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Media, News & Topics on prevention, diagnosis & treatment of cardiovascular disease
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Powerful new cholesterol drugs (PCSK9 inhibitors) offer hope - Should FDA approve?

Powerful new cholesterol drugs (PCSK9 inhibitors) offer hope - Should FDA approve? | Heart and Vascular Health | Scoop.it

More than 30 million Americans take statins to lower their cholesterol, according to estimates. But these popular drugs don't work for everyone. Now the FDA may be poised to approve two drugs in this new class.

Seth Bilazarian, MD's insight:

Drs. Harlan Krumholz and Steven Nissen do a good job summarizing the difficult task the FDA faces, regarding whether to approve these new drugs called PCSK9 inhibitors.

These powerful cholesterol lowering drugs have been shown to be safe in trials of 1 -2 years duration and can lower cholesterol by 50 -60% (compared to statins that lower cholesterol by 35 - 50%) without the side effect of muscle aches seen with statins.

Should the FDA wait 2 - 3 more years for trials to be completed or allow use earlier for patients with marked cholesterol elevation?

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New Cholesterol Guidelines => Statin Nation

New Cholesterol Guidelines => Statin Nation | Heart and Vascular Health | Scoop.it

12.8 Million more adults are eligible for statin therapy based on a new study
attempting to determine the effect of new ACC/AHA guidelines
for the management of cholesterol, with the increase seen mostly
among older adults without cardiovascular disease. Among adults
60 and 75 years without cardiovascular disease, the percentage
eligible for such therapy would increase from 30.4% to 87.4%
among men and from 21.2% to 53.6% among women.

Statin Nation - graphic is from Cardiosource  World News at http://www.joomag.com/magazine/cardiosource-worldnews-april-2014/0842627001398192120

Seth Bilazarian, MD's insight:

Are you among the 12.8 million Americans for whom statin is now recommended?

The new atherosclerotic cardiovascular risk calculator (ASCVD) is available as a smartphone app at 

https://itunes.apple.com/us/app/ascvd-risk-estimator/id808875968?mt=8

or

online at:

 http://tools.cardiosource.org/ASCVD-Risk-Estimator/


Use the risk calculator and the current guidelines recommend treatment with statin cholesterol lowering medication  if the 10 year risk of stroke MI or other vascular disease is greater than 7.5% based on this calculator.

 

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askdrmaxwell's curator insight, May 26, 2014 5:17 PM

Cholesterol guidelines have gotten so low, few people can meet them, thus they are prescribed statin drugs. 

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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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Statin myopathy:(muscle aches) => tolerability of statin rechallenge

Statin myopathy:(muscle aches) => tolerability of statin rechallenge | Heart and Vascular Health | Scoop.it

My comment: this is one of the great challenges in the practice of cardiovascular medicine.  Statins have great results for prevention of stroke and heart attack, but do cause muscle aches in a minority of patients.  Sometimes the muscle aches are not from the drug so rechallenging can be helpful to sort this out

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Statin myopathy is a generally encountered side effect of statin usage. Both muscle symptoms and a raised serum creatine kinase (CK) are used in case definition, but these are common manifestations of other conditions, which may not be statin related. Statin rechallenge assuming no contraindication in selected cases is an option before considering a different class of lipid-lowering agent.

Patients with statin myopathy constitute 10.2% of our Lipid Clinic workload. They are predominantly female (62.0%), Caucasian (63.9%), with a mean age of 58.3 years and mean BMI of 29.3 kg/m(2). The serum CK and ESR were statistically higher compared to patients with statin intolerances with no muscular component or CK elevations. Secondary causes of statin myopathy were implicated in 2.7% of cases. Following statin myopathy to simvastatin we found no statistical difference between the tolerability rates between atorvastatin, rosuvastatin, pravastatin, and fluvastatin. Fibrates, cholestyramine, and ezetimibe were statistically better tolerated in these patients.

CONCLUSIONS: Statin rechallenge is a real treatment option in patients with statin myopathy. Detailed history and examination is required to exclude muscle diseases unrelated to statin usage. In patients developing statin myopathy on simvastatin, we did not find any statistical difference between subsequent tolerability rates to rosuvastatin, pravastatin, and fluvastatin.

