Use In Secondary Prevention Research Articles

Statin and antiplatelet use in secondary prevention: Are we following the guidelines?

Statin and antiplatelet use in secondary prevention: Are we following the guidelines?

Impact of sex on outcomes associated with polyvascular disease in patients after PCI

Atherosclerosis in more than one vs. one arterial bed is associated with increased risk for major adverse cardiovascular events (MACE). This study aimed to determine whether the risk of post percutaneous coronary intervention (PCI) MACE associated with polyvascular disease (PVD) differs by sex. We analyzed 18,721 patients undergoing PCI at a tertiary-care center between 2012-2019. Polyvascular disease was defined as history of peripheral artery and/or cerebrovascular disease. The primary endpoint was MACE, a composite of all-cause death, myocardial infarction, or stroke at 1 year. Multivariate Cox regression was used to adjust for differences in baseline risk between patients with PVD vs. coronary artery disease (CAD) alone and interaction testing was used to assess risk modification by sex. Women represented 29.2% (N=5,467) of the cohort and were more likely to have PVD than men (21.7% vs. 16.1%; p<0.001). Among both sexes, patients with PVD were older with higher prevalence of comorbidities and cardiovascular risk factors. Women with PVD had the highest MACE rate (10.0%), followed by men with PVD (7.2%), women with CAD alone (5.0%), and men with CAD alone (3.6%). Adjusted analyses revealed similar relative MACE risk associated with PVD vs. CAD alone in women and men (adjusted hazard ratio [aHR] 1.54, 95% confidence interval [CI] 1.20-1.99; p<0.001 and aHR 1.31, 95% CI 1.06-1.62; p=0.014, respectively; p-interaction=0.460). Women and men derive similar excess risk of MACE from PVD after PCI. The heightened risk associated with PVD needs to be addressed with maximized use of secondary prevention in both sexes.

Statin treatment for primary and secondary prevention in elderly patients—a cross-sectional study in Stockholm, Sweden

BackgroundAge 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.AimThe 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.MethodsThis 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.ResultsA 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.ConclusionsStatins 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.

Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on the simplification of the drug regimen for secondary cardiovascular prevention.

The issue of suboptimal drug regimen adherence in secondary cardiovascular prevention presents a significant barrier to improving patient outcomes. To address this, the utilization of drug combinations, specifically single pill combinations (SPCs) and polypills, was proposed as a strategy to simplify treatment regimens. This approach aims to enhance treatment accessibility, affordability, and adherence, thereby reducing healthcare costs and improving patient health. The document is an Associazione Nazionale Medici Cardiologi Ospedalieri (ANMCO) scientific statement on simplifying drug regimens for secondary cardiovascular prevention. It discusses the underuse of treatments despite available, effective, and accessible options, highlighting a significant gap in secondary prevention across different socio-economic statuses and countries. The statement explores barriers to implementing evidence-based treatments, including patient, healthcare provider, and system-related challenges. The paper also reviews international guidelines, the role of SPCs and polypills in clinical practice, and their economic impact, advocating for their use in secondary prevention to improve patient outcomes and adherence.

ANMCO Scientific statement on combination therapies and polypill in secondary prevention

The issue of suboptimal drug regimen adherence in secondary cardiovascular prevention presents a significant barrier to improving patient outcomes. To address this, the utilization of drug combinations, specifically single pill combinations (SPCs) and polypills, was proposed as a strategy to simplify treatment regimens. This approach aims to enhance treatment accessibility, affordability, and adherence, thereby reducing healthcare costs and improving patient health. The document is an ANMCO scientific statement on simplifying drug regimens for secondary cardiovascular prevention. It discusses the underuse of treatments despite available, effective, and accessible options, highlighting a significant gap in secondary prevention across different socioeconomic statuses and countries. The statement explores barriers to implementing evidence-based treatments, including patient, healthcare provider, and system-related challenges. The paper also reviews international guidelines, the role of SPCs and polypills in clinical practice, and their economic impact, advocating for their use in secondary prevention to improve patient outcomes and adherence.

