Abstract 15568: Is the Association of Statin Use and Incident Diabetes Mellitus Still Significant in Primary Prevention Treatment When Accounting for Incident Cardiovascular Events?

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Viet T Le ◽  
Raymond O McCubrey ◽  
Tami L Bair ◽  
Benjamin D Horne ◽  
Heidi T May ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Competing Risks ◽  
Propensity Scores ◽  
Coronary Revascularization ◽  
Statin Treatment ◽  
Incident Diabetes ◽  
Prior History ◽  
First Line Therapy ◽  
Statin Use

Background: Statins are first line therapy for hyperlipidemia and the preferred treatment for primary and secondary prevention of cardiovascular disease (CVD). Meta-analyses of prior statin studies suggest an association of statin use with incident diabetes (DM). It is unknown whether incident co-morbid disease plays a role in this observed increase in incident DM amongst statin users. We examined the risk of incident DM using a competing risk of time to first event model. Method: Patients from an integrated health care system were included if they were > 45 years of age, had no prior history of either CVD or DM and who were started on a statin medication for primary prevention. Patients were followed from January 2002 to November 2012 and assessed at 1, 5, and 10 years (n=14736, 10305, and 2541 respectively) for the association of continuous statin use and incident DM or CV event (MI, CVA, AF, CHF, or coronary revascularization). Time until first event was examined using a competing risks statistical model, where the outcome was incident DM a first CV event, or neither. Risk estimates were adjusted using propensity scores of sex, age, hypertension, hyperlipidemia, renal failure, or tobacco use. Results: Patients averaged 55±6 years and were 56% male. Though not statistically significant, 1 -yr follow-up of statin use trended toward an association with incident DM (HR=1.68, 95% CI (0.978, 2.89), p=0.06). 5-yr follow-up of statin use was significantly associated with incident DM (HR=1.48, 95% CI (1.11, 1.97), p =0.008). 10-yr follow-up of statin use was not significantly associated with incident DM (HR=1.01, 95% CI (0.687, 1.47), p =0.97). Conclusion: Using a competing risks model, an association between continuous statin use at 5-years and incident DM was observed, with a trend toward an association at 1-year. Although continuous statin treatment through 5 years was associated with risk of DM , these results do not reveal whether that risk outweighs the expected benefit of statin therapy for primary prevention.

Abstract P078: Gender And Racial Disparities In Aspirin Use For Primary Prevention: Temporal Trends From The National Health And Nutrition Examination Surveys, 2011-2018

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Osama Dasa ◽  
Inyoung Jun ◽  
Ruba Sajdeya ◽  
Mohamad B Taha ◽  
Omar Sajdeya ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Primary Prevention ◽  
National Health ◽  
Gender Gap ◽  
Temporal Trends ◽  
Prior History ◽  
Race And Gender ◽  
Health And Nutrition ◽  
And Gender

Introduction: Cardiovascular disease (CVD) disproportionately affects racial minorities in the US. Aspirin is recommended for primary prevention in persons at high CVD risk. Prior evidence revealed racial and gender disparities in aspirin use for primary prevention. Objectives: To describe recent trends in aspirin use for primary prevention by race and gender to identify factors associated with differences in aspirin use. Methods: Data from the National Health and Nutrition Examination Surveys, 2011-2018, were analyzed. Participants aged 40-79 years, without prior history of CVD were included. Logistic regression was used to assess the association of aspirin use with comorbidities and sociodemographic factors. Results: Among 11212 participants, 47.0% were men; the mean (SD) age was 55.8 (9.79) years; 33.1% were non-Hispanic Whites (W), 23.7% non-Hispanic Blacks (B), and 13.1% Hispanics (H). Aspirin use was more prevalent among W (37.8%) compared to B (26.5%) and H (11.5%) ( P -value <0.001). Trends in aspirin use varied by race and gender over the eight-year follow-up period (Figure 1). Generally, aspirin use was significantly lower in women than men. There was a downward trend in aspirin use in H and B women; H men and women had the lowest prevalence of use across the follow-up duration. Aspirin use was significantly higher at older age, with higher BMI, more comorbidities, non-smokers, and having insurance. Compared to W, H (but not B) had a persistently lower likelihood of aspirin use over time in the unadjusted logistic regression model. After adjustment, race (but not gender) was no longer significantly associated with aspirin use. Conclusions: Aspirin use for primary prevention remains prevalent among W compared to others and among men compared to women. However, after adjusting for several covariates, the effects of race were removed but the gender differences remained. The persistent gender gap in aspirin use for primary prevention requires further explanation, and for those at high risk, intervention.

