1
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Zhang J, Wang X, Tian W, Wang T, Jia J, Lai R, Wang T, Zhang Z, Song L, Ju J, Xu H. The effect of various types and doses of statins on C-reactive protein levels in patients with dyslipidemia or coronary heart disease: A systematic review and network meta-analysis. Front Cardiovasc Med 2022; 9:936817. [PMID: 35966518 PMCID: PMC9363636 DOI: 10.3389/fcvm.2022.936817] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 07/04/2022] [Indexed: 11/25/2022] Open
Abstract
Objective The objective of this study was to measure the efficacy of various types and dosages of statins on C-reactive protein (CRP) levels in patients with dyslipidemia or coronary heart disease. Methods Randomized controlled trials were searched from PubMed, Embase, Cochrane Library, OpenGray, and ClinicalTrials.gov. We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines for data extraction and synthesis. The pairwise meta-analysis compared statins and controls using a random-effects model, and a network meta-analysis compared the types and dosages of statins using the Bayesian random-effects model. The PROSPERO registration number is CRD42021242067. Results The study included 37 randomized controlled trials with 17,410 participants and 20 interventions. According to the pairwise meta-analysis, statins significantly decreased CRP levels compared to controls (weighted mean difference [WMD] = −0.97, 95% confidence interval [CI] [−1.31, −0.64], P < 0.0001). In the network meta-analysis, simvastatin 40 mg/day appeared to be the best strategy for lowering CRP (Rank P = 0.18, WMD = −4.07, 95% CI = [−6.52, −1.77]). The same was true for the high-sensitivity CRP, non-acute coronary syndrome (ACS), <12 months duration, and clear measurement subgroups. In the CRP subgroup (rank P = 0.79, WMD = −1.23, 95% CI = [−2.48, −0.08]) and ≥12-month duration subgroup (Rank P = 0.40, WMD = −2.13, 95% CI = [−4.24, −0.13]), atorvastatin 80 mg/day was most likely to be the best. There were no significant differences in the dyslipidemia and ACS subgroups (P > 0.05). Node-splitting analysis showed no significant inconsistency (P > 0.05), except for the coronary heart disease subgroup. Conclusion Statins reduced serum CRP levels in patients with dyslipidemia or coronary heart disease. Simvastatin 40 mg/day might be the most effective therapy, and atorvastatin 80 mg/day showed the best long-term effect. This study provides a reference for choosing statin therapy based on LDL-C and CRP levels.
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Affiliation(s)
- Jie Zhang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Xinyi Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Wende Tian
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tongxin Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jundi Jia
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Runmin Lai
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, China Academy of Chinese Medical Sciences, Beijing, China
| | - Tong Wang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Zihao Zhang
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Luxia Song
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Graduate School, Beijing University of Chinese Medicine, Beijing, China
| | - Jianqing Ju
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- *Correspondence: Jianqing Ju
| | - Hao Xu
- National Clinical Research Center for Chinese Medicine Cardiology, Xiyuan Hospital, China Academy of Chinese Medical Sciences, Beijing, China
- Hao Xu
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2
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Affiliation(s)
- Albert Youngwoo Jang
- Division of Cardiovascular Disease, Gachon University Gil Hospital and Gachon Cardiovascular Research Institute
| | - Soo Lim
- Department of Internal Medicine, Seoul National University College of Medicine and Seoul National University Bundang Hospital
| | - Sang-Ho Jo
- Cardiovascular Center, Hallym University Sacred Heart Hospital
| | - Seung Hwan Han
- Division of Cardiovascular Disease, Gachon University Gil Hospital and Gachon Cardiovascular Research Institute
| | - Kwang Kon Koh
- Division of Cardiovascular Disease, Gachon University Gil Hospital and Gachon Cardiovascular Research Institute
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3
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Wang KW, Liang CL, Yeh LR, Liu KY, Chen CC, Chen JS, Chen HJ, Wang HK. Simvastatin-Ezetimibe enhances growth factor expression and attenuates neuron loss in the hippocampus in a model of intracerebral hemorrhage. Fundam Clin Pharmacol 2021; 35:634-644. [PMID: 33278834 PMCID: PMC8451876 DOI: 10.1111/fcp.12635] [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: 08/07/2020] [Revised: 11/26/2020] [Accepted: 12/02/2020] [Indexed: 01/02/2023]
