Cholesterol Lowering With Simvastatin Improves Prognosis of Diabetic Patients With Coronary Heart Disease: A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S)

Pyörälà, Kalevi; Pedersen, T.R.; Kjekshus, John; Færgeman, Ole; Ag, Olsson; Thorgeirsson, G

doi:10.2337/diacare.20.4.614

Cited by 1,439 publications

(535 citation statements)

References 8 publications

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“…For example, salt restriction, dietary approaches to stop hypertension (DASH), or alcohol restriction may lower systolic blood pressure (SBP) about 5-10 mm Hg on average, while drug combinations routinely lower SBP more than 10 mm Hg in many clinical trials. [10][11][12] Despite evidence that intensified therapy is usually needed to achieve and maintain evidence-based chronic disease care goals, a number of studies document high levels of clinical inertia in patients with diabetes or lipid disorders 13,14 and demonstrate that more active clinical management improves absolute glycated hemoglobin (A1c), low-density lipoprotein-cholesterol (LDL), and SBP control. 12,15 …”

Section: Prevalence and Cost Of Clinical Inertia Prevalencementioning

confidence: 99%

Clinical Inertia and Outpatient Medical Errors

O’Connor¹,

Sperl-Hillen²,

Johnson³

et al. 2005

PsycEXTRA Dataset

115

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Clinical inertia is defined as lack of treatment intensification in a patient not at evidence-based goals for care. Clinical inertia is a major factor that contributes to inadequate chronic disease care in patients with diabetes mellitus, hypertension, dyslipidemias, depression, coronary heart disease, and other conditions. Recent work suggests that clinical inertia related to the management of diabetes, hypertension, and lipid disorders may contribute to up to 80 percent of heart attacks and strokes. Clinical inertia is, therefore, a leading cause of potentially preventable adverse events, disability, death, and excess medical care costs. This paper addresses three specific objectives: (1) to present a conceptual model of clinical inertia that takes into account recent developments in human factors research, cognitive science, and organizational behavior; (2) to operationally define clinical inertia and propose simple clinical protocols that can be used to identify and map its incidence across populations of patients and physicians; and (3) to propose future research to reduce clinical inertia by specifically targeting the root causes of the problem. Ultimately, a better understanding of clinical inertia and the development of specific interventions to reduce it may be a productive strategy to reduce passive errors that contribute to hundreds of thousands of adverse events and tens of thousands of premature deaths annually in the United States.

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Section: Prevalence and Cost Of Clinical Inertia Prevalencementioning

confidence: 99%

Clinical Inertia and Outpatient Medical Errors

O’Connor¹,

Sperl-Hillen²,

Johnson³

et al. 2005

PsycEXTRA Dataset

115

View full text Add to dashboard Cite

show abstract

“…The UKPDS demonstrated the importance of maintaining good glycaemic control for prevention of the development and progression of complications among patients with type 2 diabetes [44]. Clinical trials have shown that pharmacological treatment of hypertension [45][46][47] and cholesterol reduction with a statin therapy [42,43,[48][49][50] are efficient ways of preventing stroke and other cardiovascular events in patients with diabetes or impaired fasting glucose.…”

Section: Menmentioning

confidence: 99%

The effect of diabetes and stroke at baseline and during follow-up on stroke mortality

Jousilahti

Sarti

et al. 2006

Diabetologia

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Aims/hypothesis The aim of this study was to compare the magnitude of the effect of diabetes and stroke at baseline and during follow-up on risk of stroke mortality. Materials and methods Study cohorts included 25,155 Finnish men and 26,423 women aged 25-74 years. Data on diabetes and stroke history at baseline, their incidence during follow-up, and stroke death were obtained from national registers. Results During a mean follow-up of 18.9 years, 838 stroke deaths were recorded. In the baseline study, hazard ratios (HRs) for stroke mortality were 5.26 for men with prior diabetes only, 4.76 for men with prior stroke only, and 13.4 for men with both prior diabetes and stroke compared with men without diabetes and stroke at baseline and during follow-up. In women, the corresponding hazard ratios were 7.29, 5.27 and 5.52, respectively. When only diabetes and stroke status during the follow-up were considered, the hazard ratios for stroke mortality were 1.41 for men and 1.56 for women with incident diabetes only, 5.62 for men and 5.58 for women with incident stroke only, and 5.59 for men and 4.48 for women with both incident diabetes and stroke compared with men and women without diabetes and stroke at baseline and during follow-up. Conclusions/interpretation Diabetes and stroke, present either at baseline or during follow-up, markedly increase the risk of stroke death. Prior stroke at baseline carries a similar risk of stroke mortality as prior diabetes. There is a greater risk of stroke mortality associated with incident stroke during follow-up than with incident diabetes.

