P1565Better adherence to lipid lowering guidelines in secondary prevention may result in substantial reduction in cardiovascular events

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
H Odesjo ◽  
S Bjorck ◽  
P Hjerpe ◽  
K Manhem ◽  
A Rosengren ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Prevention ◽  
Treatment Guidelines ◽  
Risk Estimation ◽  
Large Population ◽  
Substantial Reduction ◽  
Statin Treatment ◽  
Cox Proportional Hazards ◽  
Lipid Lowering ◽  
Estimation Model

Abstract Introduction The preventive effect of lipid lowering treatment in secondary prevention after coronary heart disease (CHD) is well documented. In 2015, regional guidelines recommend an LDL cholesterol of ≤1.8 mmol/L for patients with established CHD but the adherence to these guidelines is low. Purpose Our aim was to predict potential reductions in cardiovascular disease (CVD) events defined as acute myocardial infarction or stroke if patients: 1) with low-dose/less potent or no statin were treated with Atorvastatin 80 mg, or 2) all reached LDL ≤1.8 mmol/L. Methods In total, 37 120 patients with established CHD in a primary care regional register 2015 were studied. Predicted number of CVD events were calculated with actual treatment, with improved treatment and with lowered LDL. For risk estimation we used data from a Cox Proportional Hazards risk estimation model based on patients from 2010 (n=52 042) in combination with data from the literature on effect of statin treatment and LDL reduction. A risk reduction of 22% for CVD events per 1 mmol/L reduction in LDL was used in our model. The risk prediction model included age, sex, diabetes mellitus, a history of heart failure and/or atrial fibrillations, treatment with acetylic salicylic acid and stroke or AMI past year. Smoking and BMI were excluded due to missing data but sensitivity analysis has shown only small differences in results. Results In total, 18% of included patients reached LDL ≤1.8 mmol/L and 32% had no statin treatment. Based on actual LDL levels and treatments, the predicted number of CVD events over 5 years was 9209/37120. If all patients with no statin or less potent statin treatment had been given atorvastatin 80 mg this would lead to a reduction of CVD events by 14% (7901 vs 9209). The largest gain, 33% reduction, occurred when adding statins to patients without previous treatment (1970 vs 2937). Furthermore, if all patients were to reach LDL ≤1.8 mmol/L the predicted number of events would be reduced by 18% (7577 vs 9209). Conclusion There is a substantial potential to reduce the number of CVD events in the large population of patients with established CHD in primary care by improved adherence to lipid treatment guidelines. Acknowledgement/Funding Närhälsan R&D Health Care, R&D Centre Gothenburg and Södra Bohuslän. the Swedish state under the Agreement concerning research and education of doctor

scholarly journals Adherence to lipid-lowering guidelines for secondary prevention and potential reduction in CVD events in Swedish primary care: a cross-sectional study

BMJ Open ◽  
2020 ◽  
Vol 10 (10) ◽  
pp. e036920
Author(s):  
Helena Ödesjö ◽  
Staffan Björck ◽  
Stefan Franzén ◽  
Per Hjerpe ◽  
Karin Manhem ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Prevention ◽  
Substantial Reduction ◽  
Statin Treatment ◽  
Care Quality ◽  
Lipid Lowering ◽  
Secondary Outcome ◽  
Randomised Trials ◽  
Cross Sectional ◽  
Quality Register

ObjectivesThe protective effect of lipid-lowering treatment for secondary prevention after coronary heart disease (CHD) has been well documented. Current guidelines recommend a target level for low-density lipoprotein cholesterol (LDL-C) of ≤1.8 mmol/L. The aim was to describe lipid-lowering treatment patterns and to provide an estimate of the potential reductions in cardiovascular disease (CVD) events with improved adherence to guidelines.DesignCross-sectional.SettingPrimary care in a large Swedish region.Participants37 120 patients with CHD in a Swedish regional primary care quality register (QregPV), by 31 December 2015.Primary and secondary outcome measuresProportion of patients on statin treatment and proportion of patients achieving LDL-C ≤1.8 mmol/L. Estimated number of CVD events calculated for (1) current treatment, (2) improved treatment and (3) lowered LDL-C, based on applying rate reductions from meta-analyses of randomised trials to the potentially undertreated population. Risk estimation modelling was based on 52 042 patients in the same register on January 2011 followed for 5 years.ResultsOf 37 120 patients, 18% reached LDL-C ≤1.8 mmol/L and 32% were not on statin treatment. Based on individual risks, the estimated number of CVD events in the study group over 5 years was 9209/37 120. If all patients without a statin or with less potent statin treatment were given atorvastatin 80 mg, an estimated reduction of CVD events by 14% (7901 vs 9209) was seen. If all patients achieved LDL-C ≤1.8 mmol/L, the number of events was estimated to be reduced by 18% (7577 vs 9209).ConclusionOne-third of patients with CHD in primary care were not on lipid-lowering treatment. Based on the assumption that included patients would react to statin therapy the same way as the patients in randomised trials, improved adherence to treatment guidelines could lead to a substantial reduction in new CVD events.

