scholarly journals Analysis of the Dilemma Involving Statins and Aspirin as Primary Prevention Alternatives in Cardiovascular Disease

2017 ◽  
pp. 38-48
Author(s):  
Henry Sutanto
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Cardiovascular Mortality ◽  
Cardiovascular Prevention ◽  
Therapeutic Strategies ◽  
Cardiovascular Drugs ◽  
Safety Issues ◽  
The World

Cardiovascular disease is one of the deadliest diseases in the world. Nowadays, alongside the developments of various medical therapeutic strategies, there is a decreasing trend of cardiovascular mortality. However, this reduction is not adequate and needs to be supported by cardiovascular prevention approaches. Statins and aspirin are two of cardiovascular drugs that are believed to be beneficial in cardiovascular prevention. Their magnificent efficacies in the secondary prevention setting lead them to be used in the primary prevention. However, some safety issues associated with the drugs should be considered. For that reason, based on previous trials and studies, some recommendations regarding the efficacy-safety issues are developed.

scholarly journals Modern principles of cardiovascular disease prevention

2021 ◽  
Vol 13 (2) ◽  
pp. 15-26
Author(s):  
Leonid L. Bershtein
Keyword(s):  
Cardiovascular Disease ◽  
Risk Assessment ◽  
Primary Prevention ◽  
Disease Prevention ◽  
Russian Federation ◽  
Cardiovascular Prevention ◽  
Atherosclerotic Cardiovascular Disease ◽  
Middle Income ◽  
Middle Income Countries ◽  
The World

Atherosclerotic cardiovascular disease is the leading cause of death in the world, primarily in low-and middle-income countries, including Russian Federation. According to WHO experts, the global atherosclerotic cardiovascular disease epidemic can be brought under control mainly by improving the cardiovascular prevention. This paper describes the modern principles of risk assessment in people without manifested atherosclerotic cardiovascular disease, as well as considers drug and non-drug methods of primary prevention.

scholarly journals Appropriateness of aspirin prescribing for primary and secondary prevention of cardiovascular disease in type 2 diabetes in different care settings

2021 ◽  
Author(s):  
Shi Ying Tan ◽  
Heather Cronin ◽  
Stephen Byrne ◽  
Adrian O’Donovan ◽  
Antoinette Tuthill
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Primary Care ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Shared Care ◽  
University Hospital ◽  
Cross Sectional ◽  
Prevention Of Cardiovascular Disease

Abstract Background Type 2 diabetes is associated with an increased cardiovascular risk. Use of aspirin has been shown to be of benefit for secondary prevention of cardiovascular disease in patients with type 2 diabetes; benefits in primary prevention have not been clearly proven. Aims This study aims to (a) determine if aspirin is prescribed appropriately in type 2 diabetes for primary or secondary prevention of cardiovascular disease (CVD) and (b) evaluate whether there are differences in aspirin prescribing according to where people receive their care. Design Cross-sectional study Methods The medical records of individuals with type 2 diabetes aged over 18 years and attending Elmwood Primary Care Centre and Cork University Hospital Diabetes outpatient clinics (n = 400) between February and August 2017 were reviewed. Results There were 90 individuals exclusively attending primary care and 310 persons attending shared care. Overall, 49.0% (n = 196) of those were prescribed aspirin, of whom 42.3% were using it for secondary prevention. Aspirin was used significantly more in people attending shared care (p < 0.001). About 10.8% of individuals with diabetes and CVD attending shared care met guidelines for, but were not prescribed aspirin. Conclusion A significant number of people with type 2 diabetes who should have been prescribed aspirin for secondary prevention were not receiving it at the time of study assessment. In contrast, a substantial proportion who did not meet criteria for aspirin use was prescribed it for primary prevention.

scholarly journals Association between refill adherence to lipid-lowering medications and the risk of cardiovascular disease and mortality in Swedish patients with type 2 diabetes mellitus: a nationwide cohort study

BMJ Open ◽  
2018 ◽  
Vol 8 (3) ◽  
pp. e020309 ◽  
Author(s):  
Sofia Axia Karlsson ◽  
Christel Hero ◽  
Ann-Marie Svensson ◽  
Stefan Franzén ◽  
Mervete Miftaraj ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Exposure Period ◽  
Lipid Lowering ◽  
Refill Adherence

