Safety of High-Intensity Statins in the Veteran Population: Atorvastatin 40 to 80 mg Compared With Rosuvastatin 20 to 40 mg

2019 ◽  
Vol 54 (5) ◽  
pp. 405-413 ◽  
Author(s):  
Bradley Stein ◽  
Tiffany Ward ◽  
Genevieve Hale ◽  
Elise Lyver
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
Primary Objective ◽  
Current Evidence ◽  
Major Adverse Cardiovascular Events ◽  
Atherosclerotic Cardiovascular Disease ◽  
Health Administration ◽  
Veteran's Health Administration ◽  
Comparative Safety ◽  
Veteran’S Health

Background: High-intensity statin therapy is recommended in patients with clinical atherosclerotic cardiovascular disease (ASCVD) or at high risk of ASCVD. Current evidence demonstrates efficacy of high-intensity statin therapy in reducing major adverse cardiovascular events; yet the comparative safety profile between high-intensity statin agents remains unknown. In 2011, when atorvastatin became generic, the Veteran’s Health Administration made the formulary switch from rosuvastatin to atorvastatin. Currently, rosuvastatin is generic; however, at the time of this study, it was still under patent. Objective: The primary objective was to determine if high-intensity atorvastatin compared with rosuvastatin is associated with an increased incidence of adverse drug reactions (ADRs) in the veteran population. Methods: A retrospective cohort study at James A. Haley Veterans’ Hospital compared patients receiving rosuvastatin 20 to 40mg from January 2009 to November 2011 (n = 4,165) and atorvastatin 40 to 80mg from May 2012 to June 2016 (n = 5,852). Patients were excluded if they were nonadherent to statin therapy or had a documented ADR to atorvastatin prior to formulary switch. Results: A difference in overall ADR rates was found between atorvastatin and rosuvastatin groups (4.59% vs 2.91%; odds ratio [OR], 1.61; 95% CI, 1.29 to 2.00; P < 0.05). Statistically significant differences in abnormal liver transaminases (3.99% vs 1.39%; OR, 2.95; 95% CI, 2.21 to 3.94; P < 0.05) and statin-associated muscle symptoms (1.14% vs 0.5%; OR, 2.29; 95% CI, 1.39 to 3.74; P < 0.05) were identified between groups. Patients receiving rosuvastatin were on therapy 2.5 times longer before developing an ADR. Conclusion and Relevance: High-intensity atorvastatin compared with rosuvastatin is associated with an increased incidence of ADRs.

scholarly journals Mortality among older adults with opioid use disorders in the Veteran's Health Administration, 2000–2011

2015 ◽  
Vol 147 ◽  
pp. 32-37 ◽  
Author(s):  
Sarah Larney ◽  
Amy S.B. Bohnert ◽  
Dara Ganoczy ◽  
Mark A. Ilgen ◽  
Matthew Hickman ◽  
...  
Keyword(s):  
Older Adults ◽  
Health Administration ◽  
Opioid Use ◽  
Veteran's Health Administration ◽  
Opioid Use Disorders ◽  
Veteran’S Health

Abstract 12169: LDL-C Levels and Treatment Patterns Among Adults With Heterozygous Familial Hypercholesterolemia in the United States: Data From the CASCADE-FH Registry

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Emil M deGoma ◽  
Zahid S Ahmad ◽  
Emily O'Brien ◽  
Iris Kindt ◽  
Peter Shrader ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Familial Hypercholesterolemia ◽  
High Intensity ◽  
The United States ◽  
Treatment Patterns ◽  
Atherosclerotic Cardiovascular Disease ◽  
Cascade Screening ◽  
Cross Sectional ◽  
Lowering Therapy ◽  
Care Gaps

