Statins in the elderly : Is there a rationale?

Size: px
Start display at page:

Download "Statins in the elderly : Is there a rationale?"

Transcription

1 Statins in the elderly : Is there a rationale? Pr B Boland After a communication by Dr. Manfred Gogol EAMA, Sion, June,

2 RCTs with Statins Meta-Analysis, abstracts or research papers 29 used statins, 5 fulfilled search criteria: Scandinavian Simvastatin Survival Study (4S) [Simvastatin, secondary prevention] West of Scotland Coronary Prevention Study (WOSCOPS) [Pravastatin, primary prevention] Cholesterol and Recurrent Events Trial (CARE) [Pravastatin, secondary prevention] Long-term Intervention With Pravastatin in Ischaemic Disease (LIPID) [Pravastatin, secondary prevention] Airforce Coronary Atherosclerosis Prevention Study (AFCAPS) [Lovastatin, primary prevention] patients; mean age 59 y LaRosa et al. Effect of statin on risk of coronary disease: A meta-analysis of randomised controlled trials. JAMA 1999;282:

3 Questions Some answered, others not... all 5 RCTs showed a significant clinical benefit BUT in selected populations : men, white race, age 60 ± 10 y! no data in patients > 75 yrs (elderly patients) patients > 75 yrs with multimorbidity, dementia, frailty syndrome,... (geriatric patients) Birch Unanswered questions: The use of statins in older people to prevent cardiovascular event effects of statins on risk of coronary disease: A meta-analysis of randomized controlled trials. J Am Ger Soc 2002;50:

4 Why? Limitations according to age and gender 47 RCTs Gender few (8) studies excluded women Women : only 18,6 % (12-30) of included patients Few (12) reported gender-specific results Elderly 31 studies (66 %) excluded elderly 13 studies (28 %) included persons 65 yrs Only 11 reports age-related results C Bartlett et al. Women, older persons, and ethnic minorities: factors associated with their inclusion in randomised trials of statin 1990 to Heart 2003;89:

5 CTT: Cholesterol Treatment Trialists (CTT) Collaborators Efficacy and safety of cholesterol-lowering treatment: prospective Meta-analysis of data from participants in 14 randomised trials of statins. Lancet 2005;366:

6 Cholesterol Treatment Trialists (CTT) Collaborators Efficacy and safety of cholesterol-lowering treatment: prospective Meta-analysis of data from participants in 14 randomised trials of statins. Lancet 2005;366:

7 4 recent studies including elderly patients HPS, Lancet 2002 PROSPER, Lancet 2002 ALLHAT-LLA, JAMA 2002 ASCOT-LLA, Lancet

8 Heart Protection Study HPS, 2002 P : patients, a, SPrev. or DB2 mean age? yrs ; 28 % > 70 yrs I / C : Simvastatin 40 vs. Placebo, 5 yrs O: total Mortality 13 % CV Morbi-mortality (non-fatal MI, sk, CVdeath) 25 % (p<0,0001) Effective no differences related to sex and age (> 70 yrs) no data on 70+ in primary prevention MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in high-risk individuals: a randomised placebo-controlled trial. Lancet 2002;360:7 8

9 PROSPER, 2002 Prospective Study of Pravastatin in the Elderly at Risk P: pts (51% women), SPr or High risk PP aged yrs (mean age 75 yrs) [ healthy elderly ] I/C: 40 mg pravastatin 40 vs. Placebo, 3.2 years O: CV morbi-mortality (nf MI, sk, CVdeath) 15 % (p=0,01) CAD deaths 24 % (p=0,043) ; non-fatal MI new cancer No effect in women and no effect in PP men SPr Little effect if HDL > 50 + low HDL No effect on stroke in SP + CAD J Shepherd et al. Pravastatin in elderly individuals at risk of vascular disease (PROSPER): a randomised controlled trial. Lancet 2002;360:1623 9

10 ( ALLHAT-LLT, 2002 ) Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial P: patients, 48 % women mean age 66 ± 7,6 y high risk PP because of hypertension + 1 cv RF (usual LDL-C : 129 mg/dl) I/C : 40 mg pravastatin vs. placebo O: NO benefit! methodological flaws 30 % statin use in placebo group 25 % drop-outs in statin group small LDL-C reduction The ALLHAT officers and coordinators for the ALLHAT collaborative research group. Major outcomes in moderately hypercholesterolemic, hypertensive patients randomized to pravastatin vs usual care: The Antiihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT-LLT). JAMA 2002;288:

11 ASCOT-LLA Anglo-Scandinavian Cardiac Outcomes Trial Lipid Lowering Arm P: patients (19 % w); age PP_moderate risk ; HTA to be treated + 3 cv RF mean age 63 ± 8 y, total cholesterol 242 mg% [not elderly] I/C : Atorva 10 vs. placebo; follow-up 3,3 yrs O primary: coro (nf + f MI); effective (p<0,001) secondary : NS PS Sever et al. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentration, in the Anglo-Scandinavian Cardiac Outcomes Trial Lipid Lowering Arm (ASCOT-LLA): a multicetre randomised controlled trial. Lancet 2003;361:

12 Statin in high risk elderly Primary Prevention Secondary Prevention HPS ASCOT others HPS ASCOT PROSPER yrs yrs > 80 yrs +, + ±, -? +, + +, +? - 12

