NEWS & PERSPECTIVE
Preventative statin therapy reduces AHF and mortality in patients with ACS as the first manifestation of ASCVD
Mixed data have been observed on the role of statins in the preventative setting of cardiovascular disease (CVD).1 However, Dr. Raffaele Bugiardini, Department of Experimental, Diagnostic, and Specialty Medicine, University of Bologna, Italy and his colleagues conducted a recent study published in the Journal of the American College of Cardiology, which demonstrated evidence that receiving statin therapy before initial acute coronary syndrome (ACS) could reduce acute heart failure (AHF) and improve patient survival rates.2
As the prevention of AHF and mortality is a major public health concern, statin therapy has been proved to be safe and significantly contributes to the reduction of atherosclerotic cardiovascular disease (ASCVD) in North America and Europe.2-4 Also, statin therapy has been shown to be efficacious in reducing ASCVD in both men and women in a secondary preventative setting, but its efficacy for primary prevention is limited.1,5
In this study, data were collected and analyzed from 14,542 patient archives from 2 clinical registries: the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) (41 centers in 12 countries, including Bosnia-Herzegovina, Croatia, Italy, Kosovo, Lithuania, Macedonia, Hungary, Moldova, Montenegro and Romania, Russia Federation and Serbia); and the EMMACE-3X (Long-term Follow-up of Health-Related Quality of Life in Patients with Acute Coronary-Syndrome) (47 hospitals in the United Kingdom).2 Individuals diagnosed with ACS without a previous history of ASCVD events were included in the study, dated October 2010 to January 2019.2
The key outcome measure was the frequency of AHF on admission for ACS as the first incidence of ASCVD.2 Analysis also covered the correlation of AHF with mortality occurred at 30 days from admission.2 Additionally, to examine the complex association between AHF after ACS and mortality, the investigators identified ST-segment elevation myocardial infarction (STEMI) as a further indicator of outcome.2
Divided into 2 groups of statin users vs. statin non-users, patients were compared by using inverse probability weighting models.2 Analysis centered on the interaction, if any, between statin therapy and the baseline characteristics.2 The baseline characteristics were expressed as percentages for categorical variables and mean ± standard deviation (SD) for continuous variables.2 The correlation between AHF on admission and the 30-day mortality window was examined by logistic regression analyses.2 The main outcome measures were the occurrence of AHF corresponding to Killip class and the rate of 30-day all-cause mortality in individuals presenting with AHF.2
The results showed that 12.6% (n=1,824) of participants were statin users, who had the following baseline characteristics: were often former smokers, had greater body mass index (BMI), more frequently had diabetes, hypertension and hypercholesteremia, and were more likely to have received concomitant evidence-based medications before hospital admission.2
Prior statin use had a significant decreased occurrence of AHF at the time of ACS admission (absolute difference: 4.3%; RR=0.72; 95% CI: 0.62-0.83), regardless of younger (40-75 years) or older age (interaction p=0.27) and gender (interaction p=0.22).2 Prior statin use predicted a lower risk of 30-day mortality in statin users vs. statin non-users (15.5% vs. 20.7%; RR=0.71; 95% CI: 0.50-0.99).2 This advantage was not seen in patients without AHF on admission.2 Prior statin use correlated with a significantly lower risk of presenting with STEMI (RR=0.64; 95% CI: 0.58-0.71).2
Besides, the absolute risk of developing AHF on hospital admission of ACS decreased by approximately 4%.2 Notably, it was found that statin use predicted a lower risk of 30-day mortality in individuals presenting with AHF on admission after ACS (5.2% absolute risk and 29% RR reduction).2 This is an important finding because it provides additional data on the mechanistic process correlating statin therapy to a reduction in mortality due to ASCVD.2
In conclusion, there are 2 benefits of statin therapy, i.e., a reduced percentage of patients having AHF on admission; and statin users with AHF on presentation with ACS had reduced mortality, as compared with statin non-users with AHF on presentation with ACS.2 Thus, previous statin therapy in patients presenting with ACS as the first manifestation of ASCVD was associated with a reduced risk of AHF and improved patient survival from AHF.2 This knowledge may be beneficial to individuals who do not have established CVD, but may be at the risk of future CVD events, in terms of treating them with statins in a preventative primary setting.1
Hysterectomy-induced menopause linked to a higher risk of CVD and stroke among Korean women
A Korean population-based observational study has determined that women who experienced early menopause due to hysterectomy are 25% more suspectable to cardiovascular diseases compared to their non-hysterectomy counterparts.