scholarly journals Statins in Patients with COVID-19: A Retrospective Cohort Study in Iranian COVID-19 Patients

2020 ◽  
Author(s):  
Payam Peymani ◽  
Tania Dehesh ◽  
Farnaz Aligolighasemabadi ◽  
Mohammadamin Sadeghdoust ◽  
Katarzyna Kotfis ◽  
...  
Keyword(s):  
Lower Risk ◽  
Proportional Hazards ◽  
Clinical Symptoms ◽  
Statistical Significance ◽  
Statin Treatment ◽  
Careful Consideration ◽  
Cox Proportional Hazards ◽  
Lipid Lowering ◽  
Risk Of Death ◽  
Statin Use

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is spreading at an alarming rate globally. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and many known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR=0.85, 95% CI=(0.02, 3.93), P=0.762] and lower risk of death [(HR= 0.76; 95% CI=(0.16, 3.72), P=0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR=0.96, 95% CI=(0.61–2.99), P=0.942] and patients on statins had a more normal computed tomography (CT) scan result [OR=0.41, 95% CI= (0.07–2.33), P=0.312]. Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19 , we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

scholarly journals IL-1β and Statin Treatment in Patients with Myocardial Infarction and Diabetic Cardiomyopathy

2019 ◽  
Vol 8 (11) ◽  
pp. 1764 ◽  
Author(s):  
Liberale ◽  
Carbone ◽  
Camici ◽  
Montecucco
Keyword(s):  
Myocardial Infarction ◽  
Secondary Prevention ◽  
Diabetic Cardiomyopathy ◽  
Statin Treatment ◽  
Preventive Therapy ◽  
Lipid Lowering ◽  
Current Evidence ◽  
Inflammatory Microenvironment ◽  
First Line Therapy ◽  
Beneficial Impact

Statins are effective lipid-lowering drugs with a good safety profile that have become, over the years, the first-line therapy for patients with dyslipidemia and a real cornerstone of cardiovascular (CV) preventive therapy. Thanks to both cholesterol-related and “pleiotropic” effects, statins have a beneficial impact against CV diseases. In particular, by reducing lipids and inflammation statins, they can influence the pathogenesis of both myocardial infarction and diabetic cardiomyopathy. Among inflammatory mediators involved in these diseases, interleukin (IL)-1β is a pro-inflammatory cytokine that recently been shown to be an effective target in secondary prevention of CV events. Statins are largely prescribed to patients with myocardial infarction and diabetes, but their effects on IL-1β synthesis and release remain to be fully characterized. Of interest, preliminary studies even report IL-1β secretion to rise after treatment with statins, with a potential impact on the inflammatory microenvironment and glycemic control. Here, we will summarize evidence of the role of statins in the prevention and treatment of myocardial infarction and diabetic cardiomyopathy. In accordance with the dual lipid-lowering and anti-inflammatory effect of these drugs and in light of the important results achieved by IL-1β inhibition through canakinumab in CV secondary prevention, we will dissect the current evidence linking statins with IL-1β and outline the possible benefits of a potential double treatment with statins and canakinumab.

scholarly journals Statins in patients with COVID-19: a retrospective cohort study in Iranian COVID-19 patients

2021 ◽  
Vol 6 (1) ◽  
Author(s):  
Payam Peymani ◽  
Tania Dehesh ◽  
Farnaz Aligolighasemabadi ◽  
Mohammadamin Sadeghdoust ◽  
Katarzyna Kotfis ◽  
...  
Keyword(s):  
Lower Risk ◽  
Proportional Hazards ◽  
Clinical Symptoms ◽  
Statistical Significance ◽  
Statin Treatment ◽  
Careful Consideration ◽  
Cox Proportional Hazards ◽  
Lipid Lowering ◽  
Risk Of Death ◽  
Statin Use

Abstract Background The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is globally spreading at an alarming rate. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and various known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR = 0.85, 95% CI = (0.02, 3.93), P = 0.762] and lower risk of death [(HR = 0.76; 95% CI = (0.16, 3.72), P = 0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR = 0.96, 95% CI = (0.61–2.99), P = 0.942] and patients on statins showed a more normal computed tomography (CT) scan result [OR = 0.41, 95% CI = (0.07–2.33), P = 0.312]. Conclusions Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19, we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to further evaluate and validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

