scholarly journals Impact of Statin Adherence on Cardiovascular Morbidity and All-Cause Mortality in the Primary Prevention of Cardiovascular Disease: A Population-Based Cohort Study in Finland

2015 ◽  
Vol 18 (6) ◽  
pp. 896-905 ◽  
Author(s):  
Piia K. Rannanheimo ◽  
Pekka Tiittanen ◽  
Juha Hartikainen ◽  
Arja Helin-Salmivaara ◽  
Risto Huupponen ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Primary Prevention ◽  
Population Based ◽  
Cardiovascular Morbidity ◽  
All Cause Mortality ◽  
Statin Adherence ◽  
Prevention Of Cardiovascular Disease

scholarly journals Cardiovascular effect of discontinuing statins for primary prevention at the age of 75 years: a nationwide population-based cohort study in France

2019 ◽  
Vol 40 (43) ◽  
pp. 3516-3525 ◽  
Author(s):  
Philippe Giral ◽  
Anke Neumann ◽  
Alain Weill ◽  
Joël Coste
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Primary Prevention ◽  
Cardiovascular Event ◽  
Structural Model ◽  
Medication Possession Ratio ◽  
Population Based ◽  
Cerebrovascular Event ◽  
Increased Risk ◽  
Time Varying Covariates

Abstract Aims The role of statin therapy in primary prevention of cardiovascular disease in persons older than 75 years remains a subject of debate with little evidence to support or exclude the benefit of this treatment. We assessed the effect of statin discontinuation on cardiovascular outcomes in previously adherent 75-year-olds treated for primary prevention. Methods and results A population-based cohort study using French national healthcare databases was performed, studying all subjects who turned 75 in 2012–14, with no history of cardiovascular disease and with a statin medication possession ratio ≥80% in each of the previous 2 years. Statin discontinuation was defined as three consecutive months without exposure. The outcome was hospital admission for cardiovascular event. The hazard ratio comparing statin discontinuation with continuation was estimated using a marginal structural model adjusting for both baseline and time-varying covariates (cardiovascular drug use, comorbidities, and frailty indicators). A total of 120 173 subjects were followed for an average of 2.4 years, of whom 17 204 (14.3%) discontinued statins and 5396 (4.5%) were admitted for a cardiovascular event. The adjusted hazard ratios for statin discontinuation were 1.33 [95% confidence interval (CI) 1.18–1.50] (any cardiovascular event), 1.46 (95% CI 1.21–1.75) (coronary event), 1.26 (95% CI 1.05–1.51) (cerebrovascular event), and 1.02 (95% CI 0.74–1.40) (other vascular event). Conclusion Statin discontinuation was associated with a 33% increased risk of admission for cardiovascular event in 75-year-old primary prevention patients. Future studies, including randomized studies, are needed to confirm these findings and support updating and clarification of guidelines on the use of statins for primary prevention in the elderly.

scholarly journals Impact of updated recommendations on acetylsalicylic acid use for primary prevention of cardiovascular disease in Canada: a population-based survey

CMAJ Open ◽  
2020 ◽  
Vol 8 (1) ◽  
pp. E41-E47
Author(s):  
Myriam Khalili ◽  
Fanny Lepeytre ◽  
Jason Robert Guertin ◽  
Rémi Goupil ◽  
Stéphan Troyanov ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Acetylsalicylic Acid ◽  
Population Based ◽  
Prevention Of Cardiovascular Disease ◽  
Population Based Survey

scholarly journals Risk of All-Cause Mortality in Levothyroxine-Treated Hypothyroid Patients: A Nationwide Korean Cohort Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Seo Young Sohn ◽  
Gi Hyeon Seo ◽  
Jae Hoon Chung
Keyword(s):  
Cardiovascular Disease ◽  
Cohort Study ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Population Based ◽  
Overt Hypothyroidism ◽  
Risk Of Mortality ◽  
All Cause Mortality ◽  
Korean National Health Insurance ◽  
Hypothyroid Patients

BackgroundAlthough hypothyroidism is associated with various comorbidities, its relationship with increased all-cause mortality remains controversial. The aim of this nationwide retrospective cohort study was to investigate whether hypothyroid patients treated with levothyroxine had increased mortality compared to controls.MethodsHypothyroid subjects were identified through the Korean National Health Insurance Service Claims database between 2008 and 2017. Hypothyroidism in this study was defined as overt hypothyroidism treated with long-term prescription of levothyroxine (>6 months). After 1:3 age-, sex- and index year-matching, 501,882 patients with newly diagnosed hypothyroidism and 1,505,646 controls without hypothyroidism were included.ResultsDuring a mean follow-up of 6 years, 25,954 (5.2%) hypothyroid patients and 59,105 (3.9%) controls died. Hypothyroidism was significantly associated with increased all-cause mortality (adjusted hazard ratio [HR], 1.14; 95% confidence interval [CI] 1.12–1.16) even with levothyroxine treatment. When stratified by age, sex, and cardiovascular disease risk, independent associations between hypothyroidism and mortality remained significant in all subgroups. The risk of mortality was higher in the < 65 age group (HR: 1.25, 95% CI: 1.22–1.29), men (HR: 1.28, 95% CI: 1.25–1.31), and the high cardiovascular disease risk group (HR: 1.31, 95% CI: 1.29–1.34). The mortality rate of hypothyroid patients was highest within 1 year of treatment and decreased with time.ConclusionThis nationwide, population-based cohort study showed that all-cause mortality was significantly higher in levothyroxine-treated hypothyroid patients than in non-hypothyroid controls. This association remained significant regardless of age, sex, and cardiovascular disease risk.

