Previous Statin Research Articles

Association of soluble cell adhesion molecules and lipid levels in rheumatoid arthritis patients.

To evaluate the relationship between soluble vascular cell adhesion molecule-1 (sVCAM-1), soluble intracellular adhesion molecule-1 (sICAM-1), and lipid levels in rheumatoid arthritis (RA) patients with and without carotid plaque (CP). Cross-sectional study nested of a RA cohort. RA patients without a previous cardiovascular event or statins' therapy, aged 40-75years were recruited at an outpatient cardio-rheumatology clinic. Carotid ultrasound was performed in all study subjects. RA patients with CP were included and matched to RA patients without CP by age, gender, and traditional cardiovascular risk factors. Blood samples were drawn at the time of recruitment to measure sVCAM-1, sICAM-1, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lipid levels. Correlations between cell adhesion molecules, disease activity indexes, ESR and CRP with lipid levels were assessed with Spearman's correlation coefficient (rs). We included 71 RA patients, 37 with CP and 34 without CP. RA (n = 71) patients had a moderate negative correlation of sVCAM-1 with total cholesterol (TC) (rs = - 0.366, p = 0.002) and low-density lipoprotein (LDL) (rs = - 0.316, p = 0.007), and a small negative correlation with high-density lipoprotein (rs = - 0.250, p = 0.036). ESR showed a small negative correlation with LDL (rs = - 0.247, p = 0.038). Patients with CP had a moderate negative correlation between sVCAM and TC (rs = - 0.405, p = 0.013). Patients without CP showed a moderate negative correlation between sVCAM with TC (rs = - 0.364, p = 0.034) and LDL (rs = - 0.352, p = 0.041), and sICAM with VLDL (rs = - 0.343, p = 0.047). RA patients showed an inverse association of sVCAM-1 and lipid levels. More studies are needed to define the precise role of sVCAM-1 in the lipid paradox of RA.

Correlation of the characteristics of symptomatic intracranial atherosclerotic plaques with stroke types and risk of stroke recurrence: a cohort study.

BackgroundSymptomatic intracranial atherosclerotic stenosis (sICAS) patients had a higher risk of stroke recurrence, and the risk of acute ischemic stroke (AIS) was higher than transient ischemic attack (TIA). Therefore, it is important to explore the risk factors associated with sICAS clinical subtypes and the risk of stroke recurrence. The purpose of this study was to investigate the association between intracranial arterial culprit plaque characteristics with sICAS clinical subtypes and the risk of stroke recurrence.MethodsA total of 206 patients with sICAS were included. Baseline demographic data and relevant serologic indices were collected from all participants. All participants were assessed by high-resolution vessel wall imaging (HR-VWI) for culprit vessel and culprit plaque characteristics. The follow-up method was outpatient or telephone follow-up. Associated factors for sICAS clinical subtypes were analyzed by binary logistic regression. Cox proportional hazard regression analysis were used to analysis the independent risk factors for recurrent stroke.ResultsIn this group, there were 154 patients with AIS, 52 patients with TIA, 124 patients with anterior circulation ischemic symptom (ACiS), and 82 patients with posterior circulation ischemic symptom (PCiS). Male gender [odds ratio (OR) =5.575, 95% confidence interval (CI): 2.120 to 14.658], history of previous statin use (OR =0.309, 95% CI: 0.113 to 0.843) and serum apolipoprotein A/B values (OR =0.363, 95% CI: 0.139 to 0.948) were associated factors for AIS. A total of 24 patients (11.7%) experienced stroke recurrence during the 1-year follow-up period. Hyperintensity on T1 weighted imaging (T1WI) in the culprit plaque [hazard ratio (HR) =3.798, 95% CI: 1.433 to 10.062] was an independent risk factor for stroke recurrence. The incidence of significant enhancement (62.2% vs. 39.5%, χ2=9.681, P=0.002), positive remodeling (69.5% vs. 52.4%, χ2=5.661, P=0.020), and hyperintensity on T1WI (42.7% vs. 22.6%, χ2=16.472, P=0.003) was higher in the posterior circulation than in the anterior circulation.ConclusionsThe characteristics of intracranial arterial culprit plaques were independent risk factors for recurrent stroke, and there were differences in the plaque characteristics of anterior and posterior circulation. Early HR-VWI examination for sICAS patients is of great significance for patient risk stratification and personalized management.