Abstract 18396: Low Rate of LDL-Goal-Attainment in 57,855 High-Risk-Patients in Europe, Canada, South-Africa, Middle East and China - Results of DYSIS

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Anselm K Gitt ◽  
Dominik Lautsch ◽  
Martin Horack ◽  
Baishali Ambegaonkar ◽  
Jean Ferrieres ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Secondary Prevention ◽  
Goal Attainment ◽  
Ldl Cholesterol ◽  
Statin Treatment ◽  
Lipid Lowering ◽  
High Risk Patients ◽  
Risk Patients ◽  
Very High

Background: Statin treatment is routinely used for secondary prevention world-wide. Little is known about the prevalence of persistent lipid abnormalities under chronic statin treatment for secondary prevention and possible differences in LDL-Cholesterol (LDL-C) goal attainment in clinical practice between countries in different parts of the world. Methods: Between 2008 and 2012, consecutive statin-treated outpatients were enrolled in 26 countries worldwide, (DYSIS = Dyslipidemia International Study; list of countries in table) to assess LDL-C goal attainment for secondary prevention. European Society of Cardiology recommendations were used to classify patient risk, and to define LDL-cholesterol treatment goals. Data were collected under real life conditions in physicians’ offices and hospital outpatient wards. Results: Serum lipid values of 57,885 consecutive statin-treated outpatients were studied in the context of their cardiovascular risk factors, and the potency and composition of their lipid-lowering treatment. In the very-high risk patients only 21.7% did reach the currently recommended LDL-Chol target <70mg/dl with large differences between the countries varying from 9.2% to 44.3%. In the high-risk population the LDL-Chol target <100mg/dl was achieved in 38.0% oft he patients, varying between 16.6% and 66.7% between countries Conclusion: Despite chronic statin treatment, only 21.7% of the very-high-risk patients reached the current recommended LDL-Chol target <70mg/dl in this large multinational cross-sectional trial, highlighting the persistent large gap between guideline recommendations and clinical practice. Further treatment escalations are necessary to reduce the risk of subsequent cardiovascular events.

Patterns of Use and Discontinuation of Secondary Prevention Medications After Stroke

Neurology ◽  
2020 ◽  
Vol 96 (1) ◽  
pp. e30-e41
Author(s):  
Lachlan L. Dalli ◽  
Joosup Kim ◽  
Amanda G. Thrift ◽  
Nadine E. Andrew ◽  
Frank M. Sanfilippo ◽  
...  
Keyword(s):  
Primary Care ◽  
Secondary Prevention ◽  
Care Physician ◽  
Lipid Lowering ◽  
Clinical Registry ◽  
Prospective Data ◽  
Medication Discontinuation ◽  
Patterns Of Use ◽  
Medicare Claims Data ◽  
Observation Period

ObjectiveTo investigate whether certain patient, acute care, or primary care factors are associated with medication initiation and discontinuation in the community after stroke or TIA.MethodsThis is a retrospective cohort study using prospective data on adult patients with first-ever acute stroke/TIA from the Australian Stroke Clinical Registry (April 2010 to June 2014), linked with nationwide medication dispensing and Medicare claims data. Medication users were those with ≥1 dispensing in the year postdischarge. Discontinuation was assessed among medication users and defined as having no medication supply for ≥90 days in the year postdischarge. Multivariable competing risks regression, accounting for death during the observation period, was conducted to investigate factors associated with time to medication discontinuation.ResultsAmong 17,980 registry patients with stroke/TIA, 91.4% were linked to administrative datasets. Of these, 9,817 adults with first-ever stroke/TIA were included (45.4% female, 47.6% aged ≥75 years, and 11.4% intracerebral hemorrhage). While most patients received secondary prevention medications (79.3% antihypertensive, 81.8% antithrombotic, and 82.7% lipid-lowering medication), between one-fifth and one-third discontinued treatment over the subsequent year postdischarge (20.9% antihypertensive, 34.1% antithrombotic, and 28.5% lipid-lowering medications). Prescription at hospital discharge (sub–hazard ratio [SHR] 0.70; 95% confidence interval [CI] 0.62–0.79), quarterly contact with a primary care physician (SHR 0.62; 95% CI 0.57–0.67), and prescription by a specialist physician (SHR 0.87; 95% CI 0.77–0.98) were all inversely associated with antihypertensive discontinuation.ConclusionsPatterns of use of secondary prevention medications after stroke/TIA are not optimal, with many survivors discontinuing treatment within 1 year postdischarge. Improving postdischarge care for patients with stroke/TIA is needed to minimize unwarranted discontinuation.