scholarly journals Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews

BMJ Open ◽  
2019 ◽  
Vol 9 (4) ◽  
pp. e023085 ◽  
Author(s):  
Paula Byrne ◽  
John Cullinan ◽  
Amelia Smith ◽  
Susan M Smith
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Risk Reduction ◽  
Systematic Reviews ◽  
Baseline Risk ◽  
Risk Category ◽  
All Cause Mortality ◽  
Overview Of Systematic Reviews ◽  
And Gender ◽  
Prevention Of Cardiovascular Disease

ObjectiveTo synthesise evidence from exclusively primary prevention data on the effectiveness of statins for prevention of cardiovascular disease (CVD), including stroke, and outcomes stratified by baseline risk and gender.DesignOverview of systematic reviews (SRs) using Revised-AMSTAR approach to assess quality.Data sourcesCochrane Database of Systematic Reviews, MEDLINE, Embase, PubMed, Scopus and PROSPERO to June 2017.Eligibility criteria for selecting studiesSRs of randomised control trials (RCTs) or individual patient data (IPD) from RCTs, examining the effectiveness of statins versus placebo or no treatment on all-cause mortality, coronary heart disease, CVD (including stroke) and composite endpoints, with stratification by baseline risk and gender.Data extraction and synthesisTwo independent reviewers extracted data and assessed methodological quality. A narrative synthesis was conducted.ResultsThree SRs were included. Quality of included SRs was mixed, and none reported on the risk of bias of included trials.We found trends towards reduced all-cause mortality in all SRs (RR 0.91 [95% CI 0.85 to 0.97]), (RR 0.91 [95% CI 0.83 to 1.01]) and (RR 0.78 [95% CI 0.53 to 1.15]) though it was not statistically significant in two SRs. When stratified by baseline risk, the effect on all-cause mortality was no longer statistically significant except in one medium risk category. One review reported significant reductions (RR 0.85 [95% CI 0.77 to 0.95]) in vascular deaths and non-significant reductions in non-vascular deaths (RR 0.97 [95% CI 0.88 to 1.07]). There were significant reductions in composite outcomes overall, but mixed results were reported in these when stratified by baseline risk. These reviews included studies with participants considered risk equivalent to those with established CVD.ConclusionsThere is limited evidence on the effectiveness of statins for primary prevention with mixed findings from studies including participants with widely ranging baseline risks. Decision making for the use of statins should consider individual baseline risk, absolute risk reduction and whether risk reduction justifies potential harms and taking a daily medicine for life.Trial registration numberCRD42017064761.

scholarly journals Systematic review of the predictors of statin adherence for the primary prevention of cardiovascular disease

PLoS ONE ◽  
2019 ◽  
Vol 14 (1) ◽  
pp. e0201196 ◽  
Author(s):  
Holly F. Hope ◽  
George M. Binkley ◽  
Sally Fenton ◽  
George D. Kitas ◽  
Suzanne M. M. Verstappen ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Statin Adherence ◽  
Prevention Of Cardiovascular Disease

scholarly journals Effectiveness of Statins as Primary Prevention in People With Gout: A Population-Based Cohort Study

2019 ◽  
Vol 24 (6) ◽  
pp. 542-550
Author(s):  
Maria Garcia-Gil ◽  
Marc Comas-Cufí ◽  
Rafel Ramos ◽  
Ruth Martí ◽  
Lia Alves-Cabratosa ◽  
...  
Keyword(s):  
Primary Care ◽  
Cohort Study ◽  
Primary Prevention ◽  
Statin Therapy ◽  
Proportional Hazards ◽  
Population Based ◽  
Cox Proportional Hazards ◽  
Research Quality ◽  
All Cause Mortality ◽  
Clinically Significant

Background: Cardiovascular guidelines do not give firm recommendations on statin therapy in patients with gout because evidence is lacking. Aim: To analyze the effectiveness of statin therapy in primary prevention of coronary heart disease (CHD), ischemic stroke (IS), and all-cause mortality in a population with gout. Methods: A retrospective cohort study (July 2006 to December 2017) based on Information System for the Development of Research in Primary Care (SIDIAPQ), a research-quality database of electronic medical records, included primary care patients (aged 35-85 years) without previous cardiovascular disease (CVD). Participants were categorized as nonusers or new users of statins (defined as receiving statins for the first time during the study period). Index date was first statin invoicing for new users and randomly assigned to nonusers. The groups were compared for the incidence of CHD, IS, and all-cause mortality, using Cox proportional hazards modeling adjusted for propensity score. Results: Between July 2006 and December 2008, 8018 individuals were included; 736 (9.1%) were new users of statins. Median follow-up was 9.8 years. Crude incidence of CHD was 8.16 (95% confidence interval [CI]: 6.25-10.65) and 6.56 (95% CI: 5.85-7.36) events per 1000 person-years in new users and nonusers, respectively. Hazard ratios were 0.84 (95% CI: 0.60-1.19) for CHD, 0.68 (0.44-1.05) for IS, and 0.87 (0.67-1.12) for all-cause mortality. Hazard for diabetes was 1.27 (0.99-1.63). Conclusions: Statin therapy was not associated with a clinically significant decrease in CHD. Despite higher risk of CVD in gout populations compared to general population, patients with gout from a primary prevention population with a low-to-intermediate incidence of CHD should be evaluated according to their cardiovascular risk assessment, lifestyle recommendations, and preferences, in line with recent European League Against Rheumatism recommendations.

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