1
|
Xu W, Lee AL, Lam CLK, Danaei G, Wan EYF. Benefits and Risks Associated With Statin Therapy for Primary Prevention in Old and Very Old Adults : Real-World Evidence From a Target Trial Emulation Study. Ann Intern Med 2024. [PMID: 38801776 DOI: 10.7326/m24-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/29/2024] Open
Abstract
BACKGROUND There is little consensus on using statins for primary prevention of cardiovascular diseases (CVDs) and all-cause mortality in adults aged 75 years or older due to the underrepresentation of this population in randomized controlled trials. OBJECTIVE To investigate the benefits and risks of using statins for primary prevention in old (aged 75 to 84 years) and very old (aged ≥85 years) adults. DESIGN Sequential target trial emulation comparing matched cohorts initiating versus not initiating statin therapy. SETTING Territory-wide public electronic medical records in Hong Kong. PARTICIPANTS Persons aged 75 years or older who met indications for statin initiation from January 2008 to December 2015 were included. Participants with preexisting diagnosed CVDs at baseline, such as coronary heart disease (CHD), were excluded from the analysis. Among 69 981 eligible persons aged 75 to 84 years and 14 555 persons aged 85 years or older, 41 884 and 9457 had history of CHD equivalents (for example, diabetes) in the respective age groups. INTERVENTION Initiation of statin therapy. MEASUREMENTS Incidence of major CVDs (stroke, myocardial infarction, or heart failure), all-cause mortality, and major adverse events (myopathies and liver dysfunction). RESULTS Of 42 680 matched person-trials aged 75 to 84 years and 5390 matched person-trials aged 85 years or older (average follow-up, 5.3 years), 9676 and 1600 of them developed CVDs in each age group, respectively. Risk reduction for overall CVD incidence was found for initiating statin therapy in adults aged 75 to 84 years (5-year standardized risk reduction, 1.20% [95% CI, 0.57% to 1.82%] in the intention-to-treat [ITT] analysis; 5.00% [CI, 1.11% to 8.89%] in the per protocol [PP] analysis) and in those aged 85 years or older (ITT: 4.44% [CI, 1.40% to 7.48%]; PP: 12.50% [CI, 4.33% to 20.66%]). No significantly increased risks for myopathies and liver dysfunction were found in both age groups. LIMITATION Unmeasured confounders, such as lifestyle factors of diet and physical activity, may exist. CONCLUSION Reduction for CVDs after statin therapy were seen in patients aged 75 years or older without increasing risks for severe adverse effects. Of note, the benefits and safety of statin therapy were consistently found in adults aged 85 years or older. PRIMARY FUNDING SOURCE Health Bureau, the Government of Hong Kong Special Administrative Region, China, and National Natural Science Foundation of China.
Collapse
Affiliation(s)
- Wanchun Xu
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. (W.X., A.L.L.)
| | - Amanda Lauren Lee
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China. (W.X., A.L.L.)
| | - Cindy Lo Kuen Lam
- Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, and Department of Family Medicine, The University of Hong Kong - Shenzhen Hospital, Shenzhen, China (C.L.K.L.)
| | - Goodarz Danaei
- Department of Global Health and Population and Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Massachusetts (G.D.)
| | - Eric Yuk Fai Wan
- Department of Family Medicine and Primary Care and Centre for Safe Medication Practice and Research, Department of Pharmacology and Pharmacy, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Laboratory of Data Discovery for Health (D24H), Hong Kong Science and Technology Park, Sha Tin, and Advanced Data Analytics for Medical Science (ADAMS) Limited, Hong Kong Special Administrative Region, China (E.Y.F.W.)
| |
Collapse
|
2
|
Densham E, Youssef E, Ferguson O, Winter R. The effect of statins on falls and physical activity in people aged 65 and older: A systematic review. Eur J Clin Pharmacol 2024; 80:657-668. [PMID: 38353691 DOI: 10.1007/s00228-024-03632-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE Statins are commonly prescribed medications with recognised side effects including muscle weakness. Despite this, little is known about their effect on the physical activity and falls risk in the older population. This paper aims to explore the relationship between statin use and the physical activity and falls risk in adults aged 65 and older. METHODS MEDLINE, Embase, CINAHL and PsycINFO were searched on 21/11/2022 to obtain relevant articles. Data considered appropriate included that relating to muscle strength, grip strength, gait speed, balance and falls incidence. Reference and citation searches were performed to identify further relevant papers, and all eligible articles were subject to a Critical Appraisal Skills Programme (CASP) to assess potential bias. With the data being highly heterogeneous, no attempt to measure effect size was made and a narrative synthesis approach was used. The review proposal was registered with PROSPERO: CRD42022366159. RESULTS Twenty articles were included. Data were inconsistent throughout, with the overall trend suggesting no significant negative effects of statins on the parameters of physical activity, or on falls risk. This was especially true in matched and adjusted cohorts, where potential confounders had been accounted for. CONCLUSION This review did not identify a relationship between statin use and physical activity and falls risk in people aged 65 years and older. Ultimately, the risks and benefits of every medication should be considered in the context of each individual.
Collapse
Affiliation(s)
| | | | | | - Rebecca Winter
- Brighton and Sussex Medical School, Brighton, UK
- University Hospitals Sussex, Brighton, UK
| |
Collapse
|
3
|
Fayol A, Schiele F, Ferrières J, Puymirat E, Bataille V, Tea V, Chamandi C, Albert F, Lemesle G, Cayla G, Weizman O, Simon T, Danchin N. Association of Use and Dose of Lipid-Lowering Therapy Post Acute Myocardial Infarction With 5-Year Survival in Older Adults. Circ Cardiovasc Qual Outcomes 2024; 17:e010685. [PMID: 38682335 DOI: 10.1161/circoutcomes.123.010685] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 03/18/2024] [Indexed: 05/01/2024]
Abstract
BACKGROUND Older people are underrepresented in randomized trials. The association between lipid-lowering therapy (LLT) and its intensity after acute myocardial infarction and long-term mortality in this population deserves to be assessed. METHODS The FAST-MI (French Registry of Acute ST-Elevation or Non-ST-Elevation Myocardial Infarction) program consists of nationwide French surveys including all patients admitted for acute myocardial infarction ≤48 hours from onset over a 1- to 2-month period in 2005, 2010, and 2015, with long-term follow-up. Numerous data were collected and a centralized 10-year follow-up was organized. The present analysis focused on the association between prescription of LLT (atorvastatin ≥40 mg or equivalent, or any combination of statin and ezetimibe) and 5-year mortality in patients aged ≥80 years discharged alive. Cox multivariable analysis and propensity score matching were used to adjust for baseline differences. RESULTS Among the 2258 patients aged ≥80 years (mean age, 85±4 years; 51% women; 39% ST-segment elevation myocardial infarction; 58% with percutaneous coronary intervention), 415 were discharged without LLT (18%), 866 with conventional doses (38%), and 977 with high-dose LLT (43%). Five-year survival was 36%, 47.5%, and 58%, respectively. Compared with patients without LLT, high-dose LLT was significantly associated with lower 5-year mortality (adjusted hazard ratio, 0.78 [95% CI, 0.66-0.92]), whereas conventional-intensity LLT was not (adjusted hazard ratio, 0.93 [95% CI, 0.80-1.09]). In propensity score-matched cohorts (n=278 receiving high-intensity LLT and n=278 receiving no statins), 5-year survival was 52% with high-intensity LLT at discharge and 42% without statins (hazard ratio, 0.78 [95% CI, 0.62-0.98]). CONCLUSIONS In these observational cohorts, high-intensity LLT at discharge after acute myocardial infarction was associated with reduced all-cause mortality at 5 years in an older adult population. These results suggest that high-intensity LLT should not be denied to patients on the basis of old age. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: NCT00673036, NCT01237418, and NCT02566200.
Collapse
Affiliation(s)
- Antoine Fayol
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - François Schiele
- Department of Cardiology, University Hospital Jean-Minjoz, Besançon, France (F.S.)
| | - Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, Institut National pour la Santé Et la Recherche Médicale Unité Mixte de Recherche, Toulouse cedex, France Emergency Department, Rangueil Hospital, Toulouse (J.F., V.B.)
| | - Etienne Puymirat
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Vincent Bataille
- Department of Cardiology, Toulouse Rangueil University Hospital, Institut National pour la Santé Et la Recherche Médicale Unité Mixte de Recherche, Toulouse cedex, France Emergency Department, Rangueil Hospital, Toulouse (J.F., V.B.)
| | - Victoria Tea
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Chekrallah Chamandi
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Franck Albert
- Department of Cardiology, Hospital of Chartres, France (F.A.)
| | - Gilles Lemesle
- Department of Cardiology, Heart and Lung Institute, University Hospital of Lille, France (G.L.)
- University of Lille, France (G.L.)
- Institut Pasteur de Lille, France (G.L.)
- FACT (French Alliance for Cardiovascular Trials), Paris (G.L.)
| | - Guillaume Cayla
- Department of Cardiology, University Hospital of Nimes, University of Montpellier, France (G.C.)
| | - Orianne Weizman
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
| | - Tabassome Simon
- Department of Pharmacology and Clinical Research Platform of East of Paris (Unité de Recherche Clinique des hopitaux EST parisiens, Comité de Recherche Clinique des hopitaux EST parisiens, Centre de Ressources Biologiques), Hôpital St Antoine, Sorbonne University, and FACT (T.S.)
| | - Nicolas Danchin
- Assistance Publique-Hôpitaux de Paris, Departement of Cardiology, Hôpital Européen Georges-Pompidou, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- University Paris Cité, France (A.F., E.P., V.T., C.C., O.W., N.D.)
- Hôpital Paris St Joseph, and FACT (N.D.)
| |
Collapse
|
4
|
Dewi PEN, Thavorncharoensap M, Rahajeng B. Cost-utility analysis of using high-intensity statin among post-hospitalized acute coronary syndrome patients. Egypt Heart J 2024; 76:47. [PMID: 38615282 PMCID: PMC11016526 DOI: 10.1186/s43044-024-00478-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Accepted: 04/05/2024] [Indexed: 04/15/2024] Open
Abstract
BACKGROUND Post-hospitalized acute coronary syndrome (ACS) patients in Indonesia National Insurance does not pay for the use of high-intensity statin (HIS) for secondary prevention after ACS hospitalization. Moreover, a cost-utility analysis needs to be conducted to evaluate the cost-effectiveness of prescribing HIS and low-to-moderate-intensity statin (LMIS) per quality-adjusted life year (QALY). This study aimed to estimate the cost-utility of long-term HIS treatment in post-hospitalized ACS patients in Indonesia compared to current practice. RESULTS This study compared the economic outcomes of long-term HIS and LMIS in Indonesian post-hospitalized ACS patients. A lifetime Markov model predicted ACS-related events, costs, and QALY from a payer perspective. A systematic review estimated treatment-specific event probabilities, post-event survival, health-related quality of life, and Indonesia medical-care expenses from published sources. This study conducted probabilistic sensitivity analysis (PSA) using 1000 independent Monte Carlo simulations and a series of one-way deterministic sensitivity analyses utilizing a tornado diagram. The economic evaluation model proved that intensive HIS treatment can increase per-patient QALYs and care expenditures compared to LMIS. The use of HIS among post-hospitalized ACS patients had ICER 31.843.492 IDR per QALY gained, below the Indonesia willingness-to-pay (WTP) for terminal disease and life-saving treatment. CONCLUSION From the Indonesia payer perspective, using HIS for post-hospitalized ACS patients in Indonesia is cost-effective at 31.843.492 IDR per QALY gained.
