Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews

Byrne, Paula; Cullinan, John; Smith, Amelia; Smith, Susan M.

doi:10.1136/bmjopen-2018-023085

Cited by 60 publications

(73 citation statements)

References 67 publications

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“…Statins, the most widely prescribed medication worldwide, are cholesterol-lowering drugs that effectively reduce the risk of major cardiovascular events [1,2]. Statins are competitive inhibitors of 3-hydroxy-3-methylglutaryl Coenzyme A (HMG-CoA) reductase, an enzyme that catalyzes the key step of the mevalonate pathway.…”

Section: Introductionmentioning

confidence: 99%

The Influence of Statins on the Aerobic Metabolism of Endothelial Cells

Broniarek

Dominiak

Gałgański

et al. 2020

IJMS

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Endothelial mitochondrial dysfunction is considered to be the main cause of cardiovascular disease. The aim of this research was to elucidate the effects of cholesterol-lowering statins on the aerobic metabolism of endothelial cells at the cellular and mitochondrial levels. In human umbilical vein endothelial cells (EA.hy926), six days of exposure to 100 nM atorvastatin (ATOR) induced a general decrease in mitochondrial respiration. No changes in mitochondrial biogenesis, cell viability, or ATP levels were observed, whereas a decrease in Coenzyme Q10 (Q10) content was accompanied by an increase in intracellular reactive oxygen species (ROS) production, although mitochondrial ROS production remained unchanged. The changes caused by 100 nM pravastatin were smaller than those caused by ATOR. The ATOR-induced changes at the respiratory chain level promoted increased mitochondrial ROS production. In addition to the reduced level of mitochondrial Q10, the activity of Complex III was decreased, and the amount of Complex III in a supercomplex with Complex IV was diminished. These changes may cause the observed decrease in mitochondrial membrane potential and an increase in Q10 reduction level as a consequence, leading to elevated mitochondrial ROS formation. The above observations highlight the role of endothelial mitochondria in response to potential metabolic adaptations related to the chronic exposure of endothelial cells to statins.

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Section: Introductionmentioning

confidence: 99%

The Influence of Statins on the Aerobic Metabolism of Endothelial Cells

Broniarek

Dominiak

Gałgański

et al. 2020

IJMS

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“…The rates of undertreatment with antihypertensive agents are lower [36][37][38], which can be explained by well-established evidence on efficacy, good safety profiles and the low cost of these drugs [37]. Meanwhile, some controversy regarding the risks and benefits of statins used in primary prevention still exists both in scientific literature [39] and clinical practice. The causes of statin underuse involve both clinician-and patient-related factors.…”

Section: Discussionmentioning

confidence: 99%

Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

Urbonas¹,

Vencevičienė²,

Valius³

et al. 2020

Medicina

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Background and Objectives: Cardiovascular disease (CVD) prevention guidelines define targets for lifestyle and risk factors for patients at high risk of developing CVD. We assessed the control of these factors, as well as CVD risk perception in patients enrolled into the primary care arm of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey in Lithuania. Materials and Methods: Data were collected as the part of the EUROASPIRE V survey, a multicenter, prospective, cross-sectional observational study. Adults without a documented CVD who had been prescribed antihypertensive medicines and/or lipid-lowering medicines and/or treatment for diabetes (diet and/oral antidiabetic medicines and/or insulin) were eligible for the survey. Data were collected through the review of medical records, patients' interview, physical examination and laboratory tests. Results: A total of 201 patients were enrolled. Very few patients reached targets for low-density lipoprotein cholesterol (LDL-C) (4.5%), waist circumference (17.4%) and body mass index (15.4%). Only 31% of very high CVD risk patients and 52% of high-risk patients used statins. Blood pressure target was achieved by 115 (57.2%) patients. Only 21.7% of patients at very high actual CVD risk and 27% patients at high risk correctly estimated their risk. Of patients at moderate actual CVD risk, 37.5% patients accurately self-assessed the risk. About 60%-80% of patients reported efforts to reduce the intake of sugar, salt or alcohol; more than 70% of patients were current nonsmokers. Only a third of patients reported weight reduction efforts (33.3%) or regular physical activity (27.4%). Conclusions: The control of cardiovascular risk factors in a selected group of primary prevention patients was unsatisfactory, especially in terms of LDL-C level and body weight parameters. Many patients did not accurately perceive their own risk of developing CVD.

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“…The consumption of lipid-lowering drugs (statins) in the Basque Country (Spain) has gone from 46 defined daily doses/1000 inhabitants/day (DIDs) in 2006 to 90 DIDs in 2013, representing a growth of 93% [12]. This trend is despite statins having no added value for the primary prevention of CVD or at least having shown to be only effective or have some benefit for a small fraction of the target population depending on their baseline risk [13,14]. Moreover, statins have associated side-effects (e.g., muscle pain) in 5 to 10% of users [15].…”

Section: Introductionmentioning

confidence: 99%

Addressing low-value pharmacological prescribing in primary prevention of CVD through a structured evidence-based and theory-informed process for the design and testing of de-implementation strategies: the DE-imFAR study

et al. 2020

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Background: De-implementation or abandonment of ineffective or low-value healthcare is becoming a priority research field globally due to the growing empirical evidence of the high prevalence of such care and its impact in terms of patient safety and social inefficiency. Little is known, however, about the factors, barriers, and facilitators involved or about interventions that are effective in promoting and accelerating the de-implementation of lowvalue healthcare. The De-imFAR study seeks to carry out a structured, evidence-based, and theory-informed process involving the main stakeholders (clinicians, managers, patients, and researchers) for the design, deployment, and assessment of de-implementation strategies for reducing low-value pharmacological prescribing. Methods: A phase I formative study using a systematic and comprehensive framework based on theory and evidence for the design of implementation strategies-specifically, the Behavior Change Wheel (BCW)-will be conducted to design and model de-implementation strategies to favor reductions in low-value pharmacological prescribing of statins in primary prevention of cardiovascular disease (CVD) by main stakeholders (clinicians, managers, patients, and researchers) in a collegiate way. Subsequently, a phase II comparative hybrid trial will be conducted to assess the feasibility and potential effectiveness of at least one active de-implementation strategy to reduce low-value pharmacological prescribing of statins in primary prevention of CVD compared to the usual procedures for dissemination of clinical practice guidelines ("what-not-to-do" recommendations). A mixed-methods evaluation will be used: quantitative for the results of the implementation at the professional level (e.g., adoption, reach and implementation or execution of the recommended clinical practice); and qualitative to determine the feasibility and perceived impact of the de-implementation strategies from the clinicians' perspective, and patients' experiences related to the clinical care received.

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Statins for the primary prevention of cardiovascular disease: an overview of systematic reviews

Cited by 60 publications

References 67 publications

The Influence of Statins on the Aerobic Metabolism of Endothelial Cells

The Influence of Statins on the Aerobic Metabolism of Endothelial Cells

Primary Prevention of Cardiovascular Risk in Lithuania—Results from EUROASPIRE V Survey

Addressing low-value pharmacological prescribing in primary prevention of CVD through a structured evidence-based and theory-informed process for the design and testing of de-implementation strategies: the DE-imFAR study

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