Case 10-2013

Statin prescribing according to gender, age and indication: what about the benefit–risk balance?

“…However wellcalibrated, several of the widely used risk algorithms, including the European SCORE [65], seem to considerably overestimate CVD risk in the target population -especially in women [11,15,66]. For example, it has been shown that the risk calculator published by the American College of Cardiology (ACC) and the American Heart Association (AHA) in 2013 [67] overestimates risk by as much as 150% in large US populations [19,68,69]. Overestimation of risk may partly stem from most risk calculators' assumption of linearity of the association between risk factors and CVD events -independent of gender and age -although many epidemiological studies indicate non-linear associations [15,16,70], as well as gender and age differences [15,16,71].…”

“…Recently, risk thresholds for initiation statin therapy in primary prevention have been lowered considerably in the USA [67] as well as in the UK [72], leading to a greatly increased proportion of the population becoming eligible for statin therapy. Interestingly, while European guidelines [49], including the Danish [4], still recommend specific lipid goals for statin treatment, the 2013 AAC/AHA guidelines have abandoned these goals [67], and the 2014 National Institute for Health and Care Excellence (NICE) guidelines [72] recommend a proportional decrease (40%) in non-HDL cholesterol as a target rather than any specific value. Moreover, the recommendations of statins for primary preventions are based on RCTs, including participants with diabetes [24].…”

“…In fact, guidelines on statins in old age are vague [4,9]. For older adults without CVD aged 60+, statins seem to reduce all-cause and CVD mortality [17] -but this may be driven by the effect among the 'young-olds' (65)(66)(67)(68)(69)(70)(71)(72)(73)(74). Analyses limited to individuals aged 80+ reveal no convincing evidence for the life-time gaining effect of statins in individuals with CVD [9,16] -and certainly not among those without CVD [30].…”

Serum Sickness-Like Reaction Associated With Acute Hepatitis B in a Previously Vaccinated Adult Male

“…These circulating immune complexes interact with complement proteins and contribute to the inflammatory phenomenon [ 2 ]. Typically, low levels of complement proteins are expected with serum sickness, however normal levels of C3 and C4 might be observed on admission [ 3 ]. Failure to attain seroconversion after complete hepatitis B vaccination is the most likely reason for our patient’s positive hepatitis B serology and clinical presentation.…”

“…The pathogenesis of the syndrome is hypothesized to be due to circulating immune complexes composed of hepatitis B surface antigen (HBsAg) with subsequent consumption of complement [ 2 ]. The presence of normal complement levels, however, does not rule out a diagnosis of serum sickness like syndrome secondary to acute hepatitis B infection [ 3 ].…”