Statin therapy after acute myocardial infarction: Are we adequately treating high-risk patients?

Fonarow, Gregg C.

doi:10.1007/s11883-002-0032-4

Cited by 12 publications

(12 citation statements)

References 50 publications

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“…Despite the landmark studies of the 1990s there were still significant gaps in the prescription of proven cardiovascular risklowering medications in cohort 2. This finding is also in keeping with the gaps in prescribing in similar studies of therapies for cardiovascular risk reduction in diabetic patients (6,10, 21,22). The gaps in prescribing might be partly explained because this group of patients was not widely recognized as being one with a proven high mortality outside of diabetic foot care centers nor one in which there was an evidence base for successful cardiovascular risk reduction.…”

Section: Statistical Analysessupporting

confidence: 65%

“…Even the most accurate cardiovascular risk modeling would have seriously underestimated mortality and, therefore, before universal treatment recommendations in type 2 diabetic patients only those with true secondary prevention needs would have been treated and then often incompletely (6,9,10). The eventual levels of statin and antiplatelet therapy are significantly higher than those achieved by national guidelines alone in other studies (6,10, 21,22). This is likely to reflect the fact that the diabetes foot clinic, by focusing care for this high-risk group of patients and by regular review and followup, is in the best position to ensure that cardiovascular risk-reducing therapies are prescribed and used.…”

Section: Statistical Analysesmentioning

confidence: 90%

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Improved Survival of Diabetic Foot Ulcer Patients 1995–2008

et al. 2008

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OBJECTIVE -The purpose of this study was to determine whether a strategy of aggressive cardiovascular risk management reduced the mortality associated with diabetic foot ulceration. RESEARCH DESIGN AND METHODS-After an initial audit of outcomes demonstrating a high mortality rate in 404 diabetic foot ulcer patients with the first ulceration developing between 1995 and 1999, a new aggressive cardiovascular risk policy was introduced as standard practice at the Diabetic Foot Clinic, Royal Infirmary of Edinburgh, in 2001. In the first 3 years of this policy, 251 patients were screened and identified. The audit cycle was then closed by reauditing the 5-year mortality for this second group of foot ulcer patients in 2008.RESULTS -Overall 5-year mortality was reduced from 48.0% in cohort 1 to 26.8% in cohort 2 (P Ͻ 0.001). Improvement in survival was seen for both neuroischemic patients (5-year mortality of 58% reduced to 36%; relative reduction 38%) and neuropathic patients (36% reduction to 19%; relative reduction 47%) (both P Ͻ 0.001). Patients were more likely to die if they were older at the time of ulceration or had type 2 diabetes, renal impairment, or preexisting cardiovascular disease or were already taking aspirin. Prior statin use, current smoker or exsmoker status, blood pressure, A1C, and total cholesterol were not significantly different between survivors and those who died in the follow-up periods.CONCLUSIONS -Diabetic foot ulcer patients have a high risk of death. Survival has improved over the past 13 years. The adoption of an aggressive cardiovascular risk management policy in diabetic foot ulcer clinics is recommended for these patients. Diabetes Care 31:2143-2147, 2008L ower limb amputation in diabetic patients is associated with significant excess mortality (1). Foot ulceration is also believed to be associated with increased deaths due to related cardiovascular disease (2,3). In addition, patients with foot ulceration often have advanced diabetes complications (4). Cardiovascular risk reduction has, over the last 10 years, become a major part of diabetes care, particularly for type 2 diabetic patients. However, it has only been since 2004 that the U.K. General Medical Services contract has made the treatment of cardiovascular risk a renumerated part of diabetes management in primary care (5). This initiative is driven by target A1C, blood pressure, and cholesterol levels rather than absolute or calculated risk as in the past and has increased prescribing of therapies aimed to reduce cardiovascular risk (6). Patients without established risk factors might not receive adequate treatment if their values are not above the target.It is likely that the peripheral arterial disease and microvascular sclerosis associated with diabetic foot ulceration will reflect established arterial disease elsewhere in the body (3). Therefore, cardiovascular risk factor intervention might be expected to be effective in this setting. However, there are no studies of aggressive risk factor modification in patients with dia...