Abstract 05: Assessing Population Impact of Statin Treatment for Primary Prevention of Atherosclerotic Cardiovascular Diseases in US

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Quanhe Yang ◽  
Yuna Zhong ◽  
Catheen Gillespie ◽  
Robert Merritt ◽  
Barbara Bowman ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Adverse Effects ◽  
Randomized Clinical Trials ◽  
Statin Treatment ◽  
Population Based ◽  
Number Needed To Treat ◽  
Atherosclerotic Cardiovascular Disease ◽  
Population Impact ◽  
New Guidelines ◽  
Statin Use

Introduction: American College of Cardiology/American Heart Association (ACC/AHA) new cholesterol treatment guidelines recommend consideration of statin treatment for a larger proportion of population for the primary prevention of atherosclerotic cardiovascular disease (ASCVD). It is important to assess the population impact of statin treatment under these new guidelines. Hypothesis: We assessed the hypothesis that increased statin use for the primary prevention of ASCVD might be accompanied by adverse effects among population. Methods: We used 2010 US Census, Multiple Cause Mortality, Third National Health and Nutrition Examination Survey Linked Mortality File (NHANES III 1988-2006, n=7095) and NHANES 2005-2010 (n=3178) participants 40-75 years of age to estimate prevalence of statin use, annual ASCVD deaths prevented and excess adverse effects by age, sex, and race/ethnicity if everyone followed updated guidelines. Results: Among 33.0 million adults aged 40-75 years meeting new guidelines for primary prevention of ASCVD (12.4 million with diabetes and 20.6 without diabetes but with a predicted 10-year ASCVD risk ≥7.5% and 70 ≤ low-density lipoprotein (LDL) ≤189 mg/dL), 26.9% (8.8 million) were on statins, indicating an additional 24.2 million potentially eligible for statin treatment (7.7 million with diabetes and 16.5 million without). Among the 7.7 million with diabetes, assuming 100% statin use, expected annual ASCVD deaths prevented were 2,514 (95% CI 592-4,142) and number-needed-to-treat (NNT) was 3,063 (1,860-13,017). The additional cases of myopathy based on estimates from randomized clinical trials (RCT) was 482 (0-2239) and number-needed-to-harm (NNH) was 15,992 (3,440-∞), and was 11,801 (9,251-14,916) and NNH 653 (516-833) based on estimates from population-based studies. Among 16.5 million without diabetes, ASCVD deaths prevented were 5,425 (1,276-8,935) with NNT 3,039 (1,845-12,914). The additional diabetes cases were 16,406 (4,922-26,250) with NNH 1,005 (628-3,349). Additional cases of myopathy was 1,030 (0-4,791) with NNH 15,996 3,441-∞) based on RCT estimates, and 24,302 (19,363-30,292) with NNH 678 (544-851) for population-based studies. ASCVD deaths prevented increased with age and >70% of ASCVD deaths prevented would occur among adults aged ≥60 years. Conclusions: Under ACC/AHA new guidelines for primary prevention of ASCVD by statin, assuming all those eligible took a statin, up to 12.6% of annual ASCVD deaths could be prevented, but could be accompanied by additional cases of diabetes and myopathy.

scholarly journals Degree of Blood Pressure Control and Incident Diabetes Mellitus in Chinese Adults With Hypertension

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Yuanyuan Zhang ◽  
Jing Nie ◽  
Yan Zhang ◽  
Jianping Li ◽  
Min Liang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Propensity Scores ◽  
Fasting Glucose ◽  
Pressure Control ◽  
Incident Diabetes ◽  
Chinese Adults ◽  
Normal Fasting Glucose ◽  
Diagnosed Diabetes

