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1.
JAAPA ; 34(12): 8-10, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34813529

RESUMO

ABSTRACT: Low-density lipoprotein-cholesterol (LDL-C) causes atherosclerosis and increases patient risk for cardiovascular mortality. However, patients who cannot tolerate statins present a treatment challenge. Bempedoic acid, an oral once-daily drug that reduces cholesterol synthesis, may help close this treatment gap. A meta-analysis demonstrated that bempedoic acid provides a well-tolerated and effective therapeutic option for lipid lowering in patients with hyperlipidemia, both as monotherapy and in combination with various other lipid-lowering agents. Also, although bempedoic acid acts on the same pathway as statins, it does not cause the muscular adverse reactions associated with statins.


Assuntos
Ácidos Dicarboxílicos , Inibidores de Hidroximetilglutaril-CoA Redutases , LDL-Colesterol , Ácidos Graxos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos
2.
Zhonghua Liu Xing Bing Xue Za Zhi ; 42(9): 1641-1649, 2021 Sep 10.
Artigo em Chinês | MEDLINE | ID: mdl-34814596

RESUMO

Objective: To systematically evaluate and analyze the original research of prescription sequence symmetry analysis (PSSA), summarize its research progress and methodological details, and provide a reference for the future use of this method. Methods: The keywords related to PSSA were used for literature retrieval from Chinese databases (CNKI, Wanfang, and VIP) and English databases (PubMed, Embase, and Cochrane). Original articles that were related to PSSA and published before June 30, 2020 were selected. Information form was developed by Excel. Stata was used for the statistics analysis. Results: There were 45 eligible articles included in the research. Since 2013, the number of studies using PSSA has increased rapidly. These studies were mainly conducted in Japan (n=11, 24.44%), China (n=10, 22.22%), Denmark (n=9, 20.00%), and Australia (n=8, 17.78%). Medical claim database was used most commonly when PSSA was implemented. The included studies involved 16 types of drugs, of which the number of studies of psychotropic drugs and statins was highest (n=8, 17.78%), and adverse reactions of almost all human systems were involved. In terms of methodology, 35 (77.78%) and 43 (95.56%) studies clearly reported the run-in period and interval period, of which 14 (31.11%) and 9 (20.00%) respectively gave the method or reason for determining the duration. In addition, 16 articles (35.56%) and 18 articles (40.00%) reported sensitivity analysis and subgroup analysis results, respectively. Conclusions: PSSA, one of the effective methods for safety signal detection in healthcare databases, has developed rapidly, but the methodological details and result reporting need to be improved. In China, PSSA research is still in its infancy, and it is necessary to pay attention to the quality of research and promote methodological exploration.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Prescrições , Austrália , China/epidemiologia , Bases de Dados Factuais , Humanos
3.
J Assoc Physicians India ; 69(10): 11-12, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34781662

RESUMO

Statins are group of medicines that lower the level of low-density lipoprotein (LDL) cholesterol. They may exert toxic effects on skeletal muscle ranging from simple muscle pain to life-threatening complications such as rhabdomyolysis. We report a case of 74-year-old male who was prescribed statins along with other drugs for treatment of coronary artery disease (CAD) and developed rhabdomyolysis which lead to acute renal failure. We report this case as statin induced rhabdomyolysis is very rare.


Assuntos
Injúria Renal Aguda , Doença da Artéria Coronariana , Inibidores de Hidroximetilglutaril-CoA Redutases , Rabdomiólise , Injúria Renal Aguda/induzido quimicamente , Idoso , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Masculino , Músculo Esquelético , Rabdomiólise/induzido quimicamente
5.
Kardiologiia ; 61(10): 36-45, 2021 Oct 30.
Artigo em Russo, Inglês | MEDLINE | ID: mdl-34763637