ObjectivesTo analyse the association between refill adherence to lipid-lowering medications, and the risk of cardiovascular disease (CVD) and mortality in patients with type 2 diabetes mellitus.DesignCohort study.SettingNational population-based cohort of Swedish patients with type 2 diabetes mellitus.Participants86 568 patients aged ≥18 years, registered with type 2 diabetes mellitus in the Swedish National Diabetes Register, who filled at least one prescription for lipid-lowering medication use during 2007–2010, 87% for primary prevention.Exposure and outcome measuresRefill adherence of implementation was assessed using the medication possession ratio (MPR), representing the proportion of days with medications on hand during an 18-month exposure period. MPR was categorised by five levels (≤20%, 21%–40%, 41%–60%, 61%–80% and >80%). Patients without medications on hand for ≥180 days were defined as non-persistent. Risk of CVD (myocardial infarction, ischaemic heart disease, stroke and unstable angina) and mortality by level of MPR and persistence was analysed after the exposure period using Cox proportional hazards regression and Kaplan-Meier, adjusted for demographics, socioeconomic status, concurrent medications and clinical characteristics.ResultsThe hazard ratios for CVD ranged 1.33–2.36 in primary prevention patients and 1.19–1.58 in secondary prevention patients, for those with MPR ≤80% (p<0.0001). The mortality risk was similar regardless of MPR level. The CVD risk was 74% higher in primary prevention patients and 33% higher in secondary prevention patients, for those who were non-persistent (p<0.0001). The mortality risk was 6% higher in primary prevention patients and 18% higher in secondary prevention patients, for non-persistent patients (p<0.0001).ConclusionsHigher refill adherence to lipid-lowering medications was associated with lower risk of CVD in primary and secondary prevention patients with type 2 diabetes mellitus.

Rates and Predictors of Physician-Recommended and Self-Reported Aspirin Use in 2015

2020 ◽  
Vol 35 (12) ◽  
pp. 556-565
Author(s):  
Taylor Naberhaus ◽  
Nicole K. Early ◽  
Kathleen A. Fairman ◽  
Kelsey Buckley
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Task Force ◽  
Community Dwelling ◽  
Behavioral Risk ◽  
Medication History ◽  
Cross Sectional ◽  
Study Results ◽  
History Of

OBJECTIVE: This study assesses the rate of providerrecommended aspirin use through the National Ambulatory Medical Care Survey (NAMCS) database versus self-reported aspirin use through the Behavioral Risk Factor Surveillance System (BRFSS) database and identifies factors that predict initiation of aspirin. This study provides insight into the rate of providerrecommended aspirin use versus self-reported aspirin use prior to the 2016 United States Preventive Service Task Force primary prevention recommendation update.<br/> DESIGN: Retrospective, cross-sectional analysis of US population data obtained from medical records (NAMCS) and community-dwelling residents in four states (BRFSS) in 2015.<br/> SETTING: Physician offices (NAMCS) and households or telephone (BRFSS).<br/> PATIENTS, PARTICIPANTS: NAMCS: visits made by patients 40 years of age or older to physicians who permitted federal employees to abstract officevisit data. BRFSS: household or telephone interview respondents 40 years of age or older.<br/> INTERVENTIONS: Comparisons of persons with (secondary prevention) versus without (primary prevention) cardiovascular disease.<br/> MAIN OUTCOME MEASURED: Recommended (NAMCS) or self-reported (BRFSS) use of aspirin.<br/> RESULTS: The sample included 19 170 patients (NAMCS), with 2 205 having a history of cardiovascular disease and 14 872 respondents (BRFSS) with 2 024 having a history of cardiovascular disease. For both primary and secondary prevention, respondents from BRFSS reported higher rates of aspirin use (27.7% primary, 65.6% secondary prevention) compared with prescribed rates from NAMCS (11.7% primary, 45.6% secondary prevention).<br/> CONCLUSIONS: Study results highlight the value of obtaining a complete medication history, including aspirin use, from all patients.

scholarly journals Secondary prevention and cardiovascular care across Europe: A survey of European Society of Cardiology members’ views

