Statin Use for Primary Cardiovascular Disease Prevention Is Low in Inflammatory Arthritis

BackgroundPatients with inflammatory arthritis (IA) are at high risk for atherosclerotic cardiovascular disease (ASCVD), yet management of dyslipidemia is infrequently prioritized. We applied Canadian dyslipidemia guidelines to determine how many patients with IA would be eligible for primary prevention with statins.MethodsWe conducted a cross-sectional study of patients with IA in a cardio-rheumatology clinic, with no known CVD and without statin therapy at cohort entry. We stratified patients by Framingham Risk Score (FRS) and summarized the proportion meeting guideline statin-indicated criteria. Multivariable logistic regression analyses determined the association of variables with statin indication after adjustment for age, sex, traditional ASCVD risk factors, and arthritis characteristics.ResultsAmong 302 patients, most had rheumatoid arthritis (59%). Mean age was 58 years, and 71% were female. Overall, 50% of the cohort was eligible for statin therapy. The majority was low FRS risk category (68%), and the most frequent qualifier for statins was elevated apolipoprotein B (ApoB) levels or low-density lipoprotein cholesterol (LDL-c) levels. In the intermediate FRS group, 91% met criteria for statin therapy based on the presence of a coronary artery calcification (CAC) score > 0 or an elevated high-sensitivity C-reactive protein. Male sex, hypertension, elevated ApoB, and a CAC score > 0 were the factors most strongly associated with indication for statin therapy.ConclusionsStatin therapy is suboptimal in IA despite a significant number of patients meeting indication based on lipoprotein thresholds or CAC scores. Understanding the barriers and potential facilitators of implementing and interpreting these CVD screening tools in IA is needed.     

Age-Neutral Guidelines for the Primary Prevention of Cardiovascular Disease

Use of common guidelines for primary prevention of cardiovascular events based on 10-year risk results in undertreatment of younger individuals, especially women, since age and sex are major determinants of global risk. Women in their late 40s have a 10-year risk lower than the 10% threshold used for cholesterol-lowering treatment even in the presence of marked elevations of blood pressure or cholesterol. Removal of age from risk algorithms and use of lifetime global risk to treat individuals according to the degree of their modifiable risk factors rather than demographics has been proposed. Initiation of therapy at younger ages, aiming at "primordial" prevention of atherosclerotic disease rather than focusing on cardiovascular events, will result in saving more quality-adjusted life-years. Generic medications can be obtained at an affordable cost, and concerns about long-term safety and efficacy can be tested in a clinical trial of younger individuals at low 10-year risk but high lifetime risk.     

Aspirin for the Primary Prevention of Cardiovascular Disease in Women

Primary prevention of cardiovascular disease, which is the leading cause of death of women in the United States, focuses on treating or eliminating risk factors and often includes the use of aspirin to prevent thrombotic complications of atherosclerosis or atrial fibrillation. Recent evidence reveals sex-based differences in the benefits of aspirin in individuals without established cardiovascular disease. Although use of aspirin does not affect total mortality in either sex, aspirin lowers the risk of ischemic stroke in women and decreases the risk of myocardial infarction in men. Unfortunately, the use of aspirin comes at the expense of an increase in bleeding events, mostly gastrointestinal, that occurs at roughly similar rates in women and men. Aspirin may not be beneficial for primary prevention of cardiovascular events in women with diabetes. The benefits, as well as the risks, of aspirin therapy should be discussed when contemplating the use of aspirin in the primary prevention of cardiovascular disease in women.     

Statin Therapy for Primary Prevention in the Elderly and Its Association with New-Onset Diabetes,Cardiovascular Events,and All-Cause Mortality

PurposeThis study assessed associations of the use of statins for primary prevention with cardiovascular outcomes among adults ages ≥70 years.MethodsIn a retrospective population-based cohort study, new users of statins without cardiovascular disease or diabetes mellitus were stratified by ages ≥70 years and <70 years. Using a time-dependent approach, adherence to statins was evaluated according to the proportion of days covered: <25%, 25%-50%, 50%-75%, and ≥75%. We assessed associations of statin therapy with increased risk of new-onset diabetes mellitus and with decreased risks of major adverse cardiovascular events and all-cause mortality.ResultsOf 42,767 new users of statins, 5970 (14%) were ages ≥70 years. The incident rates of major adverse cardiovascular events, all-cause mortality, and new-onset diabetes mellitus in the highest to lowest proportion of days covered categories were 16.9%, 16.7%, and 9.4% and 6.3%, 1.7%, and 9.4%, respectively. For the older group, the adjusted hazard ratios of major adverse cardiovascular events and mortality were significantly decreased for the highest adherence group (proportion of days covered ≥75%): 0.71 (0.57-0.88) and 0.68 (0.54-0.84), respectively. The respective hazard ratios were less favorable for the younger group: 0.80 (0.68-0.93) and 0.74 (0.58-1.03). The risk of new-onset diabetes mellitus was increased for the younger but not the older group.ConclusionsStatin use for primary prevention was associated with cardiovascular benefit in adults ages ≥70 years without a significant risk for the development of diabetes. These data may support the use of statin therapy for primary prevention in the elderly.     

