Safety Of More Intensive Lowering Research Articles

Statin Intolerance and Noncompliance: An Empiric Approach

Statin Intolerance and Noncompliance: An Empiric Approach

19-LB: Statin Use as a Primary Prevention in Patients with Type 1 Diabetes: Where Do We Stand?

Type 1 diabetes (T1D) carries a high cardiovascular risk (CVD). Statins reduce risk of non-fatal myocardial infarction when used as primary prevention in selected patients[1]. We reviewed 205 electronic records of patients with T1D at our center from July 2019 to September 2019. We followed 2018 NICE guidelines for statin use as a primary prevention for our analysis (1)age ≥40 years (2)diabetes duration ≥10 years (3)established nephropathy (4)established other CVD risks. Our cohort consisted of 119 males (58%) with a mean BMI of 25.5±4.4 kg/m2 and mean age of 43±16 years. The median duration of diabetes was 16 [IQR 8 - 27] years. More than 50% of our patients had attended “Dose Adjustment For Normal Eating, DAFNE” course. Approximately 71% had T1D for ≥10 years and 56% were ≥40 years. Mean systolic and diastolic blood pressures were 128 (±15.3) mmHg and 77 (±10) mmHg, respectively. Mean LDL was 2.4 (±0.74) mmol/L. In total 24.8% were on statin therapy, 2.4% on fibrates and 4.4% declined statin. Of the patients reviewed, 180 (87.8%) met the criteria for primary prevention; however, of those 51/180 (28.3%) were on statin, 44/146 (30.1%) with diabetes ≥10 years, 46/115 (40.0%) ≥40, 34/93 (36.6%) with established retinopathy. Regarding macro and microvascular complications, 3.4% had CAD, 6.8% chronic kidney disease (eGFR<60) and 47.8% retinopathy. Patients with T1D have higher CVD risk, for which statin therapy is advised[2, 3]. Our patients are undertreated with statins as primary prevention.

No evidence to support high-intensity statin in Chinese patients with coronary heart disease

No evidence to support high-intensity statin in Chinese patients with coronary heart disease

NLA Task Force on Statin Safety--2014 update.

1933-2874/$ see front matter 2014 http://dx.doi.org/10.1016/j.jacl.2014.03 Statins are the most widely prescribed class of medications in the United States and their benefits for lowering lowdensity lipoprotein cholesterol (LDL-C) and reducing the risk for coronary heart disease (CHD) are well documented. Statins have been the cornerstone of pharmacotherapy for the management of high blood cholesterol levels virtually since their development. The American Heart Association /American College of Cardiology 2013 guidelines recently expanded the number of individuals eligible for statin therapy by recommending it for those with: (1) clinical atherosclerotic cardiovascular disease (ASCVD), (2) LDL-C $190 mg/dL, (3) type 2 diabetes and age between 40 and 75 years with LDL-C 70 to 189 mg/dL, and (4) an estimated 10-year risk of ASCVD $7.5% and age 40 to 75 years. Considering only those who qualify according to their estimated 10-year risk of ASCVD, it has been reported that of the 101 million people in the United States age 40 to 79 years who do not have cardiovascular disease, 33 million have an estimated 10-year risk of ASCVD $7.5%, and another 13 million have a risk between 5% and 7.4%. Using crude global estimates, 920 million people worldwide would be expected to be

Dyslipidemia

Dyslipidemia

Point: Why statins have failed to reduce mortality in just about anybody

This discussion was sparked by an editorial critique by Sniderman et al 1 Sniderman A.D. Thanassoulis G. Couture P. Williams K. Alam A. Furberg C.D. Is lower and lower better and better? A re-evaluation of the evidence from the Cholesterol Treatment Trialists’ Collaboration meta-analysis for low-density lipoprotein lowering. J Clin Lipidol. 2012; 6: 303-309 Abstract Full Text Full Text PDF PubMed Scopus (39) Google Scholar regarding the 2010 Cholesterol Treatment Trialists’ (CTT) meta-analysis that suggested a statin “event” benefit from maximal lowering of low-density lipoprotein cholesterol levels. 2 Cholesterol Treatment Trialists’ (CTT) CollaborationEfficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010; 376: 1670-1681 Abstract Full Text Full Text PDF PubMed Scopus (4534) Google Scholar There are two issues that deserve further attention: the components of the CTT study end points and, most importantly, the issue of reduction in all-cause mortality. Statins do lower cardiovascular mortalityJournal of Clinical LipidologyVol. 7Issue 5PreviewThe point/counterpart in the recent issue of the Journal of Clinical Lipidology confronts the anti-statin view of Eddie Vos, MEng, and the pro-statin view of Alan Sniderman, MD.1 I would like to add my experience to this debate. Full-Text PDF

Meta-analysis: More intensive statin therapy prevents major vascular events

Source Citation Cholesterol Treatment Trialists’ (CTT) Collaboration, Baigent C, Blackwell L, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from ...