13 Conclusions in persons 80+, free of CAD CV events are frequent, and not associated with cholesterol level No study (RCT) assessed the effects of a statin Statins may be harmful (& are expensive) Side effects Cancers Drug interactions 13

14 Observational study, men women ; mean age 81 ± 9 y SPrevention (post-mi) LDL > 125 mg% ; statin OR not (medical decision) follow-up 36 ± 21 month Coronary events New brain infarction y 36 vs 51 % (p 0,038) 13 vs 28 % (p 0,005) y 43 vs 75 % (p <0,0001) 16 vs 33 % (p 0,0001) y 49 vs 74 % (p <0,0001) 14 vs 24 % (p 0,002) y 56 vs 81 % (p <0,0004) 14 vs 20 % (p 0,323) WS Aronow et al. Incidence of new atherothrombotic brain infarction in older persons with prior myocardial infarction and LDL-C > 125 md/dl treated with statins versus no lipid-lowering drug. J Gerontol 2002;57A:333 14

APPENDIX B: LIST OF THE SELECTED SECONDARY STUDIES

APPENDIX B: LIST OF THE SELECTED SECONDARY STUDIES APPENDIX B: LIST OF THE SELECTED SECONDARY STUDIES Main systematic reviews secondary studies on the general effectiveness of statins in secondary cardiovascular prevention (search date: 2003-2006) NICE.

More information

Supplementary appendix

Supplementary appendix Supplementary appendix This appendix formed part of the original submission and has been peer reviewed. We post it as supplied by the authors. Supplement to: Cholesterol Treatment Trialists Collaboration.

More information

Calculating RR, ARR, NNT

Calculating RR, ARR, NNT Calculating RR, ARR, NNT In a trial RR = Event rate (eg # of people with one stroke/ total people) in treatment group/event rate in the control group. ARR = Event rate in control group minus the event

More information

The All Wales Medicine Strategy Group (AWMSG) is asked to support implementation of the following prescribing indicators.

The All Wales Medicine Strategy Group (AWMSG) is asked to support implementation of the following prescribing indicators. ENCLOSURE 5 APPENDIX 1 Paper presented to AWMSG in June 2006 AWPAG considered comments recorded in AWMSG minutes in July 2006 Paper subsequently updated and brought back to AWMSG for endorsement This paper

More information

How would you manage Ms. Gold

How would you manage Ms. Gold How would you manage Ms. Gold 32 yo Asian woman with dyslipidemia Current medications: Simvastatin 20mg QD Most recent lipid profile: TC = 246, TG = 100, LDL = 176, HDL = 50 What about Mr. Williams? 56

More information

An example of a systematic review and meta-analysis

An example of a systematic review and meta-analysis An example of a systematic review and meta-analysis Sattar N et al. Statins and risk of incident diabetes: a collaborative meta-analysis of randomised statin trials. Lancet 2010; 375: 735-742. Search strategy

More information

The role of statins in patients with arterial hypertension

The role of statins in patients with arterial hypertension Invited review The role of statins in patients with arterial hypertension Trygve B. Tjugen 1, Sigrun Halvorsen 1, Reidar Bjørnerheim 1, Sverre E. Kjeldsen 1, 2 1University of Oslo, Department of Cardiology,

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Navarese EP, Robinson JG, Kowalewski M, et al. Association between baseline LDL-C level and total and cardiovascular mortality after LDL-C lowering: a systematic review and

More information

The Clinical Unmet need in the patient with Diabetes and ACS

The Clinical Unmet need in the patient with Diabetes and ACS The Clinical Unmet need in the patient with Diabetes and ACS Professor Kausik Ray (UK) BSc(hons), MBChB, MD, MPhil, FRCP (lon), FRCP (ed), FACC, FESC, FAHA Diabetes is a global public health challenge

More information

LIST OF ABBREVIATIONS

LIST OF ABBREVIATIONS Diabetes & Endocrinology 2005 Royal College of Physicians of Edinburgh Diabetes and lipids 1 G Marshall, 2 M Fisher 1 Research Fellow, Department of Cardiology, Glasgow Royal Infirmary, Glasgow, Scotland,

More information

LDL cholesterol and cardiovascular outcomes?

LDL cholesterol and cardiovascular outcomes? LDL cholesterol and cardiovascular outcomes? Prof Kausik Ray, BSc (hons), MBChB, FRCP, MD, MPhil (Cantab), FACC, FESC Professor of Cardiovascular Disease Prevention St Georges University of London Honorary

More information

Cholesterol lowering intervention for cardiovascular prevention in high risk patients with or without LDL cholesterol elevation

Cholesterol lowering intervention for cardiovascular prevention in high risk patients with or without LDL cholesterol elevation TrialResults-center.org www.trialresultscenter.org Cholesterol lowering intervention for cardiovascular prevention in high risk patients with or without LDL cholesterol elevation A systematic review and

More information

STATINS FOR PAD Long - term prognosis

STATINS FOR PAD Long - term prognosis STATINS FOR PAD Long - term prognosis Prof. Pavel Poredos, MD, PhD Department of Vascular Disease University Medical Centre Ljubljana Slovenia DECLARATION OF CONFLICT OF INTEREST No conflict of interest

More information

ATP IV: Predicting Guideline Updates

ATP IV: Predicting Guideline Updates Disclosures ATP IV: Predicting Guideline Updates Daniel M. Riche, Pharm.D., BCPS, CDE Speaker s Bureau Merck Janssen Boehringer-Ingelheim Learning Objectives Describe at least two evidence-based recommendations