Collapse
Affiliation(s)
- Pramitha Esha Nirmala Dewi
- Doctor of Philosophy Program in Social, Economic, and Administrative Pharmacy, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand.
- Department of Pharmacy Profession, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia.
| | - Montarat Thavorncharoensap
- Social and Administrative Pharmacy Excellence Research (SAPER) Unit, Department of Pharmacy, Faculty of Pharmacy, Mahidol University, Bangkok, Thailand
- Health Technology Assessment Graduate Program, Mahidol University, Bangkok, Thailand
| | - Bangunawati Rahajeng
- Department of Pharmacy Profession, Faculty of Medicine and Health Sciences, Universitas Muhammadiyah Yogyakarta, Bantul, Indonesia
| |
Collapse
|
5
|
Wierzbicki AS. Preventive cardiology for the aging population: how can we better design clinical trials of statins? Expert Rev Cardiovasc Ther 2024; 22:13-18. [PMID: 38258576 DOI: 10.1080/14779072.2024.2302122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Accepted: 01/02/2024] [Indexed: 01/24/2024]
Abstract
INTRODUCTION Older adults form a fast-increasing proportion of the world population. However, gains in increasing quantity of life have not been accompanied by similar gains in quality of life. Older people frequently experience frailty, memory problems, and chronic diseases including cardiovascular disease (CVD) and neurodegenerative diseases. Recent trials have demonstrated the efficacy of anti-hypertensive therapy in older populations but failed to show benefits for aspirin. AREA COVERED Statins clearly reduce CVD events in middle-aged populations. There seems to be evidence that the effect is similar in primary prevention older populations based on meta-analyses mainly from sub-groups in large trials, but this becomes less clear with increasing age. However, given differences in drug metabolism and possibly efficacy, competing co-morbidities, their effects on mortality, disability, and dementia in this age group remain to be determined. EXPERT OPINION Two large trials are now underway to clarify the role of statin therapy in people aged over 70 years using endpoints of mortality, disability, and neurocognitive endpoints as well as standard cardiovascular disease outcomes. They may provide also provide more evidence on how to approach the over 80 year age group.
Collapse
|
6
|
Doody H, Livori A, Ayre J, Ademi Z, Bell JS, Morton JI. Guideline concordant prescribing following myocardial infarction in people who are frail: A systematic review. Arch Gerontol Geriatr 2023; 114:105106. [PMID: 37356114 DOI: 10.1016/j.archger.2023.105106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/27/2023]
Abstract
AIMS The risk-to-benefit ratio of cardioprotective medications in frail older adults is uncertain. The objective was to systematically review prescribing of guideline-recommended cardioprotective medications following myocardial infarction (MI) in people who are frail. DATA SOURCES Ovid Medline, PubMed and Cochrane were searched from inception to October 2022 for studies that reported prescribing of one or more cardioprotective medication classes post-MI or acute coronary syndromes in people with frailty. STUDY SELECTION We included observational studies that reported prescribing of cardioprotective medications post-MI stratified by frailty status. RESULTS Overall, 16 cohort studies published from 2013 to 2022 that used seven different frailty scales were included. Prescribing of all cardioprotective medication classes following MI was lower in frail compared to non-frail people, with absolute rates of prescribing varying substantially across studies. Median prescribing in frail and non-frail people, respectively, was 88.9% (IQR 81.5-96.2) and 93.1% (IQR 92.0-98.9) for aspirin; 68.1% (IQR 61.9-91.2) and 86.7% (IQR 79.5-92.8) for P2Y12-inhibitors; 83.1% (IQR 76.9-91.3) and 94.0% (IQR 87.1-95.9) for lipid-lowering therapy; 67.9% (IQR 60.6-74.0) and 74.7% (IQR 71.3-84.5) for angiotensin-converting enzyme inhibitor/angiotensin II receptor blockers; and 74.1% (IQR 69.2-79) and 77.6% (IQR 71.8-85.9) for beta-blockers. CONCLUSION People who were frail were less likely to be prescribed guideline recommended medication classes post-MI than those who were non-frail. Further research is needed into treatment benefits and risks in frail people to avoid unnecessarily withholding treatment in this high-risk population, while also minimising potential for medication related harm.
Collapse
Affiliation(s)
- Hannah Doody
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia; Pharmacy Department, Launceston General Hospital, Tasmania, Australia
| | - Adam Livori
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia; Grampians Health, Ballarat, Victoria, Australia
| | - Justine Ayre
- Pharmacy Department, Launceston General Hospital, Tasmania, Australia
| | - Zanfina Ademi
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia; School of Public Health and Preventive Medicine, Monash University, Australia
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia
| | - Jedidiah I Morton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Australia.
| |
Collapse
|
7
|
Faggiano P, Ruscica M, Bettari S, Cherubini A, Carugo S, Corsini A, Barbati G, Di Lenarda A. LDL Cholesterol Variability Impacts the Prognosis of Patients with Chronic Ischemic Heart Disease: A Real-World Italian Experience. J Clin Med 2023; 12:6231. [PMID: 37834875 PMCID: PMC10573184 DOI: 10.3390/jcm12196231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 09/24/2023] [Accepted: 09/26/2023] [Indexed: 10/15/2023] Open
Abstract
Epidemiologic, genetic, and clinical intervention studies have indisputably shown that low-density lipoprotein cholesterol (LDL-C) is causal in the development of atherosclerotic cardiovascular disease (ASCVD). However, LDL-C variability could be related to increased ASCVD risk in patients already treated with statins. The aim of the present retrospective real-life study was to assess the prognostic impact of LDL-C variability on all-cause mortality and cardiovascular hospitalizations in patients with stable cardiovascular artery disease. A total of 3398 patients were enrolled and followed up for a median of 56 months. Considering LDL-C < 70 mg/dL as the therapeutical target, during follow-up, the percentage of patients who achieved this goal raised from 20.7% to 31.9%. In total, 1988 events were recorded, of which 428 were all-cause deaths and 1560 were cardiovascular hospitalizations. At the last medical examination, each increase in LDL-C levels of 20 mg/dL corresponded to a 6% raise in the risk of any event (HR 1.06; 95%CI, 1.03 to 1.09). In conclusion, our real-world study supports the hypothesis that a continuous and progressive downward trend in LDL-C levels is needed to achieve and maintain a cardiovascular benefit, at least in secondary prevention.
Collapse
Affiliation(s)
- Pompilio Faggiano
- Cardiovascular Department, Fondazione Poliambulanza, 25100 Brescia, Italy;
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milano, 20133 Milan, Italy;
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20154 Milan, Italy;
| | - Sara Bettari
- Spedali Civili of Brescia, 25123 Brescia, Italy;
| | - Antonella Cherubini
- Cardiovascular Department, University and Hospital of Trieste, 34122 Trieste, Italy; (A.C.); (A.D.L.)
| | - Stefano Carugo
- Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Cà Granda Ospedale Maggiore Policlinico, 20154 Milan, Italy;
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences “Rodolfo Paoletti”, Università degli Studi di Milano, 20133 Milan, Italy;
| | - Giulia Barbati
- Biostatistics Unit, Department of Medical Sciences, University of Trieste, 34127 Trieste, Italy;
| | - Andrea Di Lenarda
- Cardiovascular Department, University and Hospital of Trieste, 34122 Trieste, Italy; (A.C.); (A.D.L.)
| |
Collapse
|
8
|
Fan Y, Wang J, Wu H, Dai L, Wang L, Gu L. Effect of statin treatment on mortality in elderly patients with type 2 diabetes mellitus patients: a retrospective cohort study. BMC Geriatr 2023; 23:549. [PMID: 37697242 PMCID: PMC10494359 DOI: 10.1186/s12877-023-04252-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 08/23/2023] [Indexed: 09/13/2023] Open
Abstract
BACKGROUND The effects of statins on the reduction of mortality in individuals aged 75 years or older remain controversial. We conducted this study to investigate whether there is an association between statin therapy and mortality in patients with type 2 diabetes mellitus (T2DM) who are over the age of 75 years. METHODS The present study used data from the Staged Diabetes Targeting Management Study, which began in 2005. A total of 518 T2DM patients older than 75 years were included. Cox regression analyses were used to evaluate the association between statins and specific causes of death in patients with T2DM. RESULTS After a follow-up period of 6.09 years (interquartile range 3.94-8.81 years), 111 out of 518 patients died. The results of Cox regression analyses showed that there was no significant association between statin use and all-cause mortality (HR 0.75; 95% CI 0.47, 1.19) after adjustment for all potential confounders. Subgroup analysis indicated that statins had no association with the risk of all-cause mortality or deaths caused by ischemic cardiovascular diseases in T2DM patients with or without coronary heart disease. CONCLUSIONS Our study found no significant association between all-cause mortality and statin use in T2DM patients over the age of 75 years. More evidence is needed to support the use of statins in the elderly T2DM patients.
Collapse
Affiliation(s)
- Yao Fan
- Division of Clinical Epidemiology, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Juan Wang
- Clinical Trial Center, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Haidi Wu
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Lingli Dai
- Department of Endocrinology and Metabolism, Geriatric Hospital of Nanjing Medical University, Nanjing, China
| | - Lan Wang
- Department of Cardiovascular Medicine, Geriatric Hospital of Nanjing Medical University, Nanjing, China.
| | - Liubao Gu
- Division of Clinical Epidemiology, Geriatric Hospital of Nanjing Medical University, Nanjing, China.
- Clinical Trial Center, Geriatric Hospital of Nanjing Medical University, Nanjing, China.
| |
Collapse
|
9
|
Ruscica M, Ferri N, Banach M, Sirtori CR, Corsini A. Side effects of statins: from pathophysiology and epidemiology to diagnostic and therapeutic implications. Cardiovasc Res 2023; 118:3288-3304. [PMID: 35238338 DOI: 10.1093/cvr/cvac020] [Citation(s) in RCA: 55] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 03/02/2022] [Indexed: 01/25/2023] Open
Abstract
Treatment with statins, inhibitors of 3-hydroxy-3-methylglutaryl-coenzyme A reductase, has proven beneficial preventive effects on cardiovascular events. However, discontinuation due to intolerance and non-adherence remain two of the major gaps in both primary and secondary prevention. This leads many patients with high-risk of atherosclerotic cardiovascular disease (ASCVD) to be inadequately treated or not to achieve target lipid level goals, and as consequence they undergo an increased risk of cardiovascular events. The aim of this review is thus to give an overview of the reasons for discontinuation and on the possible mechanisms behind them. Although statins, as a class, are generally safe, they are associated with an increased risk of diabetes mellitus and hepatic transaminase elevations. Incidence of cataracts or cognitive dysfunction and others presented in the literature (e.g. proteinuria and haematuria) have been never confirmed to have a causal link. Conversely, debated remains the effect on myalgia. Muscle side effects are the most commonly reported, although myalgia is still believed by some to be the result of a nocebo/drucebo effect. Concerning mechanisms behind muscular side effects, no clear conclusions have been reached. Thus, if on one side it is important to identify individuals either at higher risk to develop a side effect, or with confirmed risk factors and conditions of statin intolerance, on the other side alternative strategies should be identified to avoid an increased ASCVD risk.
