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Sakhuja S, Bittner VA, Brown TM, Farkouh ME, Levitan EB, Rosenson R, Safford MM, Muntner P, Chen L, Sun R, Noshad S, Dhalwani N, Woodward M, Colantonio LD. Recurrent atherosclerotic cardiovascular disease events preventable with guideline recommended lipid-lowering treatment following myocardial infarction. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.2374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
The 2018 American Heart Association/American College of Cardiology (AHA/ACC) cholesterol guideline provides recommendations for lipid-lowering therapy (LLT) including statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) to prevent recurrent atherosclerotic cardiovascular disease (ASCVD) events in adults with established ASCVD. Many adults with ASCVD who are recommended to take statins, ezetimibe and/or PCSK9i do not receive these medications.
Purpose
To estimate the number of recurrent ASCVD events potentially prevented by population-wide use of guideline recommended LLT following a myocardial infarction (MI).
Methods
We simulated the population-wide impact of receipt of 2018 AHA/ACC cholesterol guideline recommended LLT over 3 and 5 years among US adults with government health insurance through Medicare or commercial health insurance following hospital discharge for MI. We used data from patients with an MI hospitalization in 2018–2019 to estimate the percentage receiving guideline recommended LLT defined by having the medications available to take in the 30 days after their discharge date. We used data from patients with an MI hospitalization in 2013–2016 to estimate the 3 and 5-year cumulative incidence of recurrent ASCVD events (i.e., MI, coronary revascularization or ischemic stroke). The reduction in ASCVD events associated with guideline recommended LLT was estimated from a meta-analysis by the Cholesterol-Lowering Treatment Trialists Collaboration. We conducted a sensitivity analysis estimating the number and percentage of ASCVD events prevented if LLT recommendations from the 2019 European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) cholesterol guideline were followed. We repeated all analyses with recurrent coronary heart disease (i.e., MI or coronary revascularization) and ischemic stroke events as separate outcomes.
Results
Among 279,395 adults with an MI hospitalization in 2018–2019 (mean age 75 years, 54% men, mean low-density lipoprotein cholesterol 92 mg/dL), 27% were receiving guideline recommended LLT. With current lipid-lowering medication use, we estimated that 70,698 (95% CI: 70,311–71,077) and 89,255 (95% CI: 88,841–89,730) ASCVD events would occur in 3 and 5 years, respectively, after MI hospital discharge (Table, top panel). If all patients were to receive 2018 AHA/ACC guideline recommended LLT, the number of ASCVD events was estimated to be reduced by 21.6%, representing 15,264 (95% CI: 14,451–16,679) events prevented over 3 years and 19,271 (95% CI: 18,245–21,055) events prevented over 5 years. A higher number of recurrent ASCVD events were estimated to be averted following the LLT recommendations of the 2019 ESC/EAS cholesterol guideline (Table, bottom panel).
Conclusions
Population-wide implementation of guideline recommended LLT in adults with an MI hospitalization could prevent a substantial number of recurrent ASCVD events.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Amgen Inc.
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Affiliation(s)
- S Sakhuja
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - V A Bittner
- University of Alabama Birmingham, Department of Medicine, Division of Cardiovascular Disease , Birmingham , United States of America
| | - T M Brown
- University of Alabama Birmingham, Department of Medicine, Division of Cardiovascular Disease , Birmingham , United States of America
| | | | - E B Levitan
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - R Rosenson
- Icahn School of Medicine at Mount Sinai, Mount Sinai Heart , New York , United States of America
| | - M M Safford
- Weill Cornell Medicine , New York , United States of America
| | - P Muntner
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - L Chen
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - R Sun
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
| | - S Noshad
- Amgen Inc. , Thousand Oaks , United States of America
| | - N Dhalwani
- Amgen Inc. , Thousand Oaks , United States of America
| | - M Woodward
- Imperial College London, The George Institute for Global Health , London , United Kingdom
| | - L D Colantonio
- University of Alabama Birmingham, School of Public Health , Birmingham , United States of America
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2
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Goodman S, Steg PG, Szarek M, Bhatt DL, Bittner VA, Diaz R, Harrington RA, Jukema JW, White HD, Zeiher AM, Manvelian G, Poulouin Y, Scemama M, Stipek W, Schwartz GG. Longer-term safety of alirocumab with 24,610 patient-years of placebo-controlled observation: further insights from the ODYSSEY OUTCOMES trial. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
In the ODYSSEY OUTCOMES trial (NCT01663402), alirocumab, a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 (PCSK9), lowered low-density lipoprotein cholesterol from ∼2.3 mmol/L to ∼1.0 mmol/L at 4 months, reduced the risk of major adverse cardiovascular events (MACE: coronary heart disease death, nonfatal myocardial infarction, fatal/nonfatal ischemic stroke, unstable angina requiring hospitalization), and was associated with fewer deaths compared with placebo in 18924 patients (pts) with recent acute coronary syndrome followed for up to 5 years (yrs).
