Statins: underused by those who would benefit.
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ABSTRACT:
SUBMITTER: Hulley SB
PROVIDER: S-EPMC1118807 | biostudies-literature | 2000 Oct
REPOSITORIES: biostudies-literature
Publications
Statins: underused by those who would benefit.
Hulley S B SB Grady D D Browner W S WS
BMJ (Clinical research ed.) 20001001 7267
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Project description:End-stage renal disease (ESRD) patients have extraordinarily high cardiovascular risk and mortality, yet the benefit of statins in this population remains unclear based on the randomized trials. We investigated the prognostic value of statins in a large, pure cohort of prospectively recruited patients with ESRD awaiting renal transplantation, and being followed up in a dedicated cardiac clinic. We prospectively collected demographic, clinical, laboratory, and pharmacological data on 423 consecutive ESRD patients on hemodialysis awaiting renal transplantation. Survival analysis was performed as a function of statin therapy. The baseline characteristics were as follows: age 57 ± 11 years, males 64%, diabetes mellitus in 68%, known coronary artery disease in 30%, left ventricular (LV) ejection fraction 61 ± 11%. Over a mean follow-up of 2 years, there were 43 deaths. Adjusted for age, gender, hypertension, body mass index, diabetes mellitus, coronary artery disease, smoking, and treatment with angiotensin converting enzyme inhibitor, β blocker, and antiplatelet medications, statin use was a predictor of lower mortality (hazard ratio 0.30, 95% confidence interval 0.11-0.79, p = 0.01). This beneficial effect of statin was supported by propensity score analysis (p = 0.02) and was consistent across all clinical subgroups. The benefit of statins seemed to be greater in those with LV hypertrophy and smoking. Statin therapy in hemodialysis patients awaiting renal transplant is independently associated with better survival supporting its use in this high-risk population.
| S-EPMC4452604 | biostudies-other
Project description:We assessed 1) trends in prevalence, awareness, treatment and control rates of dyslipidaemia and associated factors, 2) the effect of statin generation/potency on control levels and 3) the effect of ESC lipid guidelines, on lipid management. Data from multiple cross-sectional, population-based surveys conducted between 2005 and 2019 in the canton of Geneva, Switzerland, were used. Prevalence, awareness, treatment and control rates of dyslipidaemia were 46.0% and 34.9% (p < 0.001), 67.0% and 77.3% (p = 0.124), 40.0% and 19.9% (p < 0.001), and 68.0% and 84.0% (p = 0.255), in 2005 and 2019, respectively. After multivariable adjustment, only the decrease in treatment rates was significant. Increasing age, higher BMI, history of hypertension or diabetes were positively associated with prevalence, while female sex was negatively associated. Female sex, history of diabetes or CVD were positively associated with awareness, while increasing age was negatively associated. Increasing age, smoking, higher BMI, history of hypertension, diabetes or CVD were positively associated with treatment, while female sex was negatively associated. Female sex was positively associated with control, while increasing age was negatively associated. Highly potent statins increased from 50.0% to 87.5% and third generation statins from 0% to 47.5% in 2009 and 2015, respectively. Increased statin potency was borderline (p = 0.059) associated with dyslipidaemia control. ESC guidelines had no effect regarding the prescription of more potent or higher generation statins. We conclude that in the canton of Geneva, treatment of diagnosed dyslipidaemia is low, but control is adequate. Women are undertreated but better controlled than men. The most potent hypolipidemic drugs are underused.
| S-EPMC10209490 | biostudies-literature
Project description:For more than a decade, methotrexate has been known to be an effective therapeutic agent in the treatment of steroid-dependent active Crohn's disease. However, international data on medication utilization suggest that this drug is rarely used in clinical practice for an indication of Crohn's disease. This review investigates the potential reasons for the underuse of methotrexate in patients with inflammatory bowel diseases.