Association of Long-term Statin Use With the Risk of Intracerebral Hemorrhage: A Danish Nationwide Case-Control Study.

A causal relationship between long-term statin use and the risk of intracerebral hemorrhage (ICH) remains uncertain. We investigated the association with statin use before hospital admission for ICH in a Danish population-based, nationwide case-control study. We used the Danish Stroke Registry to identify all patients aged 45 years or older with a first-ever ICH between 2005 and 2018. Patients with ICH were matched for age, sex, and calendar year to controls selected from the general population. A medication registry with information on all dispensed prescriptions at community pharmacies in Denmark since 1995 was used to ascertain previous statin exposure that was classified for recency, duration, and intensity. Using conditional regression and adjusting for potential confounders, we calculated adjusted odds ratios (aORs) and corresponding 95% CIs for the risk of ICH. The study population consisted of 16,235 patients with ICH and 640,943 controls. Current statin use (cases 25.9% vs controls 24.5%; aOR 0.74, 95% CI, 0.71-0.78) and a longer duration of current statin use (<1 year: aOR 0.86; 95% CI, 0.81-0.92; ≥1 to <5 years: aOR 0.72; 95% CI, 0.68-0.76; ≥5 to <10 years: aOR 0.65; 95% CI, 0.60-0.71; ≥10 years of use, 0.53; 95% CI 0.45-0.62; p for trend <0.001) were associated with a lower risk of ICH. Similar treatment duration relationships were found in analyses stratified by statin use intensity (high-intensity therapy: <1 year of use: aOR 0.78; 95% CI, 0.66-0.93; ≥10 years of use: aOR 0.46; 95% CI 0.33-0.65; p for trend 0.001). We found that a longer duration of statin use was associated with a lower risk of ICH. This study provides Class II evidence that current statin use and a longer duration of statin use are each associated with a lower risk of ICH.

Impacto del tratamiento previo con estatinas sobre la supervivencia de los pacientes hospitalizados con COVID-19

IntroductionStatin therapy might have a beneficial prognostic effect in patients with COVID-19, given its immunomodulative, anti-inflammatory and anti-atherosclerotic properties. Our purpose was to test this hypothesis by using the COVID-19 registry of a Spanish university hospital. MethodsWe conducted a single-center, observational and retrospective study in which hospitalized patients with COVID-19 diagnosed by PCR between March 2020 and October 2020 were included. By means of logistic regression, we designed a propensity score to estimate the likelihood that a patient would receive statin treatment prior to admission. We compared the survival of COVID-19 patients with and without statin treatment by means of Cox regression with inverse probability of treatment weighting (IPTW). The median follow-up was 406 days. ResultsWe studied 1122 hospitalized patients with COVID-19, whose median age was 71years and of which 488 (43.5%) were women. 451 (40.2%) patients received statins before admission. In the IPTW survival analysis, prior statin treatment was associated with a significant reduction in mortality (HR: 0.76; 95%CI: 0.59-0.97). The greatest benefit of previous statin therapy was seen in subgroups of patients with coronary artery disease (HR: 0.32; 95%CI: 0.18-0.56) and extracardiac arterial disease (HR: 0.45; 95%CI: 0.28-0.73). ConclusionsOur study showed a significant association between previous treatment with statins and lower mortality in hospitalized patients with COVID-19. The observed prognostic benefit was greater in patients with previous coronary or extracardiac atherosclerotic disease.

