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1.
J Assoc Physicians India ; 69(4): 11-12, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34470187

RESUMO

OBJECTIVE: Guidelines recommend prescription of statins in all high-risk patients with hypertension irrespective of their cholesterol levels. We performed a prescription audit in India to determine the application of recommendations. METHODS: A registry-based audit of patients with primary diagnosis of hypertension (n=3073) was performed. Details of co-morbidities and medications were obtained. Patients with known vascular disease were excluded. Patients were classified into subgroups based on risk factors and type of therapy. A multivariate model of risk was developed using clinical data and patients were classified into low, moderate and high risk. Statin prescriptions were divided into low, medium and high intensity based on US guidelines. Descriptive statistics are reported. RESULTS: Mean age of patients was 59±13 years, 47 % were women and 26 % were less than 50 years age. Diabetes was noted in 31.1 %, current smoking in 1.3 %, obesity in 14.7 % and hypothyroidism in 7.9 %. Statins were prescribed in 41.2 % (95% CI 39.4-42.9%), more in men compared to women (47.7% vs 33.7%, p<0.001). Most of the patients received moderate intensity statins (83.9%). In age-groups >40, 40-59, 60-79 and 80+ years, statins were prescribed in 18.7%, 36.5%, 49.5% and 49.4% respectively (ptrend <0.001). Statins were prescribed in 52.0% diabetics, 60.9% obese, 52.5% smokers and 34.8% hypothyroid. In the multivariate model statins use in low, medium and high risk patients was 28.4%, 46.6% and 55.1% respectively (ptrend <0.001). CONCLUSION: In an Indian secondary care practice only half of patients with moderate to high risk uncomplicated hypertension receive statins.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Hipertensão , Adulto , Idoso , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipertensão/tratamento farmacológico , Hipertensão/epidemiologia , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Prescrições , Fatores de Risco
2.
Arq Bras Cardiol ; 117(2): 270-278, 2021 08.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34495217

RESUMO

BACKGROUND: Statin use is highlighted as the most commonly utilized therapy for the treatment of dyslipidemias and can be considered as the most efficient pharmacological intervention for low-density lipoprotein (LDL) reduction. On the other hand, physical training can be considered an efficient and safe non-pharmacological strategy to promote improvements in lipid profile. However, the influence of statins on lipid adaptations arising from water-based training in populations with dyslipidemia is not known. OBJECTIVES: To analyze the influence of simvastatin use on lipid adaptations arising from water-based aerobics and resistance training in elderly women with dyslipidemia. METHODS: Sixty-nine elderly (66.13 ± 5.13 years), sedentary, and dyslipidemic women, both non-users and users of simvastatin (20 mg and 40 mg), were randomized into the following 3 groups: water-based aerobic training (WA), water-based resistance training (WR), and control group (CG). Total duration of interventions, for all experimental groups consisted of 10 weeks, with 2 weekly sessions. Biochemical analyses were performed before the beginning of the interventions and repeated after the end of the trial. Generalized estimating equations were used to compare these data, setting α = 0.05. RESULTS: In intention-to-treat analysis, the medicated participants obtained a greater magnitude of decrease in total cholesterol (TC) (-3.41 to -25.89 mg.dl-1; p = 0.038), LDL (-5.58 to -25.18 mg.dl-1; p = 0.007) and TC/HDL ratio (-0.37 to -0.61; p = 0.022) when compared to the non-medicated participants, and this decrease was statistically significant only in the WR group. CONCLUSIONS: Statin use enhances the adaptations promoted by water-based physical training in CT, LDL levels, and CT/HDL ratio, and it is more pronounced after WR.


Assuntos
Doenças Cardiovasculares , Dislipidemias , Inibidores de Hidroximetilglutaril-CoA Redutases , Idoso , HDL-Colesterol , LDL-Colesterol , Dislipidemias/tratamento farmacológico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico
3.
Zhonghua Gan Zang Bing Za Zhi ; 29(7): 696-701, 2021 Jul 20.
Artigo em Chinês | MEDLINE | ID: mdl-34371542

RESUMO

Objective: To evaluate the relationship between the application of statins and the risk of hepatocellular carcinoma in patients with chronic liver disease. Methods: PubMed, the Cochrane Library, EMBASE, Web of science, WeiPu, Wanfang Med online, and China National Knowledge Infrastructure database were searched. The literatures about statins and the risk of hepatocellular carcinoma in patients with chronic liver disease were collected, with a search deadline of February 2020. Two researchers independently conducted literature screening, data extraction, quality evaluation and proofreading. RevMan5.3 software was used for data analysis. The I2 combined with χ (2) test was used to evaluate the heterogeneity. Funnel plots were used to evaluate the publication bias of the included literature. Results: A total of 12 articles were included. Statins application had significantly reduced the risk of hepatocellular carcinoma in patients with chronic liver disease (OR = 0.50, 95% CI: 0.43~0.58, P < 0.01). Subgroup analysis showed that statins had reduced the incidence rate of hepatocellular carcinoma in patients with chronic hepatitis B (OR = 0.56, 95% CI: 0.47~0.66, P < 0.01) and chronic hepatitis C (OR = 0.56, 95% CI: 0.45~0.71, P < 0.01). Lipophilic statins had significantly reduced the risk of chronic liver disease development to hepatocellular carcinoma (OR = 0.48, 95% CI: 0.39~0.59, P < 0.01), but hydrophilic statins did not reduce the incidence rate of chronic liver disease development to hepatocellular carcinoma, and the difference was not statistically significant (OR = 0.64, 95% CI: 0.36~1.14, P = 0.13). Conclusion: Statins can effectively reduce the risk of hepatocellular carcinoma development in patients with chronic liver disease, including chronic hepatitis B and C. Among them, the lipophilic statins have a significant preventive effect on the development of chronic liver disease to hepatocellular carcinoma, but hydrophilic statins have no obvious effect.


Assuntos
Carcinoma Hepatocelular , Hepatite B Crônica , Hepatite C Crônica , Inibidores de Hidroximetilglutaril-CoA Redutases , Neoplasias Hepáticas , Carcinoma Hepatocelular/epidemiologia , Carcinoma Hepatocelular/prevenção & controle , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Neoplasias Hepáticas/epidemiologia , Neoplasias Hepáticas/prevenção & controle
4.
Acta Oncol ; 60(9): 1146-1153, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34338111

RESUMO

BACKGROUND: The prognosis of pancreatic cancer is poor and new treatment strategies are urgently needed. To identify non-cancer drugs that could be re-purposed for cancer, we investigated the association between the use of selected drugs and cancer-specific mortality in a nationwide cohort of pancreatic cancer patients. MATERIAL AND METHODS: The study is based on linkage between the Cancer Registry of Norway and the Norwegian Prescription Database, comprising 2614 pancreatic cancer patients diagnosed between 2007 and 2014. We evaluated the association between use at diagnosis of a pre-defined list of non-cancer drugs, including metformin, antihypertensives, and statins, and pancreatic cancer-specific mortality, using Cox regression. Patients were defined as users of a particular drug if it was prescribed before diagnosis, and the prescription covered the date of diagnosis. RESULTS: In total, 2096 (80.2%) patients died from pancreatic cancer; median survival was 6 months. Statin users (n = 621) had lower mortality (hazard ratio (HR): 0.86; 95% confidence interval (CI) 0.76-0.97) compared to non-users (n = 1993). This association was more pronounced (P-heterogeneity 0.062) in users of hydrophilic (n = 37, HR: 0.61; 95% CI 0.42-0.90) than lipophilic (n = 587, HR: 0.87; 95% CI 0.78-0.98) statins. An indication for lower mortality (HR: 0.85; 95% CI 0.69-1.05) was observed in users of non-selective beta-blockers (n = 113) compared to non-users (n = 2501). Notably, when compared to users of other antihypertensives (n = 643), users of non-selective beta-blockers (n = 40) had lower mortality (HR 0.67; 95% CI 0.47-0.96). The use of other drugs, including selective beta-blockers and metformin, was not associated with mortality. CONCLUSION: The findings suggest an association between the use of statins and non-selective beta-blockers and reduced pancreatic cancer mortality, and add to the literature supporting the design of randomised clinical trials to evaluate those drugs in the management of pancreatic cancer.


Assuntos
Adenocarcinoma , Inibidores de Hidroximetilglutaril-CoA Redutases , Metformina , Neoplasias Pancreáticas , Adenocarcinoma/tratamento farmacológico , Estudos de Coortes , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Metformina/uso terapêutico , Neoplasias Pancreáticas/tratamento farmacológico , Sistema de Registros
5.
Artigo em Inglês | MEDLINE | ID: mdl-34444440

RESUMO

The protective effects of statins against inner ear diseases have been suggested. This study investigated the relationship between previous statin use and the occurrence of Meniere's disease (MD). Participants ≥40 years old in the Korean National Health Insurance Service-Health Screening Cohort 2002-2015 were enrolled. A total of 7734 MD participants were matched with 38,670 comparison participants. The dates of statin prescriptions for the 2 years before the onset of MD were examined. A conditional logistic regression analysis was performed to estimate the odds ratios (ORs) of statin use for MD. Regarding the different types of statins, lipophilic statins, but not hydrophilic statins, were associated with lower odds of MD in the <65 year-old group (adjusted OR = 0.81, 95% CI = 0.68-0.97, p = 0.023). Prior statin use did not show association with MD in the adult population. Regarding the different types of statins, lipophilic statin use was related to a lower rate of MD in a middle-aged population.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Doença de Meniere , Adulto , Idoso , Estudos de Casos e Controles , Estudos de Coortes , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Doença de Meniere/epidemiologia , Pessoa de Meia-Idade , Programas Nacionais de Saúde
7.
Int J Mol Sci ; 22(13)2021 Jul 03.
Artigo em Inglês | MEDLINE | ID: mdl-34281247

RESUMO

Background: Proprotein convertase subtilisin kexin type 9 inhibitors (PCSK9i) lower LDL-cholesterol and slow atherosclerosis preventing cardiovascular events. While it is known that circulating PCSK9 enhances platelet activation (PA) and that PCSK9i reduce it, the underlying mechanism is not still clarified. Methods: In a multicenter before-after study in 80 heterozygous familial hypercholesterolemia (HeFH) patients on treatment with maximum tolerated statin dose ± ezetimibe, PA, soluble-NOX2-derived peptide (sNOX2-dp), and oxidized-LDL (ox-LDL) were measured before and after six months of PCSK9i treatment. In vitro study investigates the effects of plasma from HeFH patients before and after PCK9i on PA in washed platelets (wPLTs) from healthy subjects. Results: Compared to baseline, PCSK9i reduced the serum levels of LDL-c, ox-LDL, Thromboxane (Tx) B2, sNOX2-dp, and PCSK9 (p < 0.001). The decrease of TxB2 correlates with that of ox-LDL, while ox-LDL reduction correlated with PCSK9 and sNOX2-dp delta. In vitro study demonstrated that wPLTs resuspended in plasma from HeFH after PCSK9i treatment induced lower PA and sNOX2-dp release than those obtained using plasma before PCSK9i treatment. This reduction was vanished by adding ox-LDL. ox-LDL-induced PA was blunted by CD36, LOX1, and NOX2 inhibition. Conclusions: PCSK9i treatment reduces PA modulating NOX2 activity and in turn ox-LDL formation in HeFH patients.


Assuntos
Hiperlipoproteinemia Tipo II/tratamento farmacológico , Ativação Plaquetária/efeitos dos fármacos , Pró-Proteína Convertase 9/antagonistas & inibidores , Pró-Proteína Convertase 9/metabolismo , Adulto , Idoso , Anticorpos Monoclonais/efeitos adversos , Anticorpos Monoclonais Humanizados/efeitos adversos , Anticolesterolemiantes/efeitos adversos , LDL-Colesterol/análise , LDL-Colesterol/sangue , Ezetimiba/uso terapêutico , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hiperlipoproteinemia Tipo II/genética , Itália , Lipoproteínas LDL/análise , Lipoproteínas LDL/efeitos dos fármacos , Lipoproteínas LDL/metabolismo , Masculino , Pessoa de Meia-Idade , NADPH Oxidase 2/análise , NADPH Oxidase 2/sangue , Pró-Proteína Convertase 9/genética
8.
PLoS One ; 16(7): e0254635, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34264974

RESUMO

BACKGROUND: Statins have anti-inflammatory and immunomodulatory effects that may reduce the severity of coronavirus disease 2019 (COVID-19), in which organ dysfunction is mediated by severe inflammation. Large studies with diverse populations evaluating statin use and outcomes in COVID-19 are lacking. METHODS AND RESULTS: We used data from 10,541 patients hospitalized with COVID-19 through September 2020 at 104 US hospitals enrolled in the American Heart Association's COVID-19 Cardiovascular Disease (CVD) Registry to evaluate the associations between statin use and outcomes. Prior to admission, 42% of subjects (n = 4,449) used statins (7% on statins alone, 35% on statins plus anti-hypertensives). Death (or discharge to hospice) occurred in 2,212 subjects (21%). Outpatient use of statins, either alone or with anti-hypertensives, was associated with a reduced risk of death (adjusted odds ratio [aOR] 0.59, 95% CI 0.50-0.69), adjusting for demographic characteristics, insurance status, hospital site, and concurrent medications by logistic regression. In propensity-matched analyses, use of statins and/or anti-hypertensives was associated with a reduced risk of death among those with a history of CVD and/or hypertension (aOR 0.68, 95% CI 0.58-0.81). An observed 16% reduction in odds of death among those without CVD and/or hypertension was not statistically significant. CONCLUSIONS: Patients taking statins prior to hospitalization for COVID-19 had substantially lower odds of death, primarily among individuals with a history of CVD and/or hypertension. These observations support the continuation and aggressive initiation of statin and anti-hypertensive therapies among patients at risk for COVID-19, if these treatments are indicated based upon underlying medical conditions.


Assuntos
Anti-Hipertensivos/administração & dosagem , COVID-19/epidemiologia , Doenças Cardiovasculares/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Sistema de Registros/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , American Heart Association , Anti-Hipertensivos/uso terapêutico , COVID-19/mortalidade , Doenças Cardiovasculares/tratamento farmacológico , Uso de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Grupos Populacionais/estatística & dados numéricos , Estados Unidos
9.
Neurosci Biobehav Rev ; 128: 693-708, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34265321

RESUMO

Statins (3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors) treat dyslipidaemia and cardiovascular disease by inhibiting cholesterol biosynthesis. They also have immunomodulatory and anti-inflammatory properties. Beyond cardiovascular disease, cholesterol and inflammation appear to be components of the pathogenesis and pathophysiology of neuropsychiatric disorders. Statins may therefore afford some therapeutic benefit in mood disorders. In this paper, we review the pathophysiology of mood disorders with a focus on pharmacologically relevant pathways, using major depressive disorder and bipolar disorder as exemplars. Statins are discussed in the context of these disorders, with particular focus on the putative mechanisms involved in their anti-inflammatory and immunomodulatory effects. Recent clinical data suggest that statins may have antidepressant properties, however given their interactions with many known biological pathways, it has not been fully elucidated which of these are the major determinants of clinical outcomes in mood disorders. Moreover, it remains unclear what the appropriate dose, or appropriate patient phenotype for adjunctive treatment may be. High quality randomised control trials in concert with complementary biological investigations are needed if the potential clinical effects of statins on mood disorders, as well as their biological correlates, are to be better understood.


Assuntos
Transtorno Bipolar , Transtorno Depressivo Maior , Inibidores de Hidroximetilglutaril-CoA Redutases , Antidepressivos/uso terapêutico , Transtorno Bipolar/tratamento farmacológico , Transtorno Depressivo Maior/tratamento farmacológico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/farmacologia , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Transtornos do Humor/tratamento farmacológico
10.
Atherosclerosis ; 330: 114-121, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34243953

RESUMO

BACKGROUND AND AIMS: Statin therapy is administered to patients with high cardiovascular risk. These patients are also at risk for severe course of coronavirus disease 2019 (COVID-19). Statins exhibit not only cardioprotective but also immunomodulatory and anti-inflammatory effects. This study performed a systematic review of published evidence regarding statin treatment and COVID-19 related mortality. METHODS: A systematic PubMed/Embase search was performed from February 10, 2020 until March 05, 2021 for studies in COVID-19 patients that reported adjusted hazard or odds ratio for death in statin users versus non-users. RESULTS: 22 studies fulfilled the inclusion criteria and were included in the systematic review. Meta-analysis of 10 studies (n = 41,807, weighted age 56 ± 8 years, men 51%, hypertension 34%, diabetes 21%, statin users 14%) that reported adjusted hazard ratios for mortality in statin users versus non-users showed pooled estimate at 0.65 (95% confidence intervals [CI] 0.53, 0.81). Meta-analysis of 6 studies that reported continuation of statin therapy during hospitalization (58-100% of patients) revealed a pooled hazard ratio of 0.54 (95% CI 0.47, 0.62). Meta-analysis of 12 studies (n = 72,881, weighted age 65 ± 2 years, men 54%, hypertension 66%, diabetes 43%, statin users 30%) that reported adjusted odds ratios for mortality showed pooled estimate at 0.65 (95% CI 0.55, 0.78). Multivariable meta-regression analysis did not reveal any significant association of hazard or odds ratios with anthropometric characteristics or comorbidities. CONCLUSIONS: This meta-analysis of retrospective observational studies showed that statin therapy was associated with an about 35% decrease in the adjusted risk of mortality in hospitalized COVID-19 patients.


Assuntos
COVID-19 , Diabetes Mellitus , Inibidores de Hidroximetilglutaril-CoA Redutases , Idoso , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , SARS-CoV-2
11.
Int Heart J ; 62(4): 872-878, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34276016

RESUMO

Little is known about the association between limb prognosis in peripheral artery disease and apolipoprotein E (apoE). We evaluated the long-term impact of apoE on adverse limb events in patients with intermittent claudication receiving statin treatment.A total of 218 consecutive patients (mean age, 73 ± 8 years; 81% men) with intermittent claudication who underwent their first intervention between 2009 and 2020 were included in this study. All patients had achieved LDL-C < 100 mg/dL on statin treatment and were divided into two groups based on the apoE value (≥ 4.7 or < 4.7 mg/dL). We evaluated the incidence of major adverse limb events (MALEs), including vessel revascularization and limb ischemia development.A total of 39 and 179 patients were allocated to the higher and lower apoE groups, respectively. Compared to the lower apoE group, the higher apoE group had a significantly higher total cholesterol level, triglyceride level, and non-high-density lipoprotein cholesterol level. During the median follow-up period of 3.6 years, 30 patients (13.8%) developed MALEs. Kaplan-Meier analysis revealed that the cumulative incidence of MALEs in the higher apoE group was significantly higher than that in the lower apoE group (44.0% versus 21.6%, log-rank test, P = 0.002). During multivariable Cox hazard analysis, higher apoE level (≥ 4.7 mg/dL) (hazard ratio, 2.61; 95% confidence interval, 1.18-5.70, P = 0.019) was the only strong independent predictor of MALEs.ApoE levels could be a strong predictor and residual risk for long-term limb prognosis in patients with intermittent claudication and achieving LDL-C < 100 mg/dL with statin treatment.


Assuntos
Apolipoproteínas E/sangue , Procedimentos Endovasculares , Extremidades/irrigação sanguínea , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Claudicação Intermitente/complicações , Doença Arterial Periférica/complicações , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Claudicação Intermitente/sangue , Masculino , Doença Arterial Periférica/sangue , Doença Arterial Periférica/terapia , Estudos Retrospectivos
12.
Biomed Res Int ; 2021: 9995073, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34250095

RESUMO

Statins can help COVID-19 patients' treatment because of their involvement in angiotensin-converting enzyme-2. The main objective of this study is to evaluate the impact of statins on COVID-19 severity for people who have been taking statins before COVID-19 infection. The examined research patients include people that had taken three types of statins consisting of Atorvastatin, Simvastatin, and Rosuvastatin. The case study includes 561 patients admitted to the Razi Hospital in Ghaemshahr, Iran, during February and March 2020. The illness severity was encoded based on the respiratory rate, oxygen saturation, systolic pressure, and diastolic pressure in five categories: mild, medium, severe, critical, and death. Since 69.23% of participants were in mild severity condition, the results showed the positive effect of Simvastatin on COVID-19 severity for people that take Simvastatin before being infected by the COVID-19 virus. Also, systolic pressure for this case study is 137.31, which is higher than that of the total patients. Another result of this study is that Simvastatin takers have an average of 95.77 mmHg O2Sat; however, the O2Sat is 92.42, which is medium severity for evaluating the entire case study. In the rest of this paper, we used machine learning approaches to diagnose COVID-19 patients' severity based on clinical features. Results indicated that the decision tree method could predict patients' illness severity with 87.9% accuracy. Other methods, including the K-nearest neighbors (KNN) algorithm, support vector machine (SVM), Naïve Bayes classifier, and discriminant analysis, showed accuracy levels of 80%, 68.8%, 61.1%, and 85.1%, respectively.


Assuntos
COVID-19 , Prescrições de Medicamentos/estatística & dados numéricos , Inibidores de Hidroximetilglutaril-CoA Redutases , Idoso , Algoritmos , Atorvastatina/administração & dosagem , Atorvastatina/uso terapêutico , COVID-19/epidemiologia , COVID-19/fisiopatologia , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Hipercolesterolemia/tratamento farmacológico , Irã (Geográfico) , Aprendizado de Máquina , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Rosuvastatina Cálcica/administração & dosagem , Rosuvastatina Cálcica/uso terapêutico , Índice de Gravidade de Doença , Sinvastatina/administração & dosagem , Sinvastatina/uso terapêutico
13.
Medicina (Kaunas) ; 57(6)2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34200448

RESUMO

Background and Objectives: In this paper, we investigated the efficacy of statin therapy on cardiovascular disease (CVD) reduction in adults with no known underlying health conditions by undertaking a meta-analysis and systematic review of the current evidence. Materials and Methods: We performed a systematic search to identify Primary Prevention Randomized Controlled Trials (RCTs) that compared statins with a control group where CVD events or mortality were the primary end point. Identified RCTs were evaluated and classified into categories depending on relevance in order to determine which type of meta-analysis would be feasible. Results: No differences were observed between categories with the exception of relative risk for all CVD events combined which showed a 12% statistically significant difference favouring studies which were known to include participants without underlying health conditions. Strong negative correlations between number-need-to-treat (NNT) and LDL-C reduction were observed for all Coronary Heart Disease (CHD) outcomes combined and all CVD outcomes combined. Conclusions: This project highlights the need for further research on the effects of statins on participants who do not suffer from underlying health conditions, given that no such studies have been conducted.


Assuntos
Doenças Cardiovasculares , Doença das Coronárias , Inibidores de Hidroximetilglutaril-CoA Redutases , Adulto , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Doença das Coronárias/tratamento farmacológico , Doença das Coronárias/prevenção & controle , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prevenção Primária
14.
BMJ Open ; 11(7): e041673, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34272216

RESUMO

OBJECTIVE: To determine whether communicating personalised statin therapy-effects obtained by prognostic algorithm leads to lower decisional conflict associated with statin use in patients with stable cardiovascular disease (CVD) compared with standard (non-personalised) therapy-effects. DESIGN: Hypothesis-blinded, three-armed randomised controlled trial SETTING AND PARTICIPANTS: 303 statin users with stable CVD enrolled in a cohort INTERVENTION: Participants were randomised in a 1:1:1 ratio to standard practice (control-group) or one of two intervention arms. Intervention arms received standard practice plus (1) a personalised health profile, (2) educational videos and (3) a structured telephone consultation. Intervention arms received personalised estimates of prognostic changes associated with both discontinuation of current statin and intensification to the most potent statin type and dose (ie, atorvastatin 80 mg). Intervention arms differed in how these changes were expressed: either change in individual 10-year absolute CVD risk (iAR-group) or CVD-free life-expectancy (iLE-group) calculated with the SMART-REACH model (http://U-Prevent.com). OUTCOME: Primary outcome was patient decisional conflict score (DCS) after 1 month. The score varies from 0 (no conflict) to 100 (high conflict). Secondary outcomes were collected at 1 or 6 months: DCS, quality of life, illness perception, patient activation, patient perception of statin efficacy and shared decision-making, self-reported statin adherence, understanding of statin-therapy, post-randomisation low-density lipoprotein cholesterol level and physician opinion of the intervention. Outcomes are reported as median (25th- 75th percentile). RESULTS: Decisional conflict differed between the intervention arms: median control 27 (20-43), iAR-group 22 (11-30; p-value vs control 0.001) and iLE-group 25 (10-31; p-value vs control 0.021). No differences in secondary outcomes were observed. CONCLUSION: In patients with clinically manifest CVD, providing personalised estimations of treatment-effects resulted in a small but significant decrease in decisional conflict after 1 month. The results support the use of personalised predictions for supporting decision-making. TRIAL REGISTRATION: NTR6227/NL6080.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Doenças Cardiovasculares/tratamento farmacológico , Doenças Cardiovasculares/prevenção & controle , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Qualidade de Vida , Encaminhamento e Consulta , Telefone
15.
Rev Port Cardiol ; 40(7): 509-518, 2021 Jul.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34217584

RESUMO

Atrial fibrillation is the most common arrhythmia in adults and its prevalence is growing rapidly. It has been shown that AF is associated with increased risk of heart failure, ischemic and hemorrhagic stroke, and mortality. Hence, there is growing interest among researchers in seeking preventive and therapeutic interventions regarding AF. In recent decades, it has been suggested that statins may decrease the incidence of AF and may also decrease its recurrence after cardioversion and catheter ablation. These effects are thought to be mediated by different mechanisms such as modulating inflammation, altering the properties of transmembrane ion channels, interfering with activation of matrix metalloproteinases, and acting on endothelial function. In this article, we review and update current knowledge about the role of statins in primary and secondary prevention of AF in general and specific populations.


Assuntos
Fibrilação Atrial , Ablação por Cateter , Inibidores de Hidroximetilglutaril-CoA Redutases , Adulto , Antiarrítmicos/uso terapêutico , Fibrilação Atrial/cirurgia , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Recidiva , Fatores de Risco , Prevenção Secundária , Resultado do Tratamento
16.
J Affect Disord ; 293: 205-213, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34217957

RESUMO

BACKGROUND: Previous studies have indicated that statins can reduce the severity of depressive symptoms. However, the optimal choice of statin remains unclear. Therefore, we conducted a network meta-analysis to determine the optimal statin for treating depression. METHOD: We performed a pairwise and network meta-analysis by searching the PubMed, Embase, and Cochrane Library databases on October 29th, 2020. Eligible studies were randomized controlled trials that reported on changes in depressive symptoms. The Cochrane Collaboration tool was used to assess risk of bias. We tested for possible inconsistency globally by using a χ2-test and locally by calculating inconsistency factors for each comparison in closed loops. The ranking probabilities of being at each possible rank for each intervention were estimated. Comparison-adjusted funnel plots were obtained to assess publication bias. Sensitivity analysis was also performed. RESULTS: We identified 13 studies that matched our inclusion criteria. The risks of bias were mostly low. None of the global or local tests found significance. Compared with placebo, atorvastatin significantly reduced the severity of depressive symptoms (mean difference -3.46, 95% confidence interval -5.26 to -1.67). Atorvastatin had the first and second rank with probabilities of 44.9% and 39.0%, respectively. Comparison-adjusted funnel plots revealed no significant publication bias. LIMITATIONS: Low similarity of included studies and a relative large treatment effect of a single study were observed. CONCLUSIONS: In this first network meta-analysis, atorvastatin, with high intensity and a lipophilic effect, was identified as the optimal choice of statin for treating depression.


Assuntos
Inibidores de Hidroximetilglutaril-CoA Redutases , Atorvastatina , Depressão/tratamento farmacológico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Metanálise em Rede
17.
Ann Palliat Med ; 10(6): 6793-6803, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34237978

RESUMO

BACKGROUND: It was a meta-analysis on the efficacy of statins in the treatment of atherosclerosis. METHODS: The PubMed, Medline, Embase, Web of Sciences, and other Chinese and English databases were used to retrieve literature on randomized controlled trials (RCTs) of statins in the treatment of atherosclerosis, published from January 2000 to January 2021. The Cochrane Handbook for Systematic Reviews of Intervention 5.0.2 was used to conduct bias risk assessment, and Review Manager 5.3 software (RevMan) was used for meta-analysis. RESULTS: A total of 12 articles with 1,180 participants were included in the meta-analysis. In the observation group, the plaque area [mean difference (MD) =-1.21; 95% confidence interval (CI): -2.03 to -0.38; Z =2.87; P=0.004], total cholesterol (TC) level (MD =-0.72; 95% CI: -1.01 to -0.43; Z =4.83; P<0.00001), triglyceride (TG) level (MD =-0.43; 95% CI: -0.76 to -0.09; Z =2.51; P=0.01), and the low-density lipoprotein (LDL-C) level (MD =-0.79; 95% CI: -1.41 to -0.18; Z =2.54; P=0.01) were lower, while the clinical effective rate (MD =3.64; 95% CI: 1.39 to 9.53; Z =2.64; P=0.008) was higher, and the difference was notable. No notable difference was noted in intra-media thickness (IMT) (MD =-0.41; 95% CI: -0.88 to -0.06; Z =1.7; P=0.09), hypersensitive C-reactive protein (hs-CRP) level (MD =-1.61; 95% CI: -3.59 to 0.37; Z =1.7; P=0.09), and high-density lipoprotein (HDL-C) level (MD =0.14; 95% CI: -0.02 to 0.30; Z =2.54; P=0.09) between the 2 groups. DISCUSSION: The use of statins in the treatment of atherosclerosis can reduce the levels of TC, TG, and LDL-C, mitigate clinical symptoms, and reduce blood lipids with good efficacy.


Assuntos
Aterosclerose , Inibidores de Hidroximetilglutaril-CoA Redutases , Aterosclerose/tratamento farmacológico , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lipoproteínas LDL , Ensaios Clínicos Controlados Aleatórios como Assunto
18.
Cardiovasc Toxicol ; 21(10): 781-789, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34255300

RESUMO

Since the onset of the global COVID-19 pandemic, there has been much discussion about the advantages and disadvantages of ongoing chronic drug therapies in SARS-CoV-2-positive patients. These discussions include also statins treatment. The statins are among the most widely used drugs in the global population. Statins aim to lower cholesterol, which is essential for many biological processes but can lead to heart disease if levels are too high; however, also the pleiotropic effects of statins are well known. So could the anti-inflammatory or the potential antiviral effects of statins be helpful in avoiding extreme inflammation and severity in COVID-19? To date, there are conflicting opinions on the effects of statins in the course of COVID-19 infection. The aim of this article is to describe the molecular and pharmacological basis of the pleiotropic effects of statins that could be more involved in the fight against COVID-19 infection and to investigate the current epidemiological evidence in the literature on the current and important topic.


Assuntos
Anti-Inflamatórios/uso terapêutico , Antivirais/uso terapêutico , COVID-19/tratamento farmacológico , Cardiopatias/tratamento farmacológico , Coração/efeitos dos fármacos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , SARS-CoV-2/efeitos dos fármacos , Animais , Anti-Inflamatórios/efeitos adversos , Antivirais/efeitos adversos , COVID-19/epidemiologia , COVID-19/fisiopatologia , COVID-19/virologia , Coração/fisiopatologia , Coração/virologia , Cardiopatias/epidemiologia , Cardiopatias/fisiopatologia , Cardiopatias/virologia , Interações Hospedeiro-Patógeno , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , SARS-CoV-2/patogenicidade , Resultado do Tratamento
19.
J Stroke Cerebrovasc Dis ; 30(9): 105956, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217070

RESUMO

BACKGROUND: Leukoaraiosis (LA) is a finding in the elderly, that might be asymptomatic or can impact their motor and cognitive functions. We studied the presence of LA in the MRI of patients with AIS and its impact on functional outcome at 3 months. METHODS: 500 consecutive patients diagnosed as AIS were enrolled. Medical history included pre-medication by antiplatelets or statins, and vascular risk factors were reported by history and laboratory investigations. Severity of stroke was assessed by NIHSS and stroke outcome was evaluated on discharge and at 3 months by modified Rankin scale (mRS). LA was diagnosed by MRI-FLAIR sequence and delineated from acute infarction by diffusion-weighted image. And accordingly, patients were divided into group A (absent LA) and group B (present LA). RESULTS: 460 patients completed the study, with 53% of patients on antiplatelet therapy and 11.7% on statins prior to stroke. The percentage of patients with LA was significantly more than those without LA. Patients with LA showed a significantly higher age, more frequent and longer duration of diabetes and hypertension, ischemic heart disease, previous stroke/TIA and antiplatelet intake. Microbleeds were more and mRS was worse in LA group. CONCLUSION: The presence of LA in the background MRI of AIS patients is accompanied by the presence of more risk factors, and unfavorable outcome. Pre-medication with antiplatelets did not prevent the incidence of a new stroke especially in LA group. This might necessitate the identification of some medication for secondary prevention in patients with small vessel disease.


Assuntos
Imagem de Difusão por Ressonância Magnética , Avaliação da Deficiência , AVC Isquêmico/diagnóstico , Leucoaraiose/diagnóstico por imagem , Idoso , Estudos Transversais , Egito/epidemiologia , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Incidência , Hemorragias Intracranianas/etiologia , AVC Isquêmico/epidemiologia , AVC Isquêmico/fisiopatologia , AVC Isquêmico/terapia , Leucoaraiose/epidemiologia , Leucoaraiose/fisiopatologia , Leucoaraiose/terapia , Masculino , Pessoa de Meia-Idade , Inibidores da Agregação Plaquetária/uso terapêutico , Valor Preditivo dos Testes , Prognóstico , Recidiva , Medição de Risco , Fatores de Risco , Índice de Gravidade de Doença
20.
Curr Cardiol Rep ; 23(9): 116, 2021 07 16.
Artigo em Inglês | MEDLINE | ID: mdl-34269897

RESUMO

PURPOSE OF REVIEW: The 2015 American College of Cardiology (ACC)/American Heart Association (AHA) Focused Update of Secondary Prevention Lipid Performance Measures removed low-density lipoprotein cholesterol (LDL-C) assessment as a performance measure. This review discusses the evidence supporting the importance of lipid monitoring in the secondary prevention of atherosclerotic cardiovascular disease (ASCVD). RECENT FINDINGS: The 2018 AHA/ACC Multisociety cholesterol guideline (as did the 2013 guideline) recommends a lipid panel after initiating lipid-lowering therapy to monitor adherence and medication efficacy. The 2018 guideline also recommends adding nonstatin therapy in very-high-risk ASCVD patients with LDL-C ≥70 mg/dL despite maximally tolerated statin therapy. The removal of LDL-C monitoring as a performance measure is not consistent with the 2018 cholesterol guidelines. Given the importance of monitoring lipid-lowering medication efficacy and adherence and optimally reducing LDL-C in very-high-risk patients with additional evidence-based nonstatin therapy, LDL-C assessment after initiating lipid-lowering therapy should be reinstated as a performance measure for patients with ASCVD.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , American Heart Association , Colesterol , LDL-Colesterol , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Lipídeos , Fatores de Risco , Estados Unidos
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