Search

We hypothesized that a short-course high-intensity statin treatment during admission for myocardial infarction (MI) could rapidly reduce LDL-C and thus impact the choice of lipid-lowering therapy (LLT) at discharge. Our cohort comprised 133 MI patients (62.71 ± 11.3 years, 82% male) treated with atorvastatin 80 mg o.d. during admission. Basal LDL-C levels before admission were analyzed. We compared lipid profile variables before and during admission, and LLT at discharge was registered. Achieved theoretical LDL-C levels were estimated using LDL-C during admission and basal LDL-C as references and compared to LDL-C on first blood sample 4–6 weeks after discharge. A significant reduction in cholesterol from basal levels was noted during admission, including total cholesterol, triglycerides, HDL-C, non-HDL-C, and LDL-C (−39.23 ± 34.89 mg/dL, p < 0.001). LDL-C levels were reduced by 30% in days 1–2 and 40–45% in subsequent days (R2 0.766, p < 0.001). Using LDL-C during admission as a reference, most patients (88.7%) would theoretically achieve an LDL-C < 55 mg/dL with discharge LLT. However, if basal LDL-C levels were considered as a reference, only a small proportion of patients (30.1%) would achieve this lipid target, aligned with the proportion of patients with LDL-C < 55 mg/dL 4–6 weeks after discharge (36.8%). We conclude that statin treatment during admission for MI can induce a significant reduction in LDL-C and LLT at discharge is usually prescribed using LDL-C during admission as the reference, which leads to insufficient LDL-C reduction after discharge. Basal LDL-C before admission should be considered as the reference value for tailored LLT prescription. [ABSTRACT FROM AUTHOR]

Abstract Objective The purpose of this meta-analysis is to evaluate the role of high-intensity statin pretreatment on coronary microvascular dysfunction in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). Methods PubMed, Cochrane, and Embase were searched. This meta-analysis selection included randomized controlled trials (RCTs), involving high-intensity statin pretreatment as active treatment, and measurement of thrombolysis in myocardial infarction (TIMI), myocardial blush grade (MBG) or index of microvascular resistance (IMR) in coronary heart disease (CHD) patients undergoing PCI. I2 test was used to evaluate heterogeneity. Pooled effects of continuous variables were reported as Standard mean difference (SMD) and 95% confidence intervals (CI). Pooled effects of discontinuous variables were reported as risk ratios (RR) and 95% confidence intervals (CI). Random-effect or fix-effect meta-analyses were performed. The Benefit was further examined based on clinical characteristics including diagnosis and statin type by using subgroup analyses. Publication bias was examined by quantitative Egger’s test and funnel plot. We performed sensitivity analyses to examine the robustness of pooled effects. Results Twenty RCTs were enrolled. The data on TIMI