More information

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study

Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Lifetime clinical and economic benefits of statin-based LDL lowering in the 20-year Followup of the West of Scotland Coronary Prevention Study Harvey White Green Lane Cardiovascular Service and Cardiovascular

More information

Statin Treatment for Older Adults: The Impact of the 2013 ACC/AHA Cholesterol Guidelines

Statin Treatment for Older Adults: The Impact of the 2013 ACC/AHA Cholesterol Guidelines Drugs Aging (2015) 32:87 93 DOI 10.1007/s40266-014-0238-5 CURRENT OPINION Statin Treatment for Older Adults: The Impact of the 2013 ACC/AHA Cholesterol Guidelines Yitzchak Weinberger Benjamin H. Han Published

More information

Statins in the Treatment of Type 2 Diabetes Mellitus: A Systematic Review.

Statins in the Treatment of Type 2 Diabetes Mellitus: A Systematic Review. ISPUB.COM The Internet Journal of Cardiovascular Research Volume 7 Number 1 Statins in the Treatment of Type 2 Diabetes Mellitus: A Systematic Review. C ANYANWU, C NOSIRI Citation C ANYANWU, C NOSIRI.

More information

Is Lower Better for LDL or is there a Sweet Spot

Is Lower Better for LDL or is there a Sweet Spot Is Lower Better for LDL or is there a Sweet Spot ALAN S BROWN MD, FACC FNLA FAHA FASPC DIRECTOR, DIVISION OF CARDIOLOGY ADVOCATE LUTHERAN GENERAL HOSPITAL, PARK RIDGE, ILLINOIS DIRECTOR OF CARDIOLOGY,

More information

Landmark Clinical Trials.

Landmark Clinical Trials. Landmark Clinical Trials 1 Learning Objectives Discuss clinical trials and their role in lipid and lipoprotein treatment in cardiovascular prevention. Review the clinical trials of lipid-altering drug

More information

Comparison of Original and Generic Atorvastatin for the Treatment of Moderate Dyslipidemic Patients

Comparison of Original and Generic Atorvastatin for the Treatment of Moderate Dyslipidemic Patients Comparison of Original and Generic Atorvastatin for the Treatment of Moderate Dyslipidemic Patients Cardiology Department, Bangkok Metropolitan Medical College and Vajira Hospital, Bangkok, Thailand Abstract

More information

Since the release of the National Cholesterol PROCEEDINGS FUTURE DIRECTIONS IN DYSLIPIDEMIA MANAGEMENT * Michael B. Clearfield, DO, FACOI ABSTRACT

Since the release of the National Cholesterol PROCEEDINGS FUTURE DIRECTIONS IN DYSLIPIDEMIA MANAGEMENT * Michael B. Clearfield, DO, FACOI ABSTRACT FUTURE DIRECTIONS IN DYSLIPIDEMIA MANAGEMENT * Michael B. Clearfield, DO, FACOI ABSTRACT Since the National Cholesterol Education Program (NCEP) Third Adult Treatment Panel (ATP III) guidelines, 3 large

More information

Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes

Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes et al. British Journal of Clinical Pharmacology DOI:10.1111/j.1365-2125.2003.02060.x Meta-analysis of large randomized controlled trials to evaluate the impact of statins on cardiovascular outcomes Bernard

More information

CLINICAL OUTCOME Vs SURROGATE MARKER

CLINICAL OUTCOME Vs SURROGATE MARKER CLINICAL OUTCOME Vs SURROGATE MARKER Statin Real Experience Dr. Mostafa Sherif Senior Medical Manager Pfizer Egypt & Sudan Objective Difference between Clinical outcome and surrogate marker Proper Clinical

More information

STATIN THERAPY IN THE ELDERLY: THERE ARE MILES TO GO BEFORE WE SLEEP

STATIN THERAPY IN THE ELDERLY: THERE ARE MILES TO GO BEFORE WE SLEEP STATIN THERAPY IN THE ELDERLY: THERE ARE MILES TO GO BEFORE WE SLEEP Peter P. Toth, MD, PhD, FAAFP, FICA, FNLA, FCCP, FAHA, FACC Director of Preventative Cardiology CGH Medical Center, Sterling, Illinois

More information

Data Alert. Vascular Biology Working Group. Blunting the atherosclerotic process in patients with coronary artery disease.

Data Alert. Vascular Biology Working Group. Blunting the atherosclerotic process in patients with coronary artery disease. 1994--4 Vascular Biology Working Group www.vbwg.org c/o Medical Education Consultants, LLC 25 Sylvan Road South, Westport, CT 688 Chairman: Carl J. Pepine, MD Eminent Scholar American Heart Association

More information

Is there a mechanism of interaction between hypertension and dyslipidaemia?