Background The association between blood pressure (BP) control and incident diabetes mellitus remains unknown. We aim to investigate the association between degree of time‐averaged on‐treatment systolic blood pressure (SBP) control and incident diabetes mellitus in hypertensive adults. Methods and Results A total of 14 978 adults with hypertension without diabetes mellitus at baseline were included from the CSPPT (China Stroke Primary Prevention Trial). Participants were randomized double‐masked to daily enalapril 10 mg and folic acid 0.8 mg or enalapril 10 mg alone. BP measurements were taken every 3 months after randomization. The primary outcome was incident diabetes mellitus, defined as physician‐diagnosed diabetes mellitus, or use of glucose‐lowering drugs during follow‐up, or fasting glucose ≥126 mg/dL at the exit visit. Over a median of 4.5 years, a significantly higher risk of incident diabetes mellitus was found in participants with time‐averaged on‐treatment SBP 130 to <140 mm Hg (10.3% versus 7.4%; odds ratio [OR], 1.37; 95% CI, 1.15‒1.64), compared with those with SBP 120 to <130 mm Hg. Moreover, the risk of incident diabetes mellitus increased by 24% (OR, 1.24; 95% CI, 1.00‒1.53) and the incidence of regression to normal fasting glucose (<100 mg/dL) decreased by 29% (OR, 0.71; 95% CI, 0.57‒0.89) in participants with intermediate BP control (SBP/diastolic blood pressure, 130 to <140 and/or 80 to <90 mm Hg), compared with those with a tight BP control of <130/<80 mm Hg. Similar results were found when the time‐averaged BP were calculated using the BP measurements during the first 6‐ or 24‐month treatment period, or in the analysis using propensity scores. Conclusions In this non‐diabetic, hypertensive population, SBP control in the range of 120 to <130 mm Hg, compared with the 130 to <140 mm Hg, was associated with a lower risk of incident diabetes mellitus.

Effect of fitness on incident diabetes from statin use in primary prevention

2015 ◽  
Vol 239 (1) ◽  
pp. 43-49 ◽  
Author(s):  
Nina B. Radford ◽  
Laura F. DeFina ◽  
Carolyn E. Barlow ◽  
Alice Kerr ◽  
Ripa Chakravorty ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Incident Diabetes ◽  
Statin Use

scholarly journals Statin adherence is lower in primary than secondary prevention: A national follow-up study of new users

PLoS ONE ◽  
2020 ◽  
Vol 15 (11) ◽  
pp. e0242424
Author(s):  
Finn Sigglekow ◽  
Simon Horsburgh ◽  
Lianne Parkin
Keyword(s):  
Primary Prevention ◽  
Secondary Prevention ◽  
Medication Possession Ratio ◽  
Statin Treatment ◽  
Group A ◽  
Hospital Discharge Records ◽  
Statin Medication ◽  
Statin Adherence ◽  
Dispensing Data

Background Maintaining adherence to statins reduces the risk of an initial cardiovascular disease (CVD) event in high-risk individuals (primary prevention) and additional CVD events following the first event (secondary prevention). The effectiveness of statin therapy is limited by the level of adherence maintained by the patient. We undertook a nationwide study to compare adherence and discontinuation in primary and secondary prevention patients. Methods Dispensing data from New Zealand community pharmacies were used to identify patients who received their first statin dispensing between 2006 and 2011. The Medication Possession Ratio (MPR) and proportion who discontinued statin medication was calculated for the year following first statin dispensing for patients with a minimum of two dispensings. Adherence was defined as an MPR ≥ 0.8. Previous CVD was identified using hospital discharge records. Multivariable logistic regression was used to control for demographic and statin characteristics. Results Between 2006 and 2011 289,666 new statin users were identified with 238,855 (82.5%) receiving the statin for primary prevention compared to 50,811 (17.5%) who received it for secondary prevention. The secondary prevention group was 1.55 (95% CI 1.51–1.59) times as likely to be adherent and 0.67 (95% CI 0.65–0.69) times as likely to discontinue statin treatment than the primary prevention group. An early gap in statin coverage increased the odds of discontinuing statin treatment. Conclusion Adherence to statin medication is higher in secondary prevention than primary prevention. Within each group, a range of demographic and treatment factors further influences adherence.

scholarly journals Emulating a target trial of statin use and risk of dementia using cohort data

Neurology ◽  
2020 ◽  
Vol 95 (10) ◽  
pp. e1322-e1332
Author(s):  
Ellen C. Caniglia ◽  
L. Paloma Rojas-Saunero ◽  
Saima Hilal ◽  
Silvan Licher ◽  
Roger Logan ◽  
...  
Keyword(s):  
Statin Treatment ◽  
Target Trial ◽  
Loss To Follow Up ◽  
Intention To Treat ◽  
Dementia Risk ◽  
Diagnosis Of Dementia ◽  
Estimated Risk ◽  
Using Data ◽  
Statin Use

