Usefulness of Statins as Secondary Prevention Against Recurrent and Terminal Major Adverse Cardiovascular Events

Tecson, Kristen M.; Kluger, Aaron Y.; Cassidy‐Bushrow, Andrea E.; Liu, Bin; Coleman, Chad M.; Jones, Laney K.; Jefferson, Celeena R.; VanWormer, Jeffrey J.; McCullough, Peter A.

doi:10.1016/j.amjcard.2022.04.018

Cited by 11 publications

(13 citation statements)

References 26 publications

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“…Moreover, within the general population characteristics, there was a low percentage of medication use recommended for high-risk individuals, such as those with coronary heart disease or diabetes. Statins, for instance, were used in less than half of these patients, similar to other reports [33,34].…”

Section: Discussionsupporting

confidence: 69%

Clinical Implications of High-Sensitivity Troponin Elevation Levels in Non-ST-Segment Elevation Myocardial Infarction Patients: Beyond Diagnostics

Bravo,

Vizcarra,

Sánchez

et al. 2024

Diagnostics

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Standard troponin has long been pivotal in diagnosing coronary syndrome, especially Non-ST-Segment Elevation Myocardial Infarction (NSTEMI). The recent introduction of high-sensitivity troponin (hs-cTnI) has elevated it to the gold standard. Yet, its nuanced role in predicting angiographic lesions and clinical outcomes, notably in specific populations like obesity, remains underexplored. Aim: To evaluate the association between hs-cTnI magnitude in NSTEMI patients and angiographic findings, progression to acute heart failure, and its performance in obesity. Methods: Retrospective study of 208 NSTEMI patients at a large university center (2020–2023). Hs-cTnI values were assessed for angiographic severity, acute heart failure, and characteristics in the obese population. Data collected and diagnostic performance were evaluated using manufacturer-specified cutoffs. Results: 97.12% of patients had a single culprit vessel. Hs-cTnI elevation correlated with angiographic stenosis severity. Performance for detecting severe coronary disease was low, with no improvement using a higher cutoff. No association was found between hs-cTnI and the culprit vessel location. Hs-cTnI did not predict acute heart failure progression. In the obese population, hs-cTnI levels were higher, but acute heart failure occurred less frequently than in non-obese counterparts. Conclusions: In NSTEMI, hs-cTnI elevation is associated with significant stenosis, but not with location or acute heart failure. Obesity correlates with higher hs-cTnI levels but a reduced risk of acute heart failure during NSTEMI.

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Section: Discussionsupporting

confidence: 69%

Clinical Implications of High-Sensitivity Troponin Elevation Levels in Non-ST-Segment Elevation Myocardial Infarction Patients: Beyond Diagnostics

Bravo,

Vizcarra,

Sánchez

et al. 2024

Diagnostics

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“…First, both the prevalence and potential indication for initiating lipid-lowering therapy are relatively high in this population 9 29 30. Second, prevailing guidelines and philosophy for initiating lipid-lowering therapy for secondary prevention of ASCVD and among persons with diabetes are well entrenched 31–33. Third, consideration of initiating lipid-lowering therapy for primary prevention, particularly among older adults, should be carefully weighed based on empirical data34 35 and potential side effects, including but not limited to muscle pain or weakness36 and increased risk of developing diabetes 37–39…”

Section: Discussionmentioning

confidence: 99%

“…9 29 30 Second, prevailing guidelines and philosophy for initiating lipidlowering therapy for secondary prevention of ASCVD and among persons with diabetes are well entrenched. [31][32][33] Third, consideration of initiating lipid-lowering therapy for primary prevention, particularly among older adults, should be carefully weighed based on empirical data 34 35 and potential side effects, including but not limited to muscle pain or weakness 36 and increased risk of developing diabetes. [37][38][39] Beyond our principal finding of no indication that 'lower LDL-C is better,' other prominent findings were that overall and independent of age, the T-C/HDL-C and Open access triglycerides/HDL-C ratios were predictive of long-term mortality risk, the latter of which presented in a gradient manner.…”

Section: Discussionmentioning

confidence: 99%

Is LDL cholesterol associated with long-term mortality among primary prevention adults? A retrospective cohort study from a large healthcare system