Collapse
Affiliation(s)
- Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy
| | - Nicola Ferri
- Department of Pharmaceutical and Pharmacological Sciences, Universita degli Studi di Padova, Padova, Italy
| | - Maciej Banach
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz (MUL), Lodz, Poland.,Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| | - Cesare R Sirtori
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy
| | - Alberto Corsini
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, Via Balzaretti 9, 20133 Milan, Italy
| |
Collapse
|
10
|
Weisskopf MG, Levy J, Dickerson AS, Paganoni S, Leventer-Roberts M. Statin Medications and Amyotrophic Lateral Sclerosis Incidence and Mortality. Am J Epidemiol 2022; 191:1248-1257. [PMID: 35333291 PMCID: PMC9393061 DOI: 10.1093/aje/kwac054] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 03/10/2022] [Accepted: 03/14/2022] [Indexed: 01/26/2023] Open
Abstract
Studies of statins and amyotrophic lateral sclerosis (ALS) incidence and survival have had conflicting findings possibly related to difficulties with confounding by indication. We considered potency of statins used and duration of use to explore confounding by indication. Within the Clalit Health Services in Israel, we identified 948 ALS case patients from 2004 through 2017 and matched them with 1,000 control subjects each. Any statin use up to 3 years before ALS onset was not associated with ALS incidence but was associated with a reduced hazard ratio (HR) for death. Odds of ALS did not vary by statin potency, but use of only lower-potency statins was associated with longer survival (HR = 0.82, 95% CI: 0.68, 0.98), whereas the association with higher-potency statins was null compared with those case patients who did not use statins. However, duration of statin use appeared to account for these findings. Those who used statins only up to 3 years had longer survival (HR = 0.77, 95% CI: 0.61, 0.96) than did case patients who did not use statins, but those who used statins for >3 years did not. Although other explanations are possible, these findings could suggest a protective effect of statins on ALS survival that is partially masked by a worse prognosis from underlying reasons for taking statins that deserves further exploration.
Collapse
Affiliation(s)
- Marc G Weisskopf
- Correspondence to Marc Weisskopf, Harvard T.H. Chan School of Public Health, 665 Huntington Avenue Building 1, Suite 1402, Boston, MA 02115 (e-mail: )
| | | | | | | | | |
Collapse
|
11
|
Corn peptides ameliorate nonalcoholic fatty liver disease by suppressing endoplasmic reticulum stress via the AMPKα/Sirt1 pathway in vivo and in vitro. J Funct Foods 2022. [DOI: 10.1016/j.jff.2022.105063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
|
12
|
Mansouri A, Reiner Ž, Ruscica M, Tedeschi-Reiner E, Radbakhsh S, Bagheri Ekta M, Sahebkar A. Antioxidant Effects of Statins by Modulating Nrf2 and Nrf2/HO-1 Signaling in Different Diseases. J Clin Med 2022; 11:jcm11051313. [PMID: 35268403 PMCID: PMC8911353 DOI: 10.3390/jcm11051313] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Revised: 02/14/2022] [Accepted: 02/21/2022] [Indexed: 02/06/2023] Open
Abstract
Statins are competitive inhibitors of hydroxymethylglutaryl-CoA (HMG-CoA) reductase and have been used to treat elevated low-density lipoprotein cholesterol (LDL-C) for almost four decades. Antioxidant and anti-inflammatory properties which are independent of the lipid-lowering effects of statins, i.e., their pleiotropic effects, might be beneficial in the prevention or treatment of many diseases. This review discusses the antioxidant effects of statins achieved by modulating the nuclear factor erythroid 2 related factor 2/ heme oxygenase-1 (Nrf2/HO-1) pathway in different organs and diseases. Nrf2 and other proteins involved in the Nrf2/HO-1 signaling pathway have a crucial role in cellular responses to oxidative stress, which is a risk factor for ASCVD. Statins can significantly increase the DNA-binding activity of Nrf2 and induce the expression of its target genes, such as HO-1 and glutathione peroxidase) GPx, (thus protecting the cells against oxidative stress. Antioxidant and anti-inflammatory properties of statins, which are independent of their lipid-lowering effects, could be partly explained by the modulation of the Nrf2/HO-1 pathway.
Collapse
Affiliation(s)
- Atena Mansouri
- Cellular and Molecular Research Center, Birjand University of Medical Sciences, Birjand 9717853577, Iran;
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
| | - Željko Reiner
- Department of Internal Medicine, School of Medicine, University Hospital Center Zagreb, University of Zagreb, 10000 Zagreb, Croatia;
| | - Massimiliano Ruscica
- Department of Pharmacological and Biomolecular Sciences, Università degli Studi di Milano, 20100 Milan, Italy;
| | - Eugenia Tedeschi-Reiner
- University Hospital Center Sestre Milosrdnice, University of Osijek, Vinogradska Cesta 29, 10000 Zagreb, Croatia;
| | - Shabnam Radbakhsh
- Student Research Committee, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran;
- Department of Medical Biotechnology and Nanotechnology, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran
| | - Mariam Bagheri Ekta
- Laboratory of Cellular and Molecular Pathology of Cardiovascular System, A.P. Avtsyn Research Institute of Human Morphology, 3 Tsyurupy Str., 117418 Moscow, Russia;
| | - Amirhossein Sahebkar
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Applied Biomedical Research Center, Mashhad University of Medical Sciences, Mashhad 9177948564, Iran
- Department of Biotechnology, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad 9177948954, Iran
- Correspondence: or
| |
Collapse
|
13
|
Gumà J, Adriá-Cebrián J, Ruiz-Aguado B, Albacar C, Girona J, Rodríguez-Calvo R, Martínez-Micaelo N, Lam EWF, Masana L, Guaita-Esteruelas S. Altered Serum Metabolic Profile Assessed by Advanced 1H-NMR in Breast Cancer Patients. Cancers (Basel) 2021; 13:cancers13174281. [PMID: 34503091 PMCID: PMC8428341 DOI: 10.3390/cancers13174281] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/06/2021] [Accepted: 08/13/2021] [Indexed: 12/22/2022] Open
Abstract
Simple Summary Previously, our group demonstrated high FABP4 circulating levels in breast cancer (BC) patients. Moreover, increased cholesterol and triglycerides (TG) were found. To deeply analyse the lipid metabolism in our BC cohort, lipid and low molecular weight metabolomics processes are performed in 240 women (171 BC and 69 control women). This paper provides original data related to a novel link between TG-enriched particles and BC. The main result of this study is that TG-enriched particles and some branched amino acids, as well as tyrosine and alanine, are positively associated with BC. This suggests that BC patients have a different metabolic signature that could be used for better stratification and treatment. To our knowledge, this is the first time that advanced NMR profiling has been used to identify relevant and specifically altered lipid and amino acid metabolites in BC serum samples, which could be used for early and reliable diagnosis and prognosis. Abstract Background: Altered lipid metabolism has been described in some types of cancer. To analyse in depth the metabolic modifications in breast cancer patients, advanced 1H-nuclear magnetic resonance was performed in these patients. The main objective of this paper was to define a specific lipidomic signature for these cancer patients. Materials and methods: Serum from 240 women (171 breast cancer patients and 69 control women) were studied and analysed by nuclear magnetic resonance. Results: Triglyceride-enriched particles, specifically very low-density lipoprotein triglycerides, intermediate-density lipoprotein triglycerides, low-density lipoprotein triglycerides, and high-density lipoprotein triglycerides, were positively associated with breast cancer. Moreover, alanine, tyrosine, and branched amino acids were also associated with increased risk of breast cancer. Conclusions: Breast cancer patients showed a modified metabolome, giving a very interesting tool to draw different radar charts between control women and breast cancer patients. To our knowledge, this is the first time that advanced nuclear magnetic resonance profiling has been used to identify relevant and specifically altered lipid or amino acid metabolites in BC serum samples. The altered metabolic signature could be analysed for early and reliable BC patient diagnosis and prognosis.
Collapse
Affiliation(s)
- Josep Gumà
- Department of Oncology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (J.G.); (J.A.-C.); (B.R.-A.); (C.A.)
- Center for R&D&I in Nutrition and Health, Institut de Investigació Sanitaria Pere Virgili (IISPV), Avda. de la Universitat, 1—Second Floor, 43204 Reus, Spain; (J.G.); (R.R.-C.); (N.M.-M.); (L.M.)
| | - Jose Adriá-Cebrián
- Department of Oncology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (J.G.); (J.A.-C.); (B.R.-A.); (C.A.)
- Center for R&D&I in Nutrition and Health, Institut de Investigació Sanitaria Pere Virgili (IISPV), Avda. de la Universitat, 1—Second Floor, 43204 Reus, Spain; (J.G.); (R.R.-C.); (N.M.-M.); (L.M.)
- Research Unit on Lipids and Atherosclerosis, Institut de Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Belen Ruiz-Aguado
- Department of Oncology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (J.G.); (J.A.-C.); (B.R.-A.); (C.A.)
| | - Cinta Albacar
- Department of Oncology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (J.G.); (J.A.-C.); (B.R.-A.); (C.A.)
| | - Josefa Girona
- Center for R&D&I in Nutrition and Health, Institut de Investigació Sanitaria Pere Virgili (IISPV), Avda. de la Universitat, 1—Second Floor, 43204 Reus, Spain; (J.G.); (R.R.-C.); (N.M.-M.); (L.M.)
- Research Unit on Lipids and Atherosclerosis, Institut de Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Ricardo Rodríguez-Calvo
- Center for R&D&I in Nutrition and Health, Institut de Investigació Sanitaria Pere Virgili (IISPV), Avda. de la Universitat, 1—Second Floor, 43204 Reus, Spain; (J.G.); (R.R.-C.); (N.M.-M.); (L.M.)
- Research Unit on Lipids and Atherosclerosis, Institut de Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Neus Martínez-Micaelo
- Center for R&D&I in Nutrition and Health, Institut de Investigació Sanitaria Pere Virgili (IISPV), Avda. de la Universitat, 1—Second Floor, 43204 Reus, Spain; (J.G.); (R.R.-C.); (N.M.-M.); (L.M.)
- Research Unit on Lipids and Atherosclerosis, Institut de Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Eric W. F. Lam
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou 510060, China;
| | - Luis Masana
- Center for R&D&I in Nutrition and Health, Institut de Investigació Sanitaria Pere Virgili (IISPV), Avda. de la Universitat, 1—Second Floor, 43204 Reus, Spain; (J.G.); (R.R.-C.); (N.M.-M.); (L.M.)
- Research Unit on Lipids and Atherosclerosis, Institut de Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Institute of Health Carlos III, 28029 Madrid, Spain
| | - Sandra Guaita-Esteruelas
- Department of Oncology, Hospital Universitari de Sant Joan, 43204 Reus, Spain; (J.G.); (J.A.-C.); (B.R.-A.); (C.A.)
- Center for R&D&I in Nutrition and Health, Institut de Investigació Sanitaria Pere Virgili (IISPV), Avda. de la Universitat, 1—Second Floor, 43204 Reus, Spain; (J.G.); (R.R.-C.); (N.M.-M.); (L.M.)