ObjectiveObservational data can be used to attempt to emulate a target trial of statin use and estimate analogues of intention-to-treat and per protocol effects on dementia risk.MethodsUsing data from a prospective cohort study in the Netherlands, we conceptualized a sequence of “trials” in which eligible individuals ages 55–80 years were classified as statin initiators or noninitiators for every consecutive month between 1993 and 2007 and were followed until diagnosis of dementia, death, loss to follow-up, or the end of follow-up. We estimated 2 types of effects of statin use on dementia and a combined endpoint of dementia or death: the effect of initiation vs no initiation and the effect of sustained use vs no use. We estimated risk by statin treatment strategy over time via pooled logistic regression. We used inverse-probability weighting to account for treatment-confounder feedback in estimation of per-protocol effects.ResultsOf 233,526 eligible person-trials (6,373 individuals), there were 622 initiators and 232,904 noninitiators. Comparing statin initiation with no initiation, the 10-year risk differences (95% confidence interval) were −0.1% (−2.3% to 1.8%) for dementia and 0.3% (−2.7% to 3.3%) for dementia or death. Comparing sustained statin use vs no use, the 10-year risk differences were −2.2% (−5.2% to 1.6%) for dementia and −5.1% (−10.5% to −1.1%) for dementia or death.ConclusionsIndividuals with sustained statin use, but not statin initiation alone, had reduced 10-year risks of dementia and dementia or death. Our results should be interpreted with caution due to the small number of initiators and events and potential for residual confounding.

scholarly journals GCT-28. RECURRENCE PATTERN AND SURVIVAL FOR RELAPSED INTRACRANIAL NON-GERMINOMATOUS GERM CELL TUMORS: A SINGLE-INSTITUTION EXPERIENCE

2020 ◽  
Vol 22 (Supplement_3) ◽  
pp. iii333-iii333
Author(s):  
Lei Wen ◽  
Zhaoming Zhou ◽  
Qingjun Hu ◽  
Juan Li ◽  
Mingyao Lai ◽  
...  
Keyword(s):  
Germ Cell ◽  
Germ Cell Tumors ◽  
Late Recurrence ◽  
Salvage Chemotherapy ◽  
Recurrence Time ◽  
First Line ◽  
Primary Tumor Site ◽  
First Line Therapy ◽  
Line Therapy

Abstract PURPOSE Intracranial non-germinomatous germ cell tumors (NGGCTs) have lower overall survival than germinoma because relatively higher recurrence usually occurs after first line therapy. METHODS Between January 2003 and December 2018, 111 consecutive patients diagnosed with NGGCTs reviewed. Those who progressed after first line therapy were included in this study. Data of first line treatment, salvage treatment, clinicopathological features and survival were collected and analyzed. RESULTS Totally, thirty patients (30/111, 27.0%) relapsed in our cohort, including 19 patients with accurate relapse information detail, and 11 patients who died of disease progression during follow up but without exact time and site of relapse. The median OS from diagnosis of the disease was 49.2 months (95% CI: 14.1 to 84.3 months) and 3-year OS was 54.3%. Patients who received both CSI and chemotherapy relapsed less than those who received reduced volume of radiotherapy or only CSI or only chemotherapy (22.5% vs. 45.5%, p=0.034). Of 19 patients who had detail information of recurrence time and site, the median time from diagnosis of disease to relapse was 9.5 months (2.2 to 72.1 months). Regarding to recurrence site, most patients relapsed in primary site (10/19, 52.6%) or distant intracranial (6/19, 31.6%). The recurrence site of other 3 patients were spinal (n=1), ventricular (n=1) and peritoneal (n=1). CONCLUSION Protracted follow-up is recommended because late recurrence is not uncommon. Primary tumor site and distant intracranial are the most prevalent relapsed location. Patients who relapsed could benefited from both CSI and salvage chemotherapy.