Rasha Khatib,1 Eric J Yeh,2 Nicole Glowacki,1 Catherine B McGuiness,3 Handing Xie,4 Rolin L Wade,4 Bethany A Kalich,5 Yi Li,6 Abdelhadi Rifai,7 Neal Sawlani8 1Academic Research and Strategic Partnership, Advocate Aurora Research Institute, Advocate Aurora Health, Downers Grove, IL, USA; 2Global Health Economics and Outcomes Research (HEOR), Amgen Inc, Thousand Oaks, CA, USA; 3Health Economics and Outcomes Research, Real-World Evidence, IQVIA, Wayne, PA, USA; 4IQVIA, Wayne, PA, USA; 5Amgen Inc, Thousand Oaks, CA, USA; 6R&D Solutions, IQVIA, Bloomington, IL, USA; 7Heart & Vascular Institute, Cheyenne Regional Medical Group, Cheyenne, WY, USA; 8Advocate Lutheran General Hospital, Park Ridge, IL, USACorrespondence: Rasha Khatib, Academic Research and Strategic Partnership, Advocate Aurora Research Institute, Advocate Aurora Health, 3075 Highland Parkway, Suite 600, Downers Grove, IL, 60515, USA, Tel +1 708.684.3691, Email rasha.alkhatib@aah.orgIntroduction: Clinical practice guidelines recommend initiating a high-intensity LLT and continued monitoring of low-density lipoprotein cholesterol (LDL-C) following acute coronary syndrome (ACS). We used real-world data to describe LLT utilization after discharge and 1-year adherence. The reduction in LDL-C was also evaluated.Methods: Data were extracted from electronic health records (EHRs) from 12 hospitals in a large community healthcare system in midwestern United States between 2013 and 2019. Data on eligible patients recently discharged with an ACS event were linked to pharmacy claims data to describe LLT fill rates and 1-year post-discharge adherence. Adherence was reported as the proportion of days covered ≥ 80%.Results: Of the 10,589 eligible patients, 49% filled a high-intensity statin at discharge and only 36% were adherent at 1 year. The mean (SD) age was 66.1± 13.3, 39.3% were females, 58.8% were Caucasian, and 53.0% had Medicare. There was a clear trend for greater fill rates at discharge among patients with higher LDL-C values than those with lower values (p< 0.01). Key predictors of high-intensity (versus medium-intensity) LLT use within 21 days after an ACS event included ACS type (odds ratio [OR] 0.59; 95% confidence interval [CI] 0.52– 0.67 for NSTEMI versus STEMI), age group (OR: 0.59; 95% CI: 0.48– 0.72 for > 75 years versus < 65 years), and statin use before index ACS event (OR: 1.56; 95% CI: 1.23– 1.88).Conclusion: This real-world study found that despite recommendations in clinical practice guidelines, high-intensity LLT fill rates at discharge and 1-year adherence to LLT remain suboptimal. Clinical characteristics, including ACS type and LDL-C values, were strong predictors of filling and adherence to guideline-recommended therapy. Age, sex, and race/ethnicity disparities were observed in discharge fill rates and 1-year adherence. These results highlight the need for continued efforts at the patient and provider levels to improve LLT adherence among ACS patients.Keywords: lipid-lowering therapy, high-intensity statin, acute coronary syndrome, real-world data, prescribing, adherence

Objective: The purpose of this meta-analysis is to evaluate the role of high-intensity statin pretreatment on coronary microvascular dysfunction in patients with coronary heart disease undergoing percutaneous coronary intervention (PCI). Methods: PubMed, Cochrane, and Embase were searched. This meta-analysis selection included randomized controlled trials (RCTs), involving high-intensity statin pretreatment as active treatment, and measurement of thrombolysis in myocardial infarction (TIMI), myocardial blush grade (MBG) or index of microvascular resistance (IMR) in coronary heart disease (CHD) patients undergoing PCI. I2 test was used to evaluate heterogeneity. Pooled effects of continuous variables were reported as Standard mean difference (SMD) and 95% confidence intervals (CI). Pooled effects of discontinuous variables were reported as risk ratios (RR) and 95% confidence intervals (CI). Random-effect or fix-effect meta-analyses were performed. The Benefit was further examined based on clinical characteristics including diagnosis and statin type by using subgroup analyses. Publication bias was examined by quantitative Egger's test and funnel plot. We performed sensitivity analyses to examine the robustness of pooled effects. Results: Twenty RCTs were enrolled. The data on TIMI < 3 was reported in 18 studies. Comparing with non-high-intensity statin, high-intensity statin pretreatment significantly improved TIMI after PCI (RR = 0.62, 95%CI: 0.50 to 0.78, P < 0.0001). The data on MBG < 2 was reported in 3 studies. The rate of MBG < 2 was not different between groups (RR = 1.29, 95% CI: 0.87 to 1.93, P = 0.21). The data on IMR was reported in 2 studies. High-dose statin pretreatment significantly improved IMR after PCI comparing with non-high-dose statin (SMD = -0.94, 95% CI: -1.47 to -0.42, P = 0.0004). There were no significant between-subgroup differences in subgroups based on statin type and diagnosis. Publication bias was not indicated by using quantitative Egger's test (P = 0.97) and funnel plot. Sensitivity analyses confirmed the robustness of these findings. Conclusions: Comparing with non-high-intensity statin, high-intensity statin pretreatment significantly improved TIMI and IMR after PCI. In the future, RCTs with high quality and large samples are needed to test these endpoints. [ABSTRACT FROM AUTHOR]