- Research Unit on Lipids and Atherosclerosis, Institut de Investigació Sanitaria Pere Virgili (IISPV), Universitat Rovira i Virgili, 43204 Reus, Spain
- Spanish Biomedical Research Centre in Diabetes and Associated Metabolic Disorders (CIBERDEM), Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence:
| |
Collapse
|
14
|
He D, Guo Y, Zhang Y, Zhao J, Wu L, Yu Z, Qu W, Luo X. Thromboelastography predicts dual antiplatelet therapy-related hemorrhage in patients with acute ischemic stroke. J Neurointerv Surg 2021; 14:672-676. [PMID: 34326196 PMCID: PMC9209664 DOI: 10.1136/neurintsurg-2021-017615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 07/11/2021] [Indexed: 12/27/2022]
Abstract
Background Stratification of the risk of hemorrhage in patients with acute ischemic stroke following dual antiplatelet therapy (DAPT) is challenging. It remains unclear whether thromboelastography (TEG) can be used to predict DAPT-related hemorrhagic events. Objective The present study aims to discover predictors for hemorrhage events after DAPT based on parameters such as TEG. Methods A total of 859 patients with acute ischemic stroke who received DAPT were recruited consecutively. Demographic, clinical, and neuroimaging characteristics were evaluated at baseline; TEG parameters were obtained 7 days later after DAPT. Hemorrhagic events were monitored about 1 month after the stroke. Results Of the patients, 61 (7.1%) had hemorrhagic events. Patients in the hemorrhage group had a lower adenosine diphosphate (ADP)-induced platelet-fibrin clot maximum amplitude and a higher ADP inhibition rate (ADP%) than those in the non-hemorrhage group (p<0.05). ADP% was confirmed as an independent predictor of hemorrhagic events with an optimal cut-off point of 83.3% (area under the curve (AUC) = 0.665, 95% CI 0.573 to 0.767, p<0.01). We constructed a logistic model based on D-dimer, National Institutes of Health Stroke Scale scores, and ADP% to predict hemorrhagic events in patients with acute ischemic stroke during DAPT (AUC=0.720, 95% CI 0.625 to 0.858, p<0.01), with a sensitivity of 72.1% and a specificity of 76.5%. Conclusions Monitoring changes of TEG parameters helps to guide personalized DAPT for patients with ischemic stroke. A 30–82.3% range of ADP% is recommended for DAPT treatment.
Collapse
Affiliation(s)
- Dan He
- Department of Neurology, The First Affiliated Hospital, Sun Yat-sen University, Guangdong Provincial Key Laboratory of Diagnosis and Treatment of Major Neurological Diseases, National Key Clinical Department and Key Discipline of Neurology, Guangzhou, Guangdong, China
| | - Yinping Guo
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Yi Zhang
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Jing Zhao
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Lingshan Wu
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Zhiyuan Yu
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Wensheng Qu
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| | - Xiang Luo
- Department of Neurology, Tongji Hospital of Tongji Medical College of Huazhong University of Science and Technology, Wuhan, Hubei, China
| |
Collapse
|
15
|
Dardano A, Daniele G, Penno G, Miccoli R, Del Prato S. Breaking Therapeutic Inertia With Alirocumab in an 80-Year-Old Patient With Severe Hypercholesterolemia: A Case Report. Front Med (Lausanne) 2021; 8:699477. [PMID: 34307425 PMCID: PMC8292593 DOI: 10.3389/fmed.2021.699477] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 06/07/2021] [Indexed: 11/30/2022] Open
Abstract
Background: Therapeutic inertia, defined as the failure to initiate or intensify therapy in a timely manner as per evidence-based clinical guidelines, is an important barrier limiting optimal care in the elderly. Therefore, overcoming therapeutic inertia is the core challenge when dealing with geriatric patients. Case Description: The patient was an 80-year-old man that attended our Outpatient Lipid Clinic (Pisa University Hospital) because of persistent high LDL cholesterol (LDLc) levels in a setting of a statin contraindication. He underwent five percutaneous coronary angioplasties with drug-eluting stents. In 2014, upon starting treatment with rosuvastatin for LDLc level of 7.59 mmol/L, the patient was admitted to the Emergency Room for a presumptive diagnosis of rhabdomyolysis (creatine kinase 6685 U/L) secondary to statin. Patient developed acute kidney injury treated with dialysis. After resolution, he was discharged with ezetimibe (10 mg daily). This treatment however failed to effectively reduce LDLc levels that ranged between 5.9 and 6.6 mmol/L for the ensuing 4-years. In 2018, at the time of our evaluation, in consideration of the age, we performed a comprehensive geriatric assessment that showed good functional and mental status supporting a reliable treatment with a proprotein convertase subtilisin–kexin type 9 inhibitor. Therefore, alirocumab was prescribed as add-on to ezetimibe. At 24-month follow-up, the geriatric assessment showed no significant changes, and alirocumab was well-tolerated. LDLc was 82% lower as compared to baseline values (from 6.6 to 1.2 mmol/L). Conclusions: This report describes a case of therapeutic inertia despite a very high-risk profile. It is also instrumental in highlightening that appropriate intensification of therapy in an elderly patient at high cardiovascular risk, by means of a patient-centered approach, may allow reaching therapeutic targets and overcoming the condition of therapeutic inertia.
Collapse
Affiliation(s)
- Angela Dardano
- Section of Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Daniele
- Section of Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giuseppe Penno
- Section of Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Roberto Miccoli
- Section of Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Stefano Del Prato
- Section of Diabetes, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| |
Collapse
|
16
|
Franchi C, Lancellotti G, Bertolotti M, Di Salvatore S, Nobili A, Mannucci PM, Mussi C, Ardoino I. Use of Lipid-Lowering Drugs and Associated Outcomes According to Health State Profiles in Hospitalized Older Patients. Clin Interv Aging 2021; 16:1251-1264. [PMID: 34239298 PMCID: PMC8259728 DOI: 10.2147/cia.s305933] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Accepted: 05/10/2021] [Indexed: 12/21/2022] Open
Abstract
Objective To assess how lipid-lowering drugs (LLDs) are administered in the hospitalized patients aged 65 and older and their association with clinical outcomes according to their health-related profiles. Design This is a retrospective study based on data from REPOSI (REgistro POliterapie SIMI - Italian Society of Internal Medicine) register, an Italian network of internal medicine hospital wards. Setting and Participants A total of 4642 patients with a mean age of 79 years enrolled between 2010 and 2018. Methods Socio-demographic characteristics, functional abilities, cognitive skills, laboratory parameters and comorbidities were used to investigate the health state profiles by using multiple correspondence analysis and clustering. Logistic regression was used to assess whether LLD prescription was associated with patients' health state profiles and with short-term mortality. Results Four clusters of patients were identified according to their health state: two of them (Cluster III and IV) were the epitome of frailty conditions with poor short-term outcomes, whereas the others included healthier patients. The average prevalence of LLD use was 27.6%. The lowest prevalence was found among the healthier patients in Cluster I and among the oldest frail patients with severe functional and cognitive impairment in Cluster IV. The highest prevalence was among multimorbid patients in Cluster III (OR=4.50, 95% CI=3.76-5.38) characterized by a high cardiovascular risk. Being prescribed with LLDs was associated with a lower 3-month mortality, even after adjusting for cluster assignment (OR=0.59; 95% CI = 0.44-0.80). Conclusion The prevalence of LLD prescription was low and in overall agreement with guideline recommendations and with respect to patients' health state profiles.
Collapse
Affiliation(s)
- Carlotta Franchi
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Giulia Lancellotti
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Marco Bertolotti
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Simona Di Salvatore
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Alessandro Nobili
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | - Pier Mannuccio Mannucci
- Scientific Direction, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milano, Italy
| | - Chiara Mussi
- Division of Geriatrics, Department of Biomedical, metabolic and Neural Sciences and Center for Gerontological Evaluation and Research, Università di Modena e Reggio Emilia, Modena, Italy
| | - Ilaria Ardoino
- Department of Neuroscience, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy
| | | |
Collapse
|
17
|
Dewi PEN, Thavorncharoensap M. Statin Utilization among Patients with Acute Coronary Syndrome: Systematic Review. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.5807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: The early use of statin with intensive regimen has been recommended by the recent guidelines as the prevention of acute coronary syndrome (ACS) related events among the high-risk patients. Meanwhile, the inconsistent statin utilization for targeted patient in current practice is still an issue.
AIM: This study aims to review the utilization rate of statin among patients with ACS.
METHODS: A systematic search of relevant studies published between inceptions to June 2020 was conducted in PubMed. Patients and intervention domains were used to build up the searching formula. A study was eligible for inclusion if it was an original study of patients with ACS and it examined the utilization of statin. The risk of bias was assessed using Axis and NOS checklist.
RESULTS: Among the 49 eligible studies, 38 were cohort studies while the others were cross-sectional studies. The utilization rate of statin at hospital admission ranged from 16% to 61% while 25% to 75% during the hospitalization. Of the total studies, 35 studies reported the statin rate at discharge ranging from 58% to 99%. Almost all studies revealed the reduction of statin utilization rate along the follow-up period. The number of statins prescribed was found to be lower among female and elderly patients.
CONCLUSION: Despite the established benefits of statin among patients with ACS, our study revealed that statin was underutilized for secondary prevention after ACS. To improve patients’ clinical outcomes with ACS, efforts should be made to increase optimal treatment and compliance with a statin.
Collapse
|
18
|
Spencer-Bonilla G, Chung S, Sarraju A, Heidenreich P, Palaniappan L, Rodriguez F. Statin Use in Older Adults with Stable Atherosclerotic Cardiovascular Disease. J Am Geriatr Soc 2021; 69:979-985. [PMID: 33410499 PMCID: PMC8049971 DOI: 10.1111/jgs.16975] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Revised: 10/14/2020] [Accepted: 11/14/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND/OBJECTIVES Older adults (>75 years of age) represent two-thirds of atherosclerotic cardiovascular disease (ASCVD) deaths. The 2013 and 2018 American multi-society cholesterol guidelines recommend using at least moderate intensity statins for older adults with ASCVD. We examined annual trends and statin prescribing patterns in a multiethnic population of older adults with ASCVD. DESIGN Retrospective longitudinal study using electronic health record (EHR) data from 2007 to 2018. SETTING A large multi-specialty health system in Northern California. PARTICIPANTS A total of 24,651 adults older than 75 years with ASCVD. MEASUREMENTS Statin prescriptions for older adults with known ASCVD were trended over time. Multivariable regression models were used to identify predictors of statin prescription (logistic) after controlling for relevant demographic and clinical factors. RESULTS The study cohort included 24,651 patients older than 75 years; 48% were women. Although prescriptions for moderate/high intensity statins increased over time for adults over 75, fewer than half of the patients (45%) received moderate/high intensity statins in 2018. Women (odds ratio (OR) = 0.77; 95% confidence interval (CI) = 0.74, 0.80), patients who had heart failure (OR = 0.69; 95% CI = 0.65, 0.74), those with dementia (OR = 0.88; 95% CI = 0.82, 0.95) and patients who were underweight (OR = 0.64; 95% CI = 0.57, 0.73) were less likely to receive moderate/high intensity statins. CONCLUSIONS Despite increasing prescription rates between 2007 and 2018, guideline-recommended statins remained underused in older adults with ASCVD, with more pronounced disparities among women and those with certain comorbidities. Future studies are warranted to examine reasons for statin underuse in older adults with ASCVD.