Is there a mechanism of interaction between hypertension and dyslipidaemia? Is there a mechanism of interaction between hypertension and dyslipidaemia? Neil R Poulter International Centre for Circulatory Health NHLI, Imperial College London Daegu, Korea April 2005 Observational

More information

Weigh the benefit of statin treatment: LDL & Beyond

Weigh the benefit of statin treatment: LDL & Beyond Weigh the benefit of statin treatment: LDL & Beyond Duk-Woo Park, MD, PhD Heart Institute, University of Ulsan College of Medicine, Asan Medical, Seoul, Korea FOURIER Further cardiovascular OUtcomes Research

More information

Drug Class Review on HMG-CoA Reductase Inhibitors (Statins)

Drug Class Review on HMG-CoA Reductase Inhibitors (Statins) Drug Class Review on HMG-CoA Reductase Inhibitors () Final Report June 2004 Mark Helfand, MD, MPH Susan Carson, MPH Cathy Kelley, PharmD Oregon Evidence-based Practice Center Oregon Health & Science University

More information

Modern Lipid Management:

Modern Lipid Management: Modern Lipid Management: New Drugs, New Targets, New Hope Kirk U. Knowlton, M.D Director of Cardiovascular Research Co Chief of Cardiology Why lower LDL C in those without evidence of CAD (primary prevention)

More information

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009

The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 The JUPITER trial: What does it tell us? Alice Y.Y. Cheng, MD, FRCPC January 24, 2009 Learning Objectives 1. Understand the role of statin therapy in the primary and secondary prevention of stroke 2. Explain

More information

Statin Intolerance. Jason Evanchan DO, FACC April 20 th, 2018

Statin Intolerance. Jason Evanchan DO, FACC April 20 th, 2018 Statin Intolerance 2 nd Annual CV Course for Trainees and Early Career Physicians: Current Concepts in the Diagnosis and Management of Coronary Artery Disease Jason Evanchan DO, FACC April 20 th, 2018

More information

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION

Andrew Cohen, MD and Neil S. Skolnik, MD INTRODUCTION 2 Hyperlipidemia Andrew Cohen, MD and Neil S. Skolnik, MD CONTENTS INTRODUCTION RISK CATEGORIES AND TARGET LDL-CHOLESTEROL TREATMENT OF LDL-CHOLESTEROL SPECIAL CONSIDERATIONS OLDER AND YOUNGER ADULTS ADDITIONAL

More information

Introduction. Objective. Critical Questions Addressed

Introduction. Objective. Critical Questions Addressed Introduction Objective To provide a strong evidence-based foundation for the treatment of cholesterol for the primary and secondary prevention of ASCVD in women and men Critical Questions Addressed CQ1:

More information

Nicole Ciffone, MS, ANP-C, AACC Clinical Lipid Specialist

Nicole Ciffone, MS, ANP-C, AACC Clinical Lipid Specialist 1 Nicole Ciffone, MS, ANP-C, AACC Clinical Lipid Specialist New Cardiovascular Horizons Multidisciplinary Strategies for Optimal Cardiovascular Care February 7, 2015 2 Objectives After participating in

More information

22 Is Aggressive Lipid

22 Is Aggressive Lipid 22 Is Aggressive Lipid Lowering the Call in Era of Prevention of CAD? Abstract: Ever since the publication of the 4S study, lipid management has been the center of preventive therapy for coronary artery

More information

HYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016

HYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016 HYPERLIPIDEMIA IN THE OLDER POPULATION NICOLE SLATER, PHARMD, BCACP AUBURN UNIVERSITY, HARRISON SCHOOL OF PHARMACY JULY 16, 2016 NOTHING TO DISCLOSE I, Nicole Slater, have no actual or potential conflict

More information

4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for

4/7/ The stats on heart disease. + Deaths & Age-Adjusted Death Rates for + Update on Lipid Management Stacey Gardiner, MD Assistant Professor Division of Cardiovascular Medicine Medical College of Wisconsin + The stats on heart disease Over the past 10 years for which statistics

More information

ESC Geoffrey Rose Lecture on Population Sciences Cholesterol and risk: past, present and future

ESC Geoffrey Rose Lecture on Population Sciences Cholesterol and risk: past, present and future ESC Geoffrey Rose Lecture on Population Sciences Cholesterol and risk: past, present and future Rory Collins BHF Professor of Medicine & Epidemiology Clinical Trial Service Unit & Epidemiological Studies

More information

Cholesterol Treatment Update

Cholesterol Treatment Update Cholesterol Treatment Update Patrick E. McBride, M.D., M.P.H. Professor of Medicine, Cardiovascular Medicine Associate Director, Preventive Cardiology Program UW School of Medicine and Public Health Disclosure:

More information

The TNT Trial Is It Time to Shift Our Goals in Clinical

The TNT Trial Is It Time to Shift Our Goals in Clinical The TNT Trial Is It Time to Shift Our Goals in Clinical Angioplasty Summit Luncheon Symposium Korea Assoc Prof David Colquhoun 29 April 2005 University of Queensland, Wesley Hospital, Brisbane, Australia

More information

Cardiovascular outcomes trials with statins in diabetes

Cardiovascular outcomes trials with statins in diabetes Cardiovascular outcomes trials with statins in diabetes FARIHA NAEEM, GERARD MCKAY, MILES FISHER REVIEW Abstract Treatment with statins is one of the most effective ways of reducing cardiovascular events

More information

LAMIS (Livalo in AMI Study)

LAMIS (Livalo in AMI Study) JCR 2018. 12. 8 LAMIS (Livalo in AMI Study) Young Joon Hong Division of Cardiology, Chonnam National University Hospital Gwangju, Korea Trend of hypercholesterolemia in Korea < Prevalence of hypercholesterolemia

More information

Lessons from Recent Atherosclerosis Trials

Lessons from Recent Atherosclerosis Trials Lessons from Recent Atherosclerosis Trials Han, Ki Hoon MD PhD Asan Medical Center Seoul, Korea Change of concept Primary vs. secondary prevention Low risk vs. High risk High Risk CHD and equivalents CHD

More information

Review of guidelines for management of dyslipidemia in diabetic patients

Review of guidelines for management of dyslipidemia in diabetic patients 2012 international Conference on Diabetes and metabolism (ICDM) Review of guidelines for management of dyslipidemia in diabetic patients Nan Hee Kim, MD, PhD Department of Internal Medicine, Korea University

More information

Traitements associés chez l hypertendu: Statines, Aspirine

Traitements associés chez l hypertendu: Statines, Aspirine Traitements associés chez l hypertendu: Statines, Aspirine Pr Jean-Jacques Mourad CHU Avicenne, Université Paris 13, Bobigny DU HTA, Mars 2012 jean-jacques.mourad@avc.aphp.fr Global Mortality 2000: Impact

More information

Changing lipid-lowering guidelines: whom to treat and how low to go

Changing lipid-lowering guidelines: whom to treat and how low to go European Heart Journal Supplements (2005) 7 (Supplement A), A12 A19 doi:10.1093/eurheartj/sui003 Changing lipid-lowering guidelines: whom to treat and how low to go C.M. Ballantyne Section of Atherosclerosis,

More information

Update on Cholesterol Management: The 2013 ACC/AHA Guidelines

Update on Cholesterol Management: The 2013 ACC/AHA Guidelines Update on Cholesterol Management: The 2013 ACC/AHA Guidelines Ola Akinboboye MD MPH MBA Medical Director, Queens Heart institute Rosedale. Associate Professor of Clinical Medicine, Weill Medical College

More information

STATINS IN PRIMARY PREVENTION Who can benefit from them?

STATINS IN PRIMARY PREVENTION Who can benefit from them? STATINS IN PRIMARY PREVENTION Who can benefit from them? High blood cholesterol is one of the main risk factors for Cardiovascular disease, but it must be considered in a whole framework including others,

More information

03/30/2016 DISCLOSURES TO OPERATE OR NOT THAT IS THE QUESTION CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE

03/30/2016 DISCLOSURES TO OPERATE OR NOT THAT IS THE QUESTION CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE CAROTID INTERVENTION IS INDICATED FOR ASYMPTOMATIC CAROTID OCCLUSIVE DISEASE Elizabeth L. Detschelt, M.D. Allegheny Health Network Vascular and Endovascular Symposium April 2, 2016 DISCLOSURES I have no

More information

Screening for Lipid Disorders in Adults: Selective Update of 2001 U.S. Preventive Services Task Force Review

Screening for Lipid Disorders in Adults: Selective Update of 2001 U.S. Preventive Services Task Force Review Evidence Synthesis Number 49 Screening for Lipid Disorders in Adults: Selective Update of 2001 U.S. Preventive Services Task Force Review Prepared for : Agency for Healthcare Research and Quality (AHRQ)

More information

2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Adult Certified Nurse Practitioner North Ohio Heart, Inc.

2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Adult Certified Nurse Practitioner North Ohio Heart, Inc. 2013 Cholesterol Guidelines Anna Broz MSN, RN, CNP, AACC Adult Certified Nurse Practitioner North Ohio Heart, Inc. Disclosures Speaker Gilead Sciences NHLBI Charge to the Expert Panel Evaluate higher quality

More information

Should we treat everybody over 60 years with a statin? Comprehensive primary prevention in practice

Should we treat everybody over 60 years with a statin? Comprehensive primary prevention in practice Should we treat everybody over 60 years with a statin? Comprehensive primary prevention in practice Pathogenesis of atherosclerosis A decades-long disease course Inflammation Selectins ICAM IL M-CSF CRP

More information

Rikshospitalet, University of Oslo

Rikshospitalet, University of Oslo Rikshospitalet, University of Oslo Preventing heart failure by preventing coronary artery disease progression European Society of Cardiology Dyslipidemia 29.08.2010 Objectives The trends in cardiovascular

More information

Dyslipidemia in the light of Current Guidelines - Do we change our Practice?

Dyslipidemia in the light of Current Guidelines - Do we change our Practice? Dyslipidemia in the light of Current Guidelines - Do we change our Practice? Dato Dr. David Chew Soon Ping Senior Consultant Cardiologist Institut Jantung Negara Atherosclerotic Cardiovascular Disease

More information

TABLE 1. Cardiovascular Disease Management Guidelines for the Primary Prevention of CAD a Risk category b LDL-C goal (mg/dl) c Moderately high risk (

TABLE 1. Cardiovascular Disease Management Guidelines for the Primary Prevention of CAD a Risk category b LDL-C goal (mg/dl) c Moderately high risk ( REVIEW PRIMARY PREVENTION OF CAD Intensive Lowering of Low-Density Lipoprotein Cholesterol Levels for Primary Prevention of Coronary Artery Disease DEAN G. KARALIS, MD Coronary artery disease (CAD) is

More information

In-Ho Chae. Seoul National University College of Medicine

In-Ho Chae. Seoul National University College of Medicine The Earlier, The Better: Quantum Progress in ACS In-Ho Chae Seoul National University College of Medicine Quantum Leap in Statin Landmark Trials in ACS patients Randomized Controlled Studies of Lipid-Lowering

More information

Hyperlipidemia: Lowering the Bar on the Lipid Limbo. Community Faculty Development Symposium March 13, 2004 Hugh Huizenga MD, MPH

Hyperlipidemia: Lowering the Bar on the Lipid Limbo. Community Faculty Development Symposium March 13, 2004 Hugh Huizenga MD, MPH Mark slides Hyperlipidemia: Lowering the Bar on the Lipid Limbo Community Faculty Development Symposium March 13, 2004 Hugh Huizenga MD, MPH Hyperlipidemia is a common problem Nearly 50% of men in the

More information

JAMA. 2011;305(24): Nora A. Kalagi, MSc

JAMA. 2011;305(24): Nora A. Kalagi, MSc JAMA. 2011;305(24):2556-2564 By Nora A. Kalagi, MSc Cardiovascular disease (CVD) is the number one cause of mortality and morbidity world wide Reducing high blood cholesterol which is a risk factor for

More information

Disclosures No relationships (not even to an employer) No off-label uses. Cholesterol Lowering Guidelines: What now?