Predictive performance of a competing risk cardiovascular prediction tool CRISK compared to QRISK3 in older people and those with comorbidity: population cohort study

BackgroundRecommended cardiovascular disease (CVD) prediction tools do not account for competing mortality risk and over-predict incident CVD in older and multimorbid people. The aim of this study was to derive and validate a competing risk model (CRISK) to predict incident CVD and compare its performance to that of QRISK3 in UK primary care.MethodsWe used UK linked primary care data from the Clinical Practice Research Datalink (CPRD) GOLD to identify people aged 25–84 years with no previous CVD or statin treatment split into derivation and validation cohorts. In the derivation cohort, we derived models using the same covariates as QRISK3 with Fine-Gray competing risk modelling alone (CRISK) and with Charlson Comorbidity score (CRISK-CCI) as an additional predictor of non-CVD death. In a separate validation cohort, we examined discrimination and calibration compared to QRISK3. Reclassification analysis examined the number of patients recommended for treatment and the estimated number needed to treat (NNT) to prevent a new CVD event.ResultsThe derivation and validation cohorts included 989,732 and 494,865 women and 946,784 and 473,392 men respectively. Overall discrimination of CRISK and CRISK-CCI were excellent and similar to QRISK3 (for women, C-statistic = 0.863/0.864/0.863 respectively; for men 0.833/0.819/0.832 respectively). CRISK and CRISK-CCI calibration overall and in younger people was excellent. CRISK over-predicted in older and multimorbid people although performed better than QRISK3, whilst CRISK-CCI performed the best. The proportion of people reclassified by CRISK-CCI varied by QRISK3 risk score category, with 0.7–9.7% of women and 2.8–25.2% of men reclassified as higher risk and 21.0–69.1% of women and 27.1–57.4% of men reclassified as lower risk. Overall, CRISK-CCI recommended fewer people for treatment and had a lower estimated NNT at 10% risk threshold. Patients reclassified as higher risk were younger, had lower SBP and higher BMI, and were more likely to smoke.ConclusionsCRISK and CRISK-CCI performed better than QRISK3. CRISK-CCI recommends fewer people for treatment and has a lower NNT to prevent a new CVD event compared to QRISK3. Competing risk models should be recommended for CVD primary prevention treatment recommendations.

Screening for Anti-HMGCR Antibodies in a Large Single Myositis Center Reveals Infrequent Exposure to Statins and Diversiform Presentation of the Disease.

BackgroundThe objective of this study is to assess the frequency of autoantibodies against 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase (HMGCR) in a single center myositis cohort and to analyze associations with statin exposure, clinical features, and outcome of disease course.MethodsA total of 312 patients with idiopathic inflammatory myopathies (IIMs) followed at the rheumatology clinic, Karolinska University Hospital, were identified in the Euromyositis registry between 1988 and 2014 and were classified according to the 2017 European Alliance of Associations for Rheumatology/American College of Rheumatology (EULAR/ACR) criteria. Available serum samples were analyzed for anti-HMGCR autoantibodies by ELISA. Positive sera were confirmed by immunoprecipitation. Clinical data were extracted from Euromyositis registry and medical records. Muscle samples were examined by two pathologists blinded to the subjects’ autoantibody status.ResultsOf 312 patients, 13 (4.3%) were positive for anti-HMGCR. Two of the 13 (15%) anti-HMGCR–positive patients had histories of statin use versus 12 (4.2%) in the anti-HMGCR–negative group. In the anti-HMGCR–positive group, five (38%) had a clinical phenotype compatible with dermatomyositis. Muscle biopsies of patients with HMGCR autoantibodies showed findings consistent with immune-mediated necrotizing myopathy in all cases except for one. Five (38%) patients required treatment with intravenous immunoglobulin compared to seven (2.3%) without this antibody. At the last visit, seven patients had chronic, active disease course, and five of 13 patients were in remission, including three without treatment.ConclusionsPatients with IIM related to anti-HMGCR autoantibodies may present with a wide range of symptoms, more than previously anticipated. When a broad approach to screening for these antibodies is applied, only a minority of patients was found to have previous statin exposure. The results of this study justify the addition of anti-HMGCR autoantibodies to routine diagnostic procedures in patients with myositis.