Abstract
Intracerebral hemorrhage (ICH) is a common and severe neurological disorder associated with high morbidity and mortality rates. Despite extensive research into its pathology, there are no clinically approved neuroprotective treatments for ICH. Increasing evidence has revealed that inflammatory responses mediate the pathophysiological processes of brain injury following ICH. Experimental ICH was induced by direct infusion of 100 μL fresh (non‐heparinized) autologous whole blood into the right basal ganglia of Sprague–Dawley rats at a constant rate (10 μL/min). The simvastatin group was administered simvastatin (15 mg/kg) and the combination therapy group was administered simvastatin (10 mg/kg) and ezetimibe (10 mg/kg). Magnetic resonance imaging (MRI), the forelimb use asymmetry test, the Morris water maze test, and two biomarkers were used to evaluate the effect of simvastatin and combination therapy. MRI imaging revealed that combination therapy resulted in significantly reduced perihematomal edema. Biomarker analyses revealed that both treatments led to significantly reduced endothelial inflammatory responses. The forelimb use asymmetry test revealed that both treatment groups had significantly improved neurological outcomes. The Morris water maze test revealed improved neurological function after combined therapy, which also led to less neuronal loss in the hippocampal CA1 region. In conclusion, simvastatin–ezetimibe combination therapy can improve neurological function, attenuate the endothelial inflammatory response and lead to less neuronal loss in the hippocampal CA1 region in a rat model of ICH.
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Affiliation(s)
- Kuo-Wei Wang
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Neurosurgery, E-Da Cancer Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Cheng-Loong Liang
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Neurosurgery, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Lee-Ren Yeh
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Radiology, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Kuo-Ying Liu
- Department of Radiology, E-Da Cancer Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Chao-Chi Chen
- Department of Radiology, E-Da Cancer Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Jui-Sheng Chen
- Department of Neurosurgery, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Han-Jung Chen
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Neurosurgery, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
| | - Hao-Kuang Wang
- I-Shou University School of Medicine, No. 8, Yi-Da road, Kaohsiung, 824, Taiwan.,Department of Neurosurgery, E-DA Hospital, No. 1, Yi-Da road, Kaohsiung, 824, Taiwan
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4
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Hyun MH, Jang JW, Choi BG, Na JO, Choi CU, Kim JW, Kim EJ, Rha S, Park CG, Lee E, Seo HS. Risk of insulin resistance with statin therapy in individuals without dyslipidemia: A propensity‐matched analysis in a registry population. Clin Exp Pharmacol Physiol 2020; 47:947-954. [DOI: 10.1111/1440-1681.13272] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2019] [Revised: 01/15/2020] [Accepted: 01/28/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Myung Han Hyun
- Department of Internal Medicine Korea University Guro Hospital Seoul Korea
| | - Jae Won Jang
- Department of Biostatistics Korea University College of Medicine Seoul Korea
| | - Byoung Geol Choi
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul Korea
| | - Jin Oh Na
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul Korea
| | - Cheol Ung Choi
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul Korea
| | - Jin Won Kim
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul Korea
| | - Eung Ju Kim
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul Korea
| | - Seung‐Woon Rha
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul Korea
| | - Chang Gyu Park
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul Korea
| | - Eunmi Lee
- Division of Cardiology Department of Internal Medicine Wonkwang University Sanbon Hospital Gyeonggi‐do Korea
| | - Hong Seog Seo
- Division of Cardiology Department of Internal Medicine Korea University Guro Hospital Seoul Korea
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5
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Affiliation(s)
- Kyoung Im Cho
