![]() The moderate-to-high-intensity statin prescription rate for secondary ASCVD prevention increased from 35% in 2007 to 45% in 2018. Less than half (42%) of the patients were prescribed statin therapy, with 36% receiving moderate-to-high-intensity statin therapy, after patient data were pooled across years. The most common comorbidity was hypertension (68%), followed by renal disease (46%), malignancy (28%), diabetes (26%), heart failure (18%), and dementia (10%). More than half (56%) of the patients were overweight or obese 4% were underweight. Coronary artery disease (CAD) was followed by cerebrovascular disease as the most frequent indications for statin therapy. Of the study participants, nearly half (48%) were women, and 62%, 13%, 5%, and 1% were non-Hispanic white, Asian, Hispanic, and black, respectively. Who’s more likely to use statins for ASCVD? Statin intensity was categorized as high, moderate, or low according to ACC/AHA guidelines, and nonstatin, lipid-lowering prescriptions were also recorded. Prescription information was derived from the patient’s last visit during the study period. Body mass index was categorized as underweight (<18.5 kg/m 2), normal (18.5 to <25 kg/m 2), overweight (25 to <30 kg/m 2), and obese (≥30 kg/m 2). Total cholesterol and LDL-C were measured closest to and within at least 1 year of the index date, and again 30 days following the start of statin therapy. Comorbidities, which included diabetes, hypertension, heart failure, malignancy, dementia, and renal disease, were identified via International Classification of Diseases (ICD) codes. Patients reported their own smoking status and demographics information. These criteria were also used to select a cohort of patients ages 65 to 75 years old. Harrison's Principles of Internal Medicine.Patients (N=24,651) in this retrospective longitudinal study were older than 75 years of age, had ASCVD, and recorded ≥2 outpatient visits within 2 consecutive years. Kasper DL, Fauci AS, Hauser SL, Longo DL, Lameson JL, Loscalzo J. Journal of the American College of Cardiology. 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults. Stone NJ, Robinson JG, Lichtenstein AH et al. Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: Preventive Medication. Statins and elevated liver tests: what's the fuss?. Effects of Statins on High-Density Lipoproteins: A Potential Contribution to Cardiovascular Benefit. Effect of food on the pharmacodynamics and pharmacokinetics of atorvastatin, an inhibitor of HMG-CoA reductase. Whitfield LR, Stern RH, Sedman AJ, Abel R, Gibson DM. We list the most important adverse effects. Interaction with certain drugs can increase the risk of myopathy (see “Interactions” section below). Treatment must be discontinued if myopathy / rhabdomyolysis occurs. Management: discontinue statin therapy for 2–4 weeks start treatment with a low-dose statin (e.g., pravastatin or fluvastatin ) once symptoms have resolved.May progress to rhabdomyolysis : rare but severe side-effect that may lead to myoglobulinuria → AKI ( ↑ BUN and ↑ creatinine ).Muscle pain and weakness, especially when used alongside fibrates or niacin.Myalgia : (muscle pain ): continue treatment as long as creatinine phosphokinase (CK) remain normal.Muscular : Statins decrease the synthesis of coenzyme Q 10 and impair energy production within the muscle.Hepatic : : (up to 3% of patients) ↑ LFTs due to the involvement of cytochrome P450 systems ( CYP3A4 and CYP2C9 ) in the breakdown of statins.General (common): headache and gastrointestinal symptoms (e.g., constipation, diarrhea, flatulence).
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