Reduced Heart Failure and Mortality in Patients Receiving Statin Therapy Before Initial Acute Coronary Syndrome

BackgroundThere is uncertainty regarding the impact of statins on the risk of atherosclerotic cardiovascular disease (ASCVD) and its major complication, acute heart failure (AHF). ObjectivesThe aim of this study was to investigate whether previous statin therapy translates into lower AHF events and improved survival from AHF among patients presenting with an acute coronary syndrome (ACS) as a first manifestation of ASCVD. MethodsData were drawn from the International Survey of Acute Coronary Syndromes Archives. The study participants consisted of 14,542 Caucasian patients presenting with ACS without previous ASCVD events. Statin users before the index event were compared with nonusers by using inverse probability weighting models. Estimates were compared by test of interaction on the log scale. Main outcome measures were the incidence of AHF according to Killip class and the rate of 30-day all-cause mortality in patients presenting with AHF. ResultsPrevious statin therapy was associated with a significantly decreased rate of AHF on admission (4.3% absolute risk reduction; risk ratio [RR]: 0.72; 95% CI: 0.62-0.83) regardless of younger (40-75 years) or older age (interaction P = 0.27) and sex (interaction P = 0.22). Moreover, previous statin therapy predicted a lower risk of 30-day mortality in the subset of patients presenting with AHF on admission (5.2 % absolute risk reduction; RR: 0.71; 95% CI: 0.50-0.99). ConclusionsAmong adults presenting with ACS as a first manifestation of ASCVD, previous statin therapy is associated with a reduced risk of AHF and improved survival from AHF. (International Survey of Acute Coronary Syndromes [ISACS] Archives; NCT04008173)

Statin discontinuation in persons with and without Alzheimer’s disease

BackgroundAlthough statin use is reported to decrease after dementia diagnosis, time to statin discontinuation and factors associated with discontinuation have not been studied in persons with Alzheimer’s disease (AD). We compared the risk of discontinuation and factors associated with discontinuation, including secondary and primary prevention indication, in statin users with and without AD.MethodsThe register-based Medication Use and Alzheimer’s Disease (MEDALZ) cohort includes community dwellers with a clinically verified AD diagnosed during 2005–2011 in Finland. On the AD diagnosis date (index date), each person with AD was matched with a comparison person without AD. We included 25,137 people with AD and 22,692 without AD who used statin on the index date or initiated within 90 days after. Cox regression models restricted to 4-year follow-up were conducted.ResultThe median time to statin discontinuation was 1.46 years in people with AD and 1.36 years in people without AD. People with AD were more likely to discontinue than people without AD (adjusted HR (aHR) 1.20 (95% CI 1.18–1.24)). This was observed for both primary (aHR 1.11 (1.06–1.16)) and secondary prevention (aHR 1.30 (1.25–1.35)) purpose. Factors associated with discontinuation included higher age and female gender, whereas concomitant cardiovascular drug use and previous statin use were associated with decreased risk.ConclusionThe absolute difference in discontinuation rates was small, and the same factors were associated with statin discontinuation in people with and without AD. The findings suggest that cognitive decline plays a minor role on statin discontinuation.

Incident Rheumatoid Arthritis Following Statin Use: From the View of a National Cohort Study in Korea.

Safety issues regarding the potential risk of statins and incident rheumatoid arthritis (RA) have been raised, but the existing data are largely based on Caucasian populations, and continue to have biases and require further validation in Asian populations. Here, we aimed to verify the risk of RA depending on the duration of previous statin use and statin types using a large-scale, nationwide database. This study enrolled 3149 patients with RA and 12,596 matched non-RA participants from the national health insurance database (2002–2015), and investigated their statin prescription histories for two years before the index date. Propensity score overlap-weighted logistic regression was applied after adjusting for multiple covariates. The prior use of any statins and, specifically, the long-term use of lipophilic statins (>365 days) were related to a lower likelihood of developing RA ((odds ratio (OR) = 0.73; 95% confidence intervals (CI) = 0.63–0.85, p < 0.001) and (OR = 0.71; 95% CI = 0.61–0.84, p < 0.001), respectively). Subgroup analyses supported these preventive effects on RA in those with dyslipidemia, independent of sex, age, smoking, alcohol use, hypertension, and hyperglycemia. Hydrophilic statin use or short-term use showed no such associations. Our study suggests that prior statin use, especially long-term lipophilic statin use, appears to confer preventive benefits against RA.

The Influence of Prior Statin Use on the Prevalence and Exacerbation of Chronic Obstructive Pulmonary Disease in an Adult Population.

