Ischemic Event Rates in Very-High-Risk Adults

Colantonio, Lisandro D.; Shannon, Erin; Orroth, Kate K.; Zaha, Rebecca; Jackson, Elizabeth A.; Rosenson, Robert S.; Exter, Jason; Mues, Katherine E.; Muntner, Paul

doi:10.1016/j.jacc.2019.09.025

Cited by 39 publications

(45 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…COVID-19 associated cardiac injury and mortality is higher in patients with older age and certain comorbidities: HTN, diabetes, chronic kidney disease, atherosclerotic cardiovascular disease, and chronic heart failure ( 38 , 50 ). Thus, most patients with cardiac injury are identified as very high risk for CVD events ( 51 ). Viral illnesses incite a profound systemic inflammatory response leading to tissue injury and organ failure.…”

Section: Cardiometabolic Targetsmentioning

confidence: 99%

Coronavirus and Cardiometabolic Syndrome

Mechanick

Rosenson

Pinney

et al. 2020

Journal of the American College of Cardiology

Self Cite

View full text Add to dashboard Cite

The coronavirus disease 2019 (COVID-19) pandemic exposes unexpected cardiovascular vulnerabilities and the need to improve cardiometabolic health. Four cardiometabolic drivers—abnormal adiposity, dysglycemia, dyslipidemia, and hypertension—are examined in the context of COVID-19. Specific recommendations are provided for lifestyle change, despite social distancing restrictions, and pharmacotherapy, particularly for those with diabetes. Inpatient recommendations emphasize diligent and exclusive use of insulin to avert hyperglycemia in the face of hypercytokinemia and potential islet cell injury. Continuation of statins is advised, but initiating statin therapy to treat COVID-19 is as yet unsubstantiated by the evidence. The central role of the renin-angiotensin system is discussed. Research, knowledge, and practice gaps are analyzed with the intent to motivate prompt action. An emerging model of COVID-related cardiometabolic syndrome encompassing events before, during the acute phase, and subsequently in the chronic phase is presented to guide preventive measures and improve overall cardiometabolic health so future viral pandemics confer less threat.

show abstract

Section: Cardiometabolic Targetsmentioning

confidence: 99%

Coronavirus and Cardiometabolic Syndrome

Mechanick

Rosenson

Pinney

et al. 2020

Journal of the American College of Cardiology

Self Cite

View full text Add to dashboard Cite

show abstract

“…Higher rates of cardiovascular morbidity and mortality in COVID-19 patients have been reported in those with comorbidities including older age, hypertension, diabetes, chronic kidney disease, atherosclerotic cardiovascular disease, and chronic heart failure [ 4 , 5 ]. Thus, many of these patients with cardiac injury have baseline clinical characteristics that identify them as very high risk for cardiovascular events [ 6 ]. Viral illnesses including COVID-19 incite a profound systemic inflammatory response leading to tissue injury and organ failure.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of Statin Therapy in Patients with Hospital Admission for COVID-19

Choi

Chen

Goonewardena

et al. 2021

Cardiovasc Drugs Ther

Self Cite

View full text Add to dashboard Cite

Purpose COVID-19 is characterized by dysfunctional immune responses and metabolic derangements, which in some, lead to multi-organ failure and death. Statins are foundational lipid-lowering therapeutics for cardiovascular disease and also possess beneficial immune-modulating properties. Because of these immune-modulating properties, some have suggested their use in COVID-19. We sought to investigate the association between statin use and mortality in patients hospitalized with COVID-19. Methods Five thousand three hundred seventy-five COVID-19 patients admitted to Mount Sinai Health System hospitals in New York between February 27, 2020, and December 3, 2020, were included in this analysis. Statin use was classified as either non-user, low-to-moderate-intensity user, or high-intensity user. Multivariate Cox proportional hazards models were used to evaluate in-hospital mortality rate. Considered covariates were age, sex, race, and comorbidities. Results Compared to non-statin users, both low-to-moderate-intensity (adjusted hazard ratio; aHR 0.62, 95% confidential intervals; CI 0.51–0.76) and high-intensity statin users (aHR 0.53, 95% CI 0.43–0.65) had a reduced risk of death. Subgroup analysis of 723 coronary artery disease patients showed decreased mortality among high-intensity statin users compared to non-users (aHR 0.51, 95% CI 0.36–0.71). Conclusions Statin use in patients hospitalized with COVID-19 was associated with a reduced in-hospital mortality. The protective effect of statin was greater in those with coronary artery disease. These data support continued use of statin therapy in hospitalized patients with COVID-19. Clinical trials are needed to prospectively determine if statin use is effective in lowering the mortality in COVID-19 and other viral infections. Supplementary Information The online version contains supplementary material available at 10.1007/s10557-021-07263-2.