Abstract TP150: Magnetic Resonance Imaging Predictors of Atrial Fibrillation in Cryptogenic Stroke Cases

Introduction: Ischemic stroke is a leading cause of death and disability in the US, with 20-40% of cases, classified as cryptogenic or with an unexplained cause. Detection of one cause, paroxysmal atrial fibrillation (AF), is critical to ensuring optimal treatment with direct oral anticoagulant (DOAC). Currently, the most reliable AF detection strategy is use of an insertable cardiac monitor (ICM). However, earlier detection of occult cardioembolic patterns using MRI may promote earlier decisions for DOAC use. The overall goal of this study is to determine if MRI lesion patterns are predictive of AF detection by ICM. Methodology: Cases of consecutive patients (1/1/2015 - 12/31/2017) with MRI-confirmed stroke performed 48h from time last known well and prior to endovascular treatment were retrospectively analyzed. The primary outcome, presence of occult atrial fibrillation, was detected by ICM placement within 90 days and follow-up within 180 days from stroke. Four imaging patterns were tested as predictors of AF: i) acute stroke lesion involving multiple vascular territories (MVT, i.e. right or left carotid and/or posterior circulation), ii) MVT plus wedge-shaped cortical infarct or chronic stroke on FLAIR, iii) MVT involving 3 territories, and iv) MVT in 3 territories plus chronic FLAIR lesion. Adjustment variables were based on univariate logistic regression predictors of AF at P ≤0.1000. Results: Of the 101 cases in this analysis, the median age was 63 years and 49.5% male. Stroke in multiple vascular territories MVT was present in 22/101 (22%) at baseline. The total AF 6-month detection rate was 36/101 (36%). The imaging pattern most predictive of AF was pattern ii, MVT plus chronic FLAIR with an unadjusted odds ratio (OR) of 3.47, 95% CI of 0.3442-2.1731, P=.0073. The adjusted OR (age ≥ 55, history of stroke, and history of TIA,) was 3.26, 95% CI: 1.0358-11.1860, P =.0480. Conclusion: The presence of acute lesions in MVT and a chronic FLAIR lesion may be a biomarker of occult cardioembolic source that could be used early after the onset of stroke to determine optimal DOAC use for secondary prevention and potential risk reduction of stroke recurrence from suspected but unproven cardioembolic source. Funding: Lone Star Stroke Research Consortium

Abstract 16892: Statin Utilization and Recurrent Cardiovascular Disease Events in a Secondary Prevention Cohort of Older Adults

Introduction: The ACC/AHA guidelines recommend that patients with established ASCVD should be on high intensity statins for secondary prevention. Prior data suggests that older adults (&gt;75 years) are sub-optimally treated for both primary and secondary prevention of ASCVD events. We investigated guideline directed statin intensity (GDSI) use, associated LDL cholesterol levels and ASCVD outcomes in a cohort of older adults in a large healthcare network. Methods: EMR data was abstracted to assess statin prescriptions between 2010-2020 amongst adults with known ASCVD (CAD, ischemic stroke/TIA or PAD). Prescriptions of statins as GDSI (high intensity), &lt;GDSI (low/moderate intensity), and no statin were assessed and stratified by age groups. LDL-C levels across the follow up time were calculated. Cox regression models were used to assess HRs (Hazard Ratios) for repeat ASCVD event (MI and stroke/TIA) and all cause death, stratified by age and GDSI treatment. Results: Over ~5y follow up, amongst adults aged&gt;75 years (n=11,596), less than half (49.6%) were on GDSI and only ~54% older adults achieved LDL-c&lt;70mg/dL. Compared to GDSI use, older adults on &lt;GDSI had a greater incidence of recurrent MI [HR&gt;75y 1.59; 95% CI (1.30-1.95)], stroke [HR&gt;75 1.659; 95% CI (1.21-2.24)] and mortality [HR&gt;75 1.88; 95% CI (1.57-2.25)]; all p&lt;0.01 in &lt;GDSI group vs GDSI group. GDSI use had a greater reduction of MI and mortality in older adults than younger counterparts [Table 1]. Conclusions: In this contemporary healthcare network, GDSI use for secondary prevention and LDL-C&lt;70 mg/dL was suboptimal amongst all age groups. Any statin use conferred a greater reduction in MI and mortality amongst older adults &gt;75y. Systemic interventions for guideline implementation and optimal statin use in older adults with ASCVD should be explored further.

Redefining the Roles of Aspirin across the Spectrum of Cardiovascular Disease Prevention.