BackgroundStatins have anti-inflammatory and antioxidant properties, and previous studies have reported the positive effects of statins on chronic obstructive pulmonary disease (COPD) outcomes. However, the effects of statins on the development and acute exacerbations of COPD remain unclear. Therefore, this study aimed to assess the relation between statin use and COPD occurrence in all participants and the link between statin use and COPD acute exacerbations in participants with COPD.MethodsThis case-control study comprised 26,875 COPD participants and 107,500 control participants who were 1:4 matched from the Korean National Health Insurance Service-Health Screening Cohort. Conditional logistic regression was used to evaluate the probability of COPD occurrence associated with previous statin use. In addition, unconditional logistic regression was employed to assess the risk of exacerbations related to statin use among COPD participants. These relations were estimated in subgroup analysis according to statin type (lipophilic vs. hydrophilic).ResultsThe association between previous statin use and the occurrence of COPD did not reach statistical significance in the overall population (adjusted odds ratio [aOR] = 0.96, 95% confidence interval [CI] = 0.93–1.00, P = 0.059). However, statin use decreased the probability of exacerbations in participants with COPD (aOR = 0.79, 95% CI = 0.74–0.85, P < 0.001). Lipophilic statins decreased the probability of exacerbations, whereas hydrophilic statins were not associated with a decreased likelihood of exacerbations (aOR = 0.78, 95% CI = 0.72–0.84, P < 0.001 for lipophilic statins; aOR = 0.89, 95% CI = 0.78–1.02, P = 0.102 for hydrophilic statins).DiscussionStatin use was not associated with the occurrence of COPD in the adult population. However, statin use was associated with a reduced probability of exacerbations in participants with COPD, with a greater risk reduction with lipophilic statin use.

An audit on coronary artery calcium scoring in the mercy university hospital, co. cork, ireland

Abstract Funding Acknowledgements Type of funding sources: None. Background Coronary artery calcium (CAC) testing is an imaging technique used to non-invasively assess calcification within the coronary arteries. It has emerged as a reliable surrogate measure of coronary artery disease where higher risk individuals are more likely to benefit from medications such as aspirin and statins. A high calcium score should prompt further diagnostic tests for coronary artery disease. This was a single centre audit designed to assess the current role and the clinical implications of CAC testing in our university hospital, Ireland. Methods This was a retrospective chart review of all patients who underwent CAC testing in MUH from 1st January 2019 to 31st December 2020. Patients were recruited from the CAC database within the hospital radiology department. Demographic data, indication for CAC testing, medication records and results of invasive coronary angiography were obtained from the medical records. Assessment of CAC scores and percentiles from all patients were recorded from the radiology results system. Results Of the 218 participants, 48.6% were male and the mean age was 53.7 (± 9.7) years. The most common risk factors were hypercholesterolaemia (65.1%), family history of premature coronary artery disease (48.6%) and hypertension (31.2%). CAC results were as follows: 50.5% had a score of 0, 25.2% had a score of 1-99, 12.4% had a score of 100-399, 6.4% had a score of 400-999, and 5.5% had a score of ≥1000. The most common indications for CAC testing were risk factors (45.5%) and symptoms (38.0%). CAC testing indications were unretrievable on the database for 31 patients (14.2%). CT coronary angiography was performed in 57 patients (26.1%), while 30 patients (13.8%) had invasive coronary angiography. On invasive coronary angiography, 8 patients (3.7%) were reported to have obstructive disease and 25 patients (11.5%) had non-obstructive disease. Following CAC testing, antiplatelet therapy was started in 15 patients (6.9%). Statin therapy was started in 28 patients (12.4%). The maintenance and modification of previous statin therapy was noted in 67 patients (30.3%). Conclusion CAC testing is a useful non-invasive diagnostic test which can be used to identify individuals at risk of obstructive coronary artery disease and guide initiation of risk modifying therapy. The cohort of patients currently undergoing CAC testing in our hospital are largely asymptomatic patients with cardiovascular risk factors. The results of these tests led to commencement of risk modifying treatment in less than 20% of patients and only a small proportion of patients required follow-on invasive coronary angiography for further investigation of their coronary artery anatomy. These results show that CAC testing use in our hospital is in line with international guidelines and suggest that the use of CAC testing decreases the requirement for invasive coronary angiography in low-risk, asymptomatic patients.