Collapse
Affiliation(s)
| | - Sukyung Chung
- Palo Alto Medical Foundation Research Institute, Palo Alto, California
- Quantitative Sciences Unit, Stanford University School of Medicine, Stanford, California
| | - Ashish Sarraju
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, California
| | - Paul Heidenreich
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, California
- Division of Cardiovascular Medicine, Veterans Affairs Palo Alto Health Care System, Palo Alto, California
| | - Latha Palaniappan
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, California
| | - Fatima Rodriguez
- Division of Cardiovascular Medicine and Cardiovascular Institute, Stanford University, Stanford, California
| |
Collapse
|
19
|
Green S, Hillersdal L. Aging biomarkers and the measurement of health and risk. HISTORY AND PHILOSOPHY OF THE LIFE SCIENCES 2021; 43:28. [PMID: 33620613 PMCID: PMC7901506 DOI: 10.1007/s40656-021-00367-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2020] [Accepted: 01/09/2021] [Indexed: 05/11/2023]
Abstract
Prevention of age-related disorders is increasingly in focus of health policies, and it is hoped that early intervention on processes of deterioration can promote healthier and longer lives. New opportunities to slow down the aging process are emerging with new fields such as personalized nutrition. Data-intensive research has the potential to improve the precision of existing risk factors, e.g., to replace coarse-grained markers such as blood cholesterol with more detailed multivariate biomarkers. In this paper, we follow an attempt to develop a new aging biomarker. The vision among the project consortium, comprising both research and industrial partners, is that the new biomarker will be predictive of a range of age-related conditions, which may be preventable through personalized nutrition. We combine philosophical analysis and ethnographic fieldwork to explore the possibilities and challenges of managing aging through bodily signs that are not straightforwardly linked to symptomatic disease. We document how the improvement of measurement brings about new conceptual challenges of demarcating healthy and unhealthy states. Moreover, we highlight that the reframing of aging as risk has social and ethical implications, as it is generative of normative notions of what constitutes successful aging and good citizenship.
Collapse
Affiliation(s)
- Sara Green
- Section for History and Philosophy of Science, Department of Science Education, University of Copenhagen, Copenhagen, Denmark.
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark.
| | - Line Hillersdal
- Centre for Medical Science and Technology Studies, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
- Department of Anthropology and Center for Healthy Aging, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
20
|
Li X, Huang S, Chen X, Xu Q, Ma Y, You L, Kulikouskaya V, Xiao J, Piao J. Structural characteristic of a sulfated polysaccharide from Gracilaria Lemaneiformis and its lipid metabolism regulation effect. Food Funct 2020; 11:10876-10885. [PMID: 33245309 DOI: 10.1039/d0fo02575e] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
A sulfated polysaccharide extracted from Gracilaria lemaneiformis (GLP) with a prominent effect in regulating lipid metabolism was isolated. The molecular weight was 31.5 kDa and it was composed mainly of galactose, glucose and xylose. Fourier-transform infrared (FT-IR) spectrum and nuclear magnetic resonance (NMR) analysis suggested that GLP was composed of the following repeating unit: [3-β-Gal-4(OSO3)-1→4-α-3,6-anhydrogal-2(OSO3)-1→]. GLP could significantly decrease serum total cholesterol, triglyceride and free fatty acid levels and lower alanine aminotransferase and aspartate aminotransferase activities in high-fat-diet mice. Additionally, GLP could keep the body weight and attenuate accumulation of fat surrounding the liver and epididymis induced by high-fat diet. Results of RT-PCR indicated that GLP might regulate lipid metabolism and accelerate free fatty acid oxidation by up-regulating the expression of the PPARα, ACS and CPT1a gene. The present study suggests that GLP may be potentially useful for regulating lipid metabolism.
Collapse
Affiliation(s)
- Xiong Li
- School of Food Science and Engineering, South China University of Technology, Guangzhou 510640, Guangdong, China.
| | | | | | | | | | | | | | | | | |
Collapse
|
21
|
Picton L, Bell JS, George J, Korhonen MJ, Ilomäki J. The changing pattern of statin use in people with dementia: A population-based study. J Clin Lipidol 2020; 15:192-201. [PMID: 33309941 DOI: 10.1016/j.jacl.2020.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 11/09/2020] [Accepted: 11/16/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND After a dementia diagnosis, goals of care are often reassessed, including the use of preventive medications like statins. OBJECTIVE To examine changes in statin use after initiating medication for managing dementia. METHODS A case-crossover study utilizing medication dispensing data from the Australian Pharmaceutical Benefits Scheme (PBS) 10% random sample was conducted. Use of statins was compared in the 12 months pre- and post-initiation (pre-period and post-period) of anti-dementia medications or risperidone for behavioural symptoms of dementia. Individuals aged ≥65 years who had their first dispensing of anti-dementia medication or risperidone between July 2006 and June 2017 and survived ≥12 months after their first supply were included. Conditional logistic regression was used to estimate odds ratios (OR) and 95% confidence intervals (CI) for change in statin use in the discordant pairs. RESULTS The cohort (n = 19,809) had a median age of 81 years and 61% were female. Statins were less likely to be used after initiating anti-dementia medication or risperidone (OR 0.50; 95%CI 0.45-0.55). The OR for statin use in the post-period versus the pre-period decreased annually over the 11 years from 1.21; 95%CI 0.84-1.75 in 2006-7 to 0.31; 95%CI 0.24-0.41 in 2016-17 (p for interaction <0.05). CONCLUSION Statins are more likely to be ceased than started after initiating medication for dementia. This may reflect changes in goals of care, or changes in the interpretation of the available evidence for the safety and efficacy of statins in older people living with dementia.
Collapse
Affiliation(s)
- Leonie Picton
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | - Johnson George
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| | | | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia
| |
Collapse
|
22
|
Pani A, Pastori D, Senatore M, Romandini A, Colombo G, Agnelli F, Scaglione F, Colombo F. Clinical and pharmacological characteristics of elderly patients admitted for bleeding: impact on in-hospital mortality. Ann Med 2020; 52:413-422. [PMID: 32795156 PMCID: PMC7877962 DOI: 10.1080/07853890.2020.1808238] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Clinical and pharmacological characteristics of elderly patients hospitalized for bleeding and in-hospital mortality according to bleeding type are barely described. METHODS Retrospective cohort study of 13,496 consecutive patients admitted to internal medicine wards. Clinical characteristics, comorbidities and pharmacological treatments were collected for each patient. Predictors of in-hospital mortality were investigated. RESULTS Overall, 531 (3.9%) patients were admitted for bleeding: 189 clinically relevant non-major bleeding, 106 cerebral and 236 major non-cerebral (95.8% gastrointestinal (GI)). Among 106 cerebral bleedings, 28.3% and 24.5% were typical and atypical intracranial, respectively, and 47.2% were subdural haemorrhages. Most of patients with GI bleeding presented with anaemia (90.7%). A similar rate of GI bleeding was found in aspirin-treated patients taking or not proton pump inhibitors (PPI). In-hospital mortality was 9.98%. Age ≥80 years (odds ratio (OR) 2.513, p=.005), cerebral bleeding (OR 5.373, p<.001), eGFR <30 ml/min/m2 (OR 2.388, p=.035) and COPD (OR 2.362, p=.024) were positively associated with mortality, while ACE inhibitors/ARBs use was negatively associated (OR 0.383, p=.028). CONCLUSIONS The most frequent type of major haemorrhage was GI bleeding, which was not modified by the use of PPI in patients taking aspirin. Cerebral bleeding increased all-cause death, which was lower in ACE inhibitors/ARBs users. KEY MESSAGE Gastrointestinal (GI) bleeding was the most common reason for hospital admission. The rate of GI bleeding was similar in patients on aspirin using or not PPI. Cerebral bleeding increased in-hospital mortality, which was lower in patients taking ACE inhibitors/ARBs.
Collapse
Affiliation(s)
- Arianna Pani
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy.,Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Daniele Pastori
- Department of Clinical, Internal, Anesthesiologic and Cardiovascular Sciences, I Clinica Medica, Atherothrombosis Center, Sapienza University of Rome, Rome, Italy
| | - Michele Senatore
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy.,Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Alessandra Romandini
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy.,Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Giulia Colombo
- Internal Medicine Department, Policlinico Maggiore Ca' Granda, Milan, Italy
| | - Francesca Agnelli
- Internal Medicine Department, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Francesco Scaglione
- Department of Oncology and Onco-Hematology, Postgraduate School of Clinical Pharmacology and Toxicology, University of Milan, Milan, Italy.,Clinical Pharmacology Unit, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabrizio Colombo
- Internal Medicine Department, Azienda Socio-Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, Milan, Italy
| |
Collapse
|
23
|
Morze J, Osadnik T, Osadnik K, Lejawa M, Jakubiak G, Pawlas N, Gasior M, Schwingshackl L, Banach M. Comparative effect of nutraceuticals on lipid profile: a protocol for systematic review and network meta-analysis. BMJ Open 2020; 10:e032755. [PMID: 32819924 PMCID: PMC7440701 DOI: 10.1136/bmjopen-2019-032755] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION According to the common definition, nutraceuticals are components found in food that can act as therapeutic substances. Recently, the International Lipid Expert Panel published two position papers covering the topic of lipid-lowering nutraceuticals and their potential use as a complementary treatment in addition to statins or as an alternative treatment in statin-intolerant patients. The aim of this study was to compare the effect of different nutraceuticals on lipid profiles in a systematic review with pairwise and network meta-analyses. METHODS AND ANALYSIS Three databases, including PubMed, Embase and the Cochrane Central Register of Controlled Trials, will be searched without time or publication language restrictions. The estimated end date for the searches will be 29 March 2020. Each stage of the review, including the study section, data extraction, and risk of bias and quality of evidence assessments, will be performed in duplicate. Randomised controlled trials meeting the following criteria will be eligible for inclusion: (1) participants aged ≥18 years, (2) intervention with a selected nutraceutical (artichoke, berberine, bergamot, soluble fibres, green tea, garlic, lupin, plant sterols and stanols, red yeast rice, soybean, spirulina or a combination of the aforementioned nutraceuticals), (3) administration of the treatment in the form of capsules, pills, powders, solutions, tablets or enriched food items, (4) comparison with another nutraceutical or placebo, (5) intervention period ≥3 weeks and (6) lipid profile (low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, total cholesterol, triglycerides) as an outcome. Random-effect pairwise and network meta-analyses will be used to summarise the relative effect of each nutraceutical in comparison to the effect of every other nutraceutical. Subgroup analyses will be stratified by age, sex, ethnicity, sample size, length of trial follow-up, baseline cholesterol level and presence of other comorbidities. ETHICS AND DISSEMINATION This review will summarise findings from primary studies, and therefore no ethics approval is required. The results will be presented at conferences as well as published in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42019132877.