Even before its role in platelet inhibition was fully characterized in the 1980s, aspirin had been incorporated into the cardiovascular disease care algorithm. Early trials examining its use in unstable angina and acute myocardial infarction revealed evidence of its protective role in the secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Large trials assessing use in the primary prevention setting and optimal dosing regimens were studied in the late 1990s and early 2000s. As a cornerstone of cardiovascular care, aspirin was incorporated into primary and secondary ASCVD prevention guidelines in the United States and mechanical heart valve guidelines. However, in recent years, with significant advances in medical and interventional ASCVD therapies, scrutiny has been placed on the bleeding profile of aspirin, and guidelines have adapted to new evidence. Updates in primary prevention guidelines reserve aspirin only for patients at higher ASCVD risk and low bleeding risk - though questions remain in ASCVD risk assessment as risk-enhancing factors have proven difficult to incorporate on a population level. New thoughts regarding aspirin use in secondary prevention - especially with the concomitant use of anticoagulants - have altered recommendations as additional data accrued. Finally, a recommendation for aspirin and vitamin K antagonists with mechanical heart valves has been modified. Despite aspirin losing a foothold in cardiovascular care, new evidence has strengthened claims for its use in women at high risk for preeclampsia.

PB0496 Bleeding Risk with Long-Term Fondaparinux Use for Secondary Prevention of Thromboembolism at a Tertiary Centre in the UK: A Retrospective Observational Audit

PB0496 Bleeding Risk with Long-Term Fondaparinux Use for Secondary Prevention of Thromboembolism at a Tertiary Centre in the UK: A Retrospective Observational Audit

Aspirin for Secondary Prevention of Cardiovascular Disease in 51 Low-, Middle-, and High-Income Countries

Aspirin is an effective and low-cost option for reducing atherosclerotic cardiovascular disease (CVD) events and improving mortality rates among individuals with established CVD. To guide efforts to mitigate the global CVD burden, there is a need to understand current levels of aspirin use for secondary prevention of CVD. To report and evaluate aspirin use for secondary prevention of CVD across low-, middle-, and high-income countries. Cross-sectional analysis using pooled, individual participant data from nationally representative health surveys conducted between 2013 and 2020 in 51 low-, middle-, and high-income countries. Included surveys contained data on self-reported history of CVD and aspirin use. The sample of participants included nonpregnant adults aged 40 to 69 years. Countries' per capita income levels and world region; individuals' socioeconomic demographics. Self-reported use of aspirin for secondary prevention of CVD. The overall pooled sample included 124 505 individuals. The median age was 52 (IQR, 45-59) years, and 50.5% (95% CI, 49.9%-51.1%) were women. A total of 10 589 individuals had a self-reported history of CVD (8.1% [95% CI, 7.6%-8.6%]). Among individuals with a history of CVD, aspirin use for secondary prevention in the overall pooled sample was 40.3% (95% CI, 37.6%-43.0%). By income group, estimates were 16.6% (95% CI, 12.4%-21.9%) in low-income countries, 24.5% (95% CI, 20.8%-28.6%) in lower-middle-income countries, 51.1% (95% CI, 48.2%-54.0%) in upper-middle-income countries, and 65.0% (95% CI, 59.1%-70.4%) in high-income countries. Worldwide, aspirin is underused in secondary prevention, particularly in low-income countries. National health policies and health systems must develop, implement, and evaluate strategies to promote aspirin therapy.

Socioeconomic Disparities and Mediators for Recurrent Atherosclerotic Cardiovascular Disease Events After a First Myocardial Infarction.