- Department of Cardiology, Kosin University Gospel Hospital
| | - Jongwook Yu
- Department of Cardiovascular Medicine, Heart Center, Gachon University Gil Medical Center
| | - Toshio Hayashi
- School of Health Sciences, Nagoya University Graduate School of Medicine
| | - Seung Hwan Han
- Department of Cardiovascular Medicine, Heart Center, Gachon University Gil Medical Center
- Gachon Cardiovascular Research Institute
| | - Kwang Kon Koh
- Department of Cardiovascular Medicine, Heart Center, Gachon University Gil Medical Center
- Gachon Cardiovascular Research Institute
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6
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Tabrizi R, Tamtaji OR, Mirhosseini N, Lankarani KB, Akbari M, Dadgostar E, Borhani-Haghighi A, Peymani P, Ahmadizar F, Asemi Z. The effects of statin use on inflammatory markers among patients with metabolic syndrome and related disorders: A systematic review and meta-analysis of randomized controlled trials. Pharmacol Res 2019; 141:85-103. [PMID: 30576798 DOI: 10.1016/j.phrs.2018.12.010] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Revised: 10/24/2018] [Accepted: 12/12/2018] [Indexed: 02/08/2023]
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7
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Koh KK. Letter by Koh Regarding Article, "Benefit of Adding Ezetimibe to Statin Therapy on Cardiovascular Outcomes and Safety in Patients With Versus Without Diabetes Mellitus: Results From IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)". Circulation 2018; 138:1914-1915. [PMID: 30354661 DOI: 10.1161/circulationaha.118.035512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kwang Kon Koh
- Department of Cardiovascular Medicine, Heart Center, Gachon University, Incheon, Korea. Gil Medical Center, Incheon, Korea. Gachon Cardiovascular Research Institute, Incheon, Korea
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8
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Lee YH, Hong N, Lee CJ, Park SH, Lee BW, Cha BS, Kang ES. Differential association of ezetimibe-simvastatin combination with major adverse cardiovascular events in patients with or without diabetes: a retrospective propensity score-matched cohort study. Sci Rep 2018; 8:11925. [PMID: 30093717 PMCID: PMC6085319 DOI: 10.1038/s41598-018-30409-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 07/30/2018] [Indexed: 12/15/2022] Open
Abstract
Clinical trials suggested that the benefits of ezetimibe-statin combination therapy on major adverse cardiovascular events (MACE) might be greater in patients with diabetes. We aimed to investigate the differential association of ezetimibe-statin combination with incident MACE by presence of diabetes. In this retrospective cohort study, subjects treated with simvastatin 20 mg plus ezetimibe 10 mg (S + E) or simvastatin 20 mg alone (S) between 2005 and 2015 were 1:1 matched using propensity score as stratified by diabetes. Primary outcome was newly-developed MACE composed of cardiovascular death, ACS, coronary revascularization, or non-hemorrhagic stroke. During 5,077 and 12,439 person-years, the incidence rates of MACE were 24.9, 20.1, 35.3, and 22.8/1000 person-years among no diabetes S, no diabetes S + E, diabetes S, and diabetes S + E, respectively. Relative to no diabetes S, adjusted HR (aHR) for MACE in diabetes S was 1.23 (p = 0.086), whereas S + E was associated with a lower risk of MACE in both non-diabetic patients (aHR 0.76, p = 0.047) and diabetic patients (aHR 0.60, p = 0.007) with significant difference (relative excess risk due to interaction = -0.39, p = 0.044). In conclusion, reduction of MACE risk associated with ezetimibe plus simvastatin therapy relative to simvastatin alone was greater in patients with diabetes than in patients without diabetes.
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Affiliation(s)
- Yong-Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
| | - Namki Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
- Graduate School, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Cardiovascular Research Institute and Cardiovascular Genome Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Sung Ha Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
- Cardiovascular Research Institute and Cardiovascular Genome Center, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Byung-Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
| | - Bong-Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Endocrine Research Institute, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea.
- Institute of Endocrine Research, Yonsei University College of Medicine, 03722, Seoul, Republic of Korea.