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Atorvastatin Effect on Fibrous Cap Thickness in Coronary Artery Plaque

Atorvastatin Effect on Fibrous Cap Thickness in Coronary Artery Plaque | Heart and Vascular Health | Scoop.it

More intensive statin therapy reduces cardiovascular morbidity and mortality. However, the mechanism of the dose-dependent effect on plaque stabilization by statin therapy is not fully elucidated.

Micron resolution of optical coherence tomography allows detailed assessment of fibrous cap thickness, which contributes to plaque instability.

Increase in fibrous cap thickness in coronary atherosclerotic plaque benefits from higher dose atorvastatin compared with a lower regimen in patients with unstable angina pectoris.

Larger and longer term studies are needed to determine the direct relationship between an increase in fibrous cap thickness and coronary event risk reduction.

Seth Bilazarian, MD's insight:

This study used imaging called Optical Coherence Tomography (OCT) to assess plaques in the coronary arteries.  Use of statin medications like Atorvastatin (Lipitor) reduces the amount of cholesterol in the blood but this study adds direct evidence that in addition to reducing the plaque size it also thickened the overlying cover of the plaque called the fibrous cap.  When this cap becomes disrupted (erodes or ruptures) clot forms and a heart attack can ensue.  This mechanism of benefit through plaque stabilization is a critical contributor to the benefits of statin therapy in patients with coronary plaques.

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New Drug lowers LDL: PCSK9i might be the next stains

New Drug lowers LDL: PCSK9i might be the next stains | Heart and Vascular Health | Scoop.it

A new injectable drug can further knock down cholesterol levels in people who take cholesterol-busting statin medications, according to the results of a global trial.

People taking the new therapy alongside statins enjoyed a 63 - 75% decrease in their "bad" (LDL) cholesterol levels, on top of the reduction caused by the traditional statin medications. This drug enhances the body's natural way of reducing LDL levels in the bloodstream. Cells primarily located in the liver contain receptors that target LDL cholesterol and remove it from the bloodstream. But the liver also produces a regulatory protein called PCSK9 that binds to and breaks down these receptors, The antibodies in the tested drug, evolocumab are designed to intercept PCSK9, preventing the protein from breaking down the cells' LDL receptors, which allows them to stay in circulation longer to remove LDL cholesterol.

Seth Bilazarian, MD's insight:

We have good evidence of this drugs safety and effectiveness in lowering LDL for short term, but we do not yet have data on longer term safety or the more important effectiveness measurement of preventing heart attack, strokes and death.  The large triail called FOURIER is enrolling to assess this.  Check out http://fourierstudy.com for info.

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New Cholesterol guidelines from ACC/AHA.

New Cholesterol guidelines from ACC/AHA. | Heart and Vascular Health | Scoop.it

This downloadable spreadsheet is a companion tool to the 2013 ACC/AHA Guideline on the Assessment of Cardiovascular Risk. The spreadsheet enables health care providers and patients to estimate 10-year and lifetime risks for atherosclerotic cardiovascular disease (ASCVD), defined as coronary death or nonfatal myocardial infarction, or fatal or nonfatal stroke, based on the Pooled Cohort Equations and the work of Lloyd-Jones, et al., respectively. The information required to estimate ASCVD risk includes age, sex, race, total cholesterol, HDL cholesterol, systolic blood pressure, blood pressure lowering medication use, diabetes status, and smoking status,  Its here =>

http://goo.gl/d9NldB

Seth Bilazarian, MD's insight:

Many changes for management of patients with statin medications, based on 2013 ACC/AHA guidelines.  My Vlog review of these changes for community based physicians and patients at theheart.org and Medscape reviews the changes. 

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John Mills's curator insight, March 1, 8:58 AM

Quality Chia Seeds Online Store

 

The Cholesterol Guidelines:

 

Many changes for management of patients with statin medications, based on 2013 ACC/AHA guidelines.  My Vlog review of these changes for community based physicians and patients at theheart.org and Medscape reviews the changes. 

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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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