Purpose
In the ODYSSEY OUTCOMES trial, the overall safety of alirocumab and placebo was similar, except for an excess of local injection-site reactions with alirocumab. However, the safety among pts eligible for longer follow-up has not been fully explored.
Methods
The present post hoc analyses describe the efficacy and safety of alirocumab in a pre-specified subgroup (for efficacy) of pts eligible for a minimum of 3 and up to 5 yrs of follow-up.
Results
There were 8242 pts (43.5%) eligible for ≥3 yrs follow-up, of whom 8228 received at least one dose of study medication, comprising 24,610 pt-years of observation with a median follow-up of 3.3 yrs; 6651 pts were eligible for 3 up to 4 yrs, and 1574 patients were eligible for 4–5 yrs, follow-up. As previously reported in a pre-specified analysis of this subgroup, alirocumab significantly reduced death (4.7% vs. 5.9%; p=0.01) compared with placebo. In the present post hoc analysis, alirocumab also significantly reduced MACE vs. placebo (12.0% vs. 14.2%; Hazard Ratio 0.83 [95% CI 0.74 to 0.94]; p=0.003). In a safety analysis, 3217 (78.3%) vs. 3303 (80.2%) pts in the alirocumab vs. placebo group had at least one adverse event (AE) of whom 27.5% vs. 29.4% had a serious AE (Fig. 1). The frequency of permanent discontinuation of study drug due to AEs, incident diabetes, diabetes worsening or complications, neurocognitive events, elevations of ALT>3, AST>3, bilirubin>2, and creatine phosphokinase>10 times the upper limit of normal, were similar with alirocumab vs. placebo (Fig. 1). While pt-reported local injection-site reactions occurred more frequently with alirocumab, the Kaplan-Meier cumulative incidence for time to first local injection site reaction in the longer-term follow-up subgroup was <5% over ∼4 yrs, with most occurring within the first 6 months (Fig. 2).
Conclusions
In an 8228-pt subgroup of the ODYSSEY OUTCOMES trial eligible for at least 3, and up to 5 yrs follow-up, the safety of alirocumab was similar to placebo except for an excess of local injection site reactions. This subgroup also derived significant benefit from reduced MACE and death. Thus, alirocumab appears to be both a safe and effective lipid-modifying treatment when used for up to 5 yrs.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Sanofi and Regeneron
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Affiliation(s)
- S Goodman
- Canadian VIGOUR Centre, University of Alberta, Department of Medicine , Edmonton , Canada
| | - P G Steg
- Bichat Hospital, University Paris-Diderot, INSERM-UMR1148, FACT French Alliance for Cardiovascular T , Paris , France
| | - M Szarek
- State University of New York, Downstate School of Public Health , Brooklyn , United States of America
| | - D L Bhatt
- Brigham and Women's Hospital, Heart and Vascular Center , Boston , United States of America
| | - V A Bittner
- University of Alabama Birmingham , Birmingham , United States of America
| | - R Diaz
- Estudios Cardiologicos Latinoamerica (ECLA) , Rosario , Argentina
| | - R A Harrington
- Stanford Center for Clinical Research, Department of Medicine, Stanford University , Stanford , United States of America
| | - J W Jukema
- Leiden University Medical Center , Leiden , The Netherlands
| | - H D White
- Auckland City Hospital , Auckland , New Zealand
| | - A M Zeiher
- Department of Medicine III, Goethe University , Frankfurt am Main , Germany
| | - G Manvelian
- Regeneron , Tarrytown , United States of America
| | | | | | - W Stipek
- Sanofi , Bridgewater , United States of America
| | - G G Schwartz
- University of Colorado School of Medicine , Aurora , United States of America
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Steg P, Szarek M, Valgimigli M, Islam S, Zeiher AM, Bhatt DL, Bittner VA, Diaz R, Goodman SG, Harrington RA, Jukema JW, Pordy R, Scemama M, White HD, Schwartz GG. Lipoprotein(a) and the effect of alirocumab on coronary and non-coronary revascularization following acute coronary syndrome. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Many patients require arterial revascularization after an index ACS. Lipoprotein(a) is thought to play a pathogenic role in atherothrombosis. In the ODYSSEY OUTCOMES trial, the PCSK9 inhibitor alirocumab reduced major adverse cardiovascular events after ACS, with greater reduction among those with higher lipoprotein(a).