Disclosures No relationships (not even to an employer) No off-label uses. Cholesterol Lowering Guidelines: What now? Disclosures No relationships (not even to an employer) No off-label uses Cholesterol Lowering Guidelines: What now?, FACP 1 2 65-year-old white woman Total cholesterol 175mg/dL HDL 54 mg/dl LDL 96 mg/dl

More information

Ten Year Risk for CVD Event by Systolic HTN and CVD Risk Factors (Where s Age?)

Ten Year Risk for CVD Event by Systolic HTN and CVD Risk Factors (Where s Age?) Prevention and Treatment of CVD in Older Patients with Diabetes and Pre Diabetes: Hypertension and Dyslipidemia ASP Workshop on Diabetes Mellitus and Cardiovascular Disease in Older Adults Pentagon City

More information

Lipid Panel Management Refresher Course for the Family Physician

Lipid Panel Management Refresher Course for the Family Physician Lipid Panel Management Refresher Course for the Family Physician Objectives Understand the evidence that was evaluated to develop the 2013 ACC/AHA guidelines Discuss the utility and accuracy of the new

More information

The CARI Guidelines Caring for Australians with Renal Impairment. Cardiovascular Risk Factors

The CARI Guidelines Caring for Australians with Renal Impairment. Cardiovascular Risk Factors Cardiovascular Risk Factors ROB WALKER (Dunedin, New Zealand) Lipid-lowering therapy in patients with chronic kidney disease Date written: January 2005 Final submission: August 2005 Author: Rob Walker

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Gutierrez J, Ramirez G, Rundek T, Sacco RL. Statin therapy in the prevention of recurrent cardiovascular events: a sex-based meta-analysis. Arch Intern Med. 2012;172(12):IRA120005.

More information

Statins after 80 years old. Pros/Cons symposium. 13 th EUGMS Congress Nice Sept 2017

Statins after 80 years old. Pros/Cons symposium. 13 th EUGMS Congress Nice Sept 2017 Statins after 80 years old Pros/Cons symposium 13 th EUGMS Congress Nice 20-22 Sept 2017 Athanasios Benetos Conflict of interest: None The Statinissean War Two fearless fighters Athanasios the Athenian

More information

REAL-CAD. : Cardiovascular benefit of pitavastatin in stable coronary artery disease

REAL-CAD. : Cardiovascular benefit of pitavastatin in stable coronary artery disease REAL-CAD : Cardiovascular benefit of pitavastatin in stable coronary artery disease Soo-Joong Kim M.D., PhD. Department of Cardiology, Internal Medicine, Kyung Hee University Hospital I have nothing to

More information

CLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM

CLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM CLINICAL DECISION USING AN ARTICLE ABOUT TREATMENT JOSEFINA S. ISIDRO LAPENA MD, MFM, FPAFP PROFESSOR, UPCM Principles of Decision Making Knowing the patient s true state is often unnecessary Does my patient

More information

NCEP Report. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines

NCEP Report. Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines NCEP Report Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines Scott M. Grundy; James I. Cleeman; C. Noel Bairey Merz; H. Bryan Brewer,

More information

A Mendelian Randomized Controlled Trial of Long Term Reduction in Low-Density Lipoprotein Cholesterol Beginning Early in Life

A Mendelian Randomized Controlled Trial of Long Term Reduction in Low-Density Lipoprotein Cholesterol Beginning Early in Life A Mendelian Randomized Controlled Trial of Long Term Reduction in Low-Density Lipoprotein Cholesterol Beginning Early in Life Brian A. Ference, M.D., M.Phil., M.Sc. ACC.12 Chicago 26 March 2012 Disclosures

More information

1. Which one of the following patients does not need to be screened for hyperlipidemia:

1. Which one of the following patients does not need to be screened for hyperlipidemia: Questions: 1. Which one of the following patients does not need to be screened for hyperlipidemia: a) Diabetes mellitus b) Hypertension c) Family history of premature coronary disease (first degree relatives:

More information

However, if instead, CHD risk is plotted on a doubling scale (as in slide 2) then there is a

However, if instead, CHD risk is plotted on a doubling scale (as in slide 2) then there is a Slides 1 and 2: These two illustrative slides (based on notionaldata) were used in my presentation to Dr Godlee at our meeting on 2 December 2013 to show that, if the risk of coronary disease (CHD) is

More information

Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial

Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian Cardiac Outcomes Trial European Heart Journal (2006) 27, 2982 2988 doi:10.1093/eurheartj/ehl403 Clinical research Coronary heart disease Potential synergy between lipid-lowering and blood-pressure-lowering in the Anglo-Scandinavian

More information

2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Cer=fied Adult Nurse Prac==oner North Ohio Heart, Inc.