show abstract

“…15 The American Association of Clinical Endocrinology (AACE) and American College of Endocrinology (ACE) now recommend LDL-C goals of < 70 mg/dL (< 1.8 mmol/ L) and < 55 mg/dL (< 1.4 mmol/L) for VHR and extreme-risk patients, respectively. 16 However, observational studies indicate that patients infrequently achieve these guideline-recommended LDL-C goals in daily clinical practice, [17][18][19][20][21] with a recent analysis of US adults with health insurance in the MarketScan ® database reporting that 67% of patients with VHR ASCVD had LDL-C ≥ 70 mg/dL (≥ 1.8 mmol/L). 21 Multiple factors are thought to underpin this unmet treatment need, with suboptimal dosing, high rates of treatment discontinuation, and low rates of lipid-lowering therapy (LLT) adherence commonly observed.…”

Section: Introductionmentioning

confidence: 99%

“…16 However, observational studies indicate that patients infrequently achieve these guideline-recommended LDL-C goals in daily clinical practice, [17][18][19][20][21] with a recent analysis of US adults with health insurance in the MarketScan ® database reporting that 67% of patients with VHR ASCVD had LDL-C ≥ 70 mg/dL (≥ 1.8 mmol/L). 21 Multiple factors are thought to underpin this unmet treatment need, with suboptimal dosing, high rates of treatment discontinuation, and low rates of lipid-lowering therapy (LLT) adherence commonly observed. [22][23][24][25][26][27] Evolocumab is a PCSK9 inhibitor antibody approved to reduce the risk of MI, stroke, and coronary revascularization in adults with established CVD.…”

Section: Introductionmentioning

confidence: 99%

Low‐density lipoprotein cholesterol lowering in real‐world patients treated with evolocumab

Desai

Wade

Xiang

et al. 2021

Clinical Cardiology

Self Cite

View full text Add to dashboard Cite

Background Low‐density lipoprotein cholesterol (LDL‐C) is a risk factor for atherosclerotic cardiovascular disease (ASCVD). There are limited real‐world data on LDL‐C lowering with evolocumab in United States clinical practice. Hypothesis We assessed LDL‐C lowering during 1 year of evolocumab therapy. Methods This retrospective cohort study used linked laboratory (Prognos) and medical claims (IQVIA Dx/LRx and PharMetrics Plus®) data. Patients with a first fill for evolocumab between 7/1/2015 and 10/31/2019 (index event) and LDL‐C ≥ 70 mg/dL were included (overall cohort; N = 5897). Additionally, a patient subgroup with a recent myocardial infarction (MI) within 12 months (median 130 days) before the first evolocumab fill was identified (N = 152). Reduction from baseline LDL‐C was calculated based on the lowest LDL‐C value recorded during a 12‐month follow‐up period. Results The mean (SD) age was 65 (10) years; 61.9% of patients had ASCVD diagnoses and 70.7% of patients were in receipt of lipid‐lowering therapy. Following evolocumab treatment, changes in LDL‐C from baseline were −60% in the overall cohort (median [interquartile range (IQR)] 146 [115–180] mg/dL to 58 [36–84] mg/dL) and −65% in the recent MI subgroup (median [IQR] 137 [109–165] mg/dL to 48 [30–78] mg/dL). In the overall cohort and recent MI subgroup, 62.1% and 69.7% of patients achieved LDL‐C < 70 mg/dL, respectively. Conclusions In this real‐world analysis, evolocumab was associated with significant reductions in LDL‐C comparable to that seen in the FOURIER clinical trial, which were durable over 1 year of treatment.

show abstract

Ischemic Event Rates in Very-High-Risk Adults

Cited by 39 publications

References 22 publications

Coronavirus and Cardiometabolic Syndrome

Coronavirus and Cardiometabolic Syndrome

Efficacy of Statin Therapy in Patients with Hospital Admission for COVID-19

Low‐density lipoprotein cholesterol lowering in real‐world patients treated with evolocumab

Contact Info

Product

Resources

About