Low socioeconomic status is associated with worse secondary prevention use and prognosis after myocardial infarction (MI). Actions for health equity improvements warrant identification of risk mediators. Therefore, we assessed mediators of the association between socioeconomic status and first recurrent atherosclerotic cardiovascular disease event (rASCVD) after MI. In this cohort study on 1-year survivors of first-ever MI with Swedish universal health coverage ages 18 to 76 years, individual-level data from SWEDEHEART (Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies) and linked national registries was collected from 2006 through 2020. Exposure was socioeconomic status by disposable income quintile (principal proxy), educational level, and marital status. The primary outcome was rASCVD and secondary outcomes were cardiovascular and all-cause mortality. We initially assessed the incremental attenuation of hazard ratios with 95% CIs in sequential multivariable models adding groups of potential mediators (ie, previous risk factors, acute presentation and infarct severity, initial therapies, and secondary prevention). Thereafter, the proportion of excess rASCVD associated with a low income mediated through nonparticipation in cardiac rehabilitation, suboptimal statin management, a cardiometabolic risk profile, persistent smoking, and blood pressure above target after MI were calculated using causal mediation analysis. Among 68 775 participants (73.8% men), 7064 rASCVD occurred during a mean 5.7-year follow-up. Income, adjusted for age, sex, and calendar year, was associated with rASCVD (hazard ratio, 1.63 [95% CI, 1.51-1.76] in the lowest versus highest income quintile). Risk attenuated most by adjustment for previous risk factors and by adding secondary prevention variables for a final model (hazard ratio, 1.38 [95% CI, 1.26-1.51]) in the lowest versus highest income quintile. The proportions of the excess 15-year rASCVD risk in the lowest income quintile mediated through nonparticipation in cardiac rehabilitation, cardiometabolic risk profile, persistent smoking, and poor blood pressure control were 3.3% (95% CI 2.1-4.8), 3.9% (95% CI, 2.9-5.5), 15.2% (95% 9.1-25.7), and 1.0% (95% CI 0.6-1.5), respectively. Risk mediation through optimal statin management was negligible. Nonparticipation in cardiac rehabilitation, a cardiometabolic risk profile, and persistent smoking mediate income-dependent prognosis after MI. In the absence of randomized trials, this causal inference approach may guide decisions to improve health equity.

Trends and Gaps in Statin Use for Cardiovascular Disease Prevention in Type 2 Diabetes: A Real-World Study in Shanghai, China

BackgroundCardiovascular disease (CVD) is the major cause of death among persons with diabetes. As the preventative use of statin has been proved to reduce CVD risks, understanding the current status and the trend in statin use is crucial to improve clinical treatment strategies. ObjectiveOur study aimed to answer the question of what were the status and trend of statin use in Shanghai, China. MethodsOur study estimated statin use and trends from 2015 to 2021 among 702 727 patients with type 2 diabetes mellitus (T2DM) based on electronic health records from the Shanghai Hospital Link Database. Patients were grouped according to the presence of CVDs, tested separately for statin primary and secondary prevention use, and stratified by age and sex. ResultsIn the study population, 221 127 patients (31.5%) received statin therapy, and among patients with CVD, 157 622 patients (51.62%) received statin therapy for secondary prevention, but only 15% of patients received statins for primary prevention. The trend in the use of statins was still on the rise from 28.3% in 2015. Statin use increased with age (18-39 years, 14.0%; 40-59 years, 26.8%; 60-74 years, 33.35%; and 75 and over, 36.1%), and women (29.7%, n = 93 977) were less likely to receive statin therapy compared to men (32.9%, n = 127 150). ConclusionDespite the rise in statin use in T2DM in recent decades, a large proportion of subjects with T2DM did not receive statin therapy.

Use of optimal medical therapy in patients with diabetes and atherosclerotic cardiovascular disease: Insights from a prospective longitudinal cohort study.

