetS-VLDL may contribute to atrial remodeling in patients.
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Affiliation(s)
- Hsiang-Chun Lee
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Rd, Kaohsiung, 807, Taiwan.
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Lipid Science and Aging Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
- Institute/Center of Medical Science and Technology, National Sun Yat-Sen University, Kaohsiung, Taiwan.
- Graduate Institute of Animal Vaccine Technology, National Pingtung University of Science and Technology, Pingtung, Taiwan.
| | - Wei-Chung Cheng
- PhD Program for Cancer Molecular Biology and Drug Discovery, China Medical University and Academia Sinica, Taichung, Taiwan
- Research Center for Cancer Biology, China Medical University, Taichung, Taiwan
| | - Wen-Lung Ma
- Graduate Institute of Biomedical Sciences, and Graduate Institution of Cancer Biology, School of Medicine, China Medical University, Taichung, Taiwan
- Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
- Department of Nursing, Asia University, Taichung, Taiwan
| | - Yu-Hsun Lin
- Lipid Science and Aging Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | | | - Yi-Hsiung Lin
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, 100 Tzyou 1st Rd, Kaohsiung, 807, Taiwan
- Lipid Science and Aging Research Center, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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15
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Vandewalle L, Duchi F, Verhelle K, Vanacker P. Suboptimal lipid management in patients with acute ischemic stroke. Clin Neurol Neurosurg 2023; 229:107717. [PMID: 37079961 DOI: 10.1016/j.clineuro.2023.107717] [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: 11/16/2022] [Revised: 03/17/2023] [Accepted: 04/16/2023] [Indexed: 04/22/2023]
Abstract
OBJECTIVE Lipid-lowering drugs are among the most widely used drugs in cardiovascular prevention. Statins are often abandoned due to side effects, or under dosed, leading to unreached LDL-cholesterol goals and increased occurrence of cardiovascular events. METHODS We included hospitalized patients with an ischemic stroke or transient ischemic attack. Of 92 patients, low density lipoprotein cholesterol (LDL-C) levels and lipid lowering therapy at admission and discharge were assessed. Based on their cardiovascular risk before the current event according to the most recent European guidelines, LDL-C targets were determined. Low, moderate, high and very high risk corresponded with LDL-C targets below 116, 100, 70 and 55 mg/dL respectively. RESULTS Before current event, 59 (64%) were very high, 21 (23%) high, 11 (12%) moderate and 1 low risk patients and eight patients were treated with low, 23 moderate, and 21 high intensity lipid-lowering therapy. Upon admission, 75 patients had insufficiently managed LDL-cholesterol levels, yet 39 of them were taking lipid lowering therapy. Only eight of the 21 patients on high intensity lipid lowering therapy reached their LDL-C target. During hospitalization 40 patients were switched to a high-intensity statin. Thirty-three patients switched from no treatment or a lower-intensity to a moderate-intensity lipid lowering therapy. Three were dismissed with low-intensity lipid lowering therapy, and five in association with Ezetimibe. Three patients had documented statin-intolerance. CONCLUSION In this study, LDL-cholesterol was insufficiently managed according to international guidelines for prevention of ischemic stroke. Further optimization of lipid management in primary and secondary prevention and the use of higher intensity lipid lowering therapy in clinical practice is mandatory.
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Affiliation(s)
- L Vandewalle
- Department of Neurology, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium; Department of Neurology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium; Department of Neurosciences, Experimental neurology, KU Leuven - University of Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - F Duchi
- Department of Clinical Pharmacy, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - K Verhelle
- Department of Clinical Pharmacy, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium.
| | - P Vanacker
- Department of Neurology, AZ Groeninge, Pres. Kennedylaan 4, 8500 Kortrijk, Belgium; Research Group on Translational Sciences, University of Antwerp, Universiteitsplein 1, 2610 Wilrijk, Belgium; Antwerp University Hospital, Neurovascular Reference Center, Department of Neurology, Drie Eikenstraat 655, 2650 Edegem, Belgium.
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16
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Kytö V, Rautava P, Tornio A. Initial statin dose after myocardial infarction and long-term cardiovascular outcomes. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2022; 9:156-164. [PMID: 36385668 PMCID: PMC9892868 DOI: 10.1093/ehjcvp/pvac064] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Revised: 10/19/2022] [Accepted: 11/14/2022] [Indexed: 11/18/2022]
Abstract
AIMS Effective statin therapy is a cornerstone of secondary prevention after myocardial infarction (MI). Real-life statin dosing is nevertheless suboptimal and largely determined early after MI. We studied long-term outcome impact of initial statin dose after MI. METHODS AND RESULTS Consecutive MI patients treated in Finland who used statins early after index event were retrospectively studied (N = 72 401; 67% men; mean age 68 years) using national registries. High-dose statin therapy was used by 26.3%, moderate dose by 69.2%, and low dose by 4.5%. Differences in baseline features, comorbidities, revascularisation, and usage of other evidence-based medications were adjusted for with multivariable regression. The primary outcome was major adverse cardiovascular or cerebrovascular event (MACCE) within 10 years. Median follow-up was 4.9 years. MACCE was less frequent in high-dose group compared with moderate dose [adjusted hazard ratio (HR) 0.92; P < 0.0001; number needed to treat (NNT) 34.1] and to low dose [adj.HR 0.81; P < 0.001; NNT 13.4] as well as in moderate-dose group compared with low dose (adj.HR 0.88; P < 0.0001; NNT 23.4). Death (adj.HR 0.87; P < 0.0001; NNT 23.6), recurrent MI (adj.sHR 0.91; P = 0.0001), and stroke (adj.sHR 0.86; P < 0.0001) were less frequent with a high- vs. moderate-dose statin. Higher initial statin dose after MI was associated with better long-term outcomes in subgroups by age, sex, atrial fibrillation, dementia, diabetes, heart failure, revascularisation, prior statin usage, or usage of other evidence-based medications. CONCLUSION Higher initial statin dose after MI is dose-dependently associated with better long-term cardiovascular outcomes. These results underline the importance of using a high statin dose early after MI.
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Affiliation(s)
- Ville Kytö
- Corresponding author. Tel: +358 2 3130000,
| | - Päivi Rautava
- Turku Clinical Research Center, Turku University Hospital, Turku, Finland,Department of Public Health, University of Turku, Turku, Finland
| | - Aleksi Tornio
- Integrative Physiology and Pharmacology, Institute of Biomedicine, University of Turku, Turku, Finland,Unit of Clinical Pharmacology, Turku University Hospital, Turku, Finland
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