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Lipid lowering drugs and risk of vascular events in older patients

7 Jul, 15 | by Alistair Lindsay

Although elderly patients are at higher risk of cardiovascular events, the majority cardiovascular trials exclude these patients.  Accordingly, little is known about the use of lipid lowering medications for prevention of cardiovascular events in elderly populations. This prospective cohort study evaluated the association between use of statins or fibrates for prevention of vascular events among a random sample of 7484 patients aged 65 years of older without prior vascular disease living in three French cities recruited from 1999-2000.  Patients were followed for a median of 9.1 years, with 732 vascular events (440 coronary events, 292 strokes) occurring during the study period.  The study found that 27.4% (n=2084) of patients reported baseline lipid lowering medication use (13.5% statins, 13.9% fibrates).   more…

Why is Atherosclerotic Cardiovascular Disease Risk Overestimated by the ACC/AHA Pooled Cohort Equation?

1 Feb, 15 | by Alistair Lindsay

The 2013 ACC/AHA Cholesterol Guidelines expand the recommendations for statin use to populations previously felt to be at lower risk. Central to risk-estimation in these guidelines is a new equation for determination of atherosclerotic cardiovascular disease (ASCVD) risk. However, this risk model has been criticized overestimating ASCVD risk in validation studies of the model.  Using the Women’s Health Study, Cook et al. sought to determine the reasons for risk-overestimation by the ACC/AHA model. Among 27,542 women, 632 experienced an ASCVD event, defined as any myocardial infarction, any stroke, or death from a cardiovascular cause. more…

Differences in Statin Eligible Patients across Guidelines

29 Jun, 14 | by Alistair Lindsay

Recent ACC/AHA guidelines recommend consideration of statin therapy among patients with a 7.5% 10-year risk of atherosclerotic cardiovascular disease (CVD).  In this study, the authors examined implications of these new guidelines as compared with previous European Society of Cardiology (ESC) and Adult Treatment Panel III (ATP III) guidelines in a Dutch population-based prospective cohort of 4,854 healthy participants over 55 years of age. In this cohort,  96.4% men and 65.8% women would be recommended statinsunder the new ACC/AHA guidelines. In contrast, 66.1% of men and 39.1% of women would be recommended statins under ESC guidelines and 52.0% of men and 35.5% of women would be recommended statins by ATP III guidelines.  Subgroup analyses demonstrated under ACC/AHA guidelines nearly all women age 65 or older would be recommended statin therapy. more…

Validation of the Pooled Cohort Risk Equations from Recent ACC/AHA Guidelines

29 Jun, 14 | by Alistair Lindsay

Recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the assessment of cardiovascular risk recommend a new 10-year atherosclerotic cardiovascular disease (CVD) risk prediction tool called the Pooled Cohort risk equation. This new predictive model developed from cohorts of patients that were largely studied prior to the year 2000.  In light of the declining CVD incidence since 2000, the external validity of the Pooled Cohort risk equation has been questioned.  The present study sought to validate the Pooled Cohort equation in a contemporary cohort of 10,997 individuals aged 45-79 years without a prior history of atherosclerotic CVD for whom the guidelines would recommend consideration of a statin.  In 47,481 person-years of follow-up, 192 coronary heart disease events and 146 strokes were observed. Differences in observed and predicted risk were small in patients for whom a statin should be considered, consistent with good model calibration.  Further, the C-index was 0.72 (95% CI 0.70 – 0.75) consistent with moderate discrimination. more…

Statins inhibit thrombosis

24 Feb, 12 | by Alistair Lindsay

Hypercholesterolemia is one of the primary risk factors for atherosclerotic coronary disease. Statins have revolutionised lipid management with their proven ability to reduce circulating cholesterol levels and have even demonstrated regression of coronary plaques. Interestingly, statins have also been shown to have anti-inflammatory and anti-thrombotic activities, with several studies having shown statin therapy to be associated with a significant reduction in venous thromboembolism.  However, the mechanisms by which statins achieve this remain obscure. more…

Long-term efficacy and safety of statins

29 Jan, 12 | by Alistair Lindsay

Alth0ugh an overwhelming amount of evidence now points towards the beneficial effects of statins, most of the large statin studies have only had 5-year follow-up and there have been observational studies that have suggested a long-term increased risk of particular types of cancer, and of other non-vascular morbidity and mortality. more…

High-dose statin therapy linked to diabetes

10 Jul, 11 | by Alistair Lindsay

Three recent trials comparing intensive- to moderate-dose statin therapy have suggested an increased risk of incident diabetes in patients treated with high-dose statin regimens.  To investigate this phenomenon further, the authors conducted a collaborative meta-anlysis of published and unpublished data from five statin trials, all of which were randomise controlled end-point trials that compared intensive-dose statin therapy with moderate-dose therapy for more than one year. more…

Statins safe in patients with abnormal liver function

4 Jan, 11 | by Alistair Lindsay

Although statins are known to cause rises in liver function tests after their initiation, they have also been noted to improve liver function and biochemical tests in patients with non-alcoholic fatty liver disease, the most common cause of abnormal liver function tests in the developed world. more…

Ezetimibe and Cancer: What is the risk?

17 Jan, 09 | by Alistair Lindsay

The recent Simvastatin and Ezetimibe in Aortic Stenosis (SEAS) Trial showed that the combined treatment had no impact on the progression of aortic stenosis – but an excess of incident cancers was identified in the simvastatin-ezetimibe group when compared to placebo (105 vs 70, p=0.01). Deaths from cancer were also more frequent in the simvastatin-ezetimibe group (39 deaths vs 23 in the placebo arm, p=0.05). This was unexpected and required further investigation. Ezetimibe prevents the absorption not only of cholesterol but also of phytosterols and other phytonutrients that have been implicated to have protective roles against cancer. It is therefore possible that the drug could have an effect on the growth of cancer cells. more…

SEARCHing For A Genetic Cause of Statin Myopathy

7 Oct, 08 | by Alistair Lindsay

The incidence of myopathy secondary to statin use is approximately 1 in 10,000 patients/year on standard doses, but increases with higher doses or concurrent prescription of drugs such as cyclosporine that can inhibit statin metabolism.  Identification of genetic factors that influence an individual’s susceptibility to these complications would improve patient management by identifying those who should take a modified dose or perhaps even avoid a certain agent. more…

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