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9
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Koh KK. Letter by Koh Regarding Article, "Prevention of Stroke With the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)". Circulation 2018; 137:2660-2661. [PMID: 29891624 DOI: 10.1161/circulationaha.118.033569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Kwang Kon Koh
- Division of Cardiology, Gachon University, Gil Hospital, Incheon, Korea
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10
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Del Pinto R, Ferri C, Borghi C. Letter by Del Pinto et al Regarding Article, "Prevention of Stroke With the Addition of Ezetimibe to Statin Therapy in Patients With Acute Coronary Syndrome in IMPROVE-IT (Improved Reduction of Outcomes: Vytorin Efficacy International Trial)". Circulation 2018; 137:2654-2655. [PMID: 29891621 DOI: 10.1161/circulationaha.117.032448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Rita Del Pinto
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Italy (R.D.P., C.F.).,Division of Internal Medicine & Nephrology, San Salvatore Hospital, L'Aquila, Italy (R.D.P., C.F.).,The Italian Society of Hypertension, Milan, Italy (R.D.P., C.F., C.B.)
| | - Claudio Ferri
- Department of Life, Health, and Environmental Sciences, University of L'Aquila, Italy (R.D.P., C.F.).,Division of Internal Medicine & Nephrology, San Salvatore Hospital, L'Aquila, Italy (R.D.P., C.F.).,The Italian Society of Hypertension, Milan, Italy (R.D.P., C.F., C.B.)
| | - Claudio Borghi
- The Italian Society of Hypertension, Milan, Italy (R.D.P., C.F., C.B.).,Department of Medical and Surgical Sciences, Division of Internal Medicine, Alma Mater Studiorum University of Bologna, Policlinico S. Orsola-Malpighi, Italy (C.B.)
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11
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Razali NR, Huri HZ, Ibrahim L, Vethakkan SR, Abdullah BM. Glycemic effects of simvastatin: Where do we stand? BRAZ J PHARM SCI 2018. [DOI: 10.1590/s2175-97902018000117192] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Affiliation(s)
| | - Hasniza Zaman Huri
- University of Malaya, Malaysia; University Malaya Medical Centre, Malaysia
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12
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Hong N, Lee YH, Tsujita K, Gonzalez JA, Kramer CM, Kovarnik T, Kouvelos GN, Suzuki H, Han K, Lee CJ, Park SH, Lee BW, Cha BS, Kang ES. Comparison of the Effects of Ezetimibe-Statin Combination Therapy on Major Adverse Cardiovascular Events in Patients with and without Diabetes: A Meta-Analysis. Endocrinol Metab (Seoul) 2018; 33:219-227. [PMID: 29766679 PMCID: PMC6021322 DOI: 10.3803/enm.2018.33.2.219] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2017] [Revised: 02/03/2018] [Accepted: 02/22/2018] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Ezetimibe-statin combination therapy has been found to reduce low density lipoprotein cholesterol levels and the risk of major adverse cardiovascular events (MACEs) in large trials. We sought to examine the differential effect of ezetimibe on MACEs when added to statins according to the presence of diabetes. METHODS Randomized clinical trials with a sample size of at least 50 participants and at least 24 weeks of follow-up that compared ezetimibe-statin combination therapy with a statin- or placebo-controlled arm and reported at least one MACE, stratified by diabetes status, were included in the meta-analysis and meta-regression. RESULTS A total of seven trials with 28,191 enrolled patients (mean age, 63.6 years; 75.1% men; 7,298 with diabetes [25.9%]; mean follow-up, 5 years) were analysed. MACEs stratified by diabetes were obtained from the published data (two trials) or through direct contact (five trials). No significant heterogeneity was observed among studies (I²=14.7%, P=0.293). Ezetimibe was associated with a greater reduction of MACE risk in subjects with diabetes than in those without diabetes (pooled relative risk, 0.84 vs. 0.93; P(heterogeneity)=0.012). In the meta-regression analysis, the presence of diabetes was associated with a greater reduction of MACE risk when ezetimibe was added to statins (β=0.87, P=0.038). CONCLUSION Ezetimibe-statin combination therapy was associated with greater cardiovascular benefits in patients with diabetes than in those without diabetes. Our findings suggest that ezetimibe-statin combination therapy might be a useful strategy in patients with diabetes at a residual risk of MACEs.