Long-term safety of inclisiran among high-risk CVS patients demonstrated in a pooled safety analysis
Inclisiran is a first-in-class small interfering ribonucleic acid (siRNA) targeting hepatic proprotein convertase subtilisin/kexin type 9 (PCSK9) and lowering low-density lipoprotein-cholesterol (LDL-C).1 Administered subcutaneously at a dose of 284mg initially, at 3 months, and every 6 months there
Semaglutide gains FDA approval for treating obesity in adolescents aged ≥12 years
Semaglutide, a glucagon-like peptide-1 (GLP-1) analog that aids in weight loss by suppressing appetite, has recently gained approval from the United States (US) Food and Drug Administration (FDA) to treat obesity in children aged ≥12 years.1,2 The approval was based on the positive findings of a rec
A local case sharing: earlier evolocumab for better long-term outcomes in patients with established ASCVD
Atherosclerotic cardiovascular disease (ASCVD) continuesto be a leading cause of morbidity and mortality worldwide,with over 17.9 million people dying from cardiovascular (CV)diseases annually.1,2 Given the fact that the recurrent riskis high among patients with established ASCVD, secondarypreventio
Comparing the newly FDA-approved tirzepatide with insulin glargine in T2DM patients at high CV risk: The SURPASS-4 trial
Tirzepatide was approved by the U.S. Food and Drug Administration (FDA) on May 13, 2022 as the first and only dual glucose-dependent insulinotropic polypeptide (GIP) and glucagon-like peptide 1 (GLP-1) receptor agonist for type 2 diabetes mellitus (T2DM), given its potent glucose-lowering effects.1
The PACMAN-AMI trial: Alirocumab improves coronary atherosclerosis plaques in AMI patients
Acute myocardial infarction (AMI) is caused by large coronary plaques characterized by a lipid-rich pool covered by a thin fibrous cap, and visualized by intracoronary imaging.1 Alirocumab, a PCSK9 inhibitor, lowers low-density lipoprotein cholesterol (LDL-C) and reduces the risk of major cardiovascular (CV) events in stabilized acute coronary syndrome (ACS) patients.1 However, these patients remain at an increased risk of recurrent thrombosis due to high-risk plaques.1
Rapid CABG trial supports early surgical strategy 2-3 days after ticagrelor cessation in ACS management
Ticagrelor continues to be one of the often-used antiplatelet drugs in the management of acute coronary syndrome (ACS), however only 10% of the ACS patients treated with ticagrelor require coronary artery bypass surgery (CABG) due to perioperative bleeding.1 The current North American guidelines (Including ACC/AHA) advocate a waiting period of at least 5 days after ticagrelor cessation prior to non-urgent CABG, and the 2017 European Society of Cardiology (ESC) guidelines also recommend a waiting period of at least 3 days after ticagrelor cessation for non-urgent CABG. However, from the real-life clinical point of view, it is hypothesized that early surgery is noninferior to delayed surgery for severe or massive perioperative bleeding. Therefore, the RAPID CABG trial, a physician initiated multi-centre randomized study, was conducted to evaluate the safety of early CABG surgery after a shorter ticagrelor cessation of 2 to 3 days as compared to 5 to 7 days prior CABG, among 143 patients presenting with ACS who require non emergent CABG.1 Primary endpoint was severe/ massive bleeding by the Universal Definition of Perioperative Bleeding (UDPB): Class 3 or 4.
The results from a 6-month follow-up of RAPID CABG trial indicated patients could discontinue ticagrelor 2 to 3 days prior to CABG without increasing the risk of early post-surgical bleeding and could also reduce the average length of hospital stay.
A local case sharing: Key strategies to identify statin intolerance followed by aggressive lipid-lowering treatment
High levels of low-density lipoprotein cholesterol (LDL-C) is a potent risk factor for atherosclerotic cardiovascular disease that contributes to approximately 45% of all heart attacks.1 While statins remain the cornerstone therapy for dyslipidemia and are generally well-tolerated, 25-30% of patients would show some forms of statin intolerance resulting in treatment discontinuation.2 As lipid-lowering treatment discontinuation may increase the risk of cardiovascular events, it is clinically important to make a correct diagnosis of statin intolerance to prevent the worsening of cardiovascular outcomes.3 In a recent interview with Omnihealth Practice, Dr. Yuan Gao, Specialist in Neurology, Queen Mary Hospital, shared the critical components of assessing statin intolerance and the need to switch to a non-statin alternative such as proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) regimen if aggressive lipid-lowering treatment is required.
Latest guideline addresses the gap in managing adult stage 1 hypertension with a low 10-year ASCVD risk
The 2017 Hypertension Clinical Practice Guideline issued by the American College of Cardiology/American Heart Association (ACC/AHA) Task Force outlined the general blood pressure (BP) management approach to adults with stage 1 hypertension and a 10-year risk for atherosclerotic cardiovascular diseas