2013 Cholesterol Guidelines. Anna Broz MSN, RN, CNP, AACC Cer=fied Adult Nurse Prac==oner North Ohio Heart, Inc. 2013 Cholesterol Guidelines Anna Broz MSN, RN, CNP, AACC Cer=fied Adult Nurse Prac==oner North Ohio Heart, Inc. Disclosures Speaker Gilead Sciences NHLBI Charge to the Expert Panel Evaluate higher quality

More information

The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient

The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient Q J Med 2005; 98:599 614 Advance Access publication 8 July 2005 doi:10.1093/qjmed/hci093 Commentary The statin studies: from targeting hypercholesterolaemia to targeting the high-risk patient H.T. ONG

More information

Articles. Funding UK Medical Research Council, British Heart Foundation, Merck & Co, Roche Vitamins.

Articles. Funding UK Medical Research Council, British Heart Foundation, Merck & Co, Roche Vitamins. Effects on 11-year mortality and morbidity of lowering LDL cholesterol with simvastatin for about 5 years in 20 536 high-risk individuals: a randomised controlled trial Heart Protection Study Collaborative

More information

UCC Library and UCC researchers have made this item openly available. Please let us know how this has helped you. Thanks!

UCC Library and UCC researchers have made this item openly available. Please let us know how this has helped you. Thanks! UCC Library and UCC researchers have made this item openly available. Please let us know how this has helped you. Thanks! Title Author(s) Long-term effects of statin treatment in elderly people: extended

More information

Advanced Treatment of LDL: How Low Should You Go?

Advanced Treatment of LDL: How Low Should You Go? Advanced Treatment of LDL: How Low Should You Go? C. Michael White, Pharm.D., FCP, FCCP Professor and Head, Pharmacy Practice, UCONN Co-Director, HOPE Collaborative Group, UCONN/Hartford Hospital Potential

More information

Advanced Treatment of LDL: How Low Should You Go?

Advanced Treatment of LDL: How Low Should You Go? Advanced Treatment of LDL: How Low Should You Go? C. Michael White, Pharm.D., FCP, FCCP Professor and Head, Pharmacy Practice, UCONN Co-Director, HOPE Collaborative Group, UCONN/Hartford Hospital Potential

More information

An advisory committee to the U.S. Food and Drug

An advisory committee to the U.S. Food and Drug Perspective Over-the-Counter Statins Niteesh K. Choudhry, MD, PhD, and Jerry Avorn, MD In late 2004, the British government decided to allow a lipidlowering agent to be sold as an over-the-counter medication.

More information

Dyslipidemia 울산의대서울아산병원심장병원심장내과이철환

Dyslipidemia 울산의대서울아산병원심장병원심장내과이철환 Dyslipidemia 울산의대서울아산병원심장병원심장내과이철환 Presentation General LDL cholesterol HDL cholesterol Future Summary A top healthcare priority 사망 / 인구 10 만 Causes of Death Worldwide, 2008 140 120 2008 년 한국인 5 대사망원인

More information

Felix Vallotton Ball (1899) LDL-C management in Asian diabetes: moderate vs. high intensity statin --- a lesson from EMPATHY study

Felix Vallotton Ball (1899) LDL-C management in Asian diabetes: moderate vs. high intensity statin --- a lesson from EMPATHY study Felix Vallotton Ball (1899) LDL-C management in Asian diabetes: moderate vs. high intensity statin --- a lesson from EMPATHY study Conflict of interest disclosure None Committee of Scientific Affairs Committee

More information

When it comes to the FIELD study, what is...is

When it comes to the FIELD study, what is...is Future Lipidology ISSN: 1746-0875 (Print) (Online) Journal homepage: https://www.tandfonline.com/loi/tlip19 When it comes to the FIELD study, what is...is James McKenney To cite this article: James McKenney

More information

THE LIPID DEBATE: WHAT S NEW? Dr Detloff Rump

THE LIPID DEBATE: WHAT S NEW? Dr Detloff Rump THE LIPID DEBATE: WHAT S NEW? Dr Detloff Rump Agenda The Statin debate The TChol/LDL/HDL/Trig debate The ratio debate Conclusions 2 Statins 3 There is an academic debate and it is not concluded 4 ..and

More information

The Clinical Debates

The Clinical Debates The Clinical Debates Speakers: Round 2: Statins for Primary Prevention of Cardiovascular Disease Matthew Cantrell, PharmD, BCPS, is a 2000 graduate of Mt. Mercy College and 2005 graduate from the University

More information

Gonzalez Carmona Victor - Statins and its Role in Coronary Primary Prevention

Gonzalez Carmona Victor - Statins and its Role in Coronary Primary Prevention QCVC Committees Scientific Activities Central Hall General Information FAC Thematic Units Arrhythmias and Electrophysiology Basic Research Bioengineering and Medical Informatics Cardiac Surgical Intensive

More information

LDL and the Benefits of Statin Therapy

LDL and the Benefits of Statin Therapy LDL and the Benefits of Statin Therapy Allan Sniderman McGill University ACC/AHA did not recommend a target-based approach. Right? P 2899 The Expert Panel was unable to find any RCTs that evaluated titration

More information

Tailored Statin Treatment for Type 2 Diabetes. Han, Ki Hoon Asan Medical Center University of Ulsan

