High-Intensity Atorvastatin-Induced Rhabdomyolysis in an Elderly Patient With NSTEMI: A Case Report and Review of the Literature

2016 ◽  
Vol 30 (6) ◽  
pp. 658-662 ◽  
Author(s):  
Glen A. Huynh ◽  
Audrey J. Lee
Keyword(s):  
Case Report ◽  
Serum Creatinine ◽  
Muscle Weakness ◽  
High Intensity ◽  
American Heart ◽  
Heart Association ◽  
Blood Cholesterol ◽  
Moderate Intensity ◽  
Review Of The Literature ◽  
The Past

A 91-year-old male was admitted to the hospital for worsening muscle weakness, muscle pain, and unexplained soreness for the past 10 days. Four months prior to his admission, the patient had experienced a myocardial infarction and was initiated on atorvastatin 80 mg daily. Although the provider had instructed the patient to decrease the atorvastatin dose to 40 mg daily 3 months prior to admission, the patient did not adhere to the lower dose regimen until 10 days prior to hospitalization. Upon admission, the patient presented with muscle weakness and pain, a serum creatinine phosphokinase of 18 723 U/L, and a serum creatinine of 1.6 mg/dL. The atorvastatin dose was held and the patient was treated with intravenous fluids. The 2013 American College of Cardiology and American Heart Association Blood Cholesterol Practice Guidelines recommend the use of moderate-intensity statins in patients older than 75 years to prevent myopathy. However, in clinical practice, aggressive statin therapy is often prescribed for significant coronary disease. Prescribing high-intensity statins for patients with advanced age, such as this case, may increase the risk of rhabdomyolysis and other complications. This case report suggests that providers should avoid or be cautious with initiating high-intensity atorvastatin in elderly patients over 75 years to minimize the risk of rhabdomyolysis.

THE PEDIATRICIAN AND ATHEROSCLEROSIS

PEDIATRICS ◽  
1972 ◽  
Vol 49 (2) ◽  
pp. 165-168
Author(s):  
Shiela Mitchell ◽  
S. Gilbert Blount ◽  
Sidney Blumenthal ◽  
Mary Jane Jesse ◽  
William H. Weidman
Keyword(s):  
American Heart Association ◽  
Congenital Heart ◽  
American Heart ◽  
Heart Diseases ◽  
Heart Association ◽  
The United States ◽  
Review Of The Literature ◽  
The Past ◽  
Foreign Countries ◽  
Future Risk

The incidence of premature disability and death from complications of atherosclerosis in the adult American is so high that pediatricians must accept the responsibility of finding the threatened child and, insofar as possible, reducing the future risk. The Council of Rheumatic Fever and Congenital Heart Diseases of the American Heart Association formed a Committee which, during the past 2½ years, has met with a number of different experts in the field. These presentations have been supplemented by a selected review of the literature, and a workshop made up of experts in several related fields selected from the United States and a number of foreign countries to complement the above presentations.

Abstract 15632: The Implications of the Recent American College of Cardiology/American Heart Association Guidelines for the Treatment of Blood Cholesterol on a Rural Community: The Heart of New Ulm Project

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Michael D Miedema ◽  
Abbey C Sidebottom ◽  
Arthur Sillah ◽  
Gretchen Benson ◽  
Jackie Boucher ◽  
...  
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
American Heart Association ◽  
Census Data ◽  
American Heart ◽  
Heart Association ◽  
Blood Cholesterol ◽  
Lipid Lowering ◽  
New Guidelines ◽  
The Impact

Introduction: The impact of the new American College of Cardiology/American Heart Association (ACC/AHA) cholesterol guidelines on the volume of statin-eligible patients requires further analysis, particularly in rural communities who are rarely included in traditional large observational cohorts. Methods: We performed a cross-sectional analysis using data from the Heart of New Ulm Project, a population-based program aimed at reducing modifiable cardiovascular disease (CVD) risk factors in rural New Ulm, MN. According to 2010 census data, there were 7,855 adults aged 40-79 years in the target population at that time. The community is served by one health and electronic health records (EHR) system. EHR-based demographics, diagnoses, and medications were analyzed in residents aged 40-79 years in 2012-2013. The prevalence of indications for statin therapy and of use of statins and other lipid-lowering medications were analyzed according to the ACC/AHA guidelines. Results: There were 6,357 residents with a visit during the study period, of which 4,281 had adequate data and were included in the analysis (mean age 59.4 [10.2] years, 52.7% female). In our study sample, 2,529 (59%) met one of the 4 major indications for statin therapy (Table). Of those with an indication, 65% were on a statin, 11% were on a high-intensity statin, and 5% on other lipid-lowering agents. An age stratified analysis demonstrated that 86% of individuals 60-79 years old (n=2,036) are now statin-eligible compared to 35% of individuals 40-59 years old (n=2,245). Conclusion: Using contemporary EHR data from a rural Midwest community, approximately 3 in 5 middle-age residents qualify for statin therapy according to the new guidelines, but only two-thirds of those individuals were taking a statin. Full compliance with the new guidelines will require a significant increase in statin utilization, including more frequent use of high-intensity statins.