RESUMO

Aim      To evaluate economic results of using omega-3 acid ethyl esters 90 for primary prevention of cardiovascular catastrophes in patients with residual hypertriglyceridemia (HTG).Material and methods  The economic evaluation of using the medicine omega-3 acid ethyl esters 90 in the system of drug provision of the population of the Russian Federation was performed by analyzing the effect on the budget using a pharmacoeconomic model developed with the Microsoft Office Excel 2016 software. The effect of omega-3 acid ethyl esters 90 was evaluated in 555 643 patients with residual HGT (Moscow). The study lasted for one year. Results of the meta-analysis by A.A. Bernasconi et al. (2020) were used as a source of efficacy data. The following direct and indirect medical expenses for treatment of cardiovascular complications of residual HTG were taken into account in this study: expenses for drug therapy; expenses for therapy and rehabilitation for nonfatal complications; expenses for fatal outcomes; state support for disability; foregone per capita gross domestic product resulting from losses of earnings due to temporary incapacity to labor by people of work-able age; and salary payments for temporary incapacity to work.Results Using omega-3 acid ethyl esters 90 in 555 643 patients with residual HTG will allow preventing 1 437 fatal ischemic cardiovascular complications (including 564 deaths from ischemic heart disease and 1 128 cases of myocardial infarction (MI), including 558 fatal cases of MI). Furthermore, the difference in expenses compared to the high-dose statin treatment alone will be 359 252 253 rubles or 0.32 %.Conclusion      The results of this comprehensive pharmacoeconomical study showed that the use of omega-3 acid ethyl esters 90 in patients with residual HGT is an economically preferrable strategy compared to high-dose statin treatment alone and does not influence significantly the budgetary expenses as a part of the State Guarantee of Free Medical Care to the Citizens of the Russian Federation (increase in expenses by 0.32 % compared to the current practice). At the same time, the use of omega-3 acid ethyl esters 90 results in a 10% decrease in the number of fatal ischemic cardiovascular complications.


Assuntos
Dislipidemias , Ácidos Graxos Ômega-3 , Inibidores de Hidroximetilglutaril-CoA Redutases , Hipertrigliceridemia , Atenção à Saúde , Dislipidemias/complicações , Dislipidemias/tratamento farmacológico , Humanos
6.
Rev Prat ; 71(7): 713-716, 2021 Sep.
Artigo em Francês | MEDLINE | ID: mdl-34792904

RESUMO

TWO DECADES LATER, THE POLYPILL REVISITED Twenty years later, the promises of the designers of the Polypill are far from being fulfilled. Its effectiveness is still open to debate, while its long-term adverse effects in healthy subjects, particularly due to aspirin, continue to cause concern. Its composition, which varies from one Polypill to another, does not always appear to be as relevant as it would be desirable. In short, it is not certain that its advantages far outweigh its disadvantages. Its validation by the Authorities granting marketing authorizations seems difficult as it stands because it requires demonstrating the benefit of each of its components compared to a placebo and the contribution of each component compared to the others. As for the idea of some of its upholders to make it an over-the-counter drug, it is a headlong rush that is hardly compatible with its target, healthy subjects, and its safety profile.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Anti-Hipertensivos/uso terapêutico , Aspirina/efeitos adversos , Combinação de Medicamentos , Humanos
7.
Vasa ; 50(6): 401-411, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34743585