Introduction: In the US, LDL-C levels and treatment patterns of patients with familial hypercholesterolemia (FH) – a group prioritized for statin therapy in the 2013 ACC/AHA cholesterol guidelines – remain poorly described. In 2013 the FH Foundation launched the CAscade SCreening for Awareness and DEtection (CASCADE) of FH Registry, the only active US FH patient registry addressing this knowledge gap. Methods: We conducted a 2-year (2013-2015) cross-sectional analysis among 1,295 adults with heterozygous FH enrolled in the CASCADE FH Registry from 10 US lipid clinics. Results: Mean (SD) age at enrollment was 54 (16) years; mean age at FH diagnosis was 45 (19) years; 59% were female; and 80% were white. Mean pretreatment and post-treatment LDL-C levels were 256 (66) and 156 (71) mg/dl, respectively. At enrollment, 43% of patients were taking high-intensity statin therapy; 25% were not taking a statin; and 45% received >1 LDL-lowering therapy. Among FH patients on LDL-lowering therapy, 25% achieved an LDL-C <100 mg/dl, and 41% achieved a ≥50% LDL-C reduction (Table). Factors associated with a ≥50% LDL-C reduction included high-intensity statin use (adjusted OR 2.24, 95% CI 1.47-3.42) and use of >1 LDL-lowering therapy (1.94, 1.29-2.93) (Figure). Atherosclerotic cardiovascular disease (ASCVD) was present in 37%, of whom 44% achieved a ≥50% LDL-C reduction and 9% achieved an LDL-C <70 mg/dl. Conclusions: Despite the high prevalence of ASCVD, several care gaps exist for FH patients enrolled in the CASCADE US registry: lack of early diagnosis, insufficient use of high-intensity statin therapy, and failure to achieve adequate LDL-C reductions.

The Evolving Role of Advanced Practice Nursing within the New Veteran's Health Administration

1999 ◽  
Vol 24 (4) ◽  
pp. 80-93
Author(s):  
Marilyn M. Lynn ◽  
Carol Achtmeyer ◽  
Carol Chavez ◽  
Barbara Zicafoose ◽  
Janice Therien
Keyword(s):  
Advanced Practice Nursing ◽  
Advanced Practice ◽  
Health Administration ◽  
Veteran's Health Administration ◽  
Veteran’S Health

Abstract W P269: High vs. Moderate-intensity Statin Therapy After Ischemic Stroke: Findings from PROSPER

Stroke ◽  
2015 ◽  
Vol 46 (suppl_1) ◽  
Author(s):  
Melissa A Greiner ◽  
Emily O'Brien ◽  
Ying Xian ◽  
Deepak L Bhatt ◽  
Lesley Maisch ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Statin Therapy ◽  
High Intensity ◽  
Older Patients ◽  
Negative Binomial ◽  
Treatment Guidelines ◽  
Care Facility ◽  
Moderate Intensity ◽  
Major Adverse Cardiovascular Events ◽  
Stroke Patients

Background: Current treatment guidelines recommend high-intensity statin therapy for patients with a history of stroke. However, older patients with higher comorbidity were under-represented in trials and dosing varies in clinical practice. We compared the effectiveness of high vs moderate-intensity statins on clinical outcomes in older patients from the GWTG-Stroke registry. Methods: We studied statin-naïve ischemic stroke patients ≥65 years from GWTG-Stroke linked to Medicare claims from 2008-2011 who were discharged on statins. Outcomes included home time days (days alive and not in acute or post-acute care facility), major adverse cardiovascular events (MACE), mortality, all-cause, stroke and CV readmission within 2 years of discharge. We estimated unadjusted and adjusted associations between statin intensity and outcomes using negative binomial and Cox proportional hazards models. Inverse-weighted estimates of the probability of high-intensity statin (IPW) were used to adjust for treatment selection. Results: Of 29,631 ischemic stroke patients discharged on statins, 9,145 (31%) received high-intensity statins. Patients receiving high-intensity statins were younger and had higher LDL-C compared with patients on moderate-intensity statins. The high-intensity statin group had 5 fewer home time days and higher all-cause readmission within 2 years, but other observed outcomes were similar (Table). Except for a slightly higher hazard of all-cause readmission with high-intensity statin use, there were no significant differences in MACE, hemorrhagic stroke, or other outcomes after IPW adjustment (Table). Conclusions: We found no differences in MACE or home time days within 2 years of initiation of high vs. moderate-intensity statin therapy following ischemic stroke. These findings can inform patients and clinicians regarding the risk-benefit associated with statin dosing after ischemic stroke.

scholarly journals Prevalence of diagnosed opioid abuse in the national veteran's health administration (VA) population

2012 ◽  
Vol 13 (4) ◽  
pp. S25
Author(s):  
L. Wang ◽  
A. Joshi ◽  
D. Schaaf ◽  
J. Mardekian ◽  
O. Baser
Keyword(s):  
Opioid Abuse ◽  
Health Administration ◽  
Veteran's Health Administration ◽  
Veteran’S Health
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