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Statin Intolerance and Noncompliance: An Empiric Approach
Statins are among the most widely prescribed drugs. They reduce risk for atherosclerotic cardiovascular disease by lowering serum apolipoprotein B-containing lipoproteins, particularly low-density lipoprotein (LDL) cholesterol (LDL-C).1 Statins inhibit cholesterol synthesis in the liver, which increases expression of LDL receptors and lowers serum LDL-C.2 The latter slows progression of atherosclerotic lesions, reduces coronary plaque rupture, and decreases likelihood of acute cardiovascular syndromes (ie, myocardial infarction and stroke).
Source: The American Journal of Medicine - October 27, 2021 Category: General Medicine Authors: Scott M. Grundy, Gloria L. Vega Tags: Advancing High Value Health Care Source Type: research

Effects of Anticoagulation on Low-Density Lipoprotein-Cholesterol and Ischemic Stroke in Patients with Nonvalvular Atrial Fibrillation
The study by Omelchenko et al1 concluded that, unlike the general population, low-density lipoprotein-cholesterol (LDL-C) levels were not associated with ischemic stroke risk among patients with atrial fibrillation treated with direct oral anticoagulants (DOACs). To arrive at this conclusion, they retrospectively analyzed data of 21,229 patients with a first-time diagnosis of nonvalvular atrial fibrillation treated with DOACs categorized according to the congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke or transient ischemic attack (TIA), vascular disease, age 65 to 74 years, sex category, ...
Source: The American Journal of Medicine - September 28, 2021 Category: General Medicine Authors: Zeeshan H. Ismail, Zekarias T. Asnake, Joshua K. Salabei Tags: Letter Source Type: research

LDL Cholesterol and Ischemic Stroke in Patients with Nonvalvular Atrial Fibrillation
We examined the association between LDL-C levels and incident stroke in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs).
Source: The American Journal of Medicine - September 28, 2020 Category: General Medicine Authors: Alexander Omelchenko, Tzipi Hornik-Lurie, Hagit Gabay, Saar Minha, Abid Assali, David Pereg Tags: Clinical Research Study Source Type: research

LDL-cholesterol and ischemic stroke in patients with non-valvular atrial fibrillation
We examined the association between LDL-C levels and incident stroke in patients with atrial fibrillation treated with direct oral anticoagulants (DOACs).
Source: The American Journal of Medicine - September 27, 2020 Category: General Medicine Authors: Alexander Omelchenko, Tzipi Hornik-Lurie, Hagit Gabay, Saar Minha, Abid Assali, David Pereg Source Type: research

Cholesterol lowering and stroke: no longer room for pleiotropic effects of statins – confirmation from PCSK9 inhibitor studies
The relationship between cholesterol levels and stroke has been much less clear than between cholesterol levels and coronary heart disease. This is likely mostly due to the inadequate power of older studies and the low intensity of cholesterol-lowering interventions at that time available. Because a reduction in stroke has been, conversely, clearly observed in trials with statins, for long “pleiotropic” effects of such drugs, unrelated to cholesterol lowering, have been invoked. In a previous analysis of all randomized trials of cholesterol-lowering treatments reporting on stroke we had, however, reached the conclusion...
Source: The American Journal of Medicine - July 10, 2019 Category: General Medicine Authors: Tanya Salvatore, Riccardo Morganti, Roberto Marchioli, Raffaele De Caterina Tags: Clinical Research Study Source Type: research

Diet Redux: Which Food Type Leads to Heart Attacks?
No topic has been more hotly debated over recent decades than the role of various foods in the development of atherosclerosis. The earliest animal experiments demonstrated that diets rich in fat and cholesterol produced arterial lesions that resembled atherosclerosis in humans1. Over subsequent decades, a great deal of animal and human research has been performed exploring the concept that dietary composition is related to the development of atherosclerosis. The earliest theories followed the direction of the early animal experiments mentioned above: These investigations demonstrated that diets containing large amounts of ...
Source: The American Journal of Medicine - April 20, 2018 Category: General Medicine Authors: Joseph S. Alpert Tags: Commentary Source Type: research

Prescription of Statins to Women Poses New Clinical Challenges
In women and men, cardiovascular disease is and will remain the leading avoidable cause of premature death in the United States and is rapidly becoming so worldwide. (1) While many women fear breast cancer more than cardiovascular disease, 1 in 8 will develop and 1 in 25 will die from this disease whereas over 1 in 3 will die from coronary heart disease and 1 in 6 from stroke. (2)
Source: The American Journal of Medicine - April 18, 2018 Category: General Medicine Authors: Madeline Pung, Janet Robishaw, Marc A. Pfeffer, Charles H. Hennekens Tags: Commentary Source Type: research