To examine improvement in the use of optimal medical therapy (OMT) for secondary prevention in patients with atherosclerotic cardiovascular disease (ASCVD) and diabetes. Patients with ASCVD (coronary, cerebrovascular, peripheral) and low-density lipoprotein-cholesterol of 70 mg/dl or higher were enrolled from December 2016 to July 2018 from 107 US sites/physicians (47% cardiology, 41% primary care, 12% other) and prospectively followed for 2 years (current analysis restricted to subgroup with diabetes). OMT was defined as high-intensity lipid-lowering (high-intensity statin, any statin + ezetimibe, proprotein convertase subtilisin/kexin type 9 inhibitor), antithrombotic (antiplatelet or anticoagulant), angiotensin-converting enzyme-inhibitor/angiotensin II receptor blocker/angiotensin receptor neprilysin inhibitor (ACE-I/ARB/ARNI) (excluding glomerular filtration rate [GFR] < 30 ml/min/1.73m2 ) and sodium-glucose co-transporter-2 inhibitor (SGLT2i)/glucagon-like peptide-1 receptor agonist (GLP-1 RA) (excluding GFR < 30 ml/min/1.73m2 and type 1 diabetes). Among 1590 patients with ASCVD and diabetes (96% type 2 diabetes), 58% were on high-intensity lipid-lowering therapy at the end of follow-up, 87% antithrombotic, 71% ACE-I/ARB/ARNI and 17% SGLT2i/GLP-1 RA. Overall, 11% of patients received comprehensive OMT, which modestly improved over time (vs. 8% at baseline; P=.002). Patients treated by cardiologists (vs. non-cardiologists) were more likely to be on high-intensity lipid lowering, but less likely to be on an SGLT2i/GLP-1 RA, and thus had lower rates of composite OMT (7.8% vs. 13.7%, P < .001). In a hierarchical multivariable model, older age was associated with lower odds of OMT (OR 0.74 per 10 years, 95% CI 0.60-0.90), whereas private insurance (OR 1.93, 95% CI 1.32-2.84) and coronary disease (OR 1.62, 95% CI 1.01-2.61) were associated with higher odds. The median odds ratio was 1.82 (95% CI 1.03-7.32), indicating a moderate variability in OMT use, independent of patient factors. We found suboptimal use of secondary prevention in US patients with ASCVD and diabetes, with minimal improvement over time. Further efforts are needed to improve the use of secondary prevention therapies in these patients with high residual risk.

The Prevalence Of Aspirin Use As A Primary Prevention In Hypertensive Patients In Tikrit City

The aspirin use for secondary prevention of cardiovascular disease (CVD) is strongly supported and is well established but its use for primary prevention of cardiovascular events is a source of major debate due to that persons without a previous history of CVD are less likely to have future cardiovascular events, so there is unclear balance between benefits of aspirin to decrease the risk as primary prevention and harms of increase risk of both gastrointestinal bleeding and hemorrhagic stroke. This was reflected in international trails and guidelines. In this study, to balance the risk and benefit of using aspirin for primary prevention of CVD , and depend on trials and guidelines , the using of aspirin is more beneficial and indicated in patients with high ASCVD risk (e.g., as calculated by ASCVD risk score ((which used to calculate the 10 years risk of major coronary events in adults)) as &gt;10% , or depending on the presence of certain ASCVD risk factors) , in patients with age between 40-70 and low risk of bleeding. This study aimed to estimate the prevalence of aspirin use in hypertensive patients for primary prevention of cardiovascular diseases. One hundred fifty hypertensive patients (75 male) and (75 female) attending the outpatient clinic in Saladin general hospital in Tikrit city were included in this study from January 2018 to December 2019. Considering these parameters (age, total cholesterol level, , systolic blood pressure (BP), high density lipoprotein cholesterol (HDL), and smoking) in every patients.

Antiplatelet therapy use for the secondary prevention of cardiovascular disease in 2009–2017: a population-wide retrospective cohort study of Scotland

Abstract Background Few studies have analysed the adequacy of antiplatelet therapy (APT) use for secondary prevention of atherosclerotic cardiovascular disease (ASCVD). Some studies found utilisation to be suboptimal. However, information on the extent of APT use at different treatment stages and over time, and the role of particular individual characteristics, is limited. Purpose To use large-scale population-wide individual patient data to investigate the extent of, and determinants for, suboptimal use of effective APT, in order to identify patient groups that could be targeted to improve medication use. Methods This retrospective open cohort study used anonymised large-scale population-wide individual patient NHS Scotland data (hospital admissions, national death records, prescribing information and speciality mental health admissions) for all individuals hospitalised for ASCVD (based on ICD-10 discharge codes) in Scotland between 1 October 2009 and 31 December 2017. APT initiation was defined as a prescription of APT within 90 days of ASCVD hospital discharge with dispensing within 60 days of the prescription. Adherence was defined as ≥80% of days covered with dispensed therapy. Discontinuation of APT was defined as a treatment gap of 180 days or more since initiation. Multivariable cross-sectional logistic regression and Cox proportional hazards models were used to study the relevance of patient characteristics (e.g., demographic, clinical, socioeconomic) to the likelihood of, respectively, initiating or discontinuing APT. Findings are reported for all ASCVD events and, separately, for myocardial infarction (MI), ischaemic stroke, peripheral arterial disease (PAD) and other ASCVD events. Results Of 150,728 individuals hospitalised for ASCVD (excluding any diagnosis of atrial fibrillation), 16% did not initiate any APT. Initiation was less common in women (22% less likely than men), people aged ≥70 or &amp;lt;50 (21% and 39% less likely for patients in their 70s and 80s respectively vs. 60s; 26% less likely for patients below age 50 vs. 60s), people living in more deprived areas, people receiving specialist mental health care and people with multiple morbidities (Figure). There was substantial variation for lack of initiation across ASCVD types (e.g., MI 6%, PAD: 32%). In 2015/17, 72% of MI patients and 69% of patients undergoing percutaneous coronary intervention received guideline-recommended dual-APT. While on treatment, 93% of users were adherent. However, about a quarter (23%) discontinued treatment. Similar characteristics linked to lack of initiation of APT were associated with an increased risk of discontinuation. Conclusions APT initiation and persistence remain suboptimal, especially in women, people aged below 50 years and 70 years or older, people with multiple morbidities or mental illness, and following non-MI ASCVD events. This needs to be addressed by clinicians and policy-makers to further reduce cardiovascular risk. Funding Acknowledgement Type of funding sources: Public Institution(s). Main funding source(s): Oxford British Heart Foundation Centre of Research Excellence (BHF CRE) Pump Priming Scheme; Medical Research Council Doctoral Training Programme (MRC DTP) studentship.

