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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Genetic risk, coronary heart disease events & benefit of statins

Genetic risk, coronary heart disease events & benefit of statins | Heart and Vascular Health | Scoop.it

Genetic variants have been associated with the risk of coronary heart disease. In this study, we tested whether or not a composite of these variants could ascertain the risk of both incident and recurrent coronary heart disease events and identify those individuals who derive greater clinical benefit from statin therapy.Specifically, in the primary prevention trials, the number needed to treat to prevent one such event in 10 years was 66 in people at low genetic risk, 42 in those at intermediate genetic risk, and 25 in those at high genetic risk in JUPITER, and 57, 47, and 20, respectively, in ASCOT.A genetic risk score identified individuals at increased risk for both incident and recurrent coronary heart disease events. People with the highest burden of genetic risk derived the largest relative and absolute clinical benefit from statin therapy.

Seth Bilazarian, MD's insight:

There has been much enthusiasm about the potential for genetic testing to predict disease. Unfortunately, this has not yet found practical utility for practicing physicians and their patients. This analysis from investigators @BrighamWomens may be a major breakthrough to permit a reasoned approach to help decide which patients should get statin therapy ( drugs like Lipitor, Crestor and simvastatin ) for cholesterol lowering.

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Michel KHRONIS, MD's curator insight, March 5, 4:46 AM

Statine & gènes

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Do Statins cause dementia?

Do Statins cause dementia? | Heart and Vascular Health | Scoop.it

Adults with no history of cognitive dysfunction treated with statins were included from high-quality randomized controlled trials and prospective cohort studies after formal bias assessment. Sixteen studies were included in qualitative & 11 in quantitative synthesis.

Short-term trials did not show a consistent effect of statin therapy on cognitive end points. Long-term cognition studies included 23,443 patients with a mean exposure duration of 3 to 24.9 years. Three studies found no association between statin use and incident dementia, and 5 found a favorable effect. Pooled results revealed a 29% reduction in incident dementia in statin-treated patients.

Conclusion In patients without baseline cognitive dysfunction, short-term data are most compatible with no adverse effect of statins on cognition, and long-term data may support a beneficial role for statins in the prevention of dementia.
Seth Bilazarian, MD's insight:

Patients are understandably concerned that a medicine might cause problems with their ability to think and function as they age.  For proponents  (like me) of statin type cholesterol lowering medicines the long-term benefit of improved vascular health provided by statins is compelling.  The theoretical benefit on long term brain health from improved vascular health is also interesting but conflicts with some reports taht memory might be effected by statin use.  The authors from Johns Hopkins have provided a useful review of the literature and concluded that statins are neutral to positive for long term brain health and function, and may "support a beneficial role for statins in the prevention of dementia".

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What is PCSK9?

What is PCSK9? | Heart and Vascular Health | Scoop.it
Watch a video to learn more about the PCSK9 pathway
Seth Bilazarian, MD's insight:

The current best cholesterol lowering medicine we have are the statins.  These medicines like Lipitor (atorvastatin), Crestor (rosuvastatin) and sImvastatin lower LDL (bad cholesterol) by 30 - 50%.  For some patients with very high levels of LDL this is not low enough.  For other patients the statin medicines cannot be tolerated most commonly because of the side effect of muscle aches.  In both situations an alternative to statins is needed.

The PCSK9 inhibitors are an exciting next step that MIGHT prove to be the next big thing.   Studies are now ongoing in the US to test whether these medicines are safe over the long term AND whether the lowering of LDL that they provide (about 50%) also results in lower cardiovascular event rates for patients (less heart attacks and strokes).  The FDA is considering whether to approve these drugs this year before these trials are completed.

This is an excellent video explaining our current understanding of how these medicines lower the LDL level measured in patient's blood.  Stay tuned!

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Statin Usage - National Survey

Statin Usage - National Survey | Heart and Vascular Health | Scoop.it

Learn about statins and understand the risks of high cholesterol through the official Web resource for the USAGE Survey, the largest known cholesterol survey in the US (10,100 participants)

 

Key Findings
Survey participants were highly satisfied with the info provided to them about  cholesterol & its treatment with statins:
=> 85% USAGE participants consider their physician to be one of two most valuable resources for info
=>  53% USAGE participants use their physician as the sole source of information on statins

=>  Only about half of USAGE participants remember their cholesterol levels (knowing your numbers us correlated with treatment success)

=>  Only about half of USAGE participants remember receiving recommendations on diet & exercise at every doctor's office visit.

=>  one out of three USAGE participants had statin side effects andstopped medicine without first discussing the issue with their physician.

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