• Obicetrapib is a selective CETP inhibitor for reducing LDL-C and ASCVD. • Obicetrapib plus ezetimibe on top of high-intensity statin lowers LDL-C by 63%. • Obicetrapib monotherapy and with ezetimibe are both safe and well tolerated. Obicetrapib, a selective cholesteryl ester transfer protein (CETP) inhibitor, reduces low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (non-HDL-C), lipoprotein particles, and apolipoproteins, when added to high-intensity statin in patients with dyslipidemia. To evaluate the safety and lipid-altering efficacy of obicetrapib plus ezetimibe combination therapy as an adjunct to high-intensity statin therapy. This double-blind, randomized, phase 2 trial administered 10 mg obicetrapib plus 10 mg ezetimibe (n = 40), 10 mg obicetrapib (n = 39), or placebo (n = 40) for 12 weeks to patients with LDL-C >70 mg/dL and triglycerides (TG) <400 mg/dL, on stable high-intensity statin. Endpoints included concentrations of lipids, apolipoproteins, lipoprotein particles, and proprotein convertase subtilisin kexin type 9 (PCSK9), safety, and tolerability. Ninety-seven patients were included in the primary analysis (mean age 62.6 years, 63.9% male, 84.5% white, average body mass index of 30.9 kg/m2). LDL-C decreased from baseline to week 12 by 63.4%, 43.5%, and 6.35% in combination, monotherapy, and placebo groups, respectively (p <0.0001 vs. placebo). LDL-C levels of <100, <70, and <55 mg/dL were achieved by 100%, 93.5%, and 87.1%, respectively, of patients taking the combination. Both active treatments also significantly reduced concentrations of non-HDL-C, apolipoprotein B, and total and small LDL particles. Obicetrapib was well tolerated and no safety issues were identified. The combination of obicetrapib plus ezetimibe significantly lowered atherogenic lipid and lipoprotein parameters, and was safe and well tolerated when administered on top of high-intensity statin to patients with elevated LDL-C. [ABSTRACT FROM AUTHOR]

Background: The aim of this study was to compare moderate- versus high-intensity statin therapy in patients with type 2 diabetes and low-density lipoprotein (LDL) cholesterol less than 130 mg/dL. Methods: This was a randomized, open-label, parallel design trial comprised of 79 patients randomly allocated into two groups receiving high-intensity [atorvastatin 40 mg (A40) or rosuvastatin 20 mg (R20) daily] or moderate-intensity [atorvastatin 20 mg (A20) or rosuvastatin 10 (R10) mg daily] statins for eight weeks. The variables investigated were lipid profile, high sensitivity C-reactive protein (hs-CRP), and interleukin-6 (IL-6). Results: The percentage of decrease in LDL levels ( ± SD) for the high-intensity group (-35.5 ± 25.5) was significantly greater than the moderate-intensity group (-24.6 ± 23.5) (P = 0.04). While 38.1% (n:8) of patients receiving A20 and 55% (n:11) of those being on R10 achieved the targets of ≥ 30% reduction in the LDL level, these figures were 63.2% (n = 12) and 73.8% (n = 14) for A40 and R20 subgroups, respectively. Subsequently, the likelihood of achieving LDL reduction ≥ 30%, was significantly greater with high-intensity statin therapy (OR: 3.1, 95% CI: 1.09, 8.90, P = 0.03). Logistic regression analysis also showed that for every 1 mg/ dL increase in the baseline LDL level, the odds of achieving the LDL reduction ≥ 30% increased by 1.04 times [95% CI: (1.01, 1.07), P = 0.003]. Conclusion: Despite the general conception, moderate-intensity statins are not adequate for the majority of patients with T2DM and mild hyperlipidemia and greater numbers of patients could reach the LDL cholesterol target with high-intensity statin therapy. [ABSTRACT FROM AUTHOR]

