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In individuals at intermediate risk for cardiovascular disease, treatment with rosuvastatin but not candesartan plus hydrochlorothiazide lowers cardiovascular disease event rates
Commentary on: Lonn EM, Bosch J, López-Jaramillo P, et al.. Blood-pressure lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:2009–20 . Yusuf S, Bosch J, Dagenais G, et al. Cholesterol lowering in intermediate-risk persons without cardiovascular disease. N Engl J Med 2016;374:2021–31. Context Cardiovascular diseases (CVD) are the number one cause of death globally: more people die annually from CVDs than from any other cause.1 The incidence of CVD rises progressively with increasing blood pressure (BP) and with increasing levels of total and low density lipoprotei...
Source: Evidence-Based Medicine - November 22, 2016 Category: Internal Medicine Authors: LeFevre, M. Tags: Drugs: cardiovascular system, Pain (neurology), Stroke, Hypertension, Ischaemic heart disease Therapeutics/Prevention Source Type: research

Risk of new-onset diabetes with statin use should not be overemphasised
This study examined diabetes outcomes among Tricare beneficiaries who were evaluated between 1 October 2003 and 1 March 2012. Participants were divided into statin users and non-users. Patients who, at baseline, had a pre-existing disease indicative of cardiovascular diseases, or any positive element of the Charlson comorbidity index, were excluded. A propensity score, using 42 baseline characteristics, was generated to match statin users and non-users. The main measurements included new-onset diabetes, diabetic complications and overweight/obesity. Findings...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Chiang, C.-E., Wang, K.-L. Tags: Health policy, Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Stroke, Ischaemic heart disease, Diabetes Aetiology/Harm Source Type: research

Current 10-year atherosclerotic cardiovascular disease risk threshold for statin eligibility is cost-effective for primary prevention
Commentary on: Pandya A, Sy S, Cho S, et al. Cost effectiveness of 10-year risk thresholds for initiation of statin therapy for primary prevention of cardiovascular disease. JAMA 2015;314: 142–50 . Context The American College of Cardiology American Heart Association (ACC/AHA) cholesterol guidelines replaced the National Cholesterol Education Program Adult Treatment Panel III (NCEP/ATP III) in 2013,1 a change that was accompanied by significant controversy.2 Notable among the criticisms was that the pooled cohort equations (PCE) overestimates risk and coupled with the relatively lenient risk threshold (10-year PCE &g...
Source: Evidence-Based Medicine - November 24, 2015 Category: Internal Medicine Authors: Yeboah, J. Tags: Health policy, Epidemiologic studies, Drugs: cardiovascular system, Neuromuscular disease, Stroke, Ischaemic heart disease, Musculoskeletal syndromes, Health economics, Health service research Economic analysis Source Type: research

Ezetimibe provides incremental reduction in risk for cardiovascular events and need for revascularisation following an acute coronary syndrome
Commentary on: Cannon CP, Blazing MA, Giugliano RP, et al., IMPROVE-IT Investigators. Ezetimibe Added to Statin Therapy after Acute Coronary Syndromes. N Engl J Med 2015;372:2387–97. Context Use of statin therapy to treat dyslipidemia in patients with established coronary artery disease is the standard of care worldwide. Given the negative results of a number of trials that tested the use of adjuvant lipid-lowering therapies against a statin background, there has been great scepticism about whether or not non-statin drugs provide incremental benefit.1–3 Ezetimibe inhibits the absorption of both dietary and bili...
Source: Evidence-Based Medicine - September 24, 2015 Category: Internal Medicine Authors: Toth, P. P. Tags: Health policy, Epidemiologic studies, Genetics, Immunology (including allergy), Vaccination / immunisation, Stroke, Diet, Ischaemic heart disease, Health economics, Health service research, Lipid disorders Therapeutics/Prevention Source Type: research

New ACC-AHA cholesterol guidelines significantly increase potential eligibility for statin treatment
Commentary on: Pencina MJ, Navar-Boggan AM, D’Agostino RB, et al.. Application of new cholesterol guidelines to a population-based sample. N Engl J Med 2014;370:1422–31. Context In 2013, new guidelines for the treatment of cholesterol for the prevention of cardiovascular disease (CVD) were issued by the American College of Cardiology and the American Heart Association (ACC-AHA), based on a systematic review of lipid lowering trials and meta-analyses evaluating treatment impact on CVD morbidity and mortality, and quantitated adverse effects of lipid-lowering therapy.1 Many of these trials were reported after pub...
Source: Evidence-Based Medicine - September 15, 2014 Category: Internal Medicine Authors: Bittner, V. Tags: Epidemiologic studies, Drugs: cardiovascular system, Stroke, Diet, Ischaemic heart disease Practice guideline Source Type: research

Statins do not improve cardiovascular outcomes for dialysis patients
Commentary on: Palmer SC, Navaneethan SD, Craig JC, et al.. HMG CoA reductase inhibitors (statins) for dialysis patients: a systematic review and meta-analysis. Cochrane Database Syst Rev 2013;(9):CD004289. Context Chronic kidney disease affected nearly 19 million people in the USA, with incidence increasing globally at an annual rate of 8%, most of which were unrecognised or undiagnosed. Cardiovascular events are common among patients with chronic kidney disease and highest in dialysis patients. While dialysis patients experience a high prevalence of traditional risk factors for cardiovascular disease (CVD), such as hyper...
Source: Evidence-Based Medicine - May 19, 2014 Category: Internal Medicine Authors: Olyaei, A. Tags: Clinical trials (epidemiology), Epidemiologic studies, Drugs: cardiovascular system, Neuromuscular disease, Stroke, Hypertension, Obesity (nutrition), Ischaemic heart disease, Unwanted effects / adverse reactions, Renal medicine, Musculoskeletal syndromes Source Type: research

Statins in patients with CKD prove beneficial in reducing cardiovascular events and mortality but show no benefit in patients on dialysis
Commentary on: Palmer SC, Craig JC, Navaneethan SD, et al.. Benefits and harms of statin therapy for persons with chronic kidney disease: a systematic review and meta-analysis. Ann Intern Med 2012;157:263–75. Context High-quality evidence suggests that chronic kidney disease (CKD) should now be considered a coronary heart disease (CHD) risk equivalent. Although statin therapy consistently reduces coronary events in the general population, the clinical benefits of lipid lowering in persons with CKD are less certain. Although multiple studies have shown possible benefit from statin therapy in early-stage CKD patients, ...
Source: Evidence-Based Medicine - September 19, 2013 Category: Internal Medicine Authors: Krishnan, S., Jacobson, T. A. Tags: Epidemiologic studies, Immunology (including allergy), Drugs: cardiovascular system, Stroke, Interventional cardiology, Ischaemic heart disease, Renal medicine Therapeutics Source Type: research