RESUMO

Patients with peripheral arterial disease (PAD) are at very high risk of cardiovascular events, but risk factor management is usually suboptimal. This Joint Task Force from the European Atherosclerosis Society and the European Society of Vascular Medicine has updated evidence on the management on dyslipidaemia and thrombotic factors in patients with PAD. Guidelines recommend a low-density lipoprotein cholesterol (LDLC) goal of more than 50% reduction from baseline and <1.4 mmol/L (<55 mg/dL) in PAD patients. As demonstrated by randomized controlled trials, lowering LDL-C not only reduces cardiovascular events but also major adverse limb events (MALE), including amputations, of the order of 25%. Addition of ezetimibe or a PCSK9 inhibitor further decreases the risk of cardiovascular events, and PCSK9 inhibition has also been associated with reduction in the risk of MALE by up to 40%. Furthermore, statin- based treatment improved walking performance, including maximum walking distance, and pain-free walking distance and duration. This Task Force recommends strategies for managing statin-associated muscle symptoms to ensure that PAD patients benefit from lipid-lowering therapy. Antiplatelet therapy, either daily clopidogrel 75 mg or the combination of aspirin 100 mg and rivaroxaban (2×2.5 mg) is also indicated to prevent cardiovascular events. Dual pathway inhibition (aspirin and rivaroxaban) may be considered following revascularization, taking into account bleeding risk. This Joint Task Force believes that adherence with these recommendations for lipid-lowering and antithrombotic therapy will improve the morbidity and mortality in patients with PAD.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Doença Arterial Periférica , LDL-Colesterol , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/tratamento farmacológico , Pró-Proteína Convertase 9 , Resultado do Tratamento
8.
Ther Adv Cardiovasc Dis ; 15: 17539447211051248, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34821189

RESUMO

Atherosclerotic cardiovascular disease (ASCVD) is a common disease among the general population, and includes four major areas: (1) coronary heart disease (CHD), manifested by stable angina, unstable angina, myocardial infarction (MI), heart failure, and coronary death; (2) cerebrovascular disease, manifested by transient ischemia attack and stroke; (3) peripheral vascular disease, manifested by claudication and critical limb ischemia; and (4) aortic atherosclerosis and aortic aneurysm (thoracic and abdominal). CHD remains the leading cause of death for both men and women in the United States. So, it is imperative to identify people at risk of CHD and provide appropriate medical treatment or intervention to prevent serious complications and outcomes including sudden cardiac death. Coronary artery calcification (CAC) is a marker of subclinical coronary artery disease. Therefore, coronary artery calcium score is an important screening method for Coronary artery disease (CAD). In this article, we performed a comprehensive review of current literatures and studies assessing the prognostic value of CAC for future cardiovascular disease (CVD) events. We searched PubMed, MEDLINE, Google Scholar, and Cochrane library. We also reviewed the 2018 American College of Cardiology (ACC)/American Heart Association (AHA) guideline on the assessment of CVD risk. A CAC score of zero corresponds to very low CVD event rates (∼1% per year) and hence a potent negative risk marker. This has been referred to as the 'power of zero' and affords the lowest risk of any method of risk calculation. It is now indicated in the 2018 ACC/AHA Cholesterol guidelines to be used to avoid statins for 5-10 years after a score of zero, and then re-assess the patient.


Assuntos
Aterosclerose , Doença da Artéria Coronariana , Inibidores de Hidroximetilglutaril-CoA Redutases , Feminino , Humanos , Masculino , Medição de Risco , Fatores de Risco , Estados Unidos
9.
PLoS Med ; 18(10): e1003820, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34648516

RESUMO

BACKGROUND: The relationship between statin treatment and Coronavirus Disease 2019 (COVID-19) mortality has been discussed due to the pleiotropic effects of statins on coagulation and immune mechanisms. However, available observational studies are hampered by study design flaws, resulting in substantial heterogeneity and ambiguities. Here, we aim to determine the relationship between statin treatment and COVID-19 mortality. METHODS AND FINDINGS: This cohort study included all Stockholm residents aged 45 or older (N = 963,876), followed up from 1 March 2020 until 11 November 2020. The exposure was statin treatment initiated before the COVID-19-pandemic, defined as recorded statin dispensation in the Swedish Prescribed Drug Register between 1 March 2019 and 29 February 2020. COVID-19-specific mortality was ascertained from the Swedish Cause of Death Registry. Hazard ratios (HRs) were calculated using multivariable Cox regression models. We further performed a target trial emulation restricted to initiators of statins. In the cohort (51.6% female), 169,642 individuals (17.6%) were statin users. Statin users were older (71.0 versus 58.0 years), more likely to be male (53.3% versus 46.7%), more often diagnosed with comorbidities (for example, ischemic heart disease 23.3% versus 1.6%), more frequently on anticoagulant and antihypertensive treatments, less likely to have a university-level education (34.5% versus 45.4%), and more likely to have a low disposable income (20.6% versus 25.2%), but less likely to reside in crowded housing (6.1% versus 10.3%). A total of 2,545 individuals died from COVID-19 during follow-up, including 765 (0.5%) of the statin users and 1,780 (0.2%) of the nonusers. Statin treatment was associated with a lowered COVID-19 mortality (adjusted HR, 0.88; 95% CI, 0.79 to 0.97, P = 0.01), and this association did not vary appreciably across age groups, sexes, or COVID-19 risk groups. The confounder adjusted HR for statin treatment initiators was 0.78 (95% CI, 0.59 to 1.05, P = 0.10) in the emulated target trial. Limitations of this study include the observational design, reliance on dispensation data, and the inability to study specific drug regimens. CONCLUSIONS: Statin treatment had a modest negative association with COVID-19 mortality. While this finding needs confirmation from randomized clinical trials, it supports the continued use of statin treatment for medical prevention according to current recommendations also during the COVID-19 pandemic.