Background: The use of statin has been encouraged in elderly high-risk patients; nevertheless, the prescription rates of statin have been shown to decline with age. Despite the current Taiwan lipid guidelines has been issued, the status for management of dyslipidemia among elderly high-risk patients in Taiwan remained unclear. The present study was aimed to investigate the prescription rates of highintensity statin (HIS)/ezetimibe and LDL-C goal attainment rates among elderly high-risk patients in a tertiary medical center. Methods: Between July 2018 and August 2019, 208 high-risk patients with suboptimal serum LDL-C levels, including 70 elderly patients (age ≥ 65 years) and 138 non-elderly patients (age < 65 years) received lipid-lowering therapy (LLT) and observation for a 12-month follow-up. The prescription rates of any statins/HIS/ezetimibe, the percentages of LDL-C reduction, and LDL-C goal attainment rates at 12-month follow-up were compared between elderly and non-elderly high-risk patients. Results: The serum LDL-C levels at baseline/12-month among elderly and non-elderly high-risk patients were respectively 128.8 ± 36.3/80.7 ± 46.3 and 138.5 ± 52.3/78.1 ± 37.0 mg/dL, with respectively LDL-C reductions of 34.1% and 39.6% at 12-month follow-up. The prescription rates of any statins/HIS/ezetimibe at 12-month follow-up in elderly and non-elderly high-risk patients were respectively 88.9%/68.3%/47.6% and 96.6%/72.7%/60.7%. The LDL-C goal attainment rates at 12-month follow-up in elderly and non-elderly high-risk patients were respectively 68.3% and 73.3%. All observed study outcomes were comparable between groups without significant statistical differences. Conclusion: Our findings highlight that the elderly high-risk patients in Taiwan received similar aggressive strategy of LLT with similar LDL-C attainment rates compared with non-elderly high-risk patients. [ABSTRACT FROM AUTHOR]

Nuntakorn Thongtang,1 Natthakan Tangkittikasem,1 Kittichai Samaithongcharoen,1 Jirasak Piyapromdee,1 Varalak Srinonprasert,2 Sutin Sriussadaporn1 1Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; 2Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Nuntakorn ThongtangDivision of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, ThailandTel +66 2-419-7799Fax +66 2-419-7792Email nuntakorn@hotmail.comBackground: High-intensity statin is recommended in high-risk type 2 diabetes (T2D); however, statin dose dependently increases the risk of developing new-onset diabetes, can potentially worsen glycemic control in T2D, and may cause cognitive impairment. This study aimed to investigate the effect of statin intensification on glucose homeostasis and cognitive function in T2D.Materials and Methods: T2D patients who were taking simvastatin ≤ 20 mg/day were randomized to continue taking the same dosage of simvastatin (low-dose simvastatin group; LS, n=63) for 12 weeks, or to change to atorvastatin 40 mg/day for 6 weeks, and if tolerated, atorvastatin was increased to 80 mg/day for 6 weeks (high-dose atorvastatin group; HS, n=62). Fasting plasma glucose (FPG), glycated hemoglobin (HbA1c), plasma insulin, homeostatic model assessment of insulin resistance (HOMA-IR) and of β-cell function (HOMA-B), cognitive functions using Montreal Cognitive Assessment (MoCA), and Trail Making Test (TMT) were assessed at baseline, 6 weeks, and 12 weeks.Results: Mean age of patients was 58.8± 8.9 years, and 72% were female. Mean baseline FPG and HbA1c were 124.0± 27.5 mg/dl and 6.9± 0.8%, respectively. No differences in baseline characteristics between groups were observed. Change in HbA1c from baseline in the LS and HS groups was − 0.1% and +0.1% (p=0.03) at 6 weeks, and − 0.1% and +0.1% (p=0.07) at 12 weeks. There were no significant differences in FPG, fasting plasma insulin, HOMA-B, HOMA-IR, MoCA score, or TMT between groups at 6 or 12 weeks.Conclusion: Switching from low-dose simvastatin to high-dose atorvastatin in T2D resulted in a slight increase in HbA1c (0.1%) without causing cognitive decline.Keywords: high-intensity statin, glucose homeostasis, cognitive function, type 2 diabetes, T2D