Asthma and Pneumomediastinum

PEDIATRICS ◽  
1985 ◽  
Vol 75 (5) ◽  
pp. 990-990
Author(s):  
ROBERT G. ZWERDLING
Keyword(s):  
Case Report ◽  
Childhood Asthma ◽  
Mediastinal Emphysema ◽  
Review Of The Literature ◽  
Common Cause ◽  
The Past ◽  
Treatable Condition

To the Editor.— Sturtz's case report and brief review of the literature on spontaneous mediastinal emphysema is interesting.1 However, he neglects to mention what is perhaps the most common cause of this condition in childhood—asthma. Indeed, reports of this complication have occurred over the past 130 years.2-4 Recognition of this fact often results in an understanding of the cause for the pneumomediastinum as well as tipping the clinician off to a possibly undiagnosed but readily treatable condition.

Abstract 29: Loss of Ideal Total Cholesterol Early in Life: The National Health and Nutrition Examination Survey (NHANES)

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Joseph C Engeda ◽  
Katelyn M Holliday ◽  
Shakia T Hardy ◽  
Sujatro Chakladar ◽  
Gerardo Heiss ◽  
...  
Keyword(s):  
American Heart ◽  
Transition Probabilities ◽  
Heart Association ◽  
Blood Cholesterol ◽  
Total Blood ◽  
Cross Sectional ◽  
Demographic Groups ◽  
Health And Nutrition ◽  
One Year ◽  
Total Blood Cholesterol

Introduction: Ideal total blood cholesterol (TC) levels are associated with lower cardiovascular disease (CVD) morbidity and mortality. In the U.S. TC increases up to middle age, but declines at older ages. Few studies have characterized the transition from ideal to intermediate and poor TC levels in different life epochs and in minorities. Methods: Cross-sectional 2007-2012 NHANES data (N = 11,140) were used to estimate the age-, race-, and sex- specific prevalence of ideal (≥20 years: <200 mg/dL untreated, 16-19 years: <170 mg/dL), intermediate (≥20 years: 200-239 mg/dL or treated to goal, 16-19 years: 170-199 mg/dL), and poor (≥20 years: ≥240 mg/dL, 16-19 years: ≥200 mg/dL) TC, defined per American Heart Association criteria. We then used these data and novel Markov-type models to estimate net transition probabilities between ideal, intermediate and poor TC. Results: Between the ages of 16 and 18, the prevalence of ideal TC among European American (EA) and African American (AA) men was approximately 68%, notably higher than the prevalence in EA women (63%) and AA women (61%). Variation in the loss of ideal TC was also observed by race and sex. Between 16-50 years of age, the proportion of AA men, EA men and EA women with ideal levels of TC declined approximately 2.0% (95% CI: 1.8%, 2.2%) per year. In AA women by contrast, the age-specific decline in ideal TC was not uniform between 16-50 years of age. The proportion of AA women with ideal levels of TC declined 0.7% (95% CI: 0.2%, 1.2%) per year from 16-20 years of age but increased to 2.8% (95% CI: 2.4%, 3.3%) per year by age 50. Among populations with intermediate TC levels, estimated 1-year net transitions to poor TC peaked at age 16, the earliest age under investigation, for EA men, EA women, and AA men but remained stable for AA women through 70 years of age, where a net 0.6% (95% CI: 0.1%, 1.3%) of the population with intermediate TC levels transitioned to poor TC levels one year later. In all demographic groups and life epochs, greater proportions of the population transitioned from intermediate to poor TC than from poor to intermediate TC. Conclusions: Loss of ideal TC begins early in life and shows divergent patters by gender and race. Difficulties re-attaining ideal TC once classified as intermediate or poor support interventions that promote ideal TC levels in younger ages, especially among AA women.

scholarly journals Dietary Fat and Cardiovascular Disease: Ebb and Flow Over the Last Half Century

2019 ◽  
Vol 10 (Supplement_4) ◽  
pp. S332-S339 ◽  
Author(s):  
Alice H Lichtenstein
Keyword(s):  
Cardiovascular Disease ◽  
Systematic Reviews ◽  
American Heart ◽  
Saturated Fat ◽  
Heart Association ◽  
Polyunsaturated Fat ◽  
Cvd Risk ◽  
Unsaturated Fat ◽  
The Past ◽  
The Media

ABSTRACT Dietary modification has been the cornerstone of cardiovascular disease (CVD) prevention since the middle of the last century when the American Heart Association (AHA) first issued recommendations. For the vast majority of that time the focus has been on saturated fat, with or without concomitant guidance for total or unsaturated fat. Over the past few years there has been a renewed debate about the relation between dietary saturated fat and CVD risk, prompted by a series of systematic reviews that have come to what appears to be different conclusions. This triggered a robust discourse about this controversy in the media that in turn has led to confusion in the general public. The genesis of the different conclusions among the systematic reviews has been identified in several studies on the basis of isocaloric substitution analyses. When the data were analyzed on the basis of polyunsaturated fat replacing saturated fat, there was a positive relation between dietary saturated fat and CVD. When the data were analyzed on the basis of carbohydrate replacing saturated fat, there was a null relation between dietary saturated fat and CVD. When the substitution macronutrient was not taken into consideration, the differential effects of the macronutrient substitution went unrecognized and the relations judged as null. The lack of distinction among substituted macronutrients accounted for much of what appeared to be discrepancies. Dietary guidance consistent with replacing foods high in saturated fat with foods high in unsaturated fat, first recommended more than 50 y ago, remains appropriate to this day.

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