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Affiliation(s)
- Namki Hong
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Graduate School, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Ho Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Kenichi Tsujita
- Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan
| | - Jorge A Gonzalez
- Department of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Christopher M Kramer
- Department of Medicine (Cardiology) and Radiology, University of Virginia Health System, Charlottesville, VA, USA
| | - Tomas Kovarnik
- Second Department of Medicine, Department of Cardiovascular Medicine, First Faculty of Medicine, Charles University in Prague and General University Hospital in Prague, Prague, Czech Republic
| | - George N Kouvelos
- Vascular Surgery Unit, Department of Surgery, University of Ioannina, Ioannina, Greece
| | | | - Kyungdo Han
- Department of Biostatistics, The Catholic University of Korea, Seoul, Korea
| | - Chan Joo Lee
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute and Cardiovascular Genome Center, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Ha Park
- Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Cardiovascular Research Institute and Cardiovascular Genome Center, Yonsei University College of Medicine, Seoul, Korea
| | - Byung Wan Lee
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Bong Soo Cha
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Seok Kang
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea
- Institute of Endocrine Research, Yonsei University College of Medicine, Seoul, Korea.
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13
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Role of dual lipid-lowering therapy in coronary atherosclerosis regression: Evidence from recent studies. Atherosclerosis 2018; 269:219-228. [PMID: 29407597 DOI: 10.1016/j.atherosclerosis.2018.01.012] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 12/21/2017] [Accepted: 01/11/2018] [Indexed: 11/21/2022]
Abstract
Despite recent therapeutic advances, there is an unmet need in cardiovascular disease prevention. Clinical trials and meta-analyses have established that LDL-C lowering, particularly by statin therapy, reduces the progression of coronary atherosclerosis and the risk of coronary events. Insufficient LDL-C reduction and high residual risk in a significant proportion of statin-treated patients signify that additional therapies are required to deliver more effective coronary care. Pharmacological inhibition of cholesterol absorption (with ezetimibe) and PCSK9 activity (with evolocumab or alirocumab) provides potentially useful approaches for the therapeutic modulation of LDL-C metabolism in statin-treated patients. In recent trials, combination strategies involving a statin and non-statin agent (ezetimibe or evolocumab) have been shown to promote coronary atherosclerosis regression and improve cardiovascular outcomes in patients with moderate-to-high cardiovascular risk. This review summarizes recent evidence on the effects of dual lipid-lowering therapy on coronary atherosclerosis.
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Guimarães ES, Cerda A, Dorea EL, Bernik MMS, Gusukuma MC, Pinto GA, Fajardo CM, Hirata MH, Hirata RDC. Effects of short-term add-on ezetimibe to statin treatment on expression of adipokines and inflammatory markers in diabetic and dyslipidemic patients. Cardiovasc Ther 2017; 35. [DOI: 10.1111/1755-5922.12307] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 09/14/2017] [Accepted: 09/18/2017] [Indexed: 01/05/2023] Open
Affiliation(s)
- Elizandra Silva Guimarães
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences; University of Sao Paulo; Sao Paulo Brazil
| | - Alvaro Cerda
- Center of Excellence in Translational Medicine, CETM-BIOREN, Department of Basic Sciences; Universidad de La Frontera; Temuco Chile
| | | | | | | | | | - Cristina Moreno Fajardo
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences; University of Sao Paulo; Sao Paulo Brazil
| | - Mario Hiroyuki Hirata
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences; University of Sao Paulo; Sao Paulo Brazil
| | - Rosario Dominguez Crespo Hirata
- Department of Clinical and Toxicological Analysis, School of Pharmaceutical Sciences; University of Sao Paulo; Sao Paulo Brazil
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Abstract
PURPOSE OF REVIEW Adiponectin is an adipokine with anti-inflammatory, antioxidant, antiatherogenic, pro-angiogenic, vasoprotective and insulin-sensitizing properties. Several factors may influence adiponectin levels, such as genetic polymorphisms, obesity / body fat distribution, diet and exercise as well as cardiovascular risk factors such as sleep deprivation and smoking as well as medications. Adiponectin has been proposed as a potential prognostic biomarker and a therapeutic target in patients with cardiometabolic diseases. RECENT FINDINGS This narrative review discusses the associations of adiponectin with obesity-related metabolic disorders (metabolic syndrome, nonalcoholic fatty liver disease, hyperuricaemia and type 2 diabetes mellitus). We also focus on the links between adiponectin and lipid disorders and with coronary heart disease and noncardiac vascular diseases (i.e. stroke, peripheral artery disease, carotid artery disease, atherosclerotic renal artery stenosis, abdominal aortic aneurysms and chronic kidney disease). Further, the effects of lifestyle interventions and drug therapy on adiponectin levels are briefly reviewed. SUMMARY Based on available data, adiponectin represents a multifaceted biomarker that may beneficially affect atherosclerosis, inflammation and insulin resistance pathways. However, there are conflicting results with regard to the associations between adiponectin levels and the prevalence and outcomes of cardiometabolic diseases. Further research on the potential clinical implications of adiponectin in the diagnosis and treatment of such diseases is needed.