Nuntakorn Thongtang, Jirasak Piyapromdee, Natthakan Tangkittikasem, Kittichai Samaithongcharoen, Nithiwat Srikanchanawat, Sutin Sriussadaporn Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, ThailandCorrespondence: Nuntakorn ThongtangDivision of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Wanglang Road, Bangkoknoi, Bangkok 10700, ThailandTel +66 2-419-7799Fax +66 2-419-7792Email nuntakorn@hotmail.comIntroduction: Statin intensification is required in patients who have high-risk for cardiovascular events. However, it is unclear if this is needed in whom plasma LDL-C target was achieved with low-dose statin for primary prevention. We investigated the efficacy and safety of switching from low-dose statin to high-intensity statin among type 2 diabetes (T2D) who had achieved plasma LDL-C < 100 mg/dl with low-dose statin treatment.Methods: T2D patients with no atherosclerotic cardiovascular disease who had plasma LDL-C level < 100 mg/dl while taking simvastatin ≤ 20 mg/day were randomized to continue using the same dosage of simvastatin (low-dose statin group; LS) for 12 weeks, or to switch to atorvastatin 40 mg/day for 6 weeks, and then, if tolerated, to atorvastatin 80 mg/day for 6 weeks (high-intensity statin group; HS). Biochemical test and adverse events were evaluated at baseline, 6 weeks, and 12 weeks.Results: One hundred and fifty patients (76 LS, 74 HS, mean age 58.9± 8.9 years, 72% female) were included. The mean baseline plasma LDL-C level on statin was slightly higher in the HS group (71.9± 13.6 vs. 68.1± 14.2 mg/dl, p=0.09). The HS group had a significantly lower plasma LDL-C level at both 6 and 12 weeks (both p< 0.001). Plasma LDL-C < 40 mg/dl was found more frequently in the HS group (23.0% vs. 3.9%, p< 0.001). Discontinuation of statin due to adverse effects was more frequent in the HS group (5.4% vs. 1.3%, p=0.38 for atorvastatin 40 mg/day, 12.2% vs. 1.3%, p=0.03 for atorvastatin 80 mg/day). No serious adverse events were observed in either group.Conclusion: Switching from low-dose statins to high-intensity statins resulted in a significant reduction in plasma LDL-C levels, and was fairly well tolerated during a 12-week study period.Keywords: efficacy, safety, high-intensity statin, primary prevention, Thai patients, type 2 diabetes

Background: The attainment of target serum low-density lipoprotein cholesterol (LDL-C) levels and the prescription rates of high-intensity stain (HIS) and ezetimibe among high-risk patients in Taiwan remain unsatisfactory. We hypothesized that reminding individualized target LDL-C values to physicians and patients improved the attainment. Methods: Between July 2018 and December 2019, 214 high-risk patients with suboptimal LDL-C levels in the Lipid Clinic of our institution, including 100 patients with coronary artery disease (CAD), were enrolled. Each patient received prescription of lipid-lowering medications supported by an intelligent checklist-assisted reminding approach and informed individualized target serum LDL-C levels. The LDLC goal attainment rates and the prescription rates of HIS/ezetimibe of patients were analyzed every 3 months. Results: Patients with CAD at enrollment had a higher rate of stain prescription, lower baseline serum LDL-C levels, and a wider gap to reach serum LDL-C goals, compared to those without CAD. The prescription rates of HIS/ezetimibe at baseline, 3-month, 6-month, and 9-month follow-ups in patients with CAD were respectively 25.0%/8.0%, 78.6%/51.0%, 78.6%/69.0%, and 87.5%/82.1%, while those in patients without CAD were respectively 6.1%/9.6%, 70.8%/26.5%, 66.7%/33.3%, and 78.3%/43.5%. The LDL-C goal attainment rates at 3-month, 6-month, and 9-month follow-ups in patients with CAD were respectively 58.8%, 62.0%, and 62.5%, while those in patients without CAD were respectively 79.6%, 75.6%, and 73.9%. Conclusion: The intelligent checklist-assisted reminding approach in electronic medical order system, accompanied by an increased prescription of HIS and ezetimibe in the Lipid Clinic effectively facilitate the improvement of LDL-C goal attainment rates in high-risk patients. [ABSTRACT FROM AUTHOR]

