Lipid Management with Statins in Type 2 Diabetes Mellitus

2005 ◽  
Vol 39 (10) ◽  
pp. 1714-1719 ◽  
Author(s):  
Brian K Irons ◽  
Lisa A Kroon
Keyword(s):  
Cardiovascular Disease ◽  
Relative Risk ◽  
Risk Reduction ◽  
Relative Risk Reduction ◽  
Data Extraction ◽  
Density Lipoprotein ◽  
Coronary Event ◽  
Lipid Management ◽  
Medline Search ◽  
Patients With Diabetes

OBJECTIVE: To provide an update on lipid management and recent modifications in cholesterol guidelines for use of hydroxymethylglutaryl coenzyme A reductase inhibitors (statins), specifically in patients with diabetes. DATA SOURCES: Studies and guidelines were identified through a MEDLINE search (1996–April 2005). STUDY SELECTION AND DATA EXTRACTION: Studies were selected for review if the primary treatment intervention was a statin, at least 4% of the study population held a diagnosis of diabetes, and diabetes subgroup analysis was available. DATA SYNTHESIS: The Heart Protection Study demonstrated an approximately 25% relative risk reduction of a first coronary event in patients with diabetes, a reduction similar to those without diabetes. In subjects with diabetes, a significant reduction in coronary events was noted regardless of the baseline cholesterol level. The Collaborative Atorvastatin Diabetes Study demonstrated a 37% relative risk reduction in the primary prevention of cardiovascular morbidity in patients with diabetes. CONCLUSIONS: Based on the current literature, a low-density lipoprotein cholesterol (LDL-C) level <100 mg/dL remains an appropriate goal for patients with diabetes in the absence of established cardiovascular disease. For higher-risk patients, such as those with diabetes and a history of cardiovascular disease, a more stringent LDL-C goal of <70 mg/dL is an option according to current clinical trial evidence. At least a 30–40% reduction in the LDL-C level is advisable when initiating statin therapy.

Primary prevention of stroke and cardiovascular disease in the community (PREVENTS): Methodology of a health wellness coaching intervention to reduce stroke and cardiovascular disease risk, a randomized clinical trial

2017 ◽  
Vol 13 (2) ◽  
pp. 223-232 ◽  
Author(s):  
Susan Mahon ◽  
Rita Krishnamurthi ◽  
Alain Vandal ◽  
Emma Witt ◽  
Suzanne Barker-Collo ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Clinical Trial ◽  
Relative Risk ◽  
Risk Reduction ◽  
Stroke Prevention ◽  
Relative Risk Reduction ◽  
Disease Risk ◽  
Cardiovascular Disease Risk ◽  
Wellness Coaching

Rationale Stroke is a major cause of death and disability worldwide, yet 80% of strokes can be prevented through modifications of risk factors and lifestyle and by medication. While management strategies for primary stroke prevention in high cardiovascular disease risk individuals are well established, they are underutilized and existing practice of primary stroke prevention are inadequate. Behavioral interventions are emerging as highly promising strategies to improve cardiovascular disease risk factor management. Health Wellness Coaching is an innovative, patient-focused and cost-effective, multidimensional psychological intervention designed to motivate participants to adhere to recommended medication and lifestyle changes and has been shown to improve health and enhance well-being. Aims and/or hypothesis To determine the effectiveness of Health Wellness Coaching for primary stroke prevention in an ethnically diverse sample including Māori, Pacific Island, New Zealand European and Asian participants. Design A parallel, prospective, randomized, open-treatment, single-blinded end-point trial. Participants include 320 adults with absolute five-year cardiovascular disease risk ≥ 10%, calculated using the PREDICT web-based clinical tool. Randomization will be to Health Wellness Coaching or usual care groups. Participants randomized to Health Wellness Coaching will receive 15 coaching sessions over nine months. Study outcomes A substantial relative risk reduction of five-year cardiovascular disease risk at nine months post-randomization, which is defined as 10% relative risk reduction among those at moderate five-year cardiovascular disease risk (10–15%) and 25% among those at high risk (>15%). Discussion This clinical trial will determine whether Health Wellness Coaching is an effective intervention for reducing modifiable risk factors, and hence decrease the risk of stroke and cardiovascular disease.

scholarly journals Effects of BMI and LDL-cholesterol change pattern on cardiovascular disease in normal adults and diabetics

2020 ◽  
Vol 8 (2) ◽  
pp. e001340
Author(s):  
Tae Mi Youk ◽  
Min Jin Kang ◽  
Sun Ok Song ◽  
Eun-Cheol Park
Keyword(s):  
Cardiovascular Disease ◽  
Ldl Cholesterol ◽  
Density Lipoprotein ◽  
Diabetic Control ◽  
Individual Variability ◽  
Control Group ◽  
Simple Method ◽  
Change Pattern ◽  
Patients With Diabetes ◽  
Variability Model

IntroductionTo examine how the risk of cardiovascular disease changes according to degree of change in body mass index (BMI) and low-density lipoprotein (LDL)-cholesterol in patients with diabetes using the health medical examination cohort database of the National Health Insurance Service in Korea. In comparison, the pattern in a non-diabetic control group was also examined.Research design and methodsThe study samples were 13 800 patients with type 2 diabetes and 185 898 non-diabetic controls, and their baseline characteristics and repeatedly measured BMI and LDL-cholesterol until occurrence of cardiovascular disease were collected in longitudinal data. We used the variability model that is joint of mixed effects and regression model, then estimated parameters about variability by Bayesian methods.ResultsThe risk of cardiovascular disease was increased significantly with high average real variability (ARV) of BMI in the patients with diabetes, but the risk of cardiovascular disease was not increased according to degree of ARV in non-diabetic controls. The Bayesian variability model was used to analyze the effects of BMI and LDL-cholesterol change pattern on development of cardiovascular disease in diabetics, showing that variability did not have a statistically significant effect on cardiovascular disease. This shows the danger of the former simple method when interpreting only the mean of the absolute value of the variation.ConclusionsThe approach of simple SD in previous studies for estimation of individual variability does not consider the order of observation. However, the Bayesian method used in this study allows for flexible modeling by superimposing volatility assessments on multistage models.

