Statin Use for the Primary Prevention of Cardiovascular Disease in Adults

Mangione, Carol M.; Barry, Michael J.; Nicholson, Wanda K; Cabana, Michael D.; Chelmow, David; Coker, Tumaini R.; Davis, Esa M.; Donahue, Katrina E; Jaén, Carlos Roberto; Kubik, Martha; Li, Li; Ogedegbe, Gbenga; Pbert, Lori; Ruiz, John; Stevermer, James J.; Wong, John B.

doi:10.1001/jama.2022.13044

Cited by 172 publications

(89 citation statements)

References 43 publications

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“…Statin use was defined as a documented prescription (generic or branded) of atorvastatin, cerivastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, and/or simvastatin. Statin intensity was categorized into those at high and low/moderate intensities according to US guidelines [ 12 ]. Ezetimibe and icosapent ethyl use was also captured, and PCSK9 inhibitors included evolocumab and alirocumab.…”

Section: Methodsmentioning

confidence: 99%

Dyslipidemia Treatment and Lipid Control in US Adults with Diabetes by Sociodemographic and Cardiovascular Risk Groups in the NIH Precision Medicine Initiative All of Us Research Program

Akbarpour

Devineni

Gong

et al. 2023

JCM

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Real-world data on lipid levels and treatment among adults with diabetes mellitus (DM) are relatively limited. We studied lipid levels and treatment status in patients with DM across cardiovascular disease (CVD) risk groups and sociodemographic factors. In the All of Us Research Program, we categorized DM as (1) moderate risk (≤1 CVD risk factor), (2) high risk (≥2 CVD risk factors), and (3) DM with atherosclerotic CVD (ASCVD). We examined the use of statin and non-statin therapy as well as LDL-C and triglyceride levels. We studied 81,332 participants with DM, which included 22.3% non-Hispanic Black and 17.2% Hispanic. A total of 31.1% had ≤1 DM risk factor, 30.3% had ≥2 DM risk factors, and 38.6% of participants had DM with ASCVD. Only 18.2% of those with DM and ASCVD were on high-intensity statins. Overall, 5.1% were using ezetimibe and 0.6% PCSK9 inhibitors. Among those with DM and ASCVD, only 21.1% had LDL-C < 70 mg/dL. Overall, 1.9% of participants with triglycerides ≥ 150 mg/dL were on icosapent ethyl. Those with DM and ASCVD were more likely to be on high-intensity statins, ezetimibe, and icosapent ethyl. Guideline-recommended use of high-intensity statins and non-statin therapy among our higher risk DM patients is lacking, with LDL-C inadequately controlled.

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Section: Methodsmentioning

confidence: 99%

Dyslipidemia Treatment and Lipid Control in US Adults with Diabetes by Sociodemographic and Cardiovascular Risk Groups in the NIH Precision Medicine Initiative All of Us Research Program

Akbarpour

Devineni

Gong

et al. 2023

JCM

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show abstract

“…In the previous study conducted with patients with hypercholesterolemia, circulating sLRP1 levels were found to decrease after statin treatment and to increase after statin withdrawal [ 15 ]. As all the participants of the current study were intensively treated with statins, it would be expected that sLRP1 levels, as well as their association with inflammation, would be much higher in the absence of statin treatment [ 29 ].…”

Section: Discussionmentioning

confidence: 99%

Soluble low-density lipoprotein receptor-related protein 1 as a surrogate marker of carotid plaque inflammation assessed by 18F-FDG PET in patients with a recent ischemic stroke

et al. 2023

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Background 18F-fluorodeoxyglucose positron emission tomography (18F-FDG PET) identifies carotid plaque inflammation and predicts stroke recurrence. Aim Our aim was to evaluate the performance of soluble low-density lipoprotein receptor-related protein 1 (sLRP1) as an indicator of carotid plaque inflammation. Methods A prospective study was conducted among adult patients with recent (< 7 days) anterior circulation ischemic stroke and at least one atherosclerotic plaque in the ipsilateral internal carotid artery. Patients underwent an early (< 15 days from inclusion) 18F-FDG PET, and the maximum standardized uptake value (SUVmax) within the plaque was measured. sLRP1 levels were measured in plasma samples by ELISA. The association of sLRP1 with SUVmax was assessed using bivariate and multivariable linear regression analyses. Hazard ratios (HR) were estimated with Cox regression to evaluate the association between circulating sLRP1 and stroke recurrence. Results The study was conducted with 64 participants, of which 57.8% had ≥ 50% carotid stenosis. The multivariable linear and logistic regression analyses showed that sLRP1 was independently associated with (i) SUVmax within the plaque (β = 0.159, 95% CI 0.062–0.257, p = 0.002) and (ii) a probability of presenting SUVmax ≥ 2.85 g/mL (OR = 1.31, 95% CI 1.00–1.01, p = 0.046), respectively. Participants with stroke recurrence showed higher sLRP1 levels at baseline [6447 ng/mL (4897–11163) vs. 3713 ng/mL (2793–4730); p = 0.018]. Conclusions sLRP1 was independently associated with carotid plaque inflammation as measured by 18F-FDG PET in patients with recent ischemic stroke and carotid atherosclerosis.

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“…The landscape in cardiovascular prevention has dramatically changed in the past few years, and so have the advances made in CVD prevention. Despite this, deaths from CVD continue to rise in the United States [3] , and both established and novel therapeutic interventions that can reduce CVD risk continue to be underutilized [4] , [5] , [6] , [7] , [8] , [9] , despite supporting evidence and guidelines that encourage implementation of CVD prevention [ 2 , [10] , [11] , [12] , [13] , [14] ]. Numerous possibilities for interventions are missed, from ensuring adequate adherence to lifestyle modifications to controlling blood pressure [6] , lipids [ 4 , 5 ], diabetes [8] , referring to cardiac rehabilitation [9] , utilization of guideline directed medical therapies after ST-elevation myocardial infarction (STEMI) [15] or in those with heart failure with reduced ejection fraction (HFrEF) [7] , which continue to be lost opportunities for CVD prevention, resulting in an increased incidence of CVD, hospitalizations and mortality [3] .…”

Section: Expanding Our Reachmentioning

confidence: 99%

President's page: The re-emergence of prevention in the forefront of cardiology

Gulati

2023

American Journal of Preventive Cardiology

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Statin Use for the Primary Prevention of Cardiovascular Disease in Adults

Cited by 172 publications

References 43 publications

Dyslipidemia Treatment and Lipid Control in US Adults with Diabetes by Sociodemographic and Cardiovascular Risk Groups in the NIH Precision Medicine Initiative All of Us Research Program

Dyslipidemia Treatment and Lipid Control in US Adults with Diabetes by Sociodemographic and Cardiovascular Risk Groups in the NIH Precision Medicine Initiative All of Us Research Program

Soluble low-density lipoprotein receptor-related protein 1 as a surrogate marker of carotid plaque inflammation assessed by 18F-FDG PET in patients with a recent ischemic stroke

President's page: The re-emergence of prevention in the forefront of cardiology

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