Treatment with Multiple Therapeutic Classes of Medication is Associated with Survival after Stroke

2021 ◽  
Author(s):  
Monique F. Kilkenny ◽  
Muideen T. Olaiya ◽  
Lachlan L. Dalli ◽  
Joosup Kim ◽  
Nadine E. Andrew ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Proportional Hazards ◽  
Cox Proportional Hazards ◽  
Lipid Lowering ◽  
Pharmacological Intervention ◽  
Post Discharge ◽  
Clinical Registry ◽  
Longitudinal Association ◽  
Ischemic Attack ◽  
Number Of Classes

Introduction: Treatment with several therapeutic classes of medication is recommended for secondary prevention of stroke. We analysed the associations between the number of classes of prevention medications supplied within 90 days post-discharge for ischemic stroke (IS)/transient ischemic attack (TIA) and survival. Patients and methods: Retrospective cohort study of adults with first-ever IS/TIA (2010-2014) from the Australian Stroke Clinical Registry individually linked with data from national pharmaceutical and Medicare claims. Exposure was the number of classes of recommended medications, i.e. blood pressure-lowering, antithrombotic or lipid-lowering agents, supplied to patients within 90 days post-discharge for IS/TIA. The longitudinal association between the number of classes of medications and survival was evaluated with Cox proportional hazards regression models using the landmark approach. A landmark date of 90 days post-hospital discharge was used to separate exposure and outcome periods and only patients who survived until this date were included. Results: Of 8,429 patients (43% female, median age 74 years, 80% IS), 607 (7%) died in the year following 90 days post-discharge. Overall, 56% of patients were supplied all three classes of medications, 28% two classes of medications, 11% one class of medications, and 5% no class of medications. Compared to patients supplied all three medication classes, adjusted hazard ratios for all-cause mortality ranged from 1.43 (95% confidence interval [CI]: 1.18-1.72) in those supplied two medication classes to 2.04 (CI: 1.44-2.88) in those supplied with no medication class. Conclusion: Treatment with all three classes of guideline-recommended medications within 90 days post-discharge was associated with better survival. Ongoing efforts are required to ensure optimal pharmacological intervention for secondary prevention of stroke.

scholarly journals Statins in Patients with COVID-19: A Retrospective Cohort Study in Iranian COVID-19 Patients

2020 ◽  
Author(s):  
Payam Peymani ◽  
Tania Dehesh ◽  
Farnaz Aligolighasemabadi ◽  
Mohammadamin Sadeghdoust ◽  
Katarzyna Kotfis ◽  
...  
Keyword(s):  
Lower Risk ◽  
Proportional Hazards ◽  
Clinical Symptoms ◽  
Statistical Significance ◽  
Statin Treatment ◽  
Careful Consideration ◽  
Cox Proportional Hazards ◽  
Lipid Lowering ◽  
Risk Of Death ◽  
Statin Use

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has profoundly affected the lives of millions of people. To date, there is no approved vaccine or specific drug to prevent or treat COVID-19, while the infection is spreading at an alarming rate globally. Because the development of effective vaccines or novel drugs could take several months (if not years), repurposing existing drugs is considered a more efficient strategy that could save lives now. Statins constitute a class of lipid-lowering drugs with proven safety profiles and many known beneficial pleiotropic effects. Our previous investigations showed that statins have antiviral effects and are involved in the process of wound healing in the lung. This triggered us to evaluate if statin use reduces mortality in COVID-19 patients. Results: After initial recruitment of 459 patients with COVID-19 (Shiraz province, Iran) and careful consideration of the exclusion criteria, a total of 150 patients, of which 75 received statins, were included in our retrospective study. Cox proportional-hazards regression models were used to estimate the association between statin use and rate of death. After propensity score matching, we found that statin use appeared to be associated with a lower risk of morbidity [HR=0.85, 95% CI=(0.02, 3.93), P=0.762] and lower risk of death [(HR= 0.76; 95% CI=(0.16, 3.72), P=0.735)]; however, these associations did not reach statistical significance. Furthermore, statin use reduced the chance of being subjected to mechanical ventilation [OR=0.96, 95% CI=(0.61–2.99), P=0.942] and patients on statins had a more normal computed tomography (CT) scan result [OR=0.41, 95% CI= (0.07–2.33), P=0.312]. Conclusions: Although we could not demonstrate a significant association between statin use and a reduction in mortality in patients with COVID19 , we do feel that our results are promising and of clinical relevance and warrant the need for prospective randomized controlled trials and extensive retrospective studies to validate the potential beneficial effects of statin treatment on clinical symptoms and mortality rates associated with COVID-19.

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