Kip,

Diamond,

Mulukutla

et al. 2024

BMJ Open

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ObjectivesAmong primary prevention-type adults not on lipid-lowering therapy, conflicting results exist on the relationship between low-density lipoprotein cholesterol (LDL-C) and long-term mortality. We evaluated this relationship in a real-world evidence population of adults.DesignRetrospective cohort study.SettingElectronic medical record data for adults, from 4 January 2000 through 31 December 2022, were extracted from the University of Pittsburgh Medical Center healthcare system.ParticipantsAdults without diabetes aged 50–89 years not on statin therapy at baseline or within 1 year and classified as primary prevention-type patients. To mitigate potential reverse causation, patients who died within 1 year or had baseline total cholesterol (T-C) ≤120 mg/dL or LDL-C <30 mg/dL were excluded.Main exposure measureBaseline LDL-C categories of 30–79, 80–99, 100–129, 130–159, 160–189 or ≥190 mg/dL.Main outcome measureAll-cause mortality with follow-up starting 365 days after baseline cholesterol measurement.Results177 860 patients with a mean (SD) age of 61.1 (8.8) years and mean (SD) LDL-C of 119 (31) mg/dL were evaluated over a mean of 6.1 years of follow-up. A U-shaped relationship was observed between the six LDL-C categories and mortality with crude 10-year mortality rates of 19.8%, 14.7%, 11.7%, 10.7%, 10.1% and 14.0%, respectively. Adjusted mortality HRs as compared with the referent group of LDL-C 80–99 mg/dL were: 30–79 mg/dL (HR 1.23, 95% CI 1.17 to 1.30), 100–129 mg/dL (0.87, 0.83–0.91), 130–159 mg/dL (0.88, 0.84–0.93), 160–189 mg/dL (0.91, 0.84–0.98) and ≥190 mg/dL (1.19, 1.06–1.34), respectively. Unlike LDL-C, both T-C/HDL cholesterol (high-density lipoprotein cholesterol) and triglycerides/HDL cholesterol ratios were independently associated with long-term mortality.ConclusionsAmong primary prevention-type patients aged 50–89 years without diabetes and not on statin therapy, the lowest risk for long-term mortality appears to exist in the wide LDL-C range of 100–189 mg/dL, which is much higher than current recommendations. For counselling these patients, minimal consideration should be given to LDL-C concentration.

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“…The reduction in the nonfatal MACE number was nonsignificant, 19% (rate ratio 0.81, 95% CI: 0.49 to 1.32, p = 0.394), and the reduction in the risk of all-cause death was 65% (HR 0.35, 95% CI: 0.22 to 0.56, p < 0.001). The main advantage of taking statins was protection against premature death [48].…”

Section: Statins In Primary and Secondary Prevention Of Cardiovascula...mentioning

confidence: 99%

Don’t Judge a Book by Its Cover: The Role of Statins in Liver Cancer

Piekuś-Słomka,

Mocan,

Shkreli

et al. 2023

Cancers

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Statins, which are inhibitors of 3-hydroxy-3-methyl-glutaryl-coenzyme A (HMG-CoA) reductase, are an effective pharmacological tool for lowering blood cholesterol levels. This property makes statins one of the most popular drugs used primarily to prevent cardiovascular diseases, where hyperlipidemia is a significant risk factor that increases mortality. Nevertheless, studies conducted mainly in the last decade have shown that statins might prevent and treat liver cancer, one of the leading causes of cancer-related mortality worldwide. This narrative review summarizes the scientific achievements to date regarding the role of statins in liver tumors. Molecular biology tools have revealed that cell growth and proliferation can be inhibited by statins, which further inhibit angiogenesis. Clinical studies, supported by meta-analysis, confirm that statins are highly effective in preventing and treating hepatocellular carcinoma and cholangiocarcinoma. However, this effect may depend on the statin’s type and dose, and more clinical trials are required to evaluate clinical effects. Moreover, their potential hepatotoxicity is a significant caveat for using statins in clinical practice. Nevertheless, this group of drugs, initially developed to prevent cardiovascular diseases, is now a key candidate in hepato-oncology patient management. The description of new drug-statin-like structures, e.g., with low toxicity to liver cells, may bring another clinically significant improvement to current cancer therapies.

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Usefulness of Statins as Secondary Prevention Against Recurrent and Terminal Major Adverse Cardiovascular Events

Cited by 11 publications

References 26 publications

Clinical Implications of High-Sensitivity Troponin Elevation Levels in Non-ST-Segment Elevation Myocardial Infarction Patients: Beyond Diagnostics

Clinical Implications of High-Sensitivity Troponin Elevation Levels in Non-ST-Segment Elevation Myocardial Infarction Patients: Beyond Diagnostics

Is LDL cholesterol associated with long-term mortality among primary prevention adults? A retrospective cohort study from a large healthcare system

Don’t Judge a Book by Its Cover: The Role of Statins in Liver Cancer

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