Objectives
We determined whether the risk of first coronary or any (coronary, peripheral artery or carotid) revascularization after ACS was modified by the level of lipoprotein(a) and treatment with alirocumab or placebo.
Methods
The ODYSSEY OUTCOMES trial (NCT01663402) compared alirocumab with placebo in 18,924 patients with ACS and elevated atherogenic lipoproteins despite optimized statin treatment. Treatment effects were summarized by competing-risks proportional hazard models.
Results
A total of 1559 (8.2%) patients had coronary, 204 (1.1%) peripheral artery, and 40 (0.2%) carotid revascularization after randomization. Alirocumab reduced first coronary revascularization (9.6% vs. 11.3% at 4 years; hazard ratio [HR] 0.88, 95% confidence interval [CI] 0.80–0.97; p=0.01) and any first revascularization (10.8% vs. 13.0%; HR 0.85, 95% CI 0.78–0.94; p=0.001). Baseline lipoprotein(a) quartile was directly associated with risk of coronary or any revascularization in the placebo arm (ptrend <0.0001) and inversely related to treatment HRs (ptrend <0.001). The greatest benefits of alirocumab on coronary or any revascularization were observed in patients with baseline lipoprotein(a) in the top quartile (≥59.6 mg/dL) (figures).
Conclusions
Alirocumab reduced revascularization after ACS. The risk of revascularization and reduction in that risk with alirocumab were greatest in patients with elevated lipoprotein(a) at baseline.
Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): SanofiRegeneron Pharmaceuticals
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Affiliation(s)
- P Steg
- Hospital Bichat-Claude Bernard , Paris , France
| | - M Szarek
- State University of New York Downstate Medical Center , New York , United States of America
| | - M Valgimigli
- Cardiocentro Ticino Institute , Lugano , Switzerland
| | - S Islam
- NYU Long Island School of Medicine, Division of Health Services Research , Mineola , United States of America
| | - A M Zeiher
- Goethe University Hospital , Frankfurt , Germany
| | - D L Bhatt
- Brigham and Women's Hospital , Boston , United States of America
| | - V A Bittner
- University of Alabama Birmingham , Birmingham , United States of America
| | - R Diaz
- Estudios Cardiologicos Latinoamerica (ECLA) , Rosario , Argentina
| | | | - R A Harrington
- School of Medicine , Stanford , United States of America
| | - J W Jukema
- Leiden University Medical Center , Leiden , The Netherlands
| | - R Pordy
- Regeneron Pharmaceuticals, Inc. , Tarrytown , United States of America
| | | | - H D White
- Auckland City Hospital , Auckland , New Zealand
| | - G G Schwartz
- University of Colorado , Aurora , United States of America
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McKinley EC, Bittner VA, Brown TM, Chen L, Colantonio LD, Exter J, Orroth KK, Reading SR, Rosenson RS, Muntner P. Factors associated with time to initiation of a PCSK9 inhibitor after hospital discharge for acute myocardial infarction. J Clin Lipidol 2021; 16:75-82. [PMID: 34848176 DOI: 10.1016/j.jacl.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 10/26/2021] [Accepted: 11/01/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) lower atherosclerotic cardiovascular disease (ASCVD) event risk. OBJECTIVE Analyze patient characteristics associated with time to PCSK9i initiation following an acute myocardial infarction (AMI). METHODS We analyzed characteristics of patients ≥21 years of age in the Marketscan or Medicare databases who initiated a PCSK9i 0-89 days, 90-179 days, or 180-365 days after an AMI between July 2015 and December 2018 (n=1,705). We estimated the cumulative incidence of recurrent ASCVD events before PCSK9i initiation. RESULTS Overall, 42%, 25%, and 33% of patients who initiated a PCSK9i did so 0-89 days, 90-179 days, and 180-365 days following AMI hospital discharge, respectively. Taking ezetimibe prior to AMI hospitalization and initiating ezetimibe within 30 days after AMI hospital discharge were each associated with a higher likelihood of PCSK9i initiation in the 0-89 days versus 180-365 days post-discharge (adjusted odds ratio [OR] 1.83, 95% confidence interval [95%CI] 1.35-2.49 and 1.76, 95%CI 1.11-2.80, respectively). Statin use before and statin initiation within 30 days after AMI hospitalization were associated with a lower likelihood of PCSK9i initiation 0-89 days versus 180-365 days post-discharge (adjusted OR 0.64, 95%CI 0.49-0.84 and 0.39, 95%CI 0.28-0.54, respectively). Overall, 8.0%, 10.5%, and 12.5% of patients had an ASCVD event at 90, 180, and 365 days following AMI hospital discharge and before initiating a PCSK9i, respectively. CONCLUSION Among patients initiating a PCSK9i after AMI, a low proportion did so within 89 days of hospital discharge. Many patients had a recurrent ASCVD event before treatment initiation.
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Affiliation(s)
- E C McKinley
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
| | - V A Bittner
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham AL, United States.
| | - T M Brown
- Department of Medicine, Division of Cardiovascular Disease, University of Alabama at Birmingham, Birmingham AL, United States.
| | - L Chen
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
| | - L D Colantonio
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
| | - J Exter
- Amgen Inc., Thousand Oaks CA, United States.
| | - K K Orroth
- Center for Observational Research, Amgen Inc., Thousand Oaks CA, United States.
| | - S R Reading
- Center for Observational Research, Amgen Inc., Thousand Oaks CA, United States.
| | - R S Rosenson
- Mount Sinai Heart, Icahn School of Medicine at Mount Sinai, New York NY, United States.
| | - P Muntner
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham AL, United States.
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5
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Diaz R, Li QH, Bhatt DL, Bittner VA, Baccara-Dinet MT, Goodman SG, Jukema JW, Parkhomenko A, Pordy R, Reiner Z, Szarek M, Tse HF, Zeiher AM, Schwartz GG, Steg PG. 4115Effect of alirocumab on recurrent cardiovascular events after acute coronary syndrome, according to the intensity of background statin treatment. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz745.0119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Statins are a cornerstone of therapy for coronary heart disease. We describe the effects of alirocumab (ALI) in patients (pts) with recent acute coronary syndrome (ACS) and dyslipidaemia per category of statin use.
Methods
ODYSSEY OUTCOMES compared ALI with placebo (PBO) in 18,924 pts with recent ACS and dyslipidaemia despite high-intensity/maximum tolerated statin (atorvastatin 40–80 mg/d or rosuvastatin 20–40 mg/d). Lower doses could be used if there were symptoms, laboratory abnormalities, or contraindications with higher doses. In cases of documented intolerance to ≥2 statins, pts could qualify on no statin treatment. Pts were randomized to ALI (75 mg SC Q2W, with possible uptitration to 150 mg Q2W) or PBO. Median follow-up was 2.8 years. Primary endpoint was major adverse cardiovascular events (MACE: CHD death, non-fatal MI, ischaemic stroke, or unstable angina requiring hospitalization). Pts were categorized by statin therapy at baseline: high intensity (88.8%), low or moderate intensity (8.7%), or no statin use (2.4%). In each category we determined the relative (hazard ratio [HR]) and absolute risk reductions (ARR) for MACE with ALI.