Can the reduction percentage LDL-C or Attained LDL-C levels or both add incremental prognostic value?
The role of low-density lipoprotein cholesterol (LDL-C) in the pathophysiology of atherosclerotic cardiovascular disease, which may present as coronary heart disease, stroke, and peripheral arterial disease, has been well documented in several studies.1,2,3,4 The decrease in LDL-C levels leads to a significant reduction in the risk of atherosclerotic cardiovascular disease.5
Source: The American Journal of Medicine - November 13, 2015 Category: Journals (General) Authors: Leonardo Roever Tags: Editorial Source Type: research

Can the Reduction in Percent LDL Cholesterol or Attained LDL Cholesterol Levels or Both Add Incremental Prognostic Value?
The role of low-density lipoprotein cholesterol (LDL-C) in the pathophysiology of atherosclerotic cardiovascular disease, which may present as coronary heart disease, stroke, and peripheral arterial disease, has been well documented in several studies.1-4 The decrease in LDL-C levels leads to a significant reduction in the risk of atherosclerotic cardiovascular disease.5
Source: The American Journal of Medicine - November 13, 2015 Category: Journals (General) Authors: Leonardo Roever Tags: Editorial Source Type: research

Cholesterol Management in Older Persons
Most atherosclerotic cardiovascular disease consists of coronary heart disease and stroke, and most atherosclerotic cardiovascular disease occurs in older persons. Randomized clinical trials with cholesterol-lowering drugs, notably statins, show reduced atherosclerotic cardiovascular disease events (1,2). Statins are indicated when atherosclerotic cardiovascular disease is present. They further reduce risk in primary prevention including older persons (1,2). But their indications in primary prevention are less well defined than for secondary prevention.
Source: The American Journal of Medicine - August 19, 2014 Category: Journals (General) Authors: Scott M. Grundy Source Type: research

Adherence to Secondary Prevention Medications and Four-year Outcomes in Outpatients with Atherosclerosis
Abstract: Background: Although nonadherence with evidence-based secondary prevention medications is common in patients with established atherothrombotic disease, long-term outcomes studies are scant. We assessed the prevalence and long-term outcomes of nonadherence to secondary prevention (antiplatelet agents, statins, and antihypertensive agents) medications in stable outpatients with established atherothrombosis (coronary, cerebrovascular, or peripheral artery disease) enrolled in the international REduction of Atherothrombosis for Continued Health registry.Methods: Adherence with these medications in eligible patients a...
Source: The American Journal of Medicine - June 24, 2013 Category: Journals (General) Authors: Dharam J. Kumbhani, Ph. Gabriel Steg, Christopher P. Cannon, Kim A. Eagle, Sidney C. Smith, Elaine Hoffman, Shinya Goto, E. Magnus Ohman, Deepak L. Bhatt, REduction of Atherothrombosis for Continued Health Registry Investigators Tags: Clinical research studies Source Type: research

Emerging Clinical Challenges in the Use of Statins
In randomized trials and meta-analyses, statins decrease myocardial infarction, stroke, vascular death, and total mortality. The totality of evidence indicates no threshold below which there are no net benefits, including primary prevention subjects at low risk. In this commentary, we present some consequent new and emerging clinical challenges.
Source: The American Journal of Medicine - June 19, 2013 Category: Journals (General) Authors: Charles H. Hennekens, Nicolas R. Breuer, Ira J. Gelb, David J. Bjorkman, Jeffrey S. Borer, Marc A. Pfeffer Tags: Commentary Source Type: research

CHADS2 Score, Statin Therapy, and Risks of Atrial Fibrillation
This study aimed to evaluate the efficacy of statin treatment for atrial fibrillation prevention in elderly patients with hypertension, and to determine if comorbidity or CHADS2 (Congestive heart failure, Hypertension, Age ≥75 years, Diabetes mellitus, prior Stroke or transient ischemic attack) score can predict the effectiveness of statin treatment. Methods: Patients aged ≥65 years with hypertension were identified from a National Health Insurance research database (a systemic sampling from 2000 to 2009 with a total of 1,000,000 subjects). Medical records of 27,002 patients were used in this study, in which 2400 (8....
Source: The American Journal of Medicine - January 17, 2013 Category: Journals (General) Authors: Chen-Ying Hung, Ching-Heng Lin, El-Wui Loh, Chih-Tai Ting, Tsu-Juey Wu Tags: Clinical research studies Source Type: research