Aims: To compare the effectiveness and safety of 2 high‐intensity atorvastatin doses (40 mg vs 80 mg) among acute coronary syndrome (ACS) patients. Methods: This retrospective observational cohort study using real‐world data included patients admitted with ACS to the Heart Hospital in Qatar between 1 January 2017 and 31 December 2018. The primary endpoint was a composite of cardiovascular disease‐associated death, nonfatal ACS and nonfatal stroke. Cox proportional hazard regression analysis was used to determine the association between the 2 high‐intensity atorvastatin dosing regimens and the primary outcome at 1 month and 12 months postdischarge. Results: Of the 626 patients included in the analyses, 475 (75.9%) received atorvastatin 40 mg, while 151 (24.1%) received atorvastatin 80 mg following ACS. Most of the patients were Asian (73%), male (97%) with a mean age of 50 years and presented with ST‐elevation myocardial infarction (60%). The incidence of the primary effectiveness outcome did not differ between the atorvastatin 40‐and 80‐mg groups at 1 month (0.8 vs 1.3%; adjusted hazard ratio = 0.59, 95% confidence interval 0.04–8.13, P =.690) and at 12 months (3.2 vs 4%; adjusted hazard ratio = 0.57, 95% confidence interval 0.18–1.80, P =.340). Similarly, the use of the 2 doses of atorvastatin resulted in comparable safety outcomes, including liver toxicity, myopathy and rhabdomyolysis with an event rate of <1% in both groups. Conclusion: The use of atorvastatin 40 mg in comparison to atorvastatin 80 mg in patients with ACS resulted in similar cardiovascular effectiveness and safety outcomes. [ABSTRACT FROM AUTHOR]

Background: It has been shown recently that a considerable burden of pulmonary embolism (PE) roots from an inflammatory response. The activated inflammatory cascade will be responsible for the final fibrotic response of pulmonary vascular bed, creating further mechanical obstruction which results in subsequent right ventricular (RV) dysfunction, influencing functional capacity and future prognosis. Although anticoagulants represent the cornerstone treatment of PE, the drug class has a minimal effect on the mentioned pathology. Study Design: The present study is a single-center randomized, double-blind, parallel group controlled trial with placebo which will evaluate the effect of high-intensity statin – rosuvastatin 20 mg daily on patients with intermediate-to-high-risk PE. Study population will be selected from patients for whom statin is not otherwise indicated. Primary end point of the present trial will be echocardiographic measures of RV function. We believe that the mentioned indexes represent an accurate surrogate for the functional capacity and prognosis. Our secondary end point will be the composites of PE recurrence and exertional capacity measured by 6-minute walk test. Conclusions: The result of the present trial might influence the complimentary treatment of acute PE.