Prevalence of cardioprotective medication use in coronary heart disease patients in South America: systematic review and meta-analysis

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Coronary heart disease (CHD) is the most common cause of death globally, and clinical guidelines recommend cardioprotective medications for patients with established CHD. Suboptimal use of these medications has been reported, but an overview from the South American region is lacking. Purpose Our aim is to summarize evidence on the prevalence of cardioprotective medication use for secondary prevention of CHD in South America. We also intend to explore time-trends, guideline compliance and factors associated with medication use. Methods We conducted a systematic review searching literature in PubMed, Embase, Cochrane, Lilacs and SciElo. We searched articles published from 2000 to 2021 that reported prevalence of secondary prevention medication use in South America. We pooled the prevalence estimates in a meta-analysis, described findings on guideline compliance, and used meta-regression models to analyse time-trends and identify factors associated with medication use. Results We identified 7388 publications, from which 73 were included in the review (Fig 1). Medication prevalence varied by class: beta-blockers 73.0%(95%CI 66.6%–79.1%), ACEI/ARBs 55.8% (95%CI 49.7%–61.8), antiplatelets 84.6% (95%CI 79.6%–88.5%), acetylsalicylic acid 85.1% (95%CI 79.7%–89.3%) and statins 78.5% (95%CI 70.7%–84.7%). Heterogeneity of the pooled estimates was high. Ten publications reported low medication use and nine reported adequate use. The use of beta-blockers, ACEI/ARBs and statins significantly increased from 1993 to 2020. Medication use was lower in community, public and rehabilitation settings compared to tertiary centres. Conclusion The use of most cardioprotective medication classes for secondary prevention of CHD in South America has increased over the last 20 years, but it could be further improved particularly in community settings.

Medication use to manage comorbidities in people with dementia: a systematic review

AbstractAimTo investigate physical health outcomes associated with medications prescribed to manage chronic physical conditions in people living with dementia; and determine whether a dementia diagnosis altered drug utilisation patterns for physical health conditions.Data sourcesMedline, Embase, Central and Scopus were searched 01/2011 to 12/2020.Study selectionExperimental and observational studies, where participants with dementia using medications prescribed by doctors to prevent or treat one or more chronic comorbid physical condition, were compared to no intervention, usual care, or a non‐dementia comparison group. The outcomes of interest were clinically meaningful physical outcomes, and medication utilisation patterns.ResultsTen studies met the inclusion criteria. All were of medium to high quality relative to their study design. Mixed findings were reported for ischemic stroke (n = 3), all‐cause mortality (n = 3) and bleeding‐related outcomes (n = 2). This is likely due to the heterogeneity in exposures reported. One study found that people with dementia, receiving antidiabetic management, had a higher rate of severe hypoglycaemia compared to people without dementia. Medication utilisation pattern outcomes included oral anticoagulant use before stroke‐related hospitalisation (n = 1), antithrombotic medication use before stroke‐related hospitalisation (n = 1), cardiovascular medication use for secondary prevention of ischemic heart disease (n = 1), antidepressant medication discontinuation (n = 1), osteoporosis treatment (n = 1), diabetic medication use (n = 2), and antihypertensive medication discontinuation (n = 1).ConclusionThis systematic review showed there is currently insufficient evidence to conclude that medication management in people with dementia should differ substantially to people without dementia. Comprehensive and high‐quality evidence is needed to improve confidence that medication prescribing achieves optimum clinical outcomes, quality of life, and benefit‐to‐risk determination in this vulnerable population.