Assuntos
COVID-19/mortalidade , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Idoso , Idoso de 80 Anos ou mais , COVID-19/prevenção & controle , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Suécia/epidemiologia
10.
Hist Philos Life Sci ; 43(4): 110, 2021 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-34648083

RESUMO

Science progresses through debate and disagreement, and scientific controversies play a crucial role in the growth of scientific knowledge. However, not all controversies and disagreements are progressive in science. Sometimes, controversies can be pseudoscientific; in fact, bogus controversies, and what seem like genuine scientific disagreements, can be a distortion of science set up by non-scientific actors (e.g., interest groups). Bogus controversies are detrimental to science because they can hinder scientific progress and eventually bias science-based decisions. The first goal of this paper is to elucidate the distinction between bogus and genuine scientific controversies and provide a qualitative methodology, based on the literature on expertise, for distinguishing between the two. We will illustrate six epistemic criteria for distinguishing bogus from genuine scientific debates in science and medicine. This heuristic strategy applies directly to scientific reports, and it relies mostly on the social structure of science. We will then apply the above criteria to a case study: the controversy over statins, which are widely prescribed drugs for reducing the level of cholesterol and preventing cardiovascular disease.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Conhecimento
11.
BMC Gastroenterol ; 21(1): 379, 2021 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-34657610

RESUMO

BACKGROUND: Chemoprevention of colorectal neoplasia with aspirin and statins is under-investigated in Black patients. Since Black patients suffer disproportionately from colon cancer incidence and mortality compared to other populations, we investigated the utility of aspirin and statin in reducing advanced adenomatous polyp (AAP) risk in Black patients. METHODS: We carried out a retrospective cohort study of screening colonoscopies performed at a large urban academic center from 1/1/2011 through 12/31/2019. We analyzed self-identified Black patients with > 1 colonoscopy and no personal history of either inflammatory bowel disease or colon cancer syndromes. Our primary endpoint was first AAP development after index colonoscopy among Black patients taking both aspirin and a statin compared to those taking one or neither medication. We used multivariate logistic regression modeling to investigate our outcomes. RESULTS: We found data on chemoprophylaxis use in 560 patients. The mean observation period between index colonoscopy and AAP identification was 4 years. AAP developed in 106/560 (19%) of our cohort. We found no difference in AAP risk among Black patients taking both chemoprevention medications compared to partial or no chemoprophylaxis (20% vs 18% respectively, p = 0.49). This finding remained after adjusting for age, body mass index, and tobacco use (odds ratio 1.04, 95% CI 0.65-1.67; p = 0.87). CONCLUSIONS: Short-term aspirin-statin chemoprevention did not reduce the risk of AAP development in our cohort of Black patients. Larger and long-term prospective investigations are needed to investigate the utility of chemoprophylaxis in this population. TRIAL REGISTRATION: Not applicable.