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Affiliation(s)
- Niki Katsiki
- aSecond Department of Propaedeutic Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece bDivision of Endocrinology, Diabetes, and Metabolism, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA cDepartment of Clinical Biochemistry, Royal Free Hospital Campus, University College London Medical School, University College London (UCL), London, UK
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Koh KK, Sakuma I, Shimada K, Hayashi T, Quon MJ. Combining Potent Statin Therapy with Other Drugs to Optimize Simultaneous Cardiovascular and Metabolic Benefits while Minimizing Adverse Events. Korean Circ J 2017; 47:432-439. [PMID: 28765731 PMCID: PMC5537141 DOI: 10.4070/kcj.2016.0406] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2016] [Revised: 12/06/2016] [Accepted: 12/08/2016] [Indexed: 01/05/2023] Open
Abstract
Hypercholesterolemia and hypertension are among the most important risk factors for cardiovascular (CV) disease. They are also important contributors to metabolic diseases including diabetes that further increase CV risk. Updated guidelines emphasize targeted reduction of overall CV risks but do not explicitly incorporate potential adverse metabolic outcomes that also influence CV health. Hypercholesterolemia and hypertension have synergistic deleterious effects on interrelated insulin resistance and endothelial dysfunction. Dysregulation of the renin-angiotensin system is an important pathophysiological mechanism linking insulin resistance and endothelial dysfunction to atherogenesis. Statins are the reference standard treatment to prevent CV disease in patients with hypercholesterolemia. Statins work best for secondary CV prevention. Unfortunately, most statin therapies dose-dependently cause insulin resistance, increase new onset diabetes risk and exacerbate existing type 2 diabetes mellitus. Pravastatin is often too weak to achieve target low-density lipoprotein cholesterol levels despite having beneficial metabolic actions. Renin-angiotensin system inhibitors improve both endothelial dysfunction and insulin resistance in addition to controlling blood pressure. In this regard, combined statin-based and renin-angiotensin system (RAS) inhibitor therapies demonstrate additive/synergistic beneficial effects on endothelial dysfunction, insulin resistance, and other metabolic parameters in addition to lowering both cholesterol levels and blood pressure. This combined therapy simultaneously reduces CV events when compared to either drug type used as monotherapy. This is mediated by both separate and interrelated mechanisms. Therefore, statin-based therapy combined with RAS inhibitors is important for developing optimal management strategies in patients with hypertension, hypercholesterolemia, diabetes, metabolic syndrome, or obesity. This combined therapy can help prevent or treat CV disease while minimizing adverse metabolic consequences.