Tailored Statin Treatment for Type 2 Diabetes. Han, Ki Hoon Asan Medical Center University of Ulsan Tailored Statin Treatment for Type 2 Diabetes Han, Ki Hoon Asan Medical Center University of Ulsan 1 Cardiovascular disease ; No1. death (2001) respiratory tract infection Other NCD S HIV/AIDS deaths during

More information

Treating Hyperlipidemias in Adults. Lisa R. Tannock MD Division of Endocrinology and Molecular Medicine, University of Kentucky Lexington KY VAMC

Treating Hyperlipidemias in Adults. Lisa R. Tannock MD Division of Endocrinology and Molecular Medicine, University of Kentucky Lexington KY VAMC Treating Hyperlipidemias in Adults Lisa R. Tannock MD Division of Endocrinology and Molecular Medicine, University of Kentucky Lexington KY VAMC Disclosures Conflicts: None Talk will address off-label

More information

Use of Statins in the Nursing Home Population. Objectives

Use of Statins in the Nursing Home Population. Objectives Use of Statins in the Nursing Home Population Cari Levy, MD, PhD University of Colorado Health Sciences Center and the Rocky Mountain Regional Medical Center Objectives Discuss the evidence base for use

More information

Coronary artery disease remains the leading

Coronary artery disease remains the leading UNMET NEEDS IN THE TREATMENT OF ATHEROSCLEROSIS: WHY ARE WE NOT DONE YET? * Evan A. Stein, MD, PhD ABSTRACT Heart disease remains the leading cause of death in the United States. Despite advances in surgical,

More information

No relevant financial relationships

No relevant financial relationships MANAGEMENT OF LIPID DISORDERS Balancing Benefits and harms Disclosure Robert B. Baron, MD MS Professor and Associate Dean UCSF School of Medicine No relevant financial relationships baron@medicine.ucsf.edu

More information

Environmental. Vascular / Tissue. Metabolics

Environmental. Vascular / Tissue. Metabolics Global Risk Reduction--WINS Picking Mom and Dad-2016 Environmental Vascular / Tissue Metabolics Stop smoking-1b Physical activity-1b Weight control-1b Chelation therapy-3c Influenza vaccination-1b Blood

More information

Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy?

Macrovascular Residual Risk. What risk remains after LDL-C management and intensive therapy? Macrovascular Residual Risk What risk remains after LDL-C management and intensive therapy? Defining Residual Vascular Risk The risk of macrovascular events and microvascular complications which persists

More information

Statinsshould be in the water supply. Lipid Drug Therapy: Use in Special Populations. Objectives. TSHP 2014 Annual Seminar 1

Statinsshould be in the water supply. Lipid Drug Therapy: Use in Special Populations. Objectives. TSHP 2014 Annual Seminar 1 Lipid Drug Therapy: Use in Special Populations Mark C. Granberry, Pharm.D. Professor Texas A&M Rangel College of Pharmacy Objectives Discuss background for recommendations from the recent AHA/ACC Lipid

More information

Is it an era for statin for life?

Is it an era for statin for life? Is it an era for statin for life? Mohamed Abdel Ghany Professor of Cardiology Cairo University Cardiovascular Disease (CVD) is the leading global cause of death 1 Dyslipidemia as a main Risk Factor for

More information

Young high risk patients the role of statins Dr. Mohamed Jeilan

Young high risk patients the role of statins Dr. Mohamed Jeilan Young high risk patients the role of statins Dr. Mohamed Jeilan KCS Congress: Impact through collaboration CONTACT: Tel. +254 735 833 803 Email: kcardiacs@gmail.com Web: www.kenyacardiacs.org Disclosures

More information

Cost effectiveness of statin therapy for the primary prevention of coronary heart disease in Ireland Nash A, Barry M, Walshe V

Cost effectiveness of statin therapy for the primary prevention of coronary heart disease in Ireland Nash A, Barry M, Walshe V Cost effectiveness of statin therapy for the primary prevention of coronary heart disease in Ireland Nash A, Barry M, Walshe V Record Status This is a critical abstract of an economic evaluation that meets

More information

Disclosures. Choosing a Statin/New Therapies. Case. How else would you do to treat him? LDL-C Reduction with Different Statin Strategies

Disclosures. Choosing a Statin/New Therapies. Case. How else would you do to treat him? LDL-C Reduction with Different Statin Strategies Disclosures I have no disclosures relevant to this talk Choosing a Statin/New Therapies Aryan Aiyer, MD Assistant Professor of Medicine University of Pittsburgh School of Medicine UPMC Heart and Vascular

More information

Supplementary Online Content

Supplementary Online Content Supplementary Online Content Leibowitz M, Karpati T, Cohen-Stavi CJ, et al. Association between achieved low-density lipoprotein levels and major adverse cardiac events in patients with stable ischemic

More information

Case Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer

Case Presentation. Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation Rafael Bitzur The Bert W Strassburger Lipid Center Sheba Medical Center Tel Hashomer Case Presentation 50 YO man NSTEMI treated with PCI 1 month ago Medical History: Obesity: BMI 32,

More information

Placebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN

Placebo-Controlled Statin Trials EXPLAINING THE DECREASE IN DEATHS FROM CHD! PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN EXPLAINING THE DECREASE IN PREVENTION OF CARDIOVASCULAR DISEASE IN WOMEN Robert B. Baron MD MS Professor and Associate Dean UCSF School of Medicine Declaration of full disclosure: No conflict of interest EXPLAINING THE DECREASE

More information