Long-term Clinical Follow-up of Japanese Heart Failure Patients Received ICD Therapy for Primary Prevention of Sudden Cardiac Death

2008 ◽  
Vol 14 (7) ◽  
pp. S140-S141
Author(s):  
Kenji Ando ◽  
Yoshimitsu Soga ◽  
Masahiko Goya ◽  
Shinichi Shirai ◽  
Shinya Nagayama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Primary Prevention ◽  
Sudden Cardiac Death ◽  
Cardiac Death ◽  
Icd Therapy ◽  
Heart Failure Patients

Dementia screening in elderly high-risk patients following heart failure decompensation may predict unfavorable long-term clinical outcomes

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Stepien ◽  
P Furczynska ◽  
M Zalewska ◽  
K Nowak ◽  
A Wlodarczyk ◽  
...  
Keyword(s):  
Heart Failure ◽  
High Risk ◽  
Clinical Outcomes ◽  
Mmse Score ◽  
Coronary Revascularization ◽  
High Risk Population ◽  
Risk Population ◽  
History Of

Abstract Background Recently heart failure (HF) has been found to be a new dementia risk factor, nevertheless their relations in patients following HF decompensation remain unknown. Purpose We sought to investigate whether a screening diagnosis for dementia (SDD) in this high-risk population may predict unfavorable long-term clinical outcomes. Methods 142 patients following HF decompensation requiring hospitalization were enrolled. Within a median time of 55 months all patients were screened for dementia with ALFI-MMSE scale whereas their compliance was assessed with the Morisky Medication Adherence Scale. Any incidents of myocardial infarction, coronary revascularization, stroke or transient ischemic attack (TIA), revascularization, HF hospitalization and bleedings during follow-up were collected. Results SDD was established in 37 patients (26%) based on the result of an ALFI-MMSE score of &lt;17 points. By multivariate analysis the lower results of the ALFI-MMSE score were associated with a history of stroke/TIA (β=−0.29, P&lt;0.001), peripheral arterial disease (PAD) (β=−0.20, P=0.011) and lower glomerular filtration rate (β=0.24, P=0.009). During the follow-up, patients with SDD were more often rehospitalized following HF decompensation (48.7% vs 28.6%, P=0.014) than patients without SDD, despite a similar level of compliance (P=0.25). Irrespective of stroke/TIA history, SDD independently increased the risk of rehospitalization due to HF decompensation (HR 2.22, 95% CI 1.23–4.01, P=0.007). Conclusions As shown for the first time in literature patients following decompensated HF, a history of stroke/TIA, PAD and impaired renal function independently influenced SDD. In this high-risk population, SDD was not associated with patients' compliance but irrespective of the stroke/TIA history it increased the risk of recurrent HF hospitalization. The survival free of rehospitalization Funding Acknowledgement Type of funding source: None

scholarly journals Gait Speed as a Predictor for Diabetes Incidence in People with or at Risk of Knee Osteoarthritis: A Longitudinal Analysis from the Osteoarthritis Initiative

2021 ◽  
Vol 18 (9) ◽  
pp. 4414
Author(s):  
Aqeel M. Alenazi ◽  
Bader A. Alqahtani ◽  
Vishal Vennu ◽  
Mohammed M. Alshehri ◽  
Ahmad D. Alanazi ◽  
...  
Keyword(s):  
At Risk ◽  
Gait Speed ◽  
Area Under The Curve ◽  
Incident Diabetes ◽  
Future Research ◽  
Cutoff Score ◽  
Diabetes Incidence ◽  
Knee Oa ◽  
Osteoarthritis Initiative

Background: This study examined the association between baseline gait speed with incident diabetes mellitus (DM) among people with or at elevated risk for knee OA. Materials and Methods: Participants from the Osteoarthritis Initiative, aged 45 to 79 years, where included. Participants with or at risk of knee OA from baseline to the 96-month visit were included. Participants with self-reported DM at baseline were excluded. DM incidence was followed over the 4-time points. Gait speed was measured at baseline using a 20-m walk test. Generalized estimating equations with logistic regression were utilized for analyses. Receiver operator characteristic curves and area under the curve were used to determine the cutoff score for baseline speed. Results: Of the 4313 participants included in the analyses (58.7% females), 301 participants had a cumulative incidence of DM of 7.0% during follow-up. Decreased gait speed was a significant predictor of incident DM (RR 0.44, p = 0.018). The threshold for baseline gait speed that predicted incident DM was 1.32 m/s with an area under the curve of 0.59 (p < 0.001). Conclusions: Baseline gait speed could be an important screening tool for identifying people at risk of incident diabetes, and the determined cutoff value for gait speed should be examined in future research.

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