Abstract WMP11: Predictors Of Early Neurological Deterioration After Dual Antiplatelet Therapy In Patients With Cerebral Infarction

Background: Recent clinical evidence supports the early initiation of aspirin and clopidogrel combination for patients with minor stroke or high-risk transient ischemic attack (TIA) to prevent stroke recurrence. However, some of the patients still experience early neurological deterioration (END) despite optimal antithrombotic treatment. We investigated clinical and laboratory variables related to END after optimal antithrombotic treatment among the patients with non-cardioembolic stroke or TIA. Methods: The patients with minor neurological deficit who received aspirin and clopidogrel within 24 hours after symptom onset were selected from the prospective stroke registries of Seoul National University and Chung-Ang University Hospital, in Seoul, Korea. The END due to ischemic stroke (END_IS) was defined as two or more national institute health stroke scale increase within 5 days after stroke which us due to stroke progression or recurrence. Included patients were divided into two groups according to the presence of END_IS and demographic and laboratory variables were compared between the two groups. Multivariable logistic regression analysis was performed to assess the independent predictors of the END. Results: During the study period from January 2015 to January 2021, 33 (8.7%) out of 380 patients experienced END_IS. In multivariate analysis, independent predictors of END_IS were the presence of intracranial artery stenosis ≥ 50% (odds ratio [OR] 2.922, [95% CI, 1.342-6.364], p=0.007), higher initial NIHSS score, (OR 1.502 [95% CI 1.120-2.015], p=0.007), previous use of statin (OR 0.282 [95% CI 0.080-0.990], p=0.007) and higher serum D-dimer level (OR 1.408 [95% CI, 1.074-1.847], p=0.048). Conclusions: Intracranial artery stenosis, stroke severity, previous statin use, and D-dimer level were the independent predictors of END_IS after dual-antiplatelet treatment in patients with minor stroke. Future studies are necessary to develop an additional therapeutic strategy for the at-risk patient group.

Thrombotic microangiopathy in primary antiphospholipid syndrome is linked to stroke and less deep venous thrombosis.

To compare clinical and laboratory data obtained from patients with primary Antiphospholipid Syndrome (pAPS) with and without Thrombotic Microangiopathy (TMA). A cross-sectional study with 66 (83.3% female) pAPS patients was performed. Demographic, clinical, drug use, antiphospholipid antibodies data were evaluated. Patients were subdivided into one of two groups: pAPS with TMA and pAPS without TMA and were compared. In this sample, 5/66 (7.6%) of patients had TMA. Primary APS with TMA group exhibited a higher frequency of arterial events (100% vs. 54.1%, p=0.02), stroke (100% vs. 32.8%, p=0.001) and a lower frequency of deep venous thrombosis (0 vs. 68.9%, p=0.0009) compared to the patients without TMA. Analysis of therapy used in these patients showed a higher frequency of current (40% vs. 6.6%, p=0.0006) and previous glucocorticoid use (80% vs. 36%, p=0.0007) and statin use (50% vs. 22.9%, p=0.037) in the first group. The two groups exhibited no differences in the frequency of positive autoantibodies, except for higher IgG anticardiolipin titers (86 ± 52 vs. 34.5 ± 39 GPL, p=0.003). Patients with pAPS and TMA have distinct clinical and laboratory spectra from those without TMA, that is characterized by an increased frequency of arterial events, stroke, and higher titers of IgG anticardiolipin; they have deep venous thrombosis less frequently.