A Matter of Timing: Rudy Tanzi on Alzheimer's Disease

A Matter of Timing: Rudy Tanzi on Alzheimer's Disease

Comparison of High-Statin Therapy vs Moderate-Statin Therapy in Achieving Positive Low-Density Lipoprotein Change in Patients After Acute Coronary Syndrome: A Randomized-Control Trial.

Introduction: Statin use in secondary prevention after acute coronary syndrome (ACS) can play an important role in enhancing clinical outcomes, this has been proven in several randomized trials. This study was conducted to compare the efficacy of moderate-intensity and high-intensity statins in controlling low-density lipoprotein (LDL) after ACS.Methodology: A randomized control trial was conducted at the Cardiology Department of Liaquat National Hospital, Karachi, Pakistan, from July 2020 to September 2021. During admission, patients were either started on a high-intensity statin dose (rosuvastatin 20 mg) or moderate-intensity statin (rosuvastatin 10 mg) by a computer-generated allocation sequence. Patients were followed-up in the outpatient department (OPD) after 3 months, and a lipid profile at follow-up was obtained. The percentage of LDL change was determined on 3 months of follow-up.Results: A total of 590 patients were enrolled in the study. Out of all participants enrolled, 334 (80.48%) completed the 3-month follow-up. The mean age of participants was 58.08 (+12.06) years. High-intensity statin therapy is positively associated with positive LDL change (adjusted odds ratio [AOR]=4.45, P-value=0.001).Conclusion: Our data implies that high-intensity statin medication may be an initial therapeutic option to decrease LDL. However, future randomized clinical trials should corroborate these findings.

Abstract 9840: National Trends in Statin Use for Secondary Prevention in the Adult Cardio-Oncology Population from 2006 to 2017

Introduction: Adults with a history of cancer may have increased risk of atherosclerotic cardiovascular disease (ASCVD) from cancer therapies and shared modifiable risk factors. While cancer history is associated with disparities in other areas of cardiology care, recent trends of secondary cardiovascular prevention in the cardio-oncology population is understudied. We examined trends in statin use for secondary prevention of ASCVD in the U.S. adult population. Hypothesis: We hypothesized that cancer history is associated with decreased statin use, and this trend persists over time. Methods: This retrospective longitudinal study included adults over age 21 with ASCVD, defined as a history of coronary artery disease (CAD) or stroke. Demographics, medical conditions, and prescribed medications between January 2006 and December 2017 were obtained from the Medical Expenditure Panel Survey database. Multivariable logistic regressions examined associations between cancer history and statin use, adjusting for age, sex, calendar year, socioeconomic variables, and comorbidities. Results: Among 26,813 adults with ASCVD, 4040 participants (15.1%) also had a history of cancer, defined as the cardio-oncology group. The cardio-oncology group was older on average compared to adults with only ASCVD (mean [SE], 70.9 [0.4] years vs. 65.1 [0.2] years; P &lt; 0.001). More adults in the cardio-oncology group also had a history of diabetes (33.9% vs. 30.6%, P = 0.01) or dyslipidemia (78.2% vs. 73.0%, P &lt; 0.001) compared to those with only ASCVD. Between 2006-2007 and 2016-2017, age-adjusted rates of statin use decreased from 35.7% to 32.6% in the ASCVD only group. Across the cardio-oncology group, age-adjusted rates of statin use also decreased from 43.4% to 35.8% during this period. In multivariable adjusted analysis, cancer history was associated with decreased odds of statin use across the 12-year period (OR 0.86; 95% CI 0.76-0.98). Conclusions: Adults with a history of ASCVD and cancer were significantly less likely to use statins for secondary prevention despite higher prevalences of diabetes and dyslipidemia. This treatment gap persisted across the 12-year period, identifying a need for more cardiovascular preventive care in the cardio-oncology population.