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Affiliation(s)
- Kwang Kon Koh
- Department of Cardiology, Gachon University Gil Medical Center, Incheon, Korea.,Gachon Cardiovascular Research Institute, Incheon, Korea
| | - Ichiro Sakuma
- Cardiovascular Medicine, Hokko Memorial Clinic, Health Sciences University of Hokkaido, Sapporo, Japan
| | - Kazunori Shimada
- Cardiovascular Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshio Hayashi
- Department of Geriatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Michael J Quon
- Department of Medicine, Division of Endocrinology, Diabetes and Nutrition, University of Maryland School of Medicine, Baltimore, USA
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Cost Effectiveness of Nonstatin-to-Statin Therapy. J Am Coll Cardiol 2017; 69:1995. [DOI: 10.1016/j.jacc.2016.12.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 12/13/2016] [Indexed: 11/20/2022]
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Chen W, Huang Z, Bi M, Xu X, Zhao N. Effects of simvastatin on serum adiponectin: a meta-analysis of randomized controlled trials. Lipids Health Dis 2017; 16:53. [PMID: 28288631 PMCID: PMC5347823 DOI: 10.1186/s12944-017-0439-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Accepted: 02/26/2017] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Effects of simvastatin on serum level of adiponectin, a protein conferring benefits in both cardiovascular and metabolic system, are not fully determined. METHODS A meta-analysis of randomized controlled trials (RCTs) was performed. Studies were identified by searching of Pubmed, Embase, and the Cochrane Library databases. Heterogeneity among the RCTs was determined by Cochrane's Q test and I2 statistics. Meta-analysis was performed with random-effect model or fixed-effect model according to the heterogeneity. Meta-regression and subgroup analyses were performed to analyze the source of heterogeneity. RESULTS Twelve RCTs with 16 comparisons and 1042 patients were included. Overall, serum adiponectin was not significantly affected by simvastatin (WMD: 0.42 μg/mL; 95% CI, -0.66-1.50 μg/mL). However, significant heterogeneity was detected (Cochrane's Q test: p < 0.01; I2 = 83%). Subsequent meta-regression analyses indicated that treatment duration was a significant determinant of the effects of simvastatin treatment on serum adiponectin (Coefficient 0.04, p = 0.03). Subgroup analyses demonstrated that simvastatin treatment was associated with increased adiponectin in studies with treatment duration of 12 weeks (WMD: 3.65 μg/mL; p < 0.01), but not in studies with treatment duration of ≤ 8 weeks (WMD: -0.20 μg/mL; p = 0.38). The different between the two stratums was significant (p < 0.01). CONCLUSIONS Treatment with simvastatin of 12 weeks may increase the serum level adiponectin in patients at risk for cardiovascular diseases, but not for the short term treatment of ≤ 8 weeks.
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Affiliation(s)
- Weibin Chen
- Department of Medicine, Southern Medical University, Guangzhou, China
| | - Zhuo Huang
- Department of Medicine, the Traditional Chinese Medicine Hospital of Xiamen, Xiamen, China
| | - Minghui Bi
- Department of Medicine, the Traditional Chinese Medicine Hospital of Xiamen, Xiamen, China
| | - Xuejing Xu
- Department of Medicine, the Traditional Chinese Medicine Hospital of Xiamen, Xiamen, China
| | - Nengjiang Zhao
- Department of Internal Medicine, the First Affiliated Hospital of Xiamen University, No. 55 Zhenhai Road, Simin District, Xiamen, 361003, China.
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Koh KK, Oh PC, Sakuma I, Lee Y, Han SH, Shin EK. Rosuvastatin dose-dependently improves flow-mediated dilation, but reduces adiponectin levels and insulin sensitivity in hypercholesterolemic patients. Int J Cardiol 2016; 223:488-493. [DOI: 10.1016/j.ijcard.2016.08.051] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Revised: 06/29/2016] [Accepted: 08/03/2016] [Indexed: 01/07/2023]
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Katsiki N, Mantzoros CS. Statins in relation to adiponectin: A significant association with clinical implications. Atherosclerosis 2016; 253:270-272. [PMID: 27567030 DOI: 10.1016/j.atherosclerosis.2016.08.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 08/14/2016] [Accepted: 08/18/2016] [Indexed: 02/07/2023]
Affiliation(s)
- Niki Katsiki
- Second Propedeutic Department of Internal Medicine, Medical School, Aristotle University of Thessaloniki, Hippocration Hospital, Thessaloniki, Greece.