2019 ◽  
Vol 19 (3) ◽  
pp. 201-211 ◽  
Author(s):  
Donna Fitzsimons ◽  
Janina Stępińska ◽  
Mary Kerins ◽  
Massimo F Piepoli ◽  
Loreena Hill ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Secondary Prevention ◽  
European Society ◽  
Guideline Implementation ◽  
Cardiovascular Prevention ◽  
Evidence Base ◽  
Provision Of Services ◽  
Esc Guidelines ◽  
European Society Of Cardiology ◽  
Prevention Of Cardiovascular Disease

Introduction: Secondary prevention of cardiovascular disease is a significant clinical challenge and despite European Society of Cardiology (ESC) Guidelines, evidence confirms sub-optimal patient care. Aim: The aim of this study was to evaluate ESC members’ opinions on the current provision of cardiovascular prevention and rehabilitation services across Europe and explore barriers to guideline implementation. Method: Electronic surveys using a secure web link were sent to members of the ESC in eight purposively selected ESC affiliated countries. Results: A total of 479 professionals completed the survey, of whom 67% were cardiologists, 8.6% general physicians, 8.2% nurses and 16.2% other healthcare professionals. Respondents were predominantly (91%) practising clinicians, generally highly motivated regarding cardiovascular disease prevention, but most reported that secondary prevention in their country was sub-optimal. The main barriers to prevention were lack of available cardiac rehabilitation programmes and long-term follow-up, patients’ disease perception and professional attitudes towards prevention. While knowledge of the prevention guidelines was generally good, practices such as motivational counselling and better educational tools were called for to promote exercise, smoking cessation and for nutritional aspects. Conclusions: The provision of services focusing on the secondary prevention of cardiovascular disease varies greatly across Europe. Furthermore, despite ESC Guidelines and a strong evidence base supporting the efficacy of secondary prevention, the infrastructure and co-ordination of such care is lacking. In addition patient motivation is considered poor and some professionals remain unconvinced about the merits of prevention. The disappointing results outlined in this survey emphasise that improved tools are urgently required to educate both patients and professionals and confirm the priority of cardiovascular prevention internationally.

scholarly journals Developments in Diabetology in 2016

2016 ◽  
Vol 12 (02) ◽  
pp. 78
Author(s):  
Sanjay Kalra ◽  
Keyword(s):  
Myocardial Infarction ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Cardiovascular Mortality ◽  
Diabetes Care ◽  
Renal Outcomes ◽  
All Cause Mortality ◽  
History Of ◽  
Positive Results ◽  
Fatal Myocardial Infarction

Two major trials, LEADER and SUSTAIN 6, published in 2016, reported the cardiovascular and microvascular benefits of liraglutide and semaglutide respectively. This communication describes the results of these trials, and analyses the subtle differences in their outcomes. While semaglutide significantly reduces the risk of non-fatal myocardial infarction (primary prevention), liraglutide reduces the risk of all-cause mortality and cardiovascular mortality (secondary prevention). Both drugs significantly improve renal outcomes, but semaglutide increased the risk of retinal events. The time taken to achieve benefit was much less (4-6 months) with semaglutide than with liraglutide (12–18 months). LEADER and SUSTAIN 6 have made 2016 a landmark year in the history of diabetes care. Their positive results will help promote better, comprehensive diabetes care, using minimal drugs (therapeutic parsimony), encourage use of rational combinations to improve outcomes, and stimulate exaptation of these drugs for non-glycemic purposes.

scholarly journals Cardiovascular outcomes trials with statins in diabetes

2018 ◽  
Vol 18 (1) ◽  
pp. 7-13 ◽  
Author(s):  
Fariha Naeem ◽  
Gerard McKay ◽  
Miles Fisher
Keyword(s):  
Cardiovascular Disease ◽  
Side Effects ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Statin Therapy ◽  
Cardiovascular Events ◽  
Atherosclerotic Disease ◽  
Lipid Lowering ◽  
High Dose ◽  
Drug Side Effects

Treatment with statins is one of the most effective ways of reducing cardiovascular events in those with diabetes. Many studies containing thousands of subjects with diabetes have demonstrated that statins reduce cardiovascular events when there is no known cardiovascular disease (primary prevention) and in those with confirmed atherosclerotic disease (secondary prevention). High-dose statins appear to be even more effective in established cardiovascular disease, but at the expense of increased drug side effects. In this paper we review the evidence for the benefits of statins in diabetes. In a second review we will examine the evidence for possible benefits of other lipid-lowering therapies when these are added to background statin therapy in diabetes.