Results
Overall, ALI reduced MACE (HR 0.85, 95% CI 0.78–0.93; P<0.001). HRs were consistent across statin categories (Table). Baseline LDL-C increased across high-intensity, low/moderate-intensity, and no statin categories. Correspondingly, there was a gradient of the risk of MACE in the PBO group across these categories (10.8%, 10.7%, and 26%). With ALI treatment, the mean reduction in LDL-C from baseline to Month 4 increased across the 3 statin categories and correspondingly the ARRs for MACE were 1.3%, 3.2%, and 8.0% (P interaction <.001).
LDL-C values and MACE events All patients High-intensity statin Low-/moderate-intensity statin No statin Interaction P-value N=18,924 (100%) N=16,811 (88.8%) N=1653 (8.7%) N=460 (2.4%) (treatment x statin category) PBO (N=9462) ALI (N=9462) PBO (N=8431) ALI (N=8380) PBO (N=804) ALI (N=849) PBO (N=227) ALI (N=233) LDL-C at baseline, mmol/L, mean (SE)* 2.39 (0.01) 2.39 (0.01) 2.35 (0.01) 2.35 (0.01) 2.41 (0.03) 2.43 (0.03) 3.76 (0.08) 3.82 (0.08) Change in LDL-C from baseline to Month 4, mmol/L, mean (SE) 0.03 (0.01) −1.4 (0.01) 0.03 (0.01) −1.37 (0.01) 0.01 (0.02) −1.47 (0.02) −0.004 (0.06) −2.27 (0.06) <0.001 MACE, n (%)* 1052 (11.1) 903 (9.5) 907 (10.8) 797 (9.5) 86 (10.7) 64 (7.5) 59 (26.0) 42 (18.0) HR (95% CI) 0.85 (0.78−0.93) 0.88 (0.80−0.96) 0.69 (0.50−0.95) 0.65 (0.43−0.96) 0.14 ARR (%) (95% CI) 1.6 (0.7−2.4) 1.3 (0.3−2.2) 3.2 (0.4−5.9) 8.0 (0.4−15.5) <0.001 *P<0.001 for difference among statin categories.
Conclusions
In ODYSSEY OUTCOMES, patients unable to receive high-intensity statin treatment showed greater ARRs with ALI, consistent with higher baseline LDL-C concentration and greater absolute LDL-C reduction. Patients unable to receive high-intensity statin treatment are an important group to consider for treatment with ALI after ACS.
Acknowledgement/Funding
Funded by Sanofi and Regeneron Pharmaceuticals
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Affiliation(s)
- R Diaz
- Cardiology Studies Latin America, Rosario, Argentina
| | - Q H Li
- Regeneron Pharmaceuticals, Tarrytown, United States of America
| | - D L Bhatt
- Brigham and Womens Hospital, Boston, United States of America
| | - V A Bittner
- University of Alabama Birmingham, Birmingham, United States of America
| | | | | | - J W Jukema
- Leiden University Medical Center, Leiden, Netherlands (The)
| | - A Parkhomenko
- M.D. Strazhesko Institute of Cardiology of AMS of Ukraine, Kiev, Ukraine
| | - R Pordy
- Regeneron Pharmaceuticals, Tarrytown, United States of America
| | - Z Reiner
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - M Szarek
- SUNY Downstate Medical Center, Brooklyn, United States of America
| | - H F Tse
- Queen Mary Hospital, Hong Kong, Hong Kong
| | - A M Zeiher
- Wolfgang Goethe University, Frankfurt am Main, Germany
| | - G G Schwartz
- University of Colorado, Aurora, United States of America
| | - P G Steg
- Hospital Bichat-Claude Bernard, Paris, France
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Smith NL, Heckbert SR, Bittner VA, Savage PJ, Barzilay JI, Dobs AS, Psaty BM. Antidiabetic treatment trends in a cohort of elderly people with diabetes. The cardiovascular health study, 1989-1997. Diabetes Care 1999; 22:736-42. [PMID: 10332674 DOI: 10.2337/diacare.22.5.736] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE This study characterizes the pharmaceutical treatment of type 2 diabetes from 1989-1990 to 1996-1997 in an elderly cohort. RESEARCH DESIGN AND METHODS A total of 5,888 adults aged > or = 65 years were recruited and attended a baseline clinic visit in 1989-1990 (n = 5,201, original cohort) or 1992-1993 (n = 687. African-American [new] cohort) as participants of the Cardiovascular Health Study. Fasting serum glucose (FSG) was measured at baseline. Medication use was ascertained by drug inventory at all annual clinic visits. Diabetes was defined at baseline as insulin or oral hypoglycemic agent (OHA) use or as having an FSG > or = 7.0 mmol/l (126 mg/dl), the current consensus definition of diabetes. RESULTS A total of 387 (7%) original (FSG = 9.8 mmol/l [177 mg/dl]) and 115 (17%) new (FSG = 10.6 mmol/l [191 mg/dl]) cohort members had pharmacologically treated diabetes at baseline. Among those in the original and in the new cohorts who survived follow-up, respectively, OHA use decreased from 80 to 48% (P < 0.001) and from 67 to 50% (P < 0.003) and insulin use increased from 20 to 33% (P = 0.001) and from 33 to 37% (P = 0.603). There were 396 (8%) original (FSG = 8.8 mmol/l [159 mg/dl]) and 45 (7%) new (FSG = 10.0 mmol/l [181 mg/dl]) cohort members with diabetes untreated at baseline. Among them, respectively, OHA use reached 38 and 30% and insulin use reached 6 and 16% in 1996-1997. CONCLUSIONS Diabetes was common in this elderly cohort, and > 80% of treated patients with diabetes at baseline were not achieving fasting glucose goals of < or = 6.7 mmol/l (120 mg/dl). Many untreated at baseline remained untreated after 7 years of follow-up.
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Affiliation(s)
- N L Smith
- Department of Medicine, University of Washington, Seattle, USA.
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7
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Rogers WJ, Johnstone DE, Yusuf S, Weiner DH, Gallagher P, Bittner VA, Ahn S, Schron E, Shumaker SA, Sheffield LT. Quality of life among 5,025 patients with left ventricular dysfunction randomized between placebo and enalapril: the Studies of Left Ventricular Dysfunction. The SOLVD Investigators. J Am Coll Cardiol 1994; 23:393-400. [PMID: 8294693 DOI: 10.1016/0735-1097(94)90426-x] [Citation(s) in RCA: 114] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
OBJECTIVES This study was performed to assess the quality of life of patients with left ventricular dysfunction for up to 2 years after randomization to enalapril or placebo. BACKGROUND Previous reports have documented that survival of patients with congestive heart failure can be extended by the angiotensin-converting enzyme inhibitor enalapril. However, it is unknown whether enalapril has a long-term favorable impact on the quality of life in patients with heart failure. METHODS A brief quality of life questionnaire assessing the quality of life was administered at baseline and at 6 weeks, 1 year and 2 years of follow-up to patients randomized to placebo or enalapril in the Studies of Left Ventricular Dysfunction (SOLVD). Participants had an ejection fraction < or = 0.35, no other serious illnesses and either symptomatic heart failure (treatment trial, n = 2,465) or asymptomatic left ventricular dysfunction (prevention trial, n = 2,560). RESULTS Among the 14 scales of quality of life, better scores at one or more follow-up intervals were noted in 6 scales in the treatment trial and in 1 scale in the prevention trial among patients assigned to enalapril. Consistent superiority with enalapril at two consecutive follow-up intervals was noted in the treatment trial for social functioning and dyspnea but for no scale in the prevention trial. However, an average of 40% of quality of life responses were missing at 2 years of follow-up because of death or failure to complete the questionnaire. In the treatment trial, survivors with more severe heart failure were less likely to complete the questionnaire. CONCLUSIONS Modest benefits in quality of life for > or = 1 year occurred when patients with left ventricular dysfunction and symptomatic heart failure were treated with enalapril. No apparent beneficial or adverse effect on quality of life was observed with enalapril in asymptomatic patients with left ventricular dysfunction.
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Affiliation(s)
- W J Rogers
- University of Alabama Medical Center, Birmingham 35294
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