Collapse
Affiliation(s)
- Jakub Morze
- Department of Cardiology and Internal Diseases, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland
| | - Tadeusz Osadnik
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
- 2nd Department of Cardiology and Angiology, Silesian Center for Heart Diseases, Zabrze, Poland
| | - Kamila Osadnik
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Mateusz Lejawa
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Grzegorz Jakubiak
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Natalia Pawlas
- Department of Pharmacology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Mariusz Gasior
- 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Zabrze, Poland
| | - Lukas Schwingshackl
- Institute for Evidence in Medicine, University Medical Center Freiburg, Freiburg, Baden-Württemberg, Germany
| | - Maciej Banach
- Department of Hypertension, WAM University Hospital in Lodz, Medical University of Lodz, Lodz, Poland
- Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland
- Cardiovascular Research Centre, University of Zielona Gora, Zielona Gora, Poland
| |
Collapse
|
24
|
Wang KN, Bell JS, Tan EC, Gilmartin-Thomas JF, Dooley MJ, Ilomäki J. Statin use and fall-related hospitalizations among residents of long-term care facilities: A case-control study. J Clin Lipidol 2020; 14:507-514. [PMID: 32571729 DOI: 10.1016/j.jacl.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 05/15/2020] [Accepted: 05/17/2020] [Indexed: 11/18/2022]
Abstract
BACKGROUND Statins are associated with muscle-related adverse events, but few studies have investigated the association with fall-related hospitalizations among residents of long-term care facilities (LTCFs). OBJECTIVE The objective of the study is to investigate whether statin use is associated with fall-related hospitalizations from LTCFs. METHODS A case-control study was conducted among residents aged ≥65 years admitted to hospital from 2013 to 2015. Cases (n = 332) were residents admitted for falls and fall-related injuries. Controls (n = 332) were selected from patients admitted for reasons other than cardiovascular and diabetes. Cases and controls were matched 1:1 by age (±2 years), index date of admission (±6 months), and sex. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using conditional logistic regression, after considering for history of falls, hypertension, dementia, functional comorbidity index, polypharmacy (≥9 regular preadmission medications), and fall-risk medications. Subanalyses were performed for individual statins, dementia, and statin intensity. RESULTS Overall, 43.1% of cases and 27.1% of controls used statins. Statins were associated with fall-related hospitalizations (aOR = 2.24, 95% CI 1.56-3.23), in particular simvastatin (aOR = 2.26, 95% CI 1.22-4.20) and atorvastatin (aOR = 2.08, 95% CI 1.33-3.24). Statins were associated with fall-related hospitalizations in residents with (aOR = 2.34, 95% CI 1.33-4.11) and without dementia (aOR = 2.30, 95% CI 1.46-3.63). There was no association between statin intensity and fall-related hospitalizations (aOR = 0.78, 95% CI 0.43-1.40). CONCLUSION This study suggests a possible association between statin use and fall-related hospitalizations among residents living in LTCFs. However, there was minimal evidence for a relationship between statin intensity and fall-related hospitalizations. Further research is required to substantiate these hypothesis-generating findings.
Collapse
Affiliation(s)
- Kate N Wang
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia; School of Health & Biomedical Sciences, RMIT University, Bundoora, Victoria, Australia.
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; NHMRC Cognitive Decline Partnership Centre, Hornsby Ku-ring-gai Hospital, Hornsby, New South Wales, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, South Australia, Australia
| | - Edwin Ck Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Stockholm, Sweden; The University of Sydney, Faculty of Medicine and Health, School of Pharmacy, Sydney, New South Wales, Australia
| | - Julia Fm Gilmartin-Thomas
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Michael J Dooley
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Pharmacy Department, Alfred Health, Melbourne, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jenni Ilomäki
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, Victoria, Australia; Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
25
|
Hawley CE, Roefaro J, Forman DE, Orkaby AR. Statins for Primary Prevention in Those Aged 70 Years and Older: A Critical Review of Recent Cholesterol Guidelines. Drugs Aging 2019; 36:687-699. [PMID: 31049807 DOI: 10.1007/s40266-019-00673-w] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
The risk of atherosclerotic cardiovascular disease rises with age and remains the leading cause of death in older adults. Evidence for the use of statins for primary prevention in older adults is limited, despite the possibility that this population may derive significant clinical benefit given its increased cardiovascular risk. Until publication of the 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the Management of Blood Cholesterol, and the 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease, guidelines for statin prescription in older adults remained unchanged despite new evidence of possible benefit in older adults. In this review, we present key updates in the 2018 and 2019 guidelines and the evidence informing these updates. We compare the discordant recommendations of the seven major North American and European guidelines on cholesterol management released in the past 5 years and highlight gaps in the literature regarding primary prevention of cardiovascular disease in older adults. As most cardiovascular events in older adults are nonfatal, we ask how clinicians should weigh the risks and benefits of continuing a statin for primary prevention in older adults. We also reframe the concept of deprescribing of statins in the older population, using the Geriatrics 5Ms framework: Mind, Mobility, Medications, Multi-complexity, and what Matters Most to older adults. A recent call from the National Institute on Aging for a statin trial focusing on older adults extends from similar concerns.
Collapse
Affiliation(s)
- Chelsea E Hawley
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA. .,Pharmacy Department, VA Boston Healthcare System, Boston, MA, USA.
| | - John Roefaro
- Pharmacy Department, VA Boston Healthcare System, Boston, MA, USA
| | - Daniel E Forman
- Section of Geriatric Cardiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.,Geriatric Research, Education, and Clinical Center, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Ariela R Orkaby
- New England Geriatric Research, Education, and Clinical Center (GRECC), VA Boston Healthcare System, Boston, MA, USA.,Division of Aging, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
26
|
van der Ploeg MA, Floriani C, Achterberg WP, Bogaerts JMK, Gussekloo J, Mooijaart SP, Streit S, Poortvliet RKE, Drewes YM. Recommendations for (Discontinuation of) Statin Treatment in Older Adults: Review of Guidelines. J Am Geriatr Soc 2019; 68:417-425. [PMID: 31663610 PMCID: PMC7027549 DOI: 10.1111/jgs.16219] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2019] [Revised: 09/12/2019] [Accepted: 09/15/2019] [Indexed: 01/02/2023]
Abstract
OBJECTIVES As a person's age increases and his/her health status declines, new challenges arise that may lead physicians to consider deprescribing statins. We aimed to provide insight into recommendations available in international cardiovascular disease prevention guidelines regarding discontinuation of statin treatment applicable to older adults. DESIGN We systematically searched PubMed, EMBASE, EMCARE, and the websites of guideline development organizations and online guideline repositories for cardiovascular disease prevention guidelines aimed at the general population. We selected all guidelines with recommendations (instructions and suggestions) on discontinuation of statin treatment applicable to older adults, published between January 2009 and April 2019. In addition, we performed a synthesis of information from all other recommendations for older adults regarding statin treatment. Methodological quality of the included guidelines was appraised using the appraisal of guidelines for research & evaluation II (AGREE II) instrument. RESULTS Eighteen international guidelines for cardiovascular disease prevention in the general adult population provided recommendations for statin discontinuation that were applicable to older adults. We identified three groups of instructions for statin discontinuation related to statin intolerance, and none was specifically aimed at older adults. Three guidelines also included suggestions to consider statin discontinuation in patients with poor health status. Of the 18 guidelines included, 16 made recommendations regarding statin treatment in older adults, although details on how to implement these recommendations in practice were not provided. CONCLUSION Current international cardiovascular disease prevention guidelines provide little specific guidance for physicians who are considering statin discontinuation in older adults in the context of declining health status and short life expectancy. J Am Geriatr Soc 68:417–425, 2020
Collapse
Affiliation(s)
- Milly A van der Ploeg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Carmen Floriani
- Institute of Primary Health Care (Berner Institut für Hausarztmedizin, BIHAM), University of Bern, Bern, Switzerland
| | - Wilco P Achterberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jonathan M K Bogaerts
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacobijn Gussekloo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.,Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Simon P Mooijaart
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| | - Sven Streit
- Institute of Primary Health Care (Berner Institut für Hausarztmedizin, BIHAM), University of Bern, Bern, Switzerland
| | - Rosalinde K E Poortvliet
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Yvonne M Drewes
- Department of Internal Medicine, Section Gerontology and Geriatrics, Leiden University Medical Center, Leiden, The Netherlands
| |
Collapse
|
27
|
Jokanovic N, Kautiainen H, Bell JS, Tan ECK, Pitkälä KH. Change in Prescribing for Secondary Prevention of Stroke and Coronary Heart Disease in Finnish Nursing Homes and Assisted Living Facilities. Drugs Aging 2019; 36:571-579. [PMID: 30949985 DOI: 10.1007/s40266-019-00656-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND One quarter of residents in long-term care facilities (LTCFs) have a diagnosis of CHD or stroke and over half use at least one preventative cardiovascular medication. There have been no studies that have investigated the longitudinal change in secondary preventative cardiovascular medication use in residents in LTCFs over time. OBJECTIVE The aim of this study was to investigate the change in cardiovascular medication use among residents with coronary heart disease (CHD) and prior stroke in nursing homes (NHs) and assisted living facilities (ALFs) in Finland over time, and whether this change differs according to dementia status. METHODS Three comparable cross-sectional audits of cardiovascular medication use among residents aged 65 years and over with CHD or prior stroke in NHs in 2003 and 2011 and ALFs in 2007 and 2011 were compared. Logistic regression analyses adjusted for gender, age, mobility, cancer and length of stay were performed to examine the effect of study year, dementia and their interaction on medication use. RESULTS Cardiovascular medication use among residents with CHD (NHs: 89% vs 70%; ALFs: 89% vs 84%) and antithrombotic medication use among residents with stroke (NHs: 72% vs 63%; ALFs: 78% vs 69%) declined between 2003 and 2011 in NHs and 2007 and 2011 in ALFs. Decline in the use of diuretics, nitrates and digoxin were found in both groups and settings. Cardiovascular medication use among residents with CHD and dementia declined in NHs (88% [95% CI 85-91] in 2003 vs 70% [95% CI 64-75] in 2011) whereas there was no change among people without dementia. There was no change in cardiovascular medication use among residents with CHD in ALFs with or without dementia over time. Antithrombotic use was lower in residents with dementia compared with residents without dementia in NHs (p < 0.001) and ALFs (p = 0.026); however, the interaction between dementia diagnosis and time was non-significant. CONCLUSIONS The decline in cardiovascular medication use in residents with CHD and dementia suggests Finnish physicians are adopting a more conservative approach to the management of cardiovascular disease in the NH population.
Collapse
Affiliation(s)
- Natali Jokanovic
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia. .,Pharmacy Department, Alfred Hospital, Melbourne, Australia.
| | - Hannu Kautiainen
- Department of General Practice and Unit of Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| | - J Simon Bell
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia
| | - Edwin C K Tan
- Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Melbourne, Australia.,School of Pharmacy, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Aging Research Centre, Department of Neurobiology, Care Sciences and Society, Karolinska Institute and Stockholm University, Stockholm, Sweden
| | - Kaisu H Pitkälä
- Department of General Practice and Unit of Primary Health Care, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland
| |
Collapse
|
28
|
Vicent L, Ariza-Solé A, Díez-Villanueva P, Alegre O, Sanchís J, López-Palop R, Formiga F, González-Salvado V, Bueno H, Marín F, Llibre C, Llaó I, Vidán M, Abu-Assi E, Aboal J, Martínez-Sellés M. Statin Treatment and Prognosis of Elderly Patients Discharged after Non-ST Segment Elevation Acute Coronary Syndrome. Cardiology 2019; 143:14-21. [DOI: 10.1159/000500824] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Accepted: 05/02/2019] [Indexed: 01/05/2023]
Abstract
Background: Statins are recommended for secondary prevention. Our aims were to describe the proportion of very elderly patients receiving statins after non-ST segment elevation acute coronary syndrome (NST-ACS) and to determine the prognostic implications of statins use. Methods: This prospective registry was performed in 44 hospitals that included patients ≥80 years discharged after a NST-ACS from April 2016 to September 2016. Results: We included 523 patients, the mean age was 84.2 ± 4.0 years and 200 patients (38.2%) were women. Previous statin treatment was recorded in 282 patients (53.4%), and 135 (32.5%) had LDL cholesterol levels >2.6 mmol/L. Mean LDL cholesterol levels during admission were 2.3 ± 0.9 mmol/L. Statins were prescribed at discharge to 474 patients (90.6%). Compared with patients discharged on statins, those that did not receive statins were more often frail (22 [47.8%] vs. 114 [24.4%], p < 0.01) and underwent an invasive approach less frequently (30 [61.2%] vs. 374 [78.9%], p = 0.01). During a 6-month follow-up, 50 patients died (9.5%). There was a nonsignificant trend to higher mortality in patients not treated with statins (6 [15%] vs. 44 [9.6%], p = 0.30), but statins were not independently associated with lower mortality (hazard ratio [HR] 0.79; 95% confidence interval [CI] 0.30–2.11, p = 0.65), nor with a reduction in the combined endpoint mortality/hospitalizations (HR 0.89; 95% CI 0.52–1.55, p = 0.69). Conclusions: Although most octogenarians presenting a NST-ACS are already on statins before the episode, their LDL cholesterol is frequently >2.6 mmol/L. Octogenarians who do not receive statins have a high-risk profile, with significant frailty and comorbidity.
