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

Alter, David A.; Tu, Jack V.; Koh, Maria; Jackevicius, Cynthia A.; Austin, Peter C.; Rezai, Mohammad R.; Bhatia, R. Sacha; Johnston, Sharon; Udell, Jacob A.; Ko, Dennis T.

doi:10.1161/jaha.117.007535

Cited by 11 publications

(7 citation statements)

References 40 publications

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“…A healthy lifestyle decreases significantly the risk of atherosclerosis. The treatment with statins reduces the risk both of myocardial infarction and stroke [9,10]. People who may benefit from preventive therapy should have a life expectancy of at least five years.…”

Section: Primary Preventionmentioning

confidence: 99%

Treatment with Statins in Elderly Patients

et al. 2019

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Elderly patients are a special category of patients, due to the physiological changes induced by age, the great number of comorbidities and drug treatment and last, but not least, to the cognitive dysfunction frequently encountered in this population. Cardiovascular disease is the most important cause of morbidity and mortality in elderly individuals worldwide. The rate of cardiovascular events increases after 65 years in men and after 75 years in women. Myocardial infarction and stroke are the leading disorders caused by atherosclerosis, that lead to death or functional incapacity. Elderly people have a greater risk to develop atherosclerotic cardiovascular disease. The incidence and prevalence of atherosclerosis increase with age and the number of cardiovascular events is higher in elderly patients. The most efficient treatment against atherosclerosis is the treatment with statins, that has been shown to decrease the risk both of stroke and coronary artery disease in all age groups. The advantages of the treatment become evident after at least one year of treatment. Primary prevention is the most important way of preventing cardiovascular disease in elderly individuals, by promoting a healthy lifestyle and reducing the risk factors. Secondary prevention after a stroke or myocardial infarction includes mandatory a statin, to diminish the risk of a recurrent cardiovascular event. The possible side effects of statin therapy are diabetes mellitus, myopathy, and rhabdomyolysis, hepatotoxicity. The side effects of the treatment are more likely to occur in elderly patients, due to their multiple associated comorbidities and drugs that may interact with statins. In elderly people, the benefits and disadvantages of the treatment with statins should be put in balance, especially in those receiving high doses of statins.

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Section: Primary Preventionmentioning

confidence: 99%

Treatment with Statins in Elderly Patients

et al. 2019

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“…For example, by linking 17 sources of data, Ontario researchers assessed regional variation in cardiovascular event rates 9 and the added value of highintensity statin therapy for older patients. 10 A crucial advantage of these "real-world" data is their coverage of Canadians of all ages and ethnicities. 11 This makes findings more applicable to the entire Canadian population, including groups who tend not to participate in studies.…”

mentioning

confidence: 99%

Canadians’ views on the use of routinely collected data in health research: a patient-oriented cross-sectional survey

McCormick

Hamilton

Koehn

et al. 2019

cmajo

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Plain language summary: Every day, information is collected about how Canadians use publicly funded health care. The information collected is stored in large electronic data sets. Studying these data can teach us about the quality of our health care, help patients and improve government spending on health care. For example, some data sets can show long-term effects of a given type of treatment. This is not commonly known from single research studies involving small numbers of patients. It is not clear how much Canadians know about these data sets and how researchers can use them. This study surveyed adult Canadians on their views on using such data sets to do health research. The study was done in partnership between university researchers and 3 patients representing national arthritis and skin disease groups. Together, they wrote and tested an online survey, found participants, and interpreted and shared what they learned from the study. Most people who finished the survey agreed with using large data sets to do health research, especially after they read background information on their value. The respondents said the best uses were shown when researchers studied long-term effects in large numbers of people. They felt names and personal information should not be shown. They wished to learn more about how researchers are given access to data sets, and, at the end of survey, they still felt unsure about how privacy and security are ensured. In conclusion, providing information to the public on the use of large sets of health data may increase support for this type of health research. A nalyses of data collected routinely by provincial health ministries and other public bodies 1 can inform health policy-making 2 and advance our knowledge of the burden 3 and risks 4 of diseases, the clinical effectiveness 5 and cost-effectiveness 6 of treatments, and drivers of health care costs. 7 Health researchers in Canada can access a growing array of publicly collected data on the use

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“…19 In a recent study using real-world data in elderly statin users aged >65 years following acute coronary syndromes, the number of myocardial infarction and deaths that could be prevented by aggressive statin treatment was projected as negligible. 20 Taken together, these findings should caution the extrapolation of potential benefits and harms of statin use from the younger to the elderly patients, given the higher prevalence of multi-comorbidities, potential adverse drug effects, drug interactions due to polypharmacy, and limited life expectancy in the elderly population. 21,22…”

Section: Discussionmentioning

confidence: 99%

Prevalence and Predictors of Statin Treatment Among Patients With Chronic Heart Failure at a Tertiary-Care Center in Thailand

Kosuma

Jedsadayanmata

2019

Clin Med Insights Cardiol

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Background: Statins play important roles in the prevention of atherosclerotic vascular diseases; however, their beneficial effects in patients with chronic heart failure (CHF) are uncertain. This study aimed to investigate the prevalence and predictors of treatment with statins to better understand their prescribing patterns in CHF patients. Methods: We conducted a cross-sectional study in patients with first-time diagnoses of CHF receiving care in the outpatient clinics affiliated with a tertiary-care teaching hospital in Thailand. Data were retrieved from electronic claims database. Multivariable logistic regression was used to identify independent predictors of treatment with statins. Results: A total of 3445 patients were included in this study. Among them, 1908 (55.4%) were prescribed statins, with most of them (89.7%) receiving simvastatin 20 mg daily. Factors independently associated with the statin treatment include the following: being male (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.02-1.44, P = .03); diagnoses of dyslipidemia (OR = 4.88, 95% CI = 3.88-6.14, P < .001), ischemic heart disease (OR = 2.71, 95% CI = 2.18-3.36, P < .001), diabetes (OR = 1.95, 95% CI = 1.55-2.46, P < .001), or cerebrovascular disease (OR = 1.64, 95% CI = 1.12-2.40, P = .01); and receipt of angiotensin-converting enzyme inhibitors (OR = 3.44, 95% CI = 2.87-4.13, P < .001), aspirin (OR = 2.79, 95% CI = 2.30-3.40, P < .001), non-dihydropyridine calcium channel blockers (OR = 2.35, 95% CI = 1.30-4.24, P = .004), organic nitrates (OR = 2.04, 95% CI = 1.16-3.58, P = .01), beta-blockers (OR = 1.51, 95% CI = 1.23-1.84, P < .001), and digoxin (OR = 0.65, 95% CI = 0.50-0.86, P = .002). Conclusions: Statins were prescribed to more than half of the newly diagnosed CHF patients. Independent predictors of statin treatments include hypercholesterolemia and comorbidities indicative of high atherosclerotic vascular risk as well as drugs recommended as cardiovascular protective therapy for CHF patients.

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

Cited by 11 publications

References 40 publications

Treatment with Statins in Elderly Patients

Treatment with Statins in Elderly Patients

Canadians’ views on the use of routinely collected data in health research: a patient-oriented cross-sectional survey

Prevalence and Predictors of Statin Treatment Among Patients With Chronic Heart Failure at a Tertiary-Care Center in Thailand

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