Impact of Statin Use on Cardiorespiratory Fitness in Multi-racial Men and Women: The Henry Ford ExercIse Testing (FIT) Project (original) (raw)
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Statins are related to impaired exercise capacity in males but not females
PloS one, 2017
Exercise and statins reduce cardiovascular disease (CVD). Exercise capacity may be assessed using cardiopulmonary exercise testing (CPET). Whether statin medication is associated with CPET parameters is unclear. We investigated if statins are related with exercise capacity during CPET in the general population. Cross-sectional data of two independent cohorts of the Study of Health in Pomerania (SHIP) were merged (n = 3,500; 50% males). Oxygen consumption (VO2) at peak exercise (VO2peak) and anaerobic threshold (VO2@AT) was assessed during symptom-limited CPET. Two linear regression models related VO2peak with statin usage were calculated. Model 1 adjusted for age, sex, previous myocardial infarction, and physical inactivity and model 2 additionally for body mass index, smoking, hypertension, diabetes and estimated glomerular filtration rate. Propensity score matching was used for validation. Statin usage was associated with lower VO2peak (no statin: 2336; 95%-confidence interval [CI...
Patterns of Statin Use in a Real-World Population of Patients at High Cardiovascular Risk
Journal of Managed Care & Specialty Pharmacy, 2016
S ince their introduction in the late 1980s, 3-hydroxy-3-methylglutaryl-coenzyme A (HMG-CoA) reductase inhibitors (statins) have become the cornerstone of hypercholesterolemia treatment. Although recommendations in guidelines for cholesterol management differ, major guidelines endorse statin therapy to reduce cardiovascular (CV) risk for patients with elevated cholesterol levels for whom lifestyle change alone is insufficient. 1-4 In 2013, the American
Circulation: Cardiovascular Quality and Outcomes, 2009
Rosuvastatin (JUPITER), however, indicate that statin therapy to reduce cardiovascular risk is also effective among older persons with at-goal low-density lipoprotein but elevated high-sensitivity C-reactive protein levels. We estimate the size of and describe this new population for whom statin therapy may now be indicated based on JUPITER's findings. Methods and Results-Using data from the 1999 to 2004 National Health and Nutrition Examination Survey, we estimate that 57.9% of older adults (men Ն50 years and women Ն60 years), or 33 547 000 (95% CI, 32 217 000 to 34 877 000) Americans, are currently taking a statin (24.4%) or indicated for statin therapy (33.5%). In addition, we estimate that 19.2%, or 11 144 000 (95% CI, 10 053 000 to 12 235 000), may become newly eligible for statin therapy. This includes 8 071 000 (13.9%; 95% CI, 7 173 000 to 8 969 000) with high-sensitivity C-reactive protein Ն2 mg/L and low-density lipoprotein Ͻ130 mg/dL (ie, those meeting "strict" JUPITER criteria) and an additional 3 073 000 (5.3%; 95% CI, 2 404 000 to 3 743 000) with high-sensitivity C-reactive protein Ն2 mg/L and low-density lipoprotein of 130 to 160 mg/dL for whom JUPITER's findings might reasonably be extended. Thus, Ϸ80% of older persons may now have an indication for statin therapy. Compared with those who would continue to have no indication for statin therapy, the JUPITER group was more likely to be female, to be older, and to have obesity, hypertension, and the metabolic syndrome. Conclusions-JUPITER's findings have the potential to impact treatment recommendations for Ϸ20% of middle-aged to elderly adults, thus increasing the proportion of this segment of the population with an indication for statin therapy to nearly 80%. (Circ Cardiovasc Qual Outcomes. 2009;2:41-48.)