Statin use and pneumonia risk in Parkinson's disease

IntroductionPrevious studies reported that statin use was related to a lower risk of pneumonia in the general population. This study investigated the association between statin use and pneumonia risk in patients with Parkinson's disease (PD). MethodsPatients that had been newly diagnosed with PD between 2004 and 2006 in the 2002–2017 National Health Insurance Service database in South Korea were identified. PD patients who had received one or more statin prescriptions, and experienced pneumonia during the observation period were included in the self-controlled case series (SCCS) analysis. Patients who had no previous statin prescription record were included in the Cox proportional hazard model with a time-varying covariate (statin use). The risk of pneumonia in PD patients with statin use was estimated after adjusting potential confounders. ResultsOf the 10,159 patients with PD, 337 individuals were eligible for the SCCS analysis. The median duration of statin exposure was 2.63 years (IQR, 0.83–5.83). The incidence of pneumonia was reduced in the statin-exposed period compared to the unexposed period (incidence rate ratio, 0.88; 95% CI, 0.86–0.91). A total of 8,022 patients were included in the Cox proportional hazard model. Statin use was related to a significantly reduced pneumonia risk (adjusted hazard ratio, 0.69; 95% CI, 0.62–0.78). ConclusionsStatin use was associated with a lower risk of pneumonia in PD patients. Statins might affect pneumonia occurrence by lowering cholesterol levels or slowing the progression of PD as neuroprotective agents. Further clinical studies are needed to delineate our findings with the underlying biological mechanisms.

Efficacy and Safety of Fenofibrate-Statin Combination Therapy in Patients With Inadequately Controlled Triglyceride Levels Despite Previous Statin Monotherapy: A Multicenter, Randomized, Double-blind, Phase IV Study

PurposeResidual cardiovascular risk reduction by fenofibrate in patients with high serum triglyceride (TG) levels despite previous statin monotherapy is not well characterized. The purpose of this study was to evaluate the efficacy and safety of a combination of choline fenofibrate and statin in patients with inadequately controlled TG levels despite previous statin monotherapy. MethodsThis prospective, multicenter, randomized, double-blind study was conducted in Korea. A total of 133 patients with controlled LDL-C but elevated TG levels, already receiving statin monotherapy, were enrolled in the study, which was conducted from July 2018 to December 2019. Patients were randomly assigned to receive combination therapy with choline fenofibrate and statin or statin monotherapy in a 1:1 ratio. After 8 weeks of treatment, the lipid profiles and safety parameters of the patients in the 2 groups were compared. FindingsThe study included 127 patients (64 in the combination group and 63 in the control group) older than 19 years. After 8 weeks of therapy, mean serum TG levels significantly decreased from 269.8 to 145.5 mg/dL (P < 0.0001) in the combination therapy group, whereas no significant changes occurred in the statin monotherapy group (from 271.1 to 280.5 mg/dL). Contrarily, the mean serum HDLC levels significantly increased from 45.0 to 50.4 mg/dL (P = 0.0004) in the combination therapy group, whereas there were no significant changes in the monotherapy group (from 44.3 to 44.7 mg/dL). There were no additional serious adverse events in the combination therapy group compared with the statin monotherapy group. ImplicationsThe combination therapy using choline fenofibrate and statin was found to be effective in serum TG control and likely tolerable in patients with high TG levels despite statin monotherapy. A larger study, conducted for a longer duration, is needed to evaluate the effectiveness of this combination in reducing cardiovascular risk. ClinicalTrials.gov identifier: NCT03874260.

Association between Statin Use and Meniere's Disease: Results from a National Health Screening Cohort.

The protective effects of statins against inner ear diseases have been suggested. This study investigated the relationship between previous statin use and the occurrence of Meniere’s disease (MD). Participants ≥40 years old in the Korean National Health Insurance Service-Health Screening Cohort 2002–2015 were enrolled. A total of 7734 MD participants were matched with 38,670 comparison participants. The dates of statin prescriptions for the 2 years before the onset of MD were examined. A conditional logistic regression analysis was performed to estimate the odds ratios (ORs) of statin use for MD. Regarding the different types of statins, lipophilic statins, but not hydrophilic statins, were associated with lower odds of MD in the <65 year-old group (adjusted OR = 0.81, 95% CI = 0.68–0.97, p = 0.023). Prior statin use did not show association with MD in the adult population. Regarding the different types of statins, lipophilic statin use was related to a lower rate of MD in a middle-aged population.