| S-EPMC4629813 | biostudies-literature
Project description:To conduct the benefit-risk assessment of 3-hydroxy-3-methyl-glutaryl (HMG) coenzyme A reductase inhibitors (statins) using a discrete choice experiment, based on 3 major stakeholders' perspectives including patients, experts and policymakers in Thailand.A discrete choice experiment questionnaire survey in three stakeholders' perspectives.Public hospitals in Thailand.A total of 353 policymakers, experts and patients.Stakeholders' preferences for assessment criteria (stroke reduction, myocardial infarction reduction, myalgia and hepatotoxicity). Statins' ranking and maximum acceptable risk in all perspectives were also calculated.For any perspective, the most and least important criteria were the risk of hepatotoxicity and the benefit of myocardial infarction reduction, respectively. Patients and experts agreed on the order of importance for myalgia and stroke reduction, but policymakers had different order of importance in these criteria. Overall, results showed that the highest and lowest chances of being chosen were atorvastatin and rosuvastatin, respectively. Only patients' ranking order was different from others. Maximum acceptable risk of hepatotoxicity was lower than that of myalgia, reflecting the greater concern of all perspectives to statin consequence on liver.The results of benefit-risk assessment from every perspective were somewhat consistent. This study demonstrated the feasibility of applying a discrete choice experiment in the benefit-risk assessment of drugs and encouraged the engagement of multiple stakeholders in the decision-making process.
| S-EPMC4769438 | biostudies-other
Project description:The objective was to systematically review clinical trial data on the effects of statins on high-density lipoproteins (HDL) and to examine the possibility that this provides cardiovascular benefits in addition to those derived from reductions in low-density lipoproteins (LDL).The PubMed database was searched for publications describing clinical trials of atorvastatin, pravastatin, rosuvastatin, and simvastatin. On the basis of predefined criteria, 103 were selected for review.Compared with placebo, statins raise HDL, measured as HDL-cholesterol (HDL-C) and apolipoprotein A-I (apo A-I); these elevations are maintained in the long-term. In hypercholesterolemia, HDL-C is raised by approximately 4% to 10%. The percentage changes are greater in patients with low baseline levels, including those with the common combination of high triglycerides (TG) and low HDL-C. These effects do not appear to be dose-related although there is evidence that, with the exception of atorvastatin, the changes in HDL-C are proportional to reductions in apo B-containing lipoproteins. The most likely explanation is a reduced rate of cholesteryl ester transfer protein (CETP)-mediated flow of cholesterol from HDL. There is some evidence that the statin effects on HDL reduce progression of atherosclerosis and risk of cardiovascular disease independently of reductions in LDL.Statins cause modest increases in HDL-C and apo A-I probably mediated by reductions in CETP activity. It is plausible that such changes independently contribute to the cardiovascular benefits of the statin class but more studies are needed to further explore this possibility.
| S-EPMC2493531 | biostudies-other
Project description:AimsThe benefit of statins in patients with heart failure (HF) remains controversial and the mechanism of action is largely speculative. We investigated the determinants of the survival benefit associated with statins in HF patients.Methods and resultsWe enrolled 1680 acute HF patients receiving statins and 2157 patients not receiving statins admitted between 2009 and 2016. The left ventricular (LV) global longitudinal strain (GLS) was assessed as a measure of myocardial contractility. The primary outcome was 5 year all-cause mortality. Statin therapy was independently associated with improved survival in patients with HF with preserved ejection fraction (HFpEF) [adjusted hazard ratio (HR) 0.781, 95% confidence interval (CI) 0.621-0.981, P = 0.034], but not in those with HF with reduced EF (HFrEF) (adjusted HR 0.881, 95% CI 0.712-1.090, P = 0.244). Mortality reduction associated with statin therapy was significant in patients with ischaemic HF (adjusted HR 0.775, 95% CI 0.607-0.989, P = 0.040), but not in those with non-ischaemic HF (adjusted HR 0.895, 95% CI 0.734-1.092, P = 0.275). The relative magnitude of survival benefit with statin therapy increased as LV-EF and LV-GLS increased, with a steeper dose-response relationship in patients with ischaemic HF. In the subgroup of patients with ischaemic HF, survival benefit with statin therapy was confined to those ≤75 years of age.ConclusionsOur study suggests that the survival benefit of statins is confined to patients with HFpEF and those with ischaemic HF. Myocardial contractility may modulate the prognostic effects of statins in HF patients, particularly when the aetiology is ischaemic rather than non-ischaemic.