他汀在女性心血管疾病一级预防中的作用

冠心病是发达国家男性和女性的首要死亡原因。低密度脂蛋白胆固醇（LDL-C）升高是重要、独立的心血管危险因素。他汀能够有效地降低LDL-C水平,能够减少心血管发病率和病死率,他汀是冠心病预防策略必不可少的组成部分。但女性患者在一级和二级预防中,他汀处方使用明显不足。一度认为对于女性心脏病的预防,尤其是未诊断为冠心病的女性,无证据证明使用他汀能获益。现回顾他汀在预防女性冠心病中的作用。累积的证据显示,在一些研究中,女性受试者代表性不足,后续统计分析有限。目前的指南对于血管性疾病建议无论男性和女性,血脂异常的处理策略相似。因此,他汀治疗对于男性和女性标准一致,目标也一致。     

Primary Prevention of Cardiovascular Disease in Older People

Abstract. Cardiovascular disease is the leading cause of death, morbidity and disability in older people. Strategies for cardiovascular disease prevention and intervention in older people are similar to those available for younger ages. The population strategy for primary prevention is broad ranging from food and tobacco policy legislation and media communication to simple and direct advice delivered by all health workers. High risk strategies for reducing elevated levels of the major cardiovascular risk factors such as hypertension and hypercholesterolemia in older populations indicate that gains in life expectancy are greatest where absolute risk is highest and the intervention is the cheapest available. Non-pharmacological treatment, in particular dietary therapy, is recommended as the first line of treatment for both raised blood pressure and blood cholesterol. Because of the high excess mortality associated with smoking, even a brief advice package associated with modest success is cost effective in older people. Health policy for older people should be directed towards the overall goal of maintenance of autonomy and should include prevention, treatment and rehabilitation of cardiovascular disease as part of a comprehensive program for the prevention and control of all diseases.     

Novel and Emerging Therapeutics for Primary Prevention of Cardiovascular Disease

Cardiovascular disease is responsible for 205 deaths per 100,000 persons annually and is the leading cause of death worldwide. The public health burden of cardiovascular disease is expected to continue to grow as the prevalence of many cardiovascular risk factors increases. Several novel classes of glucose-lowering, lipid-lowering, and weight-loss therapeutics have shown mortality benefits in outcomes trials. However, a large proportion of subjects in those trials had established cardiovascular disease, so, as a result, the role of these novel therapeutics in primary cardiovascular prevention is controversial. In this review, we highlight recent advances in the pharmacotherapeutic management of the cardiovascular risk factors of hyperglycemia, dyslipidemia, and obesity. We examine key subgroups within recent cardiovascular outcome trials, weigh the risks and benefits of several novel therapeutics, and provide practical insight into the use of these agents. Our article concludes with a look toward the future and provides the practitioner and scientist with an early view of emerging therapeutics that may play an important role in primary cardiovascular prevention.     

Aspirin for Primary Cardiovascular Prevention in Patients with Family History of Cardiovascular Disease: Meta-analysis

Cardiovascular Drugs and Therapy -     

活性维生素D在老年慢性疾病防治中的地位

维生素D不仅对人体钙、磷代谢平衡重要,而且近些年研究发现VitD受体广泛存在于人体的多种组织细胞中,活性维生素D还具有重要生物学功能.VitD缺乏与多种慢性疾病发生相关,包括骨质疏松、骨折、跌倒风险增加;增加心血管风险,包括高血压、缺血性心脏病、心力衰竭;而且影响胰腺β细胞分泌及胰岛素抵抗,从而增加2型糖尿病风险.活性VitD调节人体固有免疫和获得性免疫,调控细胞生长,促进细胞分化,抑制细胞增殖及免疫平衡,从而影响免疫系统疾病和肿瘤发生、发展.应适量补充VitD对人体许多组织器官发挥最佳功能,有益于老年慢性疾病防治和健康.     

Statins vs Early Hormone Therapy for the Primary Prevention of Cardiovascular Disease in Women

Early initiation of hormone therapy (HT) following the menopause has been advocated by some for the primary prevention of coronary heart disease (CHD) based on the “timing” hypothesis. However, the net benefit in the face of harmful effects of HT on stroke, as well as other adverse effects has yet to be determined for the various HT regimens. In contrast, statins reduce the risk of CHD, stroke, cardiovascular (CVD) events, and total mortality in women as in men, with an excellent margin of safety when used in individuals at increased risk for CVD.     

Developmental Mechanisms Involved in the Primary Prevention of Atherosclerosis and Cardiovascular Disease

The common belief that signs of atherosclerosis and cardiovascular disease (CVD) are clinically relevant only during adult and elderly age is gradually changing. Increasing evidence supports the concept that CVD is initiated through developmental in utero processes beginning before birth. Epigenetic and other unknown mechanisms underlying these developmental events are yet to be elucidated. The clinical implications of such theories for the primary prevention of CVD are intuitive and logical, but clinical prospective studies and translational approaches are still warranted. The evolution of CVD is usually characterized by a long lag time between onset and clinical manifestation, thereby providing a relevant opportunity for its early non-invasive detection during childhood and tailored therapeutic strategies, both with established pharmacologic agents and newly developed drugs that can affect epigenetic mechanisms.