| | - Christos S Mantzoros
- Boston VA Healthcare System and Division of Endocrinology, Diabetes and Metabolism, Department of Internal Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Kei AA, Filippatos TD, Elisaf MS. The safety of ezetimibe and simvastatin combination for the treatment of hypercholesterolemia. Expert Opin Drug Saf 2016; 15:559-69. [PMID: 26898906 DOI: 10.1517/14740338.2016.1157164] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
INTRODUCTION In the light of the most recent and stricter dyslipidemia treatment guidelines, the need for combination hypolipidemic therapy is increasing. Ezetimibe plus simvastatin is available as a fixed dose therapy offering an efficient hypolipidemic treatment choice. Based on the positive results of the IMProved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT) trial, the use of this drug combination is expected to increase in the next years. AREAS COVERED This review discusses the current evidence regarding the safety of ezetimibe/simvastatin combination. Current evidence regarding possible associated side effects (musculoskeletal, gastrointestinal, endocrine, hematological, renal, ophthalmologic, allergic, malignancy) and drug interactions of this combination is thoroughly discussed. EXPERT OPINION Ezetimibe and simvastatin treatment, either as a single pill or the combined use of the individual compounds, offers limited additional risk compared with simvastatin monotherapy and comprises a safe and efficient choice for dyslipidemia treatment in high-risk and diabetic patients.
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Affiliation(s)
- Anastazia A Kei
- a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
| | - Theodosios D Filippatos
- a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
| | - Moses S Elisaf
- a Department of Internal Medicine, School of Medicine , University of Ioannina , Ioannina , Greece
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Filippatos TD, Elisaf MS. Effects of ezetimibe/simvastatin combination on metabolic parameters. Int J Cardiol 2016; 202:273-4. [DOI: 10.1016/j.ijcard.2015.08.130] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2015] [Accepted: 08/14/2015] [Indexed: 12/01/2022]
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23
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Reply to comment on: Effects of ezetimibe/simvastatin combination on metabolic parameters by Prof. Moses S Elisaf. Int J Cardiol 2016; 202:154-5. [PMID: 26397402 DOI: 10.1016/j.ijcard.2015.08.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 08/20/2015] [Indexed: 11/21/2022]
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Bracht L, Caparroz-Assef SM, Bracht A, Bersani-Amado CA. Effect of the Combination of Ezetimibe and Simvastatin on Gluconeogenesis and Oxygen Consumption in the Rat Liver. Basic Clin Pharmacol Toxicol 2015; 118:415-20. [PMID: 26552039 DOI: 10.1111/bcpt.12522] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2015] [Accepted: 10/26/2015] [Indexed: 11/30/2022]
Abstract
The aim of this work was to investigate the effects of chronic treatment with the combination of ezetimibe and simvastatin on gluconeogenesis in rat liver. Rats were treated daily for 28 days with the combination of ezetimibe and simvastatin (10/40 mg/kg) by oral gavage. To measure gluconeogenesis and the associated pathways, isolated perfused rat liver was used. In addition, subcellular fractions, such as microsomes and mitochondria, were used for complementary measures of enzymatic activities. Treatment with the combination of simvastatin and ezetimibe resulted in a decrease in gluconeogenesis from pyruvate (-62%). Basal oxygen consumption of the treated animals was higher (+22%) than that of the control rats, but the resulting oxygen consumption that occurred after pyruvate infusion was 43% lower in animals treated with the combination of simvastatin and ezetimibe. Oxygen consumption in the livers from treated animals was completely inhibited by cyanide (electron transport chain inhibitor), but not by proadifen (cytochrome P450 inhibitor). Chronic treatment with ezetimibe/simvastatin decreased the activity of the key enzymes glucose-6-phosphatase and fructose-1,6-bisphosphatase by 59% and 45%, respectively, which is probably the major reason for the decreased gluconeogenesis seen in ezetimibe-/simvastatin-treated rats. It is also possible that part of the effect of this combination on gluconeogenesis and on the oxygen consumption is related to the impairment of mitochondrial energy transduction.
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Affiliation(s)
- Lívia Bracht
- Laboratory of Liver Metabolism, Department of Biochemistry, State University of Maringá, Maringá, Brazil
| | | | - Adelar Bracht
- Laboratory of Liver Metabolism, Department of Biochemistry, State University of Maringá, Maringá, Brazil
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Koh KK. Intriguing Off-Target Effects of Ezetimibe. J Am Coll Cardiol 2015; 66:2808. [PMID: 26700841 DOI: 10.1016/j.jacc.2015.08.1130] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 11/26/2022]
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