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Section: Statistical Analysessupporting

confidence: 65%

Section: Statistical Analysesmentioning

confidence: 90%

Improved Survival of Diabetic Foot Ulcer Patients 1995–2008

et al. 2008

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“…17 Treatment of hyperlipidemia has been a recent area of major interest, with increasing evidence suggesting that lowering LDL is effective in both primary and secondary prevention of CAD 4,5,10,12 and is cost effective. 18 This study's data show that usage of lipid-lowering therapy is suboptimal, even among high-risk patients who are admitted to the hospital with chest pain.…”

Section: Discussionmentioning

confidence: 99%

“…4,5 Recent studies also demonstrate that despite these compelling data, many high-risk patients are undertreated or not treated at all. [6][7][8][9][10] For most patients, decisions about medical management occur in the outpatient setting. However, because hospitalizations represent significant events in any patient's medical history, strategies that intervene to promote health and reduce risk at the time of hospitalization can be invaluable.…”

Section: Introductionmentioning

confidence: 99%

Insufficient treatment of hypercholesterolemia among patients hospitalized with chest pain

Howell

Wright

Bush

et al. 2006

Clinical Cardiology

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SummaryBackground: Although morbidity and mortality from coronary artery disease can be improved with a variety of pharmacologic interventions, many patients remain undertreated.Hypothesis: This study sought to assess whether hospitalization for possible coronary artery disease would prompt initiation of appropriate lipid-lowering therapy.Methods: This prospective, observational study was conducted on consecutive patients with active chest pain admitted to the Emergency Department of the hospital for suspected myocardial ischemia. Elevated cholesterol, defined as lowdensity lipoprotein (LDL), was > 100 mg/dl with a prior history or a new diagnosis of coronary artery disease, or an LDL > 130 mg/dl without known coronary artery disease. Data were recorded at the time of admission, discharge, and at 4-month follow-up.Results: Of the patients with hyperlipidemia, 65% men and 55% women were on medication at the time of admission (p = 0.30), while at discharge, 79% men and 60% women were on treatment (p = 0.002), with similar rates of treatment at 4-month follow-up (p = 0.030). At discharge, two variables were independently associated with patients receiving lipid-lowering therapy: age ≥ 65 years (odds ratio = 2.3; 95% confidence interval 1.2-4.5) and male gender (2.7; 15-5.0).Conclusions: In patients hospitalized with chest pain, particularly in women, the initiation of treatment of hyperlipidemia frequently does not happen. This oversight repre-

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“…Currently, the National Cholesterol Education Program (NCEP) Adult Treatment Panel III and the American Heart Association and American College of Cardiology recommend a target LDL-C level of less than 100 mg/dL (2.6 mmol/L) for patients with CAD [5]. However, many patients, especially those at the highest risk for CAD do not reach these LDL-C goals by lifestyle changes and statin monotherapy despite good compliance [12,13]. For these patients the co-administration of two lipid-altering drugs with complementary mechanisms of action offers an advantage over monotherapy and may allow achievement of a lower LDL-C level, thus reducing cardiovascular risk [14].…”

Section: Introductionmentioning

confidence: 99%

Effect of ezetimibe co-administered with statin therapy in Swiss outpatients

2005

Schweiz Ärzteztg

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Statin therapy after acute myocardial infarction: Are we adequately treating high-risk patients?

Cited by 12 publications

References 50 publications

Improved Survival of Diabetic Foot Ulcer Patients 1995–2008

Improved Survival of Diabetic Foot Ulcer Patients 1995–2008

Insufficient treatment of hypercholesterolemia among patients hospitalized with chest pain

Effect of ezetimibe co-administered with statin therapy in Swiss outpatients

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