The safety concern of statins is still a major issue for Asians. The aim of this study is to compare the risk of statin-associated adverse events among potent statins. Methods: We included patients from the Taiwan National Health Insurance Research Database who had been treated with atorvastatin, rosuvastatin, or pitavastatin and were without diabetes at baseline. They were classified into three groups: usual-dose statin (atorvastatin 10 mg/d or rosuvastatin 5-10 mg/d), high-dose statin (atorvastatin 20-40 mg/d and rosuvastatin 20 mg/d), and pitavastatin (2-4 mg/d). The primary endpoint is a composite of safety events, including hepatitis, myopathy, and new-onset diabetes mellitus (NODM). We matched age, sex, and year of recruitment among the three groups (n 50,935 in each group) and then used the multivariate Cox proportional hazards model to evaluate the relation between the safety endpoint and different statin groups.Results: After a mean follow-up of 3.08 0.83 years, the safety events occurred in 9.84% in the pitavastatin group, 10.88% in the usual-dose statin group, and 10.49% in high-dose statin group. The multivariate Cox proportional hazards model indicated that usual-dose statin and high-dose statin were associated with a higher risk of the composite safety events compared with pitavastatin (adjusted hazard ratio [aHR]: 1.12, 95% confidence interval [CI]: 1.08-1.17 for usual-dose statin and aHR: 1.06, 95% CI: 1.02-1.10 for high-dose statin). The risks of hepatitis requiring hospitalization and NODM were especially lower in pitavastatin group. Conclusions:Compared with atorvastatin and rosuvastatin, pitavastatin might be associated with a lower risk of safety events in Asians.benefits in improving the cardiovascular (CV) outcome in primary and secondary prevention studies [1][2][3][4] . Statins are generally safe and tolerated well by most patients. However, statin-associated muscle
Previous studies found that cilostazol has a favorable effect on glucose and lipid homeostasis, endothelial function, atherosclerosis, and vasculo-angiogenesis. However, it is poorly understood whether these effects can translate into better clinical outcomes. This study investigated the outcome effect of cilostazol in patients with coronary artery disease (CAD) or at a high risk of cardiovascular (CV) disease. We conducted a randomized, double-blind, placebo-controlled trial involving 266 patients who received cilostazol, 200 mg/day (n = 134) or placebo (n = 132). Pre-specified clinical endpoints including composite major adverse cardiovascular events (MACE) (CV death, non-fatal myocardial infarct, non-fatal stroke, hospitalization for heart failure, or unplanned coronary revascularization), the composite major coronary event (MCE) and major adverse CV and cerebrovascular event (MACCE), were prospectively assessed. The mean duration of follow-up was 2.9 years. Relative to placebo, cilostazol treatment had a borderline effect on risk reduction of MACE (hazard ratio [HR], 0.67; 95% confidence interval (CI), 0.34–1.33), whereas the beneficial effect in favor of cilostazol was significant in patients with diabetes mellitus or a history of percutaneous coronary intervention (p for interaction, 0.02 and 0.06, respectively). Use of cilostazol, significantly reduced the risk of MCE (HR, 0.38; 95% CI, 0.17–0.86) and MACCE (HR, 0.47; 95% CI, 0.23–0.96). A significantly lower risk of angina pectoris (HR, 0.38; 95% CI, 0.17–0.86) was also observed in the cilostazol group. After multi-variable adjustment, cilostazol treatment independently predicted a lower risk of MCE. In conclusion, these results suggest cilostazol may have beneficial effects in patients with CAD or at a high risk of CV disease.
Purpose: Catheter-directed therapy has been increasingly used in acute pulmonary embolism (PE). Whether ultrasound-assisted thrombolysis (USAT) is superior to standard catheter-directed thrombolysis (SCDT) remains unclear. This is a systemic review and meta-analysis of comparative trials on USAT and SCDT for PE to determine whether either modality yielded better clinical efficacy and safety. Materials and Method: Major databases including PubMed, Embase, Cochrane Central, and Web of Science were searched through March 16, 2023. Studies that reported outcomes of SCDT and USAT for acute PE were included. Studies reported data on therapeutic efficacy (a reduction in the right ventricle [RV]/left ventricle [LV] ratio, a reduction in the systolic pulmonary artery pressure [mm Hg], change in Miller index, length of intensive care unit [ICU] and hospital stay) and safety outcomes (in-hospital mortality, overall and major bleeding events). Results: A total of 9 studies with 2610 patients were included in the meta-analysis. The analysis showed significantly greater improvement in the RV/LV ratio in the SCDT group than in the USAT group (mean difference [MD]: −0.155; 95% confidence interval [CI]: −0.249 to −0.006). No statistically significant differences were found between groups comparing change in systolic pulmonary artery pressure (MD: 0.592 mm Hg; 95% CI: −2.623 to 3.807), change in Miller index (MD: −4.1%; 95% CI: −9.5 to 1.3%), hospital stay (MD: 0.372 days; 95% CI: −0.972 to 1.717), and ICU stay (MD: −0.073.038 days; 95% CI: −1.184 to 1). No significant difference was noted in safety outcomes, including in-hospital mortality (pooled odds ratio: 0.984; 95% CI: 0.597 to 1.622), and major bleeding (pooled odds ratio: 1.162; 95% CI: 0.714 to 1.894). Conclusions: In our meta-analysis of observational and randomized studies, USAT is not superior to SCDT in patients with acute PE. INSPLAY registration number: INPLASY202240082. Clinical Impact This study compared SCDT and USAT in patients with acute pulmonary embolism. We found no additional benefit in PA pressure change, thrombus reduction, hospital stay, mortality and major bleeding rate. Additional study using consistent treatment protocol is necessary for further investigation.
Background: Although high-intensity statin (HIS) is recommended in modern lipid guidelines, hemorrhagic stroke (HS) is one of the concerns in Asia because HIS was reported to increase the risk of intracerebral hemorrhage. Whether the HS risk is different among different high potency statins was unknown. Methods and Results: We screened the database of the Taiwan National Health Insurance from January 2013 to December 2018. Adults (≥ 18 years old) who received pitavastatin 2-4 mg/d plus ezetimibe 10 mg/d (combination group) and those who received atorvastatin 40 mg/day or rosuvastatin 20 mg/day (HIS group) for any reason were enrolled for further analysis. The primary endpoint was HS. We also assessed the differences of a composite safety outcome which included hospitalization for drug-related hepatitis or myopathy and new onset diabetes. All censored subjects were follow-up till December 2019. After 1:10 propensity matching, 41437 patients were included (37670 with HIS and 3767 with combination group). After median follow-up for 3.05 ± 1.66 years, HS occurred in 1.29% and multivariable analysis showed subjects in combination group had lower rate of HS than those in HIS group (combination vs. HIS, adjusted HR: 0.650, 95% CI: 0.443-0.953). Moreover, pre-specified subgroup analysis showed similar results in those with previous history of HS or ischemic stroke as whole population. In composite safety endpoint, there was no difference between these two groups (combination vs HIS, adjusted HR: 0.910, 95% CI: 0.809-0.953). Conclusions: Our study showed Asian general population with pitavastatin plus ezetimibe had less HS during follow-up comparing to those having HIS. These results suggested that pitavastatin plus ezetimibe was a favorable choice in Asian population who needed strict lipid control but with concern of HS.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.