High-Intensity Statin Use Among Patients With Atherosclerosis in the U.S.

Nelson, Adam; Haynes, Kevin; Shambhu, Sonali; Eapen, Zubin J.; Cziraky, Mark J.; Nanna, Michael G.; Calvert, Sara B.; Gallagher, Kerrin; Pagidipati, Neha J.; Granger, Christopher B.

doi:10.1016/j.jacc.2022.02.048

Cited by 75 publications

(46 citation statements)

References 54 publications

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“…This extends beyond statin therapy to cardiovascular risk evaluation: among a cohort under the age of 55 with an AMI hospitalization, only 48.7% of females and 52.9% of males reported having been told that they were at risk for heart disease [11] . Our results further support prior work that cardiovascular risk is undertreated, which extends to patients with known ASCVD [ 3 , 12 , 13 ].…”

Section: Discussionsupporting

confidence: 90%

Use of lipid-lowering therapy preceding first hospitalization for acute myocardial infarction or stroke

Sandhu¹,

Rodríguez²,

Maron³

et al. 2022

American Journal of Preventive Cardiology

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Section: Discussionsupporting

confidence: 90%

Use of lipid-lowering therapy preceding first hospitalization for acute myocardial infarction or stroke

Sandhu¹,

Rodríguez²,

Maron³

et al. 2022

American Journal of Preventive Cardiology

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“…More recent guidelines indicate the opportunity of reducing LDL-C to very low levels to achieve optimal atherosclerotic cardiovascular benefit [ 3 , 4 ]. However, although the percentage of US adults taking high-intensity statin therapy following MI increased substantially between 2011 and 2019, a retrospective cohort study of 601,934 US patients with established atherosclerotic cardiovascular disease (ASCVD) showed gaps in appropriate statin use (only 50.1% of patients were using a statin), especially among younger patients, women, and those with noncoronary ASCVD [ 5 ]. Gaps between clinical guidelines and clinical practice have been also reported in the DA VINCI study evaluating patients in primary and secondary care across Europe [ 6 ] with even higher statin non-adherence in Central and Eastern Europe [ 7 ].…”

Section: Introductionmentioning

confidence: 99%

Bempedoic Acid: for Whom and When

Ruscica

Sirtori

Carugo

et al. 2022

Curr Atheroscler Rep

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Purpose of Review The aim of creating an orally active non-statin cholesterol-lowering drug was achieved with bempedoic acid, a small linear molecule providing both a significant low-density lipoprotein cholesterol (LDL-C) reduction and an anti-inflammatory effect by decreasing high-sensitivity C-reactive protein. Bempedoic acid antagonizes ATP citrate-lyase, a cytosolic enzyme upstream of HMGCoA reductase which is the rate-limiting step of cholesterol biosynthesis. Bempedoic acid is a pro-drug converted to its active metabolite by very-long-chain acyl-CoA synthetase 1 which is present mostly in the liver and absent in skeletal muscles. This limits the risk of myalgia and myopathy. The remit of this review is to give clinical insights on the safety and efficacy of bempedoic acid and to understand for whom it should be prescribed. Recent Findings Bempedoic acid with a single daily dose (180 mg) reduces LDL-C by a mean 24.5% when given alone, by 18% when given on top of a major statin and by 38–40% when given in a fixed-dose combination with ezetimibe. Bempedoic acid does not lead to the risk of new-onset diabetes, and moderately improves the glycaemic profile. Summary The extensive knowledge on bempedoic acid mechanism, metabolism and side effects has led to an improved understanding of the potential benefits of this agent and offers a possible alternative to cardiologists and clinical practitioners somewhat worn out today by the occurrence of the muscular side effects of statins.

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“…Opportunistic screening could be broadened to include patients with known ASCVD, given that nearly 50% are not on statin therapy. 32 Even for patients on a statin, identification of CAC may lead to dose intensification, improved medication adherence, or lifestyle changes. Increasing the eligible population may reduce the per-patient effect of notification on statin rates; for example, patients without a primary care clinician in the health care system may be less likely to receive statin therapy after notification.…”

Section: Discussionmentioning

confidence: 99%

Incidental Coronary Artery Calcium: Opportunistic Screening of Previous Nongated Chest Computed Tomography Scans to Improve Statin Rates (NOTIFY-1 Project)

et al. 2023

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Background: Coronary artery calcium (CAC) can be identified on non-gated chest CTs, but this finding is not consistently incorporated into care. A deep learning algorithm enables opportunistic CAC screening of non-gated chest CTs. Our objective was to evaluate the impact of notifying clinicians and patients of incidental CAC on statin initiation. Methods: NOTIFY-1 was a randomized quality improvement project in the Stanford healthcare system. Patients without known atherosclerotic cardiovascular disease (ASCVD) or prior statin prescription were screened for CAC on a prior non-gated chest CT from 2014-2019 using a validated deep learning algorithm with radiologist confirmation. Patients with incidental CAC were randomized to notification of the primary care clinician and patient versus usual care. Notification included a patient-specific image of CAC and guideline recommendations regarding statin use. The primary outcome was statin prescription within 6 months. Results: Among 2,113 patients who met initial clinical inclusion criteria, CAC was identified by the algorithm in 424 patients. After additional exclusions following chart review, a radiologist confirmed CAC among 173 of 194 patients (89.2%) who were randomized to notification or usual care. At 6 months, the statin prescription rate was 51.2% (44/86) in the notification arm versus 6.9% (6/87) with usual care (p<0.001). There was also more coronary artery disease testing in the notification arm (15.1% [13/86] vs. 2.3% [2/87], p=0.008). Conclusions: Opportunistic CAC screening of prior non-gated chest CTs followed by clinician and patient notification led to a significant increase in statin prescriptions. Further research is needed to determine whether this approach can reduce ASCVD events.

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High-Intensity Statin Use Among Patients With Atherosclerosis in the U.S.

Cited by 75 publications

References 54 publications

Use of lipid-lowering therapy preceding first hospitalization for acute myocardial infarction or stroke

Use of lipid-lowering therapy preceding first hospitalization for acute myocardial infarction or stroke

Bempedoic Acid: for Whom and When

Incidental Coronary Artery Calcium: Opportunistic Screening of Previous Nongated Chest Computed Tomography Scans to Improve Statin Rates (NOTIFY-1 Project)

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