Assuntos
Pólipos Adenomatosos , Inibidores de Hidroximetilglutaril-CoA Redutases , Aspirina/uso terapêutico , Quimioprevenção , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Estudos Prospectivos , Estudos Retrospectivos
12.
Georgian Med News ; (318): 75-81, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34628383

RESUMO

The liver plays an important role in the development of atherogenic dyslipidemia, since changes in lipid metabolism begin at the hepatocyte level. Given the prevalence of dyslipidemias and their proven effect on the development of thrombotic cardiovascular complications in patients with non-alcoholic fatty liver disease (NAFLD), it is important to understand the role of platelets and hemostatic blood activity. Objective - to determine the state of platelet-plasma hemostasis in patients with essential hypertension, with concomitant non-alcoholic fatty liver disease. 152 patients were examined: 72 men and 80 women. Three groups were identified: I - 46 patients with hypertension stage II, II - 54 patients with NAFLD without hypertension, Group III - 52 patients with hypertension stage II with concomitant NAFLD. The total amount of spontaneous and induced platelet aggregation ability, coagulation activity, anticoagulant and fibrinolytic potential of blood was studied. The degree of spontaneous aggregation was significantly higher in patients with hypercholesterolemia - by 32.4% (p<0.05). that the level of fibrinogen was higher by 13.5% (p<0.05) precisely in hypercholesterolemia. In a cohort with a comorbid course of hypertension and NAFLD, patients on statin therapy had a 16.5% (p<0.05) lower degree of spontaneous aggregation than patients who did not receive this treatment. In patients with NAFLD without statin treatment, prothrombin time (PTT) was shortened by 19.2% (p<0.01) and international normalization ratio (INR) by 15.3% (p<0.01) than in patients who received lipid-lowering therapy. A decrease in thrombin time (TT) by 12.2% (p<0.05) was observed in the subgroup receiving statins among NAFLD patients. The use of statins in the general cohort increased the activity of antithrombin (AT) III by 10.7% (p<0.01), and in the NAFLD group by 14.3% (p<0.001). In patients with essential hypertension (HT) and NAFLD with a high level of cholesterolemia, spontaneous aggregation was 17.1% (p<0.05) less than in patients who did not receive statins and had high cholesterol levels, and the degree of collagen-induced aggregation decreased by 33.7% (p<0.05). In the subgroup with hypercholesterolemia, statins contributed to an increase in PTT by 32.5% (p<0.05), INR by 25.4% (p<0.05), and thrombin time - by 23.2% (p<0.05) and increased the activity of the anticoagulant link of hemostasis - the level of AT III increased by 3.1% (p<0.05) Hypercholesterolemia is associated with a higher functional activity of platelets, hyperfibrinogenemia. Statin therapy in patients with HT stage. and NAFLD is accompanied by a decrease in the activity of spontaneous aggregation, the coagulation link and increases the anticoagulant potential of the blood.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Hipercolesterolemia , Hepatopatia Gordurosa não Alcoólica , Plaquetas , Hipertensão Essencial , Feminino , Hemostasia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/complicações , Hipercolesterolemia/tratamento farmacológico , Masculino , Hepatopatia Gordurosa não Alcoólica/complicações , Hepatopatia Gordurosa não Alcoólica/tratamento farmacológico
13.
Medicine (Baltimore) ; 100(37): e26966, 2021 Sep 17.
Artigo em Inglês | MEDLINE | ID: mdl-34664827