Use of Antiplatelet Agents for Primary and Secondary Prevention of Cardiovascular Disease Amongst Type 2 Diabetic Patients

2008 ◽  
Vol 21 (4) ◽  
pp. 287-301 ◽  
Author(s):  
Hasniza Zaman Huri ◽  
Lee Qiu Yi ◽  
Rokiah Pendek ◽  
Che Zuraini Sulaiman
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Type 2 Diabetes Mellitus ◽  
Primary Prevention ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Antiplatelet Agents ◽  
Prevention Of Cardiovascular Disease

Background. A retrospective observational study was conducted to study the use of antiplatelet agents for primary and secondary prevention of cardiovascular disease among hospitalized type 2 diabetes mellitus patients. Method. A total of 355 patients were included in the study. The compliance with the American Diabetes Association recommendation on the use of antiplatelet therapy for prevention of cardiovascular disease was studied. Results. For the primary prevention group, type 2 diabetes mellitus, patients with known dyslipidemia were more likely to receive antiplatelet therapy than those without dyslipidemia (P = 0.023). The rate of adherence to the American Diabetes Association recommendations on the use of antiplatelet therapy for secondary prevention of cardiovascular disease was higher than for primary prevention of cardiovascular disease (P = 0.001). Conclusion. In conclusion, many of the eligible patients still do not receive antiplatelet therapy, particularly in primary prevention of cardiovascular disease. Measures should be taken to ensure that type 2 diabetes mellitus patients receive the antiplatelet therapy and hence prevent macrovascular complications.

A Meta-Analysis of Randomized Controlled Trials of Aspirin in Primary Prevention of Cardiovascular Disease.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 174-174
Author(s):  
Nina C Raju ◽  
Magda Sobieraj-Teague ◽  
John W Eikelboom
Keyword(s):  
Myocardial Infarction ◽  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Cardiovascular Mortality ◽  
Cardiovascular Events ◽  
Conflicts Of Interest ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Controlled Trials ◽  
All Cause Mortality

Abstract Abstract 174 Primary prevention with aspirin reduces the risk of non-fatal cardiovascular events but has not been demonstrated to reduce mortality. We performed an updated meta-analysis of randomised controlled trials of aspirin in primary prevention to obtain best estimates of the benefits and harm of aspirin compared with no aspirin with a focus on mortality. Eligible articles were identified by computerized search of MEDLINE, EMBASE, Cochrane library and CINAHL databases, review of bibliographies of relevant publications and a related article search using PubMed. The outcomes of interest included all cause mortality, cardiovascular mortality, the composite of myocardial infarction, stroke or death, and bleeding. 2 reviewers independently extracted study information and data. Data were pooled from individual trials using the DerSimonian-Laird random-effects model and results are presented as relative risk (RR) and 95% confidence intervals (CI). 8 studies comprising a total of 96,726 subjects were included. Aspirin reduced all-cause mortality (RR 0.94; 95%CI 0.88–1.00), the composite of myocardial infarction, stroke or cardiovascular death (RR 0.87; 95%CI 0.82–0.93), and myocardial infarction (RR 0.8; 95%CI 0.66–0.98) but did not significantly reduce cardiovascular mortality (RR 0.94; 95%CI 0.82–1.08) or stroke (RR 0.93; 95%CI 0.81–1.07). Aspirin increased the risk of major bleeding (RR; 1.69 95%CI 1.38–2.08), gastrointestinal bleeding (RR 1.38; 95%CI 1.16–1.65) and hemorrhagic stroke (RR 1.36; 95%CI 1.01–1.84). There was no interaction between subjects with or without diabetes for the outcomes of all cause mortality, cardiovascular mortality, the composite of myocardial infarction, stroke or death. Aspirin therapy in subjects with no prior history of cardiovascular disease reduces the risk of cardiovascular events, myocardial infarction and overall mortality. These benefits are achieved at the expense of increased bleeding. Disclosures: No relevant conflicts of interest to declare.

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