Abstract 181: Application of the 2018 Cholesterol Guideline for Secondary Prevention in Very High-risk Patients with Atherosclerotic Cardiovascular Disease in the United States

Seasonal influenza remains a major health burden in the United States. Despite recommendations of early antiviral treatment of high-risk patients, the effective treatment coverage remains very low. We developed an influenza transmission model that incorporates data on infectious viral load, social contact, and healthcare-seeking behavior, to evaluate the population-level impact of increasing antiviral treatment timeliness and coverage among high-risk patients in the US. We found that increasing the rate of early treatment among high-risk patients who received treatment more than 48 hours after symptoms onset, would substantially avert infections and influenza-induced hospitalizations. We found that treatment of the elderly has the highest impact on reducing hospitalizations, whereas treating high-risk individuals aged 5-19 years old has the highest impact on transmission. The population-level impact of increased timeliness and coverage of treatment among high-risk patients was observed regardless of seasonal influenza vaccination coverage and the severity of the influenza season.

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Pre-existing Cardiovascular Disease in United States Population at High Risk for Severe COVID-19 Infection

10.1101/2020.05.11.20089714 ◽

2020 ◽

Author(s):

Adnan I Qureshi

Keyword(s):

United States ◽

Risk Factors ◽

Cardiovascular Disease ◽

At Risk ◽

High Risk ◽

Low Risk ◽

Chronic Obstructive ◽

Moderate Risk ◽

High Risk Patients ◽

Risk Patients

Background and Purpose There is increasing recognition of a relatively high burden of pre-existing cardiovascular disease in Corona Virus Disease 2019 (COVID 19) infected patients. We determined the burden of pre-existing cardiovascular disease in persons residing in United States (US) who are at risk for severe COVID-19 infection. Methods Age (60 years or greater), presence of chronic obstructive pulmonary disease, diabetes, mellitus, hypertension, and/or malignancy were used to identify persons at risk for admission to intensive care unit, or invasive ventilation, or death with COVID-19 infection. Persons were classified as low risk (no risk factors), moderate risk (1 risk factor), and high risk (two or more risk factors present) using nationally representative sample of US adults from National Health and Nutrition Examination Survey 2017 and 2018 survey. Results Among a total of 5856 participants, 2386 (40.7%) were considered low risk, 1325 (22.6%) moderate risk, and 2145 persons (36.6%) as high risk for severe COVID-19 infection. The proportion of patients who had pre-existing stroke increased from 0.6% to 10.5% in low risk patients to high risk patients (odds ratio [OR]19.9, 95% confidence interval [CI]11.6-34.3). The proportion of who had pre-existing myocardial infection (MI) increased from 0.4% to 10.4% in low risk patients to high risk patients (OR 30.6, 95% CI 15.7-59.8). Conclusions A large proportion of persons in US who are at risk for developing severe COVID 19 infection are expected to have pre-existing cardiovascular disease. Further studies need to identify whether targeted strategies towards cardiovascular diseases can reduce the mortality in COVID-19 infected patients.

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Patterns of care in treating childhood neuroblastoma: Evidence from a population level study (SEER) in the United States.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.15_suppl.e22011 ◽

2017 ◽

Vol 35 (15_suppl) ◽

pp. e22011-e22011

Author(s):

Diarmuid Coughlan ◽

Charles Lynch ◽

Matthew Gianferante ◽

Jennifer Stevens ◽

Linda C Harlan

Keyword(s):