Collapse
|
29
|
Paseban M, Butler AE, Sahebkar A. Mechanisms of statin‐induced new‐onset diabetes. J Cell Physiol 2019; 234:12551-12561. [DOI: 10.1002/jcp.28123] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Accepted: 12/20/2018] [Indexed: 08/30/2023]
Abstract
AbstractStatins, with their lipid‐lowering properties, are a first‐line therapy for the prevention of cardiovascular diseases. Recent evidence, however, suggests that statins can increase the risk of new‐onset diabetes (NOD). The molecular mechanisms of statin‐induced NOD are not precisely known, although some pathophysiologic mechanisms have been suggested. Specific to the beta cell, these mechanisms include alterations in insulin secretion, changes in ion channels, modulation of signaling pathways, and inflammation/oxidative stress. Outwith the beta cell, other suggested mechanisms involve adipocytes, including alterations in adipocyte differentiation and modulation of leptin and adiponectin, and genetic and epigenetic mechanisms, including alterations in microRNA. The evidence supporting these and other mechanisms will be discussed. Greater understanding of the underlying mechanisms linking the onset of diabetes to statin therapy is essential and clinically relevant, as it may enable novel preventative or therapeutic approaches to be instituted and guide the production of a new generation of statins lacking this side effect.
Collapse
Affiliation(s)
- Maryam Paseban
- Department of Physiology Faculty of Medicine, Mashhad University of Medical Sciences Mashhad Iran
| | | | - Amirhossein Sahebkar
- Neurogenic Inflammation Research Center, Mashhad University of Medical Sciences Mashhad Iran
- Biotechnology Research Center, Pharmaceutical Technology Institute, Mashhad University of Medical Sciences Mashhad Iran
- School of Pharmacy, Mashhad University of Medical Sciences Mashhad Iran
| |
Collapse
|
30
|
Agustini B, Mohebbi M, Woods RL, McNeil JJ, Nelson MR, Shah RC, Murray AM, Ernst ME, Reid CM, Tonkin A, Lockery JE, Berk M. Association Between Statin Use and Depressive Symptoms in a Large Community-Dwelling Older Population Living in Australia and the USA: A Cross-Sectional Study. CNS Drugs 2019; 33:685-694. [PMID: 31062260 PMCID: PMC6719539 DOI: 10.1007/s40263-019-00633-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Statin use has been frequently associated with depressive symptoms in an older population. However, the nature of this association is uncertain in the literature. In this study, we aimed to investigate the association of statin intake and the prevalence of depressive symptoms in healthy community-dwelling older adults living in Australia and the USA. METHODS We analysed baseline data from 19,114 participants, over 70 years of age (over 65 years of age, if from an ethnic minority). The association of self-reported statin use and prevalence of depressive symptoms, as measured by a validated depression scale [Center for Epidemiological Studies Depression Scale (CES-D 10)], was determined using logistic regression models. Multivariable logistic models were implemented to account for important demographics and other lifestyle and socioeconomic factors, such as sex, age, living status, education and smoking history. RESULTS A total of 5987 individuals were statin users. Of those, 633 (10.6%) had depressive symptoms (CES-D 10 cut-off ≥ 8), compared with 1246 (9.5%) of the non-statin users. In the unadjusted model, statin use was associated with an increase in prevalence of depressive symptoms (odds ratio 1.13, confidence interval 1.02-1.25, p = 0.02). However, after adjusting for important demographic and socioeconomic factors, the use of statins was not significantly associated with depressive symptoms (odds ratio 1.09, confidence interval 0.98-1.20, p = 0.11). In secondary analyses, only simvastatin was marginally associated with an increased prevalence of depressive symptoms. Statins were associated with a decreased prevalence of depressive symptoms in individuals with severe obesity (body mass index > 35 kg/m2) and an increased prevalence in participants between 75 and 84 years of age. CONCLUSION This study in a large community-dwelling older population did not show any association of statins with late-life depressive symptoms, after accounting for important socioeconomic and demographic factors. Confounding by indication is an important issue to be addressed in future pharmacoepidemiologic studies of statins.
Collapse
Affiliation(s)
- Bruno Agustini
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC, 3220, Australia.
| | - Mohammadreza Mohebbi
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC 3220, Australia,Biostatistics Unit, Deakin University, Geelong, VIC, Australia
| | - Robyn L. Woods
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - John J. McNeil
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Mark R. Nelson
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Raj C. Shah
- Department of Family Medicine and Rush Alzheimer’s Disease Center, Rush University Medical Center, Chicago, IL, USA
| | - Anne M. Murray
- Berman Center for Outcomes and Clinical Research, Hennepin Healthcare Research Institute, Hennepin Healthcare, Minneapolis, MN, USA
| | - Michael E. Ernst
- Department of Pharmacy Practice and Science, College of Pharmacy, The University of Iowa, Iowa, IO, USA,Department of Family Medicine, Carver College of Medicine, The University of Iowa, Iowa, IO, USA
| | - Christopher M. Reid
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia,School of Public Health, Curtin University, Perth, WA, Australia
| | - Andrew Tonkin
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Jessica E. Lockery
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Michael Berk
- IMPACT Strategic Research Centre (Innovation in Mental and Physical Health and Clinical Treatment Strategic Research Centre), School of Medicine, Deakin University, PO Box 281, Geelong, VIC 3220, Australia,Orygen, National Centre of Excellence in Youth Health, Department of Psychiatry and the Florey Institute for Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | | |
Collapse
|
31
|
Ruscica M, Reiner Z, Sirtori CR. Can we further optimize statin therapy to increase tolerability? Expert Opin Drug Discov 2019; 14:843-847. [DOI: 10.1080/17460441.2019.1615436] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Massimiliano Ruscica
- Department of Pharmacological and Bimolecular Sciences, Università degli Studi di Milano, Milan, Italy
| | - Zeljko Reiner
- Department of Internal Medicine, University Hospital Centre Zagreb, School of Medicine, Zagreb University, Zagreb, Croatia
| | - Cesare R. Sirtori
- Centro Dislipidemie, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| |
Collapse
|
32
|
Ponce OJ, Larrea-Mantilla L, Hemmingsen B, Serrano V, Rodriguez-Gutierrez R, Spencer-Bonilla G, Alvarez-Villalobos N, Benkhadra K, Haddad A, Gionfriddo MR, Prokop LJ, Brito JP, Murad MH. Lipid-Lowering Agents in Older Individuals: A Systematic Review and Meta-Analysis of Randomized Clinical Trials. J Clin Endocrinol Metab 2019; 104:1585-1594. [PMID: 30903687 DOI: 10.1210/jc.2019-00195] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2019] [Accepted: 01/25/2019] [Indexed: 02/13/2023]
Abstract
BACKGROUND The efficacy of lipid-lowering agents on patient-important outcomes in older individuals is unclear. METHODS We included randomized trials that enrolled individuals aged 65 years or older and that included at least 1 year of follow-up.Pairs of reviewers selected and appraised the trials. RESULTS We included 23 trials that enrolled 60,194 elderly patients. For primary prevention, statins reduced the risk of coronary artery disease [CAD; relative risk (RR): 0.79, 95% CI: 0.68 to 0.91] and myocardial infarction (MI; RR: 0.45, 95% CI: 0.31 to 0.66) but not all-cause or cardiovascular mortality or stroke. These effects were imprecise in patients with diabetes, but there was no significant interaction between diabetes status and the intervention effect. For secondary prevention, statins reduced all-cause mortality (RR: 0.80, 95% CI: 0.73 to 0.89), cardiovascular mortality (RR: 0.68, 95% CI: 0.58 to 0.79), CAD (RR: 0.68, 95% CI: 0.61 to 0.77), MI (RR: 0.68, 95% CI: 0.59 to 0.79), and revascularization (RR: 0.68, 95% CI: 0.61 to 0.77). Intensive (vs less-intensive) statin therapy reduced the risk of CAD and heart failure. Niacin did not reduce the risk of revascularization, and fibrates did not reduce the risk of stroke, cardiovascular mortality, or CAD. CONCLUSION High-certainty evidence supports statin use for secondary prevention in older individuals. Evidence for primary prevention is less certain. Data in older individuals with diabetes are limited; however, no empirical evidence has shown a significant difference based on diabetes status.
Collapse
Affiliation(s)
- Oscar J Ponce
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
- Unidad de Conocimiento y Evidencia (CONEVID), Universidad Peruana Cayetano Heredia, Lima, Peru
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Laura Larrea-Mantilla
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | - Bianca Hemmingsen
- Department of Internal Medicine, Herlev University Hospital, Herlev, Denmark
| | - Valentina Serrano
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Department of Nutrition, Diabetes and Metabolism, Escuela de Medicina, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Rene Rodriguez-Gutierrez
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José E. Gonzalez," Plataforma INVEST-KER Mexico, Monterrey, Nuevo León, México
| | - Gabriela Spencer-Bonilla
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
| | - Neri Alvarez-Villalobos
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
- Universidad Autonoma de Nuevo Leon, Hospital Universitario "Dr. José E. Gonzalez," Plataforma INVEST-KER Mexico, Monterrey, Nuevo León, México
| | - Khaled Benkhadra
- Department of Internal Medicine, School of Medicine, Wayne State University, Detroit, Michigan
| | - Abdullah Haddad
- Department of Medicine, Saint Clair Memorial Hospital, Pittsburgh, Pennsylvania
| | | | - Larry J Prokop
- Evidence-Based Practice Center, Mayo Clinic, Rochester, Minnesota
| | - Juan P Brito
- Knowledge and Evaluation Research Unit, Division of Endocrinology, Diabetes, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|
33
|
Bertolotti M, Lancellotti G, Mussi C. Management of high cholesterol levels in older people. Geriatr Gerontol Int 2019; 19:375-383. [PMID: 30900369 DOI: 10.1111/ggi.13647] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 01/23/2019] [Accepted: 01/31/2019] [Indexed: 12/22/2022]
Abstract
The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol-lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug-related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid-lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375-383.