Association between statin medication and hearing impairment in a national health screening cohort

This study aimed to investigate the association of previous stain use with hearing impairment in an adult population. Data from the ≥ 40-year-old population in the Korean National Health Insurance Service Health Screening Cohort were used. The hearing impairment group was classified based on the national registry of hearing-impaired persons. Control participants were randomly selected and matched for age, sex, income, and region of residence. The number of days of statin prescription during the 2 years before the diagnosis of hearing impairment was compared between the hearing impairment group and the control group using conditional logistic regression analysis. Additional analyses were conducted according to age and sex. The number of days of previous statin use was not different between the hearing impairment group and the control group (adjusted odds ratio [aOR] = 0.94, 95% confidence interval (CI) = 0.86–1.02, P = 0.118). According to age, in the ≥ 70-year-old group, those with hearing impairment had 11% lower rates of previous statin use than those in the control group (aOR = 0.89, 95% CI = 0.80–0.99, P = 0.039). According to sex, in the male group, 12% lower rates of previous statin use were observed among those with hearing impairment than among those in the control group (aOR = 0.88, 95% CI = 0.79–0.99, P = 0.037). Previous statin use might have an effect on reducing the prevalence of hearing impairment in elderly individuals and men.

Statin therapy for patients with aortic stenosis who underwent transcatheter aortic valve implantation: a report from a Japanese multicentre registry

ObjectiveData on statin for patients with aortic stenosis (AS) who underwent transcatheter aortic valve implantation (TAVI) are limited. The present study aimed to evaluate the impact of statin on midterm...

MO419THE ROLE OF SHORT-TERM, HIGH-DOSE ATORVASTATIN FOR PREVENTION OF CONTRAST-INDUCED ACUTE KIDNEY INJURY (CI-AKI) IN PATIENTS WITH CARDIOVASCULAR DISEASES UNDERGOING COMPUTED TOMOGRAPHY WITH INTRAVENOUS CONTRAST ADMINISTRATION

Abstract Background and Aims Computed tomography with intravenous contrast media is widely used in hospitals. The incidence of CI-AKI due to intravenous contrast media administration in high-risk patients remains not studied as well as CI-AKI after intraarterial contrast media administration is. According to other researchers, the use of statins in the prevention of AKI after intra-arterial administration of a contrast agent is currently considered an efficient preventive measure. The aim of our study is to assess the incidence of contrast-induced acute kidney injury in patients with cardiovascular diseases during CT scan with intravenous contrast media and analyze the efficacy and safety of various statin dosing regimens for prevention of CI-AKI. Method A randomized controlled open prospective study is planned. Statin naive patients with cardiovascular diseases will be divided into 3 groups. Patients in the first group will receive atorvastatin 80mg 24 hours and 40mg 2 hours before CT scans and 40 mg after. The second group – 40 mg 2 hours before CT scans and 40 mg after. A third group is a control group. Exclusion criteria were current or previous statin treatment, contraindications to statins, severe renal failure, acute coronary syndrome, administration of nephrotoxic drugs. The primary endpoint will the development of CI-AKI, defined as an increase in serum Cr concentration 0.5 mg/dl (44.2 mmol/l) or 25% above baseline at 72 h after exposure to the contrast media. Results We assume a higher incidence of contrast-induced acute kidney injury in the group of patients not receiving statin therapy (about 5-10%). At the same time, it is unlikely to get a significant difference between statin dosing regimens. Risk factors such as age over 75 years, the presence of chronic kidney disease, diabetes mellitus, and chronic heart failure increase the risk of contrast-induced acute kidney injury. Conclusion Despite the significantly lower incidence of CI-AKI with intravenous contrast compared to intra-arterial, patients with CVD have a greater risk of this complication even with intravenous contrast. Therefore, the development of prevention methods and scales for assessing the likelihood of CI-AKI is an important problem. As a result of the study, we expect to conclude the benefits of statins in CI-AKI prevention and the optimal dosage regimen. This information will help us to reduce the burden of CI-AKI after CT scanning in statin naive patients with cardiovascular diseases in everyday clinical practice. ClinicalTrials.gov ID: NCT04666389

Do statins reduce mortality in older people? Findings from a longitudinal study using primary care records

ObjectiveAssess whether statins reduce mortality in the general population aged 60 years and above.DesignRetrospective cohort study.SettingPrimary care practices contributing to The Health Improvement Network database, England and Wales, 1990–2017.ParticipantsCohort who...