Circulation, 2016
Association (ACC/AHA) cholesterol guidelines determined that except for those with diabetes mellitus or low-density lipoprotein (LDL) cholesterol (LDL-C) >190 mg/dL, individuals should be selected for statin therapy for primary prevention of cardiovascular disease on the basis of predicted 10-year cardiovascular risk. 1 Such a risk-based approach leads to greater statin eligibility among older individuals with lower levels of LDL-C while limiting eligibility in younger individuals with higher LDL-C because predicted risk is driven primarily by age. 2 Defining statin eligibility with the use of a predicted risk threshold also implicitly assumes that the benefit of statins is constant in all eligible individuals, regardless of the factors that contribute to their increased risk such as higher age as opposed to higher LDL-C. Alternative approaches in determining statin eligibility have also been proposed recently, including the use of novel markers for better risk classification 3,4 and the use of entry criteria for randomized, controlled trials (RCTs) to define statin benefit groups. 5,6 Moreover, Pandya et al 7 have shown that statin preventive therapy remains cost-effective even at lower risk thresholds than selected by the ACC/AHA guidelines. Although each of these approaches has advantages and disadvantages, none directly considers the clinical benefits from statin therapy for each individual on the basis of the available clinical trial data. 8 Background-Current guidelines recommend statins in the primary prevention of cardiovascular disease on the basis of predicted cardiovascular risk without directly considering the expected benefits of statin therapy based on the available randomized, controlled trial evidence. Methods and Results-We included 2134 participants representing 71.8 million American residents potentially eligible for statins in primary prevention from the National Health and Nutrition Examination Survey for the years 2005 to 2010. We compared statin eligibilities using 2 separate approaches: a 10-year risk-based approach (≥7.5% 10-year risk) and an individualized benefit approach (ie, based on predicted absolute risk reduction over 10 years [ARR 10 ] ≥2.3% from randomized, controlled trial data). A risk-based approach led to the eligibility of 15.0 million (95% confidence interval, 12.7-17.3 million) Americans, whereas a benefit-based approach identified 24.6 million (95% confidence interval, 21.0-28.1 million). The corresponding numbers needed to treat over 10 years were 21 (range, 9-44) and 25 (range, 9-44). The benefit-based approach identified 9.5 million lower-risk (<7.5% 10-year risk) Americans not currently eligible for statin treatment who had the same or greater expected benefit from statins (≥2.3% ARR 10) compared with higher-risk individuals. This lower-risk/acceptable-benefit group includes younger individuals (mean age, 55.2 versus 62.5 years; P<0.001 for benefit based versus risk based) with higher low-density lipoprotein cholesterol (140 versus133 mg/dL; P=0.01). Statin treatment in this group would be expected to prevent an additional 266 508 cardiovascular events over 10 years. Conclusions-An individualized statin benefit approach can identify lower-risk individuals who have equal or greater expected benefit from statins in primary prevention compared with higher-risk individuals. This approach may help develop guideline recommendations that better identify individuals who meaningfully benefit from statin therapy.
2012
This study compared actual use of individual statin drugs to expected use based on their efficacy and safety profiles. Methods: Five panels covering the years 1999 to 2008 from the National Health and Nutrition Examination Survey provided interview, demographic, and laboratory data for 8769 (365,503,838 weighted) people aged 20 years or older who were not taking a statin medication. An individual's risk for coronary heart disease and low-density lipoprotein (LDL) cholesterol goal were determined, following the Adult Treatment Panel III Cholesterol Guidelines. The percentage LDL cholesterol lowering required to reach his/her LDL cholesterol level goal was calculated. Depending on the amount of LDL cholesterol lowering needed and on if the individual had a liver condition (i.e., enhanced risk of rhabdomyolysis) statins were hypothetically prescribed. Predicted use was compared to actual use by US Medicaid beneficiaries in the third quarter of 2009, obtained from the Medicaid State Drug Utilization Data maintained by the Centers for Medicare and Medicaid Services. Results: Results showed that 72.34% of the population was in the lowest coronary heart disease risk group and that 86.30% required no statin therapy. Among the people who did require LDL cholesterol lowering, a significant majority (37.3 million or 10.22% of the population) needed 30% lowering or less. Only 314,784 (0.09%) required LDL cholesterol lowering of greater than 60%. Utilization shares based on safety and efficacy were estimated at 19.26% (rosuvastatin), 18.67% (atorvastatin), 16.48% (simvastatin), 16.30% (lovastatin), 14.93% (pravastatin), and 14.36% (fluvastatin). Conclusions: Actual statin use differed substantially from predicted use. It may be appropriate to develop and maintain policies that encourage use of less costly products that have essentially equivalent safety profiles and efficacy.