| S-EPMC8712823 | biostudies-literature
Project description:BackgroundCardiovascular disease (CVD) influences phenotypic variation in Parkinson's disease (PD), and is usually an indication for statin therapy. It is less clear whether cardiovascular risk factors influence PD phenotype, and if statins are prescribed appropriately.ObjectivesTo quantify vascular risk and statin use in recent-onset PD, and examine the relationship between vascular risk, PD severity and phenotype.MethodsCardiovascular risk was quantified using the QRISK2 calculator (high ≥20%, medium ≥10 and <20%, low risk <10%). Motor severity and phenotype were assessed using the Movement Disorder Society Unified PD Rating Scale (UPDRS) and cognition by the Montreal cognitive assessment.ResultsIn 2909 individuals with recent-onset PD, the mean age was 67.5 years (SD 9.3), 63.5% were men and the mean disease duration was 1.3 years (SD 0.9). 33.8% of cases had high vascular risk, 28.7% medium risk, and 22.3% low risk, while 15.2% of cases had established CVD. Increasing vascular risk and CVD were associated with older age (p<0.001), worse motor score (p<0.001), more cognitive impairment (p<0.001) and worse motor phenotype (p=0.021). Statins were prescribed in 37.2% with high vascular risk, 15.1% with medium vascular risk and 6.5% with low vascular risk, which compared with statin usage in 75.3% of those with CVD.ConclusionsOver 60% of recent-onset PD patients have high or medium cardiovascular risk (meriting statin usage), which is associated with a worse motor and cognitive phenotype. Statins are underused in these patients, compared with those with vascular disease, which is a missed opportunity for preventive treatment.Trial registration numberGN11NE062, NCT02881099.
| S-EPMC5116532 | biostudies-literature
Project description: Not available
| S-EPMC7571786 | biostudies-literature
Project description:BackgroundWe determined the risk thresholds above which statin use would be more likely to provide a net benefit for people over the age of 75 years without history of cardiovascular disease (CVD).MethodsAn exponential model was used to estimate the differences in expected benefit and harms in people treated with statins over a 10-year horizon versus not treated. The analysis was repeated 100,000 times to consider the statistical uncertainty and produce a distribution of the benefit-harm balance index from which we determined the 10-year CVD risk threshold where benefits outweighed the harms. We considered treatment estimates from trials and observational studies, baseline risks, patient preferences, and competing risks of non-CVD death, and statistical uncertainty.ResultsBased on average preferences, statins were more likely to provide a net benefit at a 10-year CVD risk of 24% and 25% for men aged 75-79 years and 80-84 years, respectively, and 21% for women in both age groups. However, these thresholds varied significantly depending on differences in individual patient preferences for the statin-related outcomes, with interquartile ranges of 21-33% and 23-36% for men aged 75-79 years and 80-84 years, respectively, as well as 20-32% and 21-32% for women aged 75-79 years and 80-84 years, respectively.ConclusionsStatins would more likely provide a net benefit for primary prevention in older people taking the average preferences if their CVD risk is well above 20%. However, the thresholds could be much higher or lower depending on preferences of individual patients, which suggests more emphasis should be placed on individual-based decision-making, instead of recommending statins for everyone based on a single or a small number of thresholds.
| S-EPMC6764041 | biostudies-literature
Project description:AimsThe DoUble-blind Atorvastatin AmLodipine (DUAAL) trial investigated whether atorvastatin decreases ischaemia by a vascular benefit, independent of low-density lipoprotein cholesterol lowering, in patients with coronary artery disease (CAD), both alone and in combination with the traditional anti-anginal therapy, amlodipine.Methods and resultsRandomized, double-blind, parallel-group, multicountry trial (2 weeks run-in and 24 weeks active therapy) comparing three treatments: amlodipine, atorvastatin, and amlodipine + atorvastatin; in 311 patients (78% male; mean age 62 years) with stable angina (≥ 2 attacks/week), CAD history, ≥ 3 transient myocardial ischaemia (TMI) episodes, and/or ≥ 15 min ischaemia on 48 h ambulatory electrocardiographic (AECG) monitoring. Efficacy variables were change in TMI by AECG, exercise ischaemia, angina diary data, and inflammatory biomarkers at Week 26. There was a comparable, highly significant decrease in TMI with amlodipine and atorvastatin, but no additional benefit for the combination. More than 50% of patients became TMI-free in all three groups and this was accompanied by a comparable, marked reduction in angina and nitroglycerin consumption. High-sensitivity C-reactive protein fell by 40% in patients receiving atorvastatin but there was no change with amlodipine. Adverse events were comparable among groups.ConclusionAtorvastatin was as potent an anti-ischaemic agent as amlodipine. Future studies of combination therapies will be instructive.Clinical trial registration informationNational clinical trial number: NCT00159718, protocol number A0531031 listed on http://clinicaltrials.gov/.
| S-EPMC2966969 | biostudies-literature