2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult

Anderson, Todd J.; Grégoire, Jean; Pearson, Glen J.; Barry, Arden R.; Couture, Patrick; Dawes, Martin; Francis, Gordon A.; Genest, Jacques; Grover, Steven A.; Gupta, Milan; Hegele, Robert A.; Lau, David C.W.; Leiter, Lawrence A.; Lonn, Eva; Mancini, G.B. John; McPherson, Ruth; Ngui, Daniel; Poirier, Paul; Sievenpiper, John L.; Stone, James A.; Thanassoulis, George; Ward, Richard A.

doi:10.1016/j.cjca.2016.07.510

Cited by 844 publications

(715 citation statements)

References 113 publications

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“…Clinically, statins have been shown to reduce rates of stroke, myocardial infarction, and death in patients with cardiovascular disease. To that end, major clinical practice guidelines recommend statin therapy for secondary prevention in most patients with established cardiovascular disease and for primary prevention in high‐risk patients 4, 5…”

Section: Introductionmentioning

confidence: 99%

Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

Hussain

Saposnik

Raju

et al. 2018

JAHA

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BackgroundStatins are commonly used for the prevention of cardiovascular events; however, statins are underutilized in patients with noncoronary atherosclerosis. We sought to establish the rates of statin use in patients with carotid artery disease and to examine the association between statin therapy and outcomes after carotid revascularization.Methods and ResultsIn this population‐level retrospective cohort study, we identified all individuals aged ≥66 years who underwent carotid endarterectomy or stenting in Ontario, Canada (2002–2014). The primary outcome was a composite of 1‐year stroke, myocardial infarction, or death (major adverse cardiac and cerebrovascular events). Five‐year risks were also examined. Adjusted hazard ratios were computed using inverse probability of treatment weighting based on propensity scores. A total of 7893 of 10 723 patients (73.6%) who underwent carotid revascularization were on preprocedural statin therapy; moderate‐ or high‐dose therapy was utilized by 7384 patients (68.9%). The composite rate of 1‐year major adverse cardiac and cerebrovascular events was lower among statin users (adjusted hazard ratio: 0.76; 95% confidence interval, 0.70–0.83). Patients who were on persistent long‐term statin therapy after the carotid procedure continued to experience significantly lower risk of major adverse cardiac and cerebrovascular events at 5 years (adjusted hazard ratio: 0.75, 95% confidence interval, 0.71–0.80). The beneficial associations with statin use were observed regardless of type of carotid revascularization procedure, carotid artery symptom status, or statin dose.ConclusionsContinuous statin therapy was associated with a 25% lower risk of long‐term adverse cardiovascular events in patients with significant carotid disease. Along with other supportive evidence, statins should be considered in patients undergoing carotid revascularization, and efforts are required to increase statin use in this undertreated population.

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Section: Introductionmentioning

confidence: 99%

Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

Hussain

Saposnik

Raju

et al. 2018

JAHA

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“…We explored 2 pre‐specified LDL cholesterol targets: (1) An LDL cholesterol target of ≤70 mg/dL as recommended by the European Society of Cardiology/Canadian Cardiovascular Society guidelines for post‐ACS populations,15, 16 and (2) an LDL cholesterol target of ≤50 mg/dL, which approximates the mean LDL cholesterol levels associated with aggressive LDL lower strategies in recent clinical trials 1, 3, 4…”

Section: Methodsmentioning

confidence: 99%

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Alter

Koh

et al. 2018

JAHA

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BackgroundThe extent to which outcome benefits may be achieved through the implementation of aggressive low‐density lipoprotein (LDL) cholesterol targets in real world settings remains unknown, especially among elderly statin users following acute coronary syndromes.Methods and ResultsA population‐based cohort study consisting of 19 544 post‐acute coronary syndrome statin‐users aged ≥66 years between January 1, 2017 and March 31, 2014 was used to project the number of adverse outcome events (acute myocardial infarction or death from any cause) that could be prevented if all post‐acute coronary syndrome elderly statin users were treated to 1 of 2 LDL cholesterol target levels (≤50 and ≤70 mg/dL). The number of preventable adverse outcomes was estimated by using model‐based expected event probabilities as derived from Cox Proportional hazards models. In total, 61.6% and 25.5% of the elderly patients met LDL cholesterol targets of ≤70 and ≤50 mg/dL, respectively, based on current management. No more than 2.3 adverse events per 1000 elderly statin users (95% confidence interval: −0.7 to 5.4, P=0.62) could be prevented over 8.1 years if all patients were to be treated from current LDL cholesterol levels to either of the 2 LDL cholesterol targets of 70 or 50 mg/dL.ConclusionsThe number of acute myocardial infarctions or death that could be prevented through the implementation of LDL cholesterol targets with statins is negligible among an elderly post‐acute coronary syndrome population. Such findings may have implications for the applicability of newer agents, such as proprotein convertase subtilisin/kexin type‐9‐ inhibitors.

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“…Las estatinas son la terapia farmacológica de elección en la mayoría de los pacientes para reducir el colesterol sérico y son recomendadas para prevención primaria y secundaria de la enfermedad coronaria por guías de práctica clínica de diversas sociedades científicas (21)(22)(23). Durante los últimos años han surgido nuevos tratamientos que buscan una reducción mayor del colesterol y en una mayor cantidad de pacientes.…”

Section: Asignación: Aleatoriaunclassified

Ronda clínica y epidemiológica: club de revistas

Galeano

Restrepo

Caraballo

et al. 2017

iatreia

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RESUMENEn esta edición de la Ronda Clínica y Epidemiológica analizamos cuatro artículos que consideramos relevantes para la práctica clínica. Spaite y colaboradores estudian por primera vez en la literatura médica el verdadero significado pronóstico de un valor exacto que defina hipotensión arterial pre-hospitalaria, en el contexto de la reanimación del paciente con trauma craneoencefálico moderado a grave. Oluwalana y colaboradores estudian el impacto de la administración oral de azitromicina durante el periparto en el riesgo de infecciones maternas y neonatales. Por otro lado, Esplin y colaboradores estudian la capacidad de la cervicometría y la fibronectina fetal seriada, solas o en combinación, para predecir la probabilidad de parto pretérmino espontáneo en gestantes nulíparas. Finalmente, el estudio del grupo FOURIER evalúa el efecto de la reducción de los niveles de colesterol LDL lograda con la administración de evolocumab, en pacientes con evidencia clínica de enfermedad cardiovascular que reciben tratamiento optimizado con estatinas, en el riesgo del desenlace compuesto por muerte cardiovascular, accidente cerebrovascular isquémico, infarto de miocardio u hospitalización por angina inestable o revascularización coronaria.

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2016 Canadian Cardiovascular Society Guidelines for the Management of Dyslipidemia for the Prevention of Cardiovascular Disease in the Adult

Cited by 844 publications

References 113 publications

Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

Association Between Statin Use and Cardiovascular Events After Carotid Artery Revascularization

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Ronda clínica y epidemiológica: club de revistas

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