Collapse
Affiliation(s)
- Marco Bertolotti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
| | - Giulia Lancellotti
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
| | - Chiara Mussi
- Department of Biomedical, Metabolic and Neural Sciences, Center for Gerontological Evaluation and Research, University of Modena and Reggio Emilia, Modena, Italy.,Division of Geriatric Medicine, City Hospital Sant'Agostino-Estense of Modena, Modena, Italy
| |
Collapse
|
34
|
Use of statins in the elderly according to age and indication-a cross-sectional population-based register study. Eur J Clin Pharmacol 2019; 75:959-967. [PMID: 30826850 DOI: 10.1007/s00228-019-02645-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 02/04/2019] [Indexed: 12/13/2022]
Abstract
PURPOSE To investigate statin use in the elderly by age (≥ 80 vs. 65-79 years) in relation to established indications. METHODS A population-based cohort, including data from four registers, encompassing inhabitants in Region Västra Götaland, Sweden, was used. Statin users were defined as those filling statin prescriptions ≥ 75% of the year 2010. Primary care and hospital diagnoses in 2005-2010 regarding ischemic heart disease, stroke, transient ischemic attacks, and diabetes were considered established indications. RESULTS A total of 278,205 individuals were analyzed. In individuals aged ≥ 80 and 65-79 years (n = 81,885 and n = 196,320, respectively), 17% (95% confidence interval 17%; 18%) and 23% (23%; 23%) respectively, were statin users. Among the statin users, 74% (73%; 74%) of those aged ≥ 80 and 60% (59%; 60%) of those aged 65-79 years had ≥ 1 established indication. Conversely, of those with ≥ 1 established indication, 30% (30%; 31%) and 53% (52%; 53%) were on statins in the respective age groups. Logistic regression revealed that age, nursing home residence, and multi-dose drug dispensing were the most prominent negative predictors for statin use; adjusted odds ratios (95% confidence interval): 0.45 (0.44; 0.46), 0.39 (0.36; 0.42), and 0.47 (0.44; 0.49), respectively. CONCLUSIONS In the oldest old (≥ 80 years), statin users were fewer and had more often an established indication, suggesting that physicians extrapolate scientific evidence for beneficial effects in younger age groups to the oldest, but require a more solid ground for treatment. As the oldest old, nursing home residents, and those with multi-dose drug-dispensing were statin users to a lesser extent, physicians may often refrain from treatment in those with lower life expectancy, either due to age or to severely reduced health status. In both age groups, our results however also indicate some over- as well as undertreatment.
Collapse
|
35
|
Ruscica M, Banach M, Sahebkar A, Corsini A, Sirtori CR. ETC-1002 (Bempedoic acid) for the management of hyperlipidemia: from preclinical studies to phase 3 trials. Expert Opin Pharmacother 2019; 20:791-803. [PMID: 30810432 DOI: 10.1080/14656566.2019.1583209] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Tolerability problems in treating hypercholesterolemic patients undergoing statin treatment are of growing concern to physicians and patients, thus underlining the need for an agent with a similar mechanism but minimal side effects. A drug with a somewhat similar mechanism to statins but free of muscular side effects is ETC-1002 (bempedoic acid). It inhibits cholesterol biosynthesis at a step preceding HMG-CoA reductase, i.e. ATP citrate lyase (ACLY). A prodrug, ETC-1002 is converted to the active agent only in liver, not in skeletal muscle, and this may prevent any myotoxic activity. Area covered: The mechanism of ETC-1002 activity is described in detail, considering that ACLY inhibition markedly attenuated atherosclerosis in animal models. Clinical studies are also reported. Expert opinion: Present day LDL-C lowering treatments lead to significant reductions of cardiovascular (CV) events but, at times, the need to interrupt statin treatment appears to be dangerous due to a rapid rise in CV risk. The excellent tolerability of ETC-1002 makes it a useful alternative, either alone or as an adjunct to ezetimibe, for patients with statin intolerance needing to achieve significant CV risk reduction. ETC-1002 is also associated with a marked fall in high-sensitivity C-reactive protein.
Collapse
Affiliation(s)
- M Ruscica
- a Dipartimento di Scienze Farmacologiche e Biomolecolari , Università degli Studi di Milano , Milan , Italy
| | - M Banach
- b Department of Hypertension , WAM University Hospital in Lodz, Medical University of Lodz , Lodz , Poland.,c Polish Mother's Memorial Hospital Research Institute (PMMHRI), Lodz, Poland; Cardiovascular Research Centre , University of Zielona Gora , Zielona Gora , Poland
| | - A Sahebkar
- d Biotechnology Research Center, Pharmaceutical Technology Institute , Mashhad University of Medical Sciences , Mashhad , Iran.,e Neurogenic Inflammation Research Center , Mashhad University of Medical Sciences , Mashhad , Iran.,f School of Pharmacy , Mashhad University of Medical Sciences , Mashhad , Iran
| | - A Corsini
- a Dipartimento di Scienze Farmacologiche e Biomolecolari , Università degli Studi di Milano , Milan , Italy.,g Multimedica IRCCS , Milan , Italy
| | - C R Sirtori
- h Dyslipidemia Center , A.S.S.T. Grande Ospedale Metropolitano Niguarda , Milan , Italy
| |
Collapse
|
36
|
Burton JK, Papworth R, Haig C, McCowan C, Ford I, Stott DJ, Quinn TJ. Statin Use is Not Associated with Future Long-Term Care Admission: Extended Follow-Up of Two Randomised Controlled Trials. Drugs Aging 2019; 35:657-663. [PMID: 29916140 DOI: 10.1007/s40266-018-0560-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Statins have been associated with later life, long-term care admission in observational studies. However, by preventing vascular events, statins may also prevent or delay admission. We wished to determine statin and long-term care admission associations in a randomised controlled trial context, and describe associations between long-term care admission and other clinical and demographic factors. METHODS We used extended follow-up of two randomised trial populations, using national data to assign the long-term care admission outcome, and included individuals screened or recruited to two large randomised trials of pravastatin 40 mg daily-the West of Scotland Coronary Prevention Study (WOSCOPS) and the pravastatin in elderly individuals at risk of vascular disease (PROSPER) study. We described univariable and multivariable analyses of potential predictors of long-term care admission with corresponding survival curves of incident long-term care admission and analyses adjusted for competing risk. RESULTS In total 11,015 (10%) of the trial participants were admitted to long-term care. There was no difference between participants in the statin or placebo arms of either trial in regard to admissions to long-term care. On multivariable analyses, independent associations with incident long-term care admission in the PROSPER trial were age (hazard ratio [HR] 1.06 per year, 95% confidence interval [CI] 1.03-1.09) and male sex (HR 0.72, 95% CI 0.53-0.99). In the WOSCOPS, age (HR 1.12 per year, 95% CI 1.10-1.13) and increasing social deprivation (HR 1.05, 95% CI 1.03-1.08) were associated with incident long-term care admission. CONCLUSION We did not demonstrate an association between historical statin use and future long-term care admission. The strongest associations with incident long-term care admission were non-modifiable factors of age, sex and socioeconomic deprivation.
Collapse
Affiliation(s)
- Jennifer K Burton
- Alzheimer Scotland Dementia Research Centre and Centre for Cognitive Ageing and Cognitive Epidemiology, University of Edinburgh, Edinburgh, Scotland, UK
| | - Richard Papworth
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Caroline Haig
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Colin McCowan
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - Ian Ford
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, Scotland, UK
| | - David J Stott
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, Glasgow Royal Infirmary, University of Glasgow, Room 2.44, New Lister Building Campus, Glasgow, G4 0SF, Scotland, UK
| | - Terence J Quinn
- Academic Geriatric Medicine, Institute of Cardiovascular and Medical Sciences, Glasgow Royal Infirmary, University of Glasgow, Room 2.44, New Lister Building Campus, Glasgow, G4 0SF, Scotland, UK.
| |
Collapse
|
37
|
Ruscica M, Ferri N, Macchi C, Corsini A, Sirtori CR. Lipid lowering drugs and inflammatory changes: an impact on cardiovascular outcomes? Ann Med 2018; 50:461-484. [PMID: 29976096 DOI: 10.1080/07853890.2018.1498118] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Inflammatory changes are responsible for maintenance of the atherosclerotic process and may underlie some of the most feared vascular complications. Among the multiple mechanisms of inflammation, the arterial deposition of lipids and particularly of cholesterol crystals is the one responsible for the activation of inflammasome NLRP3, followed by the rise of circulating markers, mainly C-reactive protein (CRP). Elevation of lipoproteins, LDL but also VLDL and remnants, associates with increased inflammatory changes and coronary risk. Lipid lowering medications can reduce cholesterolemia and CRP: patients with elevations of both are at greatest cardiovascular (CV) risk and receive maximum benefit from therapy. Evaluation of the major drug series indicates that statins exert the largest LDL and CRP reduction, accompanied by reduced CV events. Other drugs, mainly active on the triglyceride/HDL axis, for example, PPAR agonists, may improve CRP and the lipid pattern, especially in patients with metabolic syndrome. PCSK9 antagonists, the newest most potent medications, do not induce significant changes in inflammatory markers, but patients with the highest baseline CRP levels show the best CV risk reduction. Parallel evaluation of lipids and inflammatory changes clearly indicates a significant link, both guiding to patients at highest risk, and to the best pharmacological approach. Key messages Lipid lowering agents with "pleiotropic" effects provide a more effective approach to CV prevention In CANTOS study, patients achieving on-treatment hsCRP concentrations ≤2 mg/L had a higher benefit in terms of reduction in major CV events The anti-inflammatory activity of PCSK9 antagonists appears to be of a minimal extent.
Collapse
Affiliation(s)
- M Ruscica
- a Dipartimento di Scienze Farmacologiche e Biomolecolari , Università degli Studi di Milano , Milan , Italy
| | - N Ferri
- b Dipartimento di Scienze del Farmaco , Università degli Studi di Padova , Padova , Italy
| | - C Macchi
- a Dipartimento di Scienze Farmacologiche e Biomolecolari , Università degli Studi di Milano , Milan , Italy
| | - A Corsini
- a Dipartimento di Scienze Farmacologiche e Biomolecolari , Università degli Studi di Milano , Milan , Italy
| | - C R Sirtori
- c Centro Dislipidemie , A.S.S.T. Grande Ospedale Metropolitano Niguarda , Milan , Italy
| |
Collapse
|
38
|
Stavropoulos K, Imprialos K, Doumas M, Athyros VG. What is the role of statins in the elderly population? Expert Rev Clin Pharmacol 2018; 11:329-331. [DOI: 10.1080/17512433.2018.1439737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Konstantinos Stavropoulos
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Konstantinos Imprialos
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| | - Michael Doumas
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
- Department of Internal Medicine, George Washington University, Washington, DC, USA
| | - Vasilios G. Athyros
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippokration Hospital, Thessaloniki, Greece
| |
Collapse
|
39
|
The Burden of Statin Therapy based on ACC/AHA and NCEP ATP-III Guidelines: An Iranian Survey of Non-Communicable Diseases Risk Factors. Sci Rep 2018; 8:4928. [PMID: 29563602 PMCID: PMC5862872 DOI: 10.1038/s41598-018-23364-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Accepted: 03/01/2018] [Indexed: 02/06/2023] Open
Abstract
To compare the burden of statin therapy according to the Third Adult Treatment Panel (ATP-III) and the American College of Cardiology/American Heart Association (ACC/AHA) guidelines the Survey of Risk Factors of Non-Communicable Disease (SuRFNCD)−2011of Iran was used. A survey analysis associated with sex and age categorization was run. Of total 3496 persons (1322 men) aged 40–70 years, based on the ACC/AHA guidelines, about 46.5% were eligible to receive moderate- to high-intensity statin therapy. Based on the ATP-III guidelines, 17.0% were considered as needing statin drugs. Among adults aged <60 years, the proportion of those who were eligible for statin therapy was higher (38.3%) according to the ACC/AHA guidelines compared to the ATP-III guidelines (15.2%), a difference more prominent in adults aged ≥60 years (85.2% versus 25.0%). Agreement between the two guidelines was low (kappa: 0.32). Compared to the ATP-III guidelines, the ACC/AHA guidelines increase the number of adults eligible for statin therapy in an Iraninan population from 2.5 million to 7.0 million people according to the 2011 census, specifically in those aged ≥ 60 years, a finding in agreement with those of studies from different countries.
Collapse
|