Fluvastatin for Prevention of Cardiac Events Following Successful First Percutaneous Coronary Intervention&lt;SUBTITLE&gt;A Randomized Controlled Trial&lt;/SUBTITLE&gt;

Serruys, Patrick W.; Feyter, Pim de; Macaya, Carlos; Kokott, N.; Puel, Jacques; Vrolix, Matthias; Branzi, Angelo; Bertolami, Marcelo Chiara; Jackson, Graham; Strauss, Bradley H.; Meier, Bernhard

doi:10.1001/jama.287.24.3215

Cited by 645 publications

(151 citation statements)

References 24 publications

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“…However, most studies that have supported a “lower is better” linear relationship between LDL cholesterol and outcomes have been conducted in younger populations. Indeed, elderly populations have been significantly under‐represented in statin and PCSK‐9 inhibitor outcome trials 5, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35. Our study suggests that the linear “dose‐dependent” relationship between LDL cholesterol and outcomes may not apply to elderly populations on statins following ACS hospitalizations, and the effectiveness of using aggressive LDL cholesterol targets among such elderly subpopulations may be unwarranted.…”

Section: Discussionmentioning

confidence: 90%

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Alter

Koh

et al. 2018

JAHA

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BackgroundThe extent to which outcome benefits may be achieved through the implementation of aggressive low‐density lipoprotein (LDL) cholesterol targets in real world settings remains unknown, especially among elderly statin users following acute coronary syndromes.Methods and ResultsA population‐based cohort study consisting of 19 544 post‐acute coronary syndrome statin‐users aged ≥66 years between January 1, 2017 and March 31, 2014 was used to project the number of adverse outcome events (acute myocardial infarction or death from any cause) that could be prevented if all post‐acute coronary syndrome elderly statin users were treated to 1 of 2 LDL cholesterol target levels (≤50 and ≤70 mg/dL). The number of preventable adverse outcomes was estimated by using model‐based expected event probabilities as derived from Cox Proportional hazards models. In total, 61.6% and 25.5% of the elderly patients met LDL cholesterol targets of ≤70 and ≤50 mg/dL, respectively, based on current management. No more than 2.3 adverse events per 1000 elderly statin users (95% confidence interval: −0.7 to 5.4, P=0.62) could be prevented over 8.1 years if all patients were to be treated from current LDL cholesterol levels to either of the 2 LDL cholesterol targets of 70 or 50 mg/dL.ConclusionsThe number of acute myocardial infarctions or death that could be prevented through the implementation of LDL cholesterol targets with statins is negligible among an elderly post‐acute coronary syndrome population. Such findings may have implications for the applicability of newer agents, such as proprotein convertase subtilisin/kexin type‐9‐ inhibitors.

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Section: Discussionmentioning

confidence: 90%

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Alter

Koh

et al. 2018

JAHA

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“…Randomized trials considered for this analysis are listed in table 1[11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47]. After screening for eligibility we selected 29 trials accounting for a total of 90,480 patients, with a mean age of 59 years and a mean follow-up of 3.5 years.…”

Section: Resultsmentioning

confidence: 99%

Non-Cardiovascular Mortality, Low-Density Lipoprotein Cholesterol and Statins: A Meta-Regression Analysis

Razzolini¹,

Tarantini²,

Ossena³

et al. 2007

Cardiology

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Background: As of today, the effect of statins on non-cardiovascular mortality is still being debated. Single studies have not been able to provide definite answers. We performed a meta-regression analysis on randomized statin trials in order to provide evidence that non-cardiovascular mortality is related to statin treatment and low-density lipoprotein (LDL) cholesterol plasma level. Methods: We selected 29 randomized controlled trials of statins versus placebo, a total of 90,480 patients, with a follow-up of >12 months. Baseline and follow-up LDL levels and all-cause, cardiovascular and non-cardiovascular mortality were recorded. Weighted linear regression analysis was carried out separately for placebo and treatment groups. Results: LDL level was inversely related to overall mortality (p = 0.0105) and non-cardiovascular mortality (p = 0.0171) in the treatment group. By contrast, in the placebo group only non-cardiovascular mortality was inversely correlated to LDL (p = 0.0032). The regression lines have similar slopes and run almost parallel to each other, with the treatment line lying below the placebo line. To identify the threshold of risk for starting statin therapy, we analysed the relationship between baseline cardiovascular risk and overall mortality in the two groups. Both correlations are highly significant and regression lines intersect at a risk of 0.29% per year. This implies that the effects of statins are favourable when the baseline cardiovascular risk exceeds approximately 3% in 10 years. Conclusions: A trend of increased non-cardiovascular mortality with decreased LDL exists both in placebo and treatment groups. However, at each given LDL cholesterol level, non-cardiovascular mortality is lower in treated patients. Therefore, statin therapy may improve the biological impact of LDL on non-cardiovascular mortality.

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“…[20][21] [22] These drugs, especially Fluvastatin, are prescribed for hypercholesterolemia and for prevention of cardiovascular diseases. [23] For the gene MIA3, with the sole SNP variant association of variants rs10495197 and rs17163303, it was found that each of the SNPs individually has the potential to influence the drug therapy for Vancomycin. [24] Vancomycin is the drug of choice for therapy of bacterial sepsis, meningitis, hemolytic anemia, and for reducing the levels of creatine kinase in blood.…”

Section: Pharmacogenetic Implication Studymentioning

confidence: 99%

SNP Analysis, Genome Wide Association Studies and Pharmacogenetic implications of Acute Myocardial Infarction

Ganugapati¹,

Mathur²,

Chamarty³

et al. 2017

IJCA

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Fluvastatin for Prevention of Cardiac Events Following Successful First Percutaneous Coronary Intervention<SUBTITLE>A Randomized Controlled Trial</SUBTITLE>

Abstract: Fluvastatin treatment in patients with average cholesterol levels undergoing their first successful PCI significantly reduces the risk of major adverse cardiac events.

Cited by 645 publications

References 24 publications

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Projected Real‐World Effectiveness of Using Aggressive Low‐Density Lipoprotein Cholesterol Targets Among Elderly Statin Users Following Acute Coronary Syndromes in Canada

Non-Cardiovascular Mortality, Low-Density Lipoprotein Cholesterol and Statins: A Meta-Regression Analysis

SNP Analysis, Genome Wide Association Studies and Pharmacogenetic implications of Acute Myocardial Infarction

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