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“…3-Hydroxy-3-methylglutaryl CoA (HMG-CoA) reductase inhibitors, also known as statins, are commonly used for the treatment of dyslipidaemia. A number of large studies have demonstrated that statin therapy is associated with a reduction in cardiovascular events in people both with and without type 2 diabetes [6][7][8][9][10][11][12]. While a reduction in LDL-cholesterol was observed in many of these studies, it is now considered that statins also mediate pleiotropic antiatherogenic effects that are independent of their effects on lipoproteins, and that this action may contribute to their efficacy in reducing cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

The HMG-CoA reductase inhibitor rosuvastatin and the angiotensin receptor antagonist candesartan attenuate atherosclerosis in an apolipoprotein E-deficient mouse model of diabetes via effects on advanced glycation, oxidative stress and inflammation

et al. 2008

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Aims/hypothesis We evaluated the anti-atherosclerotic effect of the 3-hydroxy-3-methylglutaryl CoA reductase inhibitor, rosuvastatin, and the angiotensin II receptor blocker (ARB), candesartan, alone and in combination, in the streptozotocin-induced diabetic apolipoprotein Edeficient (Apoe −/− ) mouse. Methods Control and streptozotocin-induced diabetic Apoe −/− mice received rosuvastatin (5 mg kg −1 day −1 ), candesartan (2.5 mg kg −1 day −1 ), dual therapy or no treatment for 20 weeks. Aortic plaque deposition was assessed by Sudan IV staining and subsequent visual quantification. The abundance of proteins was measured using immunohistochemistry. Results Diabetes was associated with a fourfold increase in total plaque area. Rosuvastatin attenuated plaque area in diabetic mice in the absence of lipid-lowering effects. The anti-atherosclerotic effect of rosuvastatin was comparable to that observed with candesartan. A similar beneficial effect was seen with dual therapy, although it was not superior to monotherapy. Rosuvastatin treatment was associated with attenuated accumulation of AGE and AGE receptor (RAGE) in plaques. Similar beneficial effects on markers of oxidative stress were seen with the ARB and statin. Candesartan was more effective at reducing macrophage accumulation and collagen I abundance in plaques compared with rosuvastatin. The combined effect of candesartan and rosuvastatin was superior in reducing macrophage infiltration, monocyte chemoattractant protein-1 level, vascular AGE accumulation and RAGE abundance in the vascular wall. Furthermore, the combination tended to be more effective in reducing smooth muscle cell infiltration and connective tissue growth factor abundance in plaques. Conclusions/interpretation Rosuvastatin has direct antiatherosclerotic effects in diabetic macrovascular disease. These effects are independent of effects on lipids and comparable to the effects observed with candesartan.

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Cholesterol Lowering With Simvastatin Improves Prognosis of Diabetic Patients With Coronary Heart Disease: A subgroup analysis of the Scandinavian Simvastatin Survival Study (4S)

Cited by 1,439 publications

References 8 publications

Clinical Inertia and Outpatient Medical Errors

Clinical Inertia and Outpatient Medical Errors

The effect of diabetes and stroke at baseline and during follow-up on stroke mortality

The HMG-CoA reductase inhibitor rosuvastatin and the angiotensin receptor antagonist candesartan attenuate atherosclerosis in an apolipoprotein E-deficient mouse model of diabetes via effects on advanced glycation, oxidative stress and inflammation

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