United States ◽

Clinical Trial ◽

High Risk ◽

Cancer Registries ◽

The United States ◽

Patterns Of Care ◽

Treatment Modalities ◽

High Dose ◽

High Risk Patients ◽

Risk Patients

e22011 Background: Childhood neuroblastoma describes a heterogeneous group of extracranial solid tumors. This heterogeneity is reflected in the sequence and variety of treatment modalities administered. We describe the treatment pattern and survival of childhood neuroblastoma patients using population-based data in the United States. Methods: Using the National Cancer Institute’s (NCI) Patterns of Care data, we examined treatment provided to childhood neuroblastoma patients newly diagnosed in 2010 and 2011 and registered to one of 14 Surveillance, Epidemiology, and End Results (SEER) cancer registries. Data were re-abstracted from hospital records and treating physicians were contacted to verify the treatment given. Stratifying by the Children’s Oncology Group (COG)’s 3-level (low, intermediate and high) neuroblastoma risk classification system for therapeutic decision-making, gave a snapshot of community-based treatment patterns. Kaplan-Meier survival analyses were also performed. Results: The majority of 250 patients (76%) were enrolled on an open/active clinical trial. All low-risk patients received surgery with/without chemotherapy. The majority of intermediate-risk patients (77%) received chemotherapy regimen that included carboplatin, etoposide, cyclophosphamide and doxorubicin. High-risk patients received extensive, multimodal treatment consisting of chemotherapy, surgery, high dose chemotherapy with stem cell rescue (transplant), radiation, immunotherapy (dinutuximab), and isotretinoin therapy. Cyclophosphamide was the most utilized chemotherapy agent (94%) in high-risk patients. Survival with a maximum follow-up of 48 months, was lowest (68%) for patients diagnosed with high-risk disease. Conclusions: The majority of childhood neuroblastoma patients are registered on a risk-based open/active clinical trial. Variation in modality, systemic agents and sequence of treatment reflects the heterogeneity of therapy for childhood neuroblastoma patients.

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The Role of Suppressing Inflammation in the Treatment of Atherosclerotic Cardiovascular Disease

Annals of Pharmacotherapy ◽

10.1177/1060028020922994 ◽

2020 ◽

Vol 54 (10) ◽

pp. 1021-1029

Author(s):

Yuani M. Roman ◽

Adrian V. Hernandez ◽

C. Michael White

Keyword(s):

Cardiovascular Disease ◽

High Risk ◽

English Language ◽

Atherosclerotic Cardiovascular Disease ◽

C Reactive Protein ◽

High Risk Patients ◽

Reactive Protein ◽

Risk Patients ◽

Hs Crp ◽

The Impact

Objective: To review the 3 anti-inflammatory drugs, canakinumab, colchicine, and methotrexate, that have been investigated in major clinical trials for treating patients with atherosclerotic cardiovascular disease (ASCVD). Data Sources: An Ovid MEDLINE literature search (1946 to February 2, 2020) was performed using search strategy [( C-reactive protein OR ASCVD OR cardiac disease OR cardiovascular disease) AND (canakinumab OR methotrexate OR Colchicine)]. Additional references were identified from the citations. Study Selection and Data Extraction: English-language studies assessing the impact of these 3 drugs on inflammation as measured by high-sensitivity C-reactive protein (hs-CRP) or the association with reducing ASCVD events were included. Data Synthesis: Canakinumab and colchicine significantly reduced ASCVD events in high-risk patients with median baseline hs-CRP levels of ~4.0 mg/L. Methotrexate was ineffective at reducing ASCVD events in high-risk patients, but their baseline hs-CRP concentrations were a median of <2 mg/L. In subgroup analyses of the Canakinumab Antiinflammatory Thrombosis Outcome Study (CANTOS), patients whose baseline hs-CRP was 2 to 4 mg/L had benefits from canakinumab therapy similar to those with baseline levels exceeding 4. Relevance to Patient Care and Clinical Practice: Even with the best current drug therapies, patients with underlying inflammation can benefit from the addition of both colchicine and canakinumab to further lower CV events. Given its cost, colchicine is a more attractive option. Conclusions: Patients at high risk of recurrent cardiovascular disease events with an hs-CRP of 2 mg/L or greater can reduce the occurrence of ASCVD events with canakinumab or colchicine therapy. Colchicine is the preferable option, in particular for those with myocardial infarction, given its more reasonable cost.

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