Primary prevention of cardiovascular disease in high-risk patients: physiologic and demographic risk factor differences between african american and white american populations

1999 ◽  
Vol 107 (2) ◽  
pp. 22-24 ◽  
Author(s):  
Luther T Clark
Keyword(s):  
Cardiovascular Disease ◽  
African American ◽  
Risk Factor ◽  
Primary Prevention ◽  
High Risk ◽  
White American ◽  
Risk Patients ◽  
Demographic Risk ◽  
Demographic Risk Factor ◽  
Prevention Of Cardiovascular Disease

scholarly journals Statins for primary prevention of cardiovascular disease: modelling guidelines and patient preferences based on an Irish cohort

2019 ◽  
Vol 69 (683) ◽  
pp. e373-e380 ◽  
Author(s):  
Paula Byrne ◽  
John Cullinan ◽  
Paddy Gillespie ◽  
Rafael Perera ◽  
Susan M Smith
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
Clinical Guidelines ◽  
Baseline Risk ◽  
Recommended Treatment ◽  
Risk Patients ◽  
Very High ◽  
Prevention Of Cardiovascular Disease

BackgroundChanges in clinical guidelines for primary prevention of cardiovascular disease (CVD) have widened eligibility for statin therapy.AimTo illustrate the potential impacts of changes in clinical guidelines.Design and settingModelling the impacts of seven consecutive European guidelines based on a cohort of people aged ≥50 years from the Irish Longitudinal Study on Ageing.MethodThe eligibility for statin therapy of a sample of people without a history of CVD was established, according to changing guideline recommendations and modelled associated potential costs. The authors calculated the numbers needed to treat (NNT) to prevent one major vascular event in patients at the lowest baseline risk for which each of the seven guidelines recommended treatment, and for those at low, medium, high, and very-high risk according to 2016 guidelines. These were compared with the NNT that patients reported as required to justify taking a daily medicine.ResultsThe proportion of patients eligible for statins increased from approximately 8% in 1987 to 61% in 2016; associated costs rose from €13.9 million to €107.1 million per annum. The NNT for those at the lowest risk for which each guideline recommended treatment rose from 40 to 400. By 2016, the NNT for low-risk patients was 400 compared to ≤25 very-high risk patients. The proportion of patients eligible for statins achieving NNT levels that patients regarded as justified to taking a daily medicine fell as guidelines changed over time.ConclusionIncreased eligibility for statin therapy impacts large proportions of the present population and healthcare budgets. Decisions to take and reimburse statins should be considered on the basis of expected cost-effectiveness and acceptability to patients.

Abstract 15941: Derivation of Risk-Scores That Stratify Risk of Hospitalization and Death in SARS-CoV-2 Positive Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Kirk U Knowlton ◽  
Heidi T May ◽  
Stacey Knight ◽  
Tami L Bair ◽  
Viet T Le ◽  
...  
Keyword(s):  
Risk Factors ◽  
Risk Factor ◽  
High Risk ◽  
Risk Groups ◽  
Risk Scores ◽  
Individual Risk ◽  
Variable Intensity ◽  
Intermountain Healthcare ◽  
Demographic Risk ◽  
Demographic Risk Factor

Introduction: It is well-documented that COVID-19 patients with pre-existing cardiovascular-related disorders are at higher risk of a complicated course. It would be valuable to integrate individual risk factors into overall risk scores for hospitalization and death from COVID-19. Methods: The Intermountain Healthcare medical record database was searched for all individuals tested for SARS-CoV-2 infection up to June 8, 2020. Data from test-positive patients (pts) was analyzed to determine the characteristics of pts requiring hospitalization. From these data, 2 risk scores for hospitalization were derived using multi-variable modeling: of only demographic and risk-factor data, or also including concurrent medications. The risk scores were also applied to predict the risk of dying from COVID-19. Results: Of 104,018 people tested at Intermountain Healthcare for SARS-CoV-2, 5505 (5.3%) were positive. Of test-positive pts, 451 (8.2%) were hospitalized, and 37 (0.7%) died. Using a demographic/risk factor only score, 1.4, 7.0, and 36.6% of low-, moderate-, and high-risk groups, respectively, were hospitalized (AUC=0.826). Using demographic risk-factors and medications, 1.4, 5.6, and 40.3% of low-, moderate-, and high-risk patients were hospitalized (AUC=0.854, Table 1). The demographic/risk factor-score was also predictive of the risk of dying, with 0%, 0.9% and 4.5% in low-, moderate-, and high-risk groups dying (AUC=0.918). Adding medications to the risk-factors model further improved the prediction of death with 0.1, 0.04, and 4.9% in the low-, moderate-, and high-risk groups dying (AUC=0.942, Table 2). Conclusions: We demonstrate the derivation of highly predictive risk scores for COVD-19 patients at low, moderate, and high risks of hospitalization or death. Pending appropriate validation in another cohort, application of these risk-scores may allow healthcare systems to risk-stratify COVID-19 patients requiring variable intensity of care.

scholarly journals The Clinical Utility of High-Sensitivity C-Reactive Protein in Cardiovascular Disease and the Potential Implication of JUPITER on Current Practice Guidelines

2009 ◽  
Vol 55 (2) ◽  
pp. 219-228 ◽  
Author(s):  
Samia Mora ◽  
Kiran Musunuru ◽  
Roger S Blumenthal
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
High Sensitivity ◽  
C Reactive Protein ◽  
Potential Implication ◽  
Reactive Protein ◽  
Risk Patients ◽  
Asymptomatic Individuals

Abstract Background: High-sensitivity C-reactive protein (hsCRP) testing is relatively inexpensive and has been shown to predict the risk of cardiovascular disease (CVD) and diabetes in multiple patient groups, including those treated with statin therapy. JUPITER (Justification for the Use of Statins in Primary Prevention: An Intervention Trial Evaluating Rosuvastatin) is a recently completed large multicenter randomized clinical trial that tested whether statin therapy should be given to apparently healthy individuals with lower LDL cholesterol (LDL-C) concentrations but increased hsCRP concentrations. Content: This review discusses the literature on hsCRP in asymptomatic populations, analyzes it according to CVD and diabetes, and provides summary recommendations for the use of hsCRP in clinical practice. In this context, we highlight recent data from the landmark JUPITER trial, which demonstrated that hsCRP can be used to target high-risk patients who have typical LDL-C concentrations and no known vascular disease or diabetes and who would benefit from statin use. We also summarize evidence that among patients treated with statin therapy, achieving low hsCRP concentrations may be a clinically relevant therapeutic goal along with achieving very low LDL-C concentrations. Summary: JUPITER has demonstrated that combining hsCRP testing with traditional testing of lipids can reduce incident CVD in high-risk asymptomatic individuals by 44% and all-cause mortality by approximately 20%, extending the therapeutic use of statins for the primary prevention of CVD. Guidelines for practitioners could include testing asymptomatic individuals for increased concentrations of hsCRP in men ≥50 years and women ≥60 years when LDL-C concentrations are not increased and for whom the decision to treat with statin therapy is not otherwise clear.

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