Statin Therapy, Fitness, and Mortality Risk in Middle-Aged Hypertensive Male Veterans
American Journal of Hypertension, 2014
The efficacy of statin therapy in lowering the risk of cardiovascular events and death in secondary prevention of cardiovascular disease (CVD) is well accepted. 1,2 Several studies also support the use of statins for primary prevention among individuals at high risk for CVD. The health benefits of statin therapy are largely attributed to the lipidlowering characteristics of statins. 5 However, pleiotropic properties such as favorable effects on their interaction with the renin-angiotensin system, 6 endothelial function, 7 and arterial compliance 8 have also been suggested. In addition, recent studies, 9,10 including two meta-analyses of randomized controlled trials, 5,11 demonstrated a small but clinically relevant reductions in systolic blood pressure (BP) attributable to statin therapy. This evidence, along with the likely coexistence of hypertension and hypercholesterolemia, 12 makes the combination of antihypertensive medication and statins a common course of therapy in such individuals.
2012
Hypercholesterolemia and dyslipidemia are independent risk factors for cardiovascular disease and death. Statins are the drugs of choice to decrease plasma cholesterol and have other beneficial actions beyond lipid-lowering leading to substantial improvements in cardiovascular morbidity and mortality. However, evaluation of the effects of statins to reduce overall morbidity and mortality must integrate metabolic consequences of statin therapy with its lipid-lowering effect. Indeed, reduction in LDL-cholesterol to target level achieved by statins does not completely eliminate risk of cardiovascular disease and may elevate metabolic risk factors that contribute to dysregulation of metabolic homeostasis. This may lead to increased incidence of diabetes and its cardiovascular complications that are explained, in part, by reciprocal relationships between insulin resistance and endothelial dysfunction. Genetic factors may determine 40-60% of total cholesterol levels and 70% of the efficacy of statin treatments. Metabolic and cardiovascular phenotypes that are either genetically determined or environmentally acquired are also important determinants of responses to specific statins. Moreover, differences between biological outcomes of specific statins or increasing dosages of statins result in differential metabolic actions due to off-target or unknown mechanism that have important implications for the use of statins to reduce overall morbidity and mortality. In this review, we discuss differential cardiovascular and metabolic pleiotropic actions of specific statins that interact in a context-dependent manner with patient phenotypes and genotypes. These important considerations may influence progression of atherosclerosis, risk of diabetes, and modulation of insulin resistance that help determine overall morbidity and mortality in patients undergoing statin therapy.
Factors Associated with the Prescribing of High-Intensity Statins
Journal of Clinical Medicine
In this study, we investigated the relationship between sociodemographic, clinical, anthropometric, and lifestyle characteristics and the type of statin prescribed for primary prevention of cardiovascular disease (CVD). We conducted an observational study in workers who began statin treatment. Statin therapy was categorized as “high-intensity” or “low–moderate-intensity”. Workers were classified according to the alignment of their statin therapy with the recommended management practices. Logistic regression models were used to evaluate the association between the different variables studied and the probability of being prescribed high-intensity statins. The only variables associated with a higher probability of being treated with high-intensity statins were increased physical activity (>40 versus <20 METs (metabolic equivalent of task) h/wk; odds ratio (OR), 1.65; 95%CI, 1.08–2.50) and, in diabