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Statins Are Independently Associated with Reduced Mortality in Patients Undergoing Infrainguinal Bypass Graft Surgery for Critical Limb Ischemia
Published in Juan Carlos Jimenez, Samuel Eric Wilson, 50 Landmark Papers Every Vascular and Endovascular Surgeon Should Know, 2020
Juan Carlos Jimenez, Samuel Eric Wilson
Relevant StudiesHeart Protection Study4,5: Statins demonstrated to confer 22% relative risk reduction in major vascular events in patients with peripheral arterial disease, broadly defined as “intermittent claudication, previous arterial revascularization, amputation, or aneurysm repair.”
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Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Both hypertension and hypercholesterolaemia are risk factors for cardiovascular disease. Statins are commonly used to lower cholesterol levels in patients whose levels are too high, following an MI and in those that are at high risk of cardiovascular disease. The West of Scotland Coronary Prevention Trial found that taking a statin daily reduces the incidence of primary cardiac events in those with no signs of cardiac disease by up to one third. The Heart Protection Study later found that those known to be high risk for developing cardiac disease but have normal cholesterol also benefit from taking statins. They are generally well tolerated, although some patients complain of muscular aches and pains, particularly of the legs. The main side effect of concern is reversible myositis, which causes severe muscle pains, a raised creatinine kinase (CK) and may lead to rhabdomyolysis.
Management of the older patient after myocardial infarction
Published in Wilbert S. Aronow, Jerome L. Fleg, Michael W. Rich, Tresch and Aronow’s Cardiovascular Disease in the Elderly, 2019
Howard A. Cooper, Julio A. Panza, Wilbert S. Aronow
In the Heart Protection Study, 3500 persons had initial serum LDL-C levels less than 100 mg/dL (53). Decrease of serum LDL-C from 97 mg/dL to 65 mg/dL by simvastatin in these persons caused a similar decrease in risk as did treating patients with higher serum LDL-C levels. The Heart Protection Study Investigators recommended treating persons at high risk for cardiovascular events with statins, regardless of the initial levels of serum lipids, age, or gender (53). In the Study Assessing Goals in the Elderly (SAGE), 893 ambulatory patients with CAD were randomized to atorvastatin 80 mg daily or to pravastatin 40 mg daily. At 1-year follow-up, compared with pravastatin, atorvastatin significantly reduced serum LDL-C and significantly reduced all-cause mortality by 67% (54).
An evidence-based review of neuronal cholesterol role in dementia and statins as a pharmacotherapy in reducing risk of dementia
Published in Expert Review of Neurotherapeutics, 2021
Siddhartha Dutta, Sayeeda Rahman, Rahnuma Ahmad, Tarun Kumar, Gitashree Dutta, Sudeshna Banerjee, Abdullahi Rabiu Abubakar, Adekunle Babajide Rowaiye, Sameer Dhingra, Velayutham Ravichandiran, Santosh Kumar, Paras Sharma, Mainul Haque, Jaykaran Charan
There is also evidence suggesting statin therapy does not prevent dementia. A study titled ‘The Lipitor’s Effect in Alzheimer’s Dementia (LEADe)’ [192] enrolled patients of mild-to-moderate AD who were on donepezil for dementia and were given atorvastatin. The researchers failed to find any observed difference in cognitive performance compared to the placebo [192,193]. A similar clinical trial named ‘Cholesterol-lowering Agent to Slow the Progression (CLASP) of AD Study’ (https://ichgcp.net/clinical-trials-registry/NCT00053599) revealed that randomized patients with mild-to-moderate AD received simvastatin with a follow-up of 18 months. Recipients failed to demonstrate any significant differences in cognitive performance and disease progression than placebo [161,194]. In another large trial tagged the ‘Heart Protection Study’ conducted in the United Kingdom by the Medical Research Council (MRC) and the British Heart Foundation (BHF), patients between 40 and 80 years were treated with a statin. A placebo was administered to assess dementia and cognitive impairment. At the end of the study, which spanned for about 5 years, they could not find any differences between the two groups [195].
Biochemical risk factors of atherosclerotic cardiovascular disease: from a narrow and controversial approach to an integral approach and precision medicine
Published in Expert Review of Cardiovascular Therapy, 2021
Arnoud van der Laarse, Christa M. Cobbaert
Diamond & Ravnskov noted that the directors of clinical trials make an effort of minimizing the significance of numerous adverse effects of statin treatment. That is caused by the policy of withdrawing a large number of eligible subjects from a study during the run-in period, probably because these subjects did not tolerate the adverse effects of the statin therapy [35]. As an example, they mentioned the British Heart Protection Study that was published in 2002 [36]. In this study, 26% of all eligible subjects were withdrawn from the study after being on simvastatin for 1 month before the formal initiation of the study. The major reason to withdraw was occurrence of muscle pain. In his Anitschkov lecture read during the congress of the European Atherosclerosis Society in 2021 Collins elegantly showed that inclusion or exclusion of eligible subjects from RCTs did not change the conclusion about the health effects of the statin being tested [37].
Evolving concepts on the management of dyslipidaemia
Published in Acta Clinica Belgica, 2020
Olivier S. Descamps, Ann Verhaegen, Fabien Demeure, Michel Langlois, Ernst Rietzschel, Ann Mertens, Johan De Sutter, Caroline Wallemacq, Patrizio Lancellotti, Guy De Backer
A question that arises from the causal association of LDL with ASCVD is ‘how low can we get for LDL-C and is there an LDL-C threshold for clinical benefit?’. The LDL-C limit (also called ‘target’) recommended in the past guidelines has evolved quite a lot over time. A quarter of a century ago, the 4S trial was the first modern trial on lipid-based ASCVD prevention in patients with established coronary disease [5]. These patients had high levels of LDL-C (around 190 mg/dL) and the reduction of LDL-C to the normal range (around 120 mg/dL) was associated with a significant benefit in terms of all-cause mortality and major coronary event. This allowed to conclude that ‘high is bad’ and that a reduction of high levels with simvastatin was effective and safe. The next question was then: “Should we also lower LDL-C in individuals with so-called average levels of LDL-C?” The idea that average (‘normal’ in terms of population distribution) is not ‘appropriate’ for the arterial wall was a tricky concept, different from what we know from many biological variables where the average level in the general population is the ideal level for health. A series of trials like ‘CARE’ [6] and ‘the Heart Protection Study’ [7] were thus carried out in individuals in secondary prevention with average levels of LDL-C (around 120–150 mg/dL). The significant benefit demonstrated in achieving LDL-C less than 100 mg/dl in these patients demonstrated that “average is not good” and supported the new target of <115 mg/dL in the 1998 European guidelines [8] then <100 mg/dl in the 2003 European guidelines [9].