Absolute v relative risk reduction

BMJ ◽  
2010 ◽  
Vol 341 (nov16 4) ◽  
pp. c6333-c6333
Author(s):  
P. E. Norman
Keyword(s):  
Relative Risk ◽  
Risk Reduction ◽  
Relative Risk Reduction

scholarly journals Preimplantation Genetic Testing for Polygenic Disease Relative Risk Reduction: Evaluation of Genomic Index Performance in 11,883 Adult Sibling Pairs

Genes ◽  
2020 ◽  
Vol 11 (6) ◽  
pp. 648 ◽  
Author(s):  
Nathan R. Treff ◽  
Jennifer Eccles ◽  
Diego Marin ◽  
Edward Messick ◽  
Louis Lello ◽  
...  
Keyword(s):  
Genetic Testing ◽  
Relative Risk ◽  
Risk Reduction ◽  
Relative Risk Reduction ◽  
Embryo Selection ◽  
Type I ◽  
Preimplantation Genetic Testing ◽  
Sibling Pairs ◽  
Polygenic Disease ◽  
Diabetes Status

Preimplantation genetic testing for polygenic disease risk (PGT-P) represents a new tool to aid in embryo selection. Previous studies demonstrated the ability to obtain necessary genotypes in the embryo with accuracy equivalent to in adults. When applied to select adult siblings with known type I diabetes status, a reduction in disease incidence of 45–72% compared to random selection was achieved. This study extends analysis to 11,883 sibling pairs to evaluate clinical utility of embryo selection with PGT-P. Results demonstrate simultaneous relative risk reduction of all diseases tested in parallel, which included diabetes, cancer, and heart disease, and indicate applicability beyond patients with a known family history of disease.

scholarly journals Coronary Artery Calcium for Personalized Allocation of Aspirin in Primary Prevention of Cardiovascular Disease in 2019

Circulation ◽  
2020 ◽  
Vol 141 (19) ◽  
pp. 1541-1553 ◽  
Author(s):  
Miguel Cainzos-Achirica ◽  
Michael D. Miedema ◽  
John W. McEvoy ◽  
Mahmoud Al Rifai ◽  
Philip Greenland ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery ◽  
Relative Risk ◽  
Primary Prevention ◽  
American Heart Association ◽  
Relative Risk Reduction ◽  
American Heart ◽  
Heart Association ◽  
Risk Of Bleeding ◽  
Ascvd Risk

Background: Recent American College of Cardiology/American Heart Association Primary Prevention Guidelines recommended considering low-dose aspirin therapy only among adults 40 to 70 years of age who are at higher atherosclerotic cardiovascular disease (ASCVD) risk but not at high risk of bleeding. However, it remains unclear how these patients are best identified. The present study aimed to assess the value of coronary artery calcium (CAC) for guiding aspirin allocation for primary prevention by using 2019 aspirin meta-analysis data on cardiovascular disease relative risk reduction and bleeding risk. Methods: The study included 6470 participants from the MESA Study (Multi-Ethnic Study of Atherosclerosis). ASCVD risk was estimated using the pooled cohort equations, and 3 strata were defined: <5%, 5% to 20%, and >20%. All participants underwent CAC scoring at baseline, and CAC scores were stratified as =0, 1 to 99, ≥100, and ≥400. A 12% relative risk reduction in cardiovascular disease events was used for the 5-year number needed to treat (NNT 5 ) calculations, and a 42% relative risk increase in major bleeding events was used for the 5-year number needed to harm (NNH 5 ) estimations. Results: Only 5% of MESA participants would qualify for aspirin consideration for primary prevention according to the American College of Cardiology/American Heart Association guidelines and using >20% estimated ASCVD risk to define higher risk. Benefit/harm calculations were restricted to aspirin-naive participants <70 years of age not at high risk of bleeding (n=3540). The overall NNT 5 with aspirin to prevent 1 cardiovascular disease event was 476 and the NNH 5 was 355. The NNT 5 was also greater than or similar to the NNH 5 among estimated ASCVD risk strata. Conversely, CAC≥100 and CAC≥400 identified subgroups in which NNT 5 was lower than NNH 5 . This was true both overall (for CAC≥100, NNT 5 =140 versus NNH 5 =518) and within ASCVD risk strata. Also, CAC=0 identified subgroups in which the NNT 5 was much higher than the NNH 5 (overall, NNT 5 =1190 versus NNH 5 =567). Conclusions: CAC may be superior to the pooled cohort equations to inform the allocation of aspirin in primary prevention. Implementation of current 2019 American College of Cardiology/American Heart Association guideline recommendations together with the use of CAC for further risk assessment may result in a more personalized, safer allocation of aspirin in primary prevention. Confirmation of these findings in experimental settings is needed.

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