Intensifying statin therapy to maximize cardiovascular risk reduction: is 50 the new 70? Goals are getting old

Evaluation of: Cholesterol Treatment Trialists' (CTT) Collaboration; Baigent C, Blackwell L,Emberson J et al.: Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysisof data from 170,000 participants in 26 randomized trials. Lancet 376(9753), 1670–168(2010). As the primary target of therapy in the management of dyslipidemia, LDL-C has been a central focus for practicing clinicians for more than a decade. National Cholesterol Education Program guidelines encourage physicians to lower LDL-C levels to outlined therapeutic targets nthe basis of ongoing randomized controlled trials demonstrating significant benefit in cardiovascular outcomes among primary and secondary prevention individuals. Relevant epidemiological analysis of cardiovascular outcomes in the USA reports that although statin therapy provides arelative risk reduction of 30%, many coronary heart disease patients at the LDL-C target levelare still having major events, of which more than half are recurrent. Although statins – the mainstay of therapy – are able to decrease LDL-C by a range of approximately 30–50% depending on the potency and dose of the statin administered, they remain underused in the clinical setting by practicing physicians. There also remains controversy as to whether more intensive lowering of LDL-C provides additional cardiovascular benefit or not. Intensive lowering of LDL-C asit pertains to the incidence of cardiovascular outcomes (including myocardial infarction, coronary revascularization and ischemic stroke) is assessed in this meta-analysis of 170,000 individuals from 26 large, randomized controlled trials. The implications of the Cholesterol Treatment Trialists' Collaboration for practicing physicians are discussed here.

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170 000 participants in 26 randomised trials

SummaryBackgroundLowering of LDL cholesterol with standard statin regimens reduces the risk of occlusive vascular events in a wide range of individuals. We aimed to assess the safety and efficacy of more intensive lowering of LDL cholesterol with statin therapy.MethodsWe undertook meta-analyses of individual participant data from randomised trials involving at least 1000 participants and at least 2 years' treatment duration of more versus less intensive statin regimens (five trials; 39 612 individuals; median follow-up 5·1 years) and of statin versus control (21 trials; 129 526 individuals; median follow-up 4·8 years). For each type of trial, we calculated not only the average risk reduction, but also the average risk reduction per 1·0 mmol/L LDL cholesterol reduction at 1 year after randomisation.FindingsIn the trials of more versus less intensive statin therapy, the weighted mean further reduction in LDL cholesterol at 1 year was 0·51 mmol/L. Compared with less intensive regimens, more intensive regimens produced a highly significant 15% (95% CI 11–18; p<0·0001) further reduction in major vascular events, consisting of separately significant reductions in coronary death or non-fatal myocardial infarction of 13% (95% CI 7–19; p<0·0001), in coronary revascularisation of 19% (95% CI 15–24; p<0·0001), and in ischaemic stroke of 16% (95% CI 5–26; p=0·005). Per 1·0 mmol/L reduction in LDL cholesterol, these further reductions in risk were similar to the proportional reductions in the trials of statin versus control. When both types of trial were combined, similar proportional reductions in major vascular events per 1·0 mmol/L LDL cholesterol reduction were found in all types of patient studied (rate ratio [RR] 0·78, 95% CI 0·76–0·80; p<0·0001), including those with LDL cholesterol lower than 2 mmol/L on the less intensive or control regimen. Across all 26 trials, all-cause mortality was reduced by 10% per 1·0 mmol/L LDL reduction (RR 0·90, 95% CI 0·87–0·93; p<0·0001), largely reflecting significant reductions in deaths due to coronary heart disease (RR 0·80, 99% CI 0·74–0·87; p<0·0001) and other cardiac causes (RR 0·89, 99% CI 0·81–0·98; p=0·002), with no significant effect on deaths due to stroke (RR 0·96, 95% CI 0·84–1·09; p=0·5) or other vascular causes (RR 0·98, 99% CI 0·81–1·18; p=0·8). No significant effects were observed on deaths due to cancer or other non-vascular causes (RR 0·97, 95% CI 0·92–1·03; p=0·3) or on cancer incidence (RR 1·00, 95% CI 0·96–1·04; p=0·9), even at low LDL cholesterol concentrations.InterpretationFurther reductions in LDL cholesterol safely produce definite further reductions in the incidence of heart attack, of revascularisation, and of ischaemic stroke, with each 1·0 mmol/L reduction reducing the annual rate of these major vascular events by just over a fifth. There was no evidence of any threshold within the cholesterol range studied, suggesting that reduction of LDL cholesterol by 2–3 mmol/L would reduce risk by about 40–50%.FundingUK Medical Research Council, British Heart Foundation, European Community Biomed Programme, Australian National Health and Medical Research Council, and National Heart Foundation.