Evidence suggests that statin therapy in patients with peripheral artery disease (PAD) is beneficial yet use remains suboptimal. We examined trends in statin use, intensity, and discontinuation among adults aged ⩾ 40 years with incident severe PAD and a subset with critical limb ischemia (CLI) between 2002 and 2015 within an integrated healthcare delivery system. Discontinuation of statin therapy was defined as the first 90-day gap in treatment within 1 year following PAD diagnosis. We identified 11,059 patients with incident severe PAD: 31.1% (n = 3442) with CLI and 68.9% (n = 7617) without CLI. Mean (SD) age was 68.6 (11.3) years, 60.5% were male, 54.2% white, 23.2% Hispanic, and 16.2% black. Statin use in the year before diagnosis increased from 50.4% in 2002 to 66.0% in 2015 (CLI: 43.7% to 68.0%; without CLI: 53.1% to 64.2%, respectively). The proportion of patients on high-intensity statins increased from 7.3% in 2002 to 41.9% in 2015 (CLI: 7.2% to 39.4%; without CLI: 7.4% to 44.2%, respectively). Of the 40.5% (n = 4481) who were not on a statin in the year before diagnosis, 13.5% (n = 607) newly initiated therapy within 1 month (CLI: 10.1% (n = 150); without CLI: 15.3% (n = 457)). Following diagnosis, 12.5% (n = 660) discontinued statin therapy within 1 year (CLI: 15.5% (n = 202); without CLI: 11.5% (n = 458)). Although use of statins increased from 2002 to 2015, a substantial proportion of the overall PAD and CLI subpopulation remained untreated with statins, representing a significant treatment gap in a population at high risk for cardiovascular events and adverse limb outcomes. [ABSTRACT FROM AUTHOR]

BackgroundThe 2013 American College of Cardiology/American Heart Association blood cholesterol guideline recommends high‐intensity statin therapy among certain groups of patients, but full implementation of the guideline has not yet been satisfactory. We aimed to investigate the temporal trends and predictors of high‐intensity statin therapy among veterans who had been treated with percutaneous coronary intervention (PCI) and followed up by cardiologists within the Veterans Health Administrative system. Methods and ResultsA retrospective cohort study was conducted at the Veterans Health Administrative system including all patients >18 years old who had their PCI procedure between October 2010 and September 2016. National Veterans Health Administrative databases were used to retrieve study participant's demographics, comorbid conditions, statin type and dose within 90 days before and after the PCI procedure. There were 48 862 patients who underwent a PCI procedure during the study period. High‐intensity statin use at 90 days post‐PCI rose from 23% in 2010 to 37% before release of the 2013 American College of Cardiology/American Heart Association cholesterol guideline, then rose sharply to 80% by 2016. The projected 10‐year risk of arteriosclerotic cardiovascular disease events among our study population was projected to be ≈1841 fewer if the cohort had received high‐intensity statin therapy versus moderate‐intensity statin. ConclusionsBy 2016, the 2013 American College of Cardiology/American Heart Association blood cholesterol guideline was well implemented among veterans who had a PCI procedure in the Veterans Health Administrative system, suggesting systems of care can be improved to increase rates of high‐intensity statin initiation.

Background: Adding ezetimibe to high-intensity statin therapy is used for additional lowering of low-density lipoprotein cholesterol (LDL-C); however, there are little data on the efficacy of ezetimibe when combined with a high-intensity statin. A meta-analysis was performed to evaluate the efficacy of ezetimibe added to high-intensity statin therapy on LDL-C levels., Methods: A literature search from database inception to May 2020 was performed using PubMed, EMBASE and Cochrane Central Register of Controlled Trials. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines were used in this meta-analysis, in which the random-effects model was adopted for the calculation of the mean difference (MD). The Cochrane Collaboration's tool for assessing the risk of bias was used to evaluate the quality of the included trials., Results: A total of 14 trials with 2,007 patients were included in this study. Compared to the high-intensity statin monotherapy, the MD in LDL-C reduction with high-intensity statin therapy plus ezetimibe was -14.00% (95% confidence interval: -17.78 to -10.22; P < 0.001) with a moderate degree of heterogeneity (P < 0.001, I 2 = 66%). No significant publication bias among the included trials was identified., Conclusions: Our study found that adding ezetimibe to high-intensity statin therapy provided a significant but attenuated incremental reduction in LDL-C levels. Whether the magnitude of this additional lowering of LDL-C levels would lead to benefits in clinical cardiovascular outcomes needs further investigation., Competing Interests: None to declare., (Copyright 2021, Lee et al.)