RESUMO

ABSTRACT: The association between stopping statins and 1-year mortality in the general population of the oldest-old - with or without ischemic heart disease (IHD) - has been studied herein for the first time.This was a retrospective study. Included were all consecutive patients (n = 369) aged 80 years or more (mean age 87.8 years) hospitalized in a single Geriatrics department during 1 year. The study group included 140 patients in whom statins were stopped upon admission (statin stoppers). The control group included 229 patients who did not use statins in the first place (statin non-users). All-cause 1-year mortality rates were studied in both groups following propensity score matching and in IHD patients separately.Overall, 110 (29.8%) patients died during the year following admission: 38 (27.1%) statin stoppers and 72 (31.4%) statin non-users (P = .498). Cox regression analysis showed no association between stopping statins and 1-year mortality in the crude analysis (hazard ratio [HR] 0.976, 95% confidence interval [CI] 0.651-1.463, P = .907) and following propensity score matching (HR 1.067, 95%CI 0.674-1.689, P = .782). Among 108 IHD patients, 38 (35.2%) patients died during the year following admission: 18 (27.7%) statin stoppers and 20 (46.5%) statin non-users (P = .059). Cox regression analysis showed a nearly significant association between stopping statins (rather than not using statins) in IHD patients and lower 1-year mortality (HR 0.524, 95%CI 0.259-1.060, P = .072).Hence, stopping statins in the general population of the oldest-old - with or without IHD - is possibly safe. Future studies including the oldest-old statin continuers are warranted to confirm this observation.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Mortalidade/tendências , Isquemia Miocárdica/tratamento farmacológico , Idoso de 80 Anos ou mais , Distribuição de Qui-Quadrado , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Israel , Masculino , Modelos de Riscos Proporcionais , Estudos Retrospectivos
14.
Int J Chron Obstruct Pulmon Dis ; 16: 2721-2733, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34621122

RESUMO

Background: Several observational studies have found that statins may materially decrease the risk of chronic obstructive pulmonary disease (COPD) exacerbations. However, most of these studies used a prevalent user, non-user comparison approach, which may lead to overestimation of the clinical benefits of statins. We aimed to explore the risk of COPD exacerbations associated with statins with a new user, active comparison approach to address potential methodological concerns. We selected fibrates, another class of lipid-lowering agents, as the reference group because no evidence suggests that fibrates have an effect on COPD exacerbations. Methods: We identified patients with COPD who initiated statins or fibrates from a nationwide Taiwanese database. Patients were followed from cohort entry to the earliest of the following: hospitalization for COPD exacerbations, death, end of the data, or 180 days after cohort entry. Stratified Cox regression models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) of COPD exacerbations comparing statins with fibrates after variable-ratio propensity score (PS) matching and high-dimensional PS (hd-PS) matching, respectively. Results: We identified a total of 134,909 eligible patients (110,726 initiated statins; 24,183 initiated fibrates); 1979 experienced COPD exacerbations during follow-up. The HRs were 1.10 (95% CI, 0.96 to 1.26) after PS matching and 1.08 (95% CI, 0.94 to 1.24) after hd-PS matching. The results did not differ materially by type of statins and patient characteristic and did not change with longer follow-up durations. Conclusion: This large-scale, population-based cohort study did not show that use of statins was associated with a reduced risk of acute exacerbations in patients with COPD using state-of-the-art pharmacoepidemiologic approaches. The findings emphasize the importance of applying appropriate methodology in exploring statin effectiveness in real-world settings.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Doença Pulmonar Obstrutiva Crônica , Estudos de Coortes , Progressão da Doença , Ácidos Fíbricos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Pontuação de Propensão , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Doença Pulmonar Obstrutiva Crônica/epidemiologia
15.
Lipids Health Dis ; 20(1): 141, 2021 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-34689776

RESUMO

The global coronavirus disease 2019 (COVID-19) pandemic caused by the SARS-CoV-2 coronavirus started in March 2020. The conclusions from numerous studies indicate that people with comorbidities, such as arterial hypertension, diabetes, obesity, underlying cardiovascular disease, are particularly vulnerable to the severe course of COVID-19. The available data also suggest that patients with dyslipidemia, the most common risk factor of cardiovascular diseases, are also at greater risk of severe course of COVID-19. On the other hand, it has been shown that COVID-19 infection has an influence on lipid profile leading to dyslipidemia, which might require appropriate treatment. Owing to antiviral, anti-inflammatory, immunomodulatory, and cardioprotective activity, statin therapy has been considered as valuable tool to improve COVID-19 outcomes. Numerous observational studies have shown potential beneficial effects of lipid-lowering treatment on the course of COVID-19 with significant improved prognosis and reduced mortality.


Assuntos
COVID-19/etiologia , Dislipidemias/tratamento farmacológico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemia Tipo II/tratamento farmacológico , COVID-19/tratamento farmacológico , COVID-19/epidemiologia , Comorbidade , Dislipidemias/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Hiperlipoproteinemia Tipo II/epidemiologia , Hiperlipoproteinemia Tipo II/metabolismo , Metabolismo dos Lipídeos , Prognóstico
17.
Curr Atheroscler Rep ; 23(12): 74, 2021 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-34648074

RESUMO

PURPOSE OF REVIEW: For many years, the lipid-lowering armamentarium consisted of statins and/or ezetimibe and/or bile acid sequestrants and/or fibrates. Now, with the availability of new drugs mostly injectables, the field has changed and the role of oral non-statin drugs (including bempedoic acid) must be reevaluated. RECENT FINDINGS: Ezetimibe remains a very important combination partner for statins with continuously increasing treatment numbers. Bempedoic acid is another interesting combination partner for statin/ezetimibe or ezetimibe alone but lacks in contrast to ezetimibe evidence from outcome trials. The role of fibrates is less clear as they have shown disappointing results in outcome trials but may still be used in selected, high-risk patients with combined dyslipidemia. Bile acid sequestrants are now rarely used as there are stronger, better tolerable ways to lower LDL-cholesterol. With the introduction of new injectable lipid-lowering drugs, some oral drugs such as ezetimibe and bempedoic acid still have an important spot in our treatment algorithm others such as fibrates have a less clear role while again others are now rarely used.


Assuntos
Anticolesterolemiantes , Inibidores de Hidroximetilglutaril-CoA Redutases , Anticolesterolemiantes/uso terapêutico , LDL-Colesterol , Ezetimiba/uso terapêutico , Humanos , Lipídeos
18.
J Am Coll Cardiol ; 78(16): 1635-1654, 2021 10 19.
Artigo em Inglês | MEDLINE | ID: mdl-34649702

RESUMO

Coronavirus disease-2019 (COVID-19) is associated with systemic inflammation, endothelial activation, and multiorgan manifestations. Lipid-modulating agents may be useful in treating patients with COVID-19. These agents may inhibit viral entry by lipid raft disruption or ameliorate the inflammatory response and endothelial activation. In addition, dyslipidemia with lower high-density lipoprotein cholesterol and higher triglyceride levels portend worse outcomes in patients with COVID-19. Upon a systematic search, 40 randomized controlled trials (RCTs) with lipid-modulating agents were identified, including 17 statin trials, 14 omega-3 fatty acids RCTs, 3 fibrate RCTs, 5 niacin RCTs, and 1 dalcetrapib RCT for the management or prevention of COVID-19. From these 40 RCTs, only 2 have reported preliminary results, and most others are ongoing. This paper summarizes the ongoing or completed RCTs of lipid-modulating agents in COVID-19 and the implications of these trials for patient management.


Assuntos
COVID-19/tratamento farmacológico , COVID-19/prevenção & controle , Ácidos Graxos Ômega-3/uso terapêutico , Ácidos Fíbricos/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Niacina/uso terapêutico , Amidas/farmacologia , Amidas/uso terapêutico , Ésteres/farmacologia , Ésteres/uso terapêutico , Ácidos Graxos Ômega-3/farmacologia , Ácidos Fíbricos/farmacologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Reguladores do Metabolismo de Lipídeos/farmacologia , Reguladores do Metabolismo de Lipídeos/uso terapêutico , Niacina/farmacologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Compostos de Sulfidrila/farmacologia , Compostos de Sulfidrila/uso terapêutico
19.
BMJ Open ; 11(10): e050675, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34598987

RESUMO

OBJECTIVES: We aim to describe the frequency and type of adverse drug reactions (ADRs) in patients on statins in published studies from Latin American (LATAM) countries. DESIGN: Scoping review. METHODS: A literature search was conducted in three databases (PubMed, EMBASE and LILACS) in addition to a manual search in relevant journals from LATAM universities or medical societies. A snowballing technique was used to identify further references. Randomised controlled trials (RCTs) and observational studies between 2000 and 2020 were included. Studies were considered eligible if they included adults on statin therapy from LATAM and reported data on ADRs. Data on ADRs were abstracted and presented by study design. RESULTS: Out of 8076 articles, a total of 20 studies were included (7 RCTs and 13 observational studies). We identified three head-to-head statin RCTs, two statin-versus-policosanol RCTs and only two placebo-controlled trials. The statin-related ADRs frequency ranged from 0% to 35.1% in RCTs and 0% to 28.4% in observational studies. The most common ADRs were muscle-related events including myalgia and elevated creatine phosphokinase. Other reported ADRs were gastrointestinal symptoms, headache and altered fasting plasma glucose. CONCLUSIONS: We identified differences in the frequency of ADRs in both observational studies and RCTs from LATAM countries. This could be due to the absence of standard definitions and reporting of ADRs as well as differences among the study's interventions, population characteristics or design. The variability of ADRs and the absence of definitions are similar to studies from other geographical locations. Further placebo-controlled trials and real-world data registries with universal definitions should follow.


Assuntos
Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Inibidores de Hidroximetilglutaril-CoA Redutases , Adulto , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , América Latina/epidemiologia
20.
JMIR Public Health Surveill ; 7(10): e29379, 2021 10 08.
Artigo em Inglês | MEDLINE | ID: mdl-34623311

RESUMO

BACKGROUND: Basic studies suggest that statins as add-on therapy may benefit patients with COVID-19; however, real-world evidence of such a beneficial association is lacking. OBJECTIVE: We investigated differences in SARS-CoV-2 test positivity and clinical outcomes of COVID-19 (composite endpoint: admission to intensive care unit, invasive ventilation, or death) between statin users and nonusers. METHODS: Two independent population-based cohorts were analyzed, and we investigated the differences in SARS-CoV-2 test positivity and severe clinical outcomes of COVID-19, such as admission to the intensive care unit, invasive ventilation, or death, between statin users and nonusers. One group comprised an unmatched cohort of 214,207 patients who underwent SARS-CoV-2 testing from the Global Research Collaboration Project (GRCP)-COVID cohort, and the other group comprised an unmatched cohort of 74,866 patients who underwent SARS-CoV-2 testing from the National Health Insurance Service (NHIS)-COVID cohort. RESULTS: The GRCP-COVID cohort with propensity score matching had 29,701 statin users and 29,701 matched nonusers. The SARS-CoV-2 test positivity rate was not associated with statin use (statin users, 2.82% [837/29,701]; nonusers, 2.65% [787/29,701]; adjusted relative risk [aRR] 0.97; 95% CI 0.88-1.07). Among patients with confirmed COVID-19 in the GRCP-COVID cohort, 804 were statin users and 1573 were matched nonusers. Statin users were associated with a decreased likelihood of severe clinical outcomes (statin users, 3.98% [32/804]; nonusers, 5.40% [85/1573]; aRR 0.62; 95% CI 0.41-0.91) and length of hospital stay (statin users, 23.8 days; nonusers, 26.3 days; adjusted mean difference -2.87; 95% CI -5.68 to -0.93) than nonusers. The results of the NHIS-COVID cohort were similar to the primary results of the GRCP-COVID cohort. CONCLUSIONS: Our findings indicate that prior statin use is related to a decreased risk of worsening clinical outcomes of COVID-19 and length of hospital stay but not to that of SARS-CoV-2 infection.


Assuntos
COVID-19/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , Teste para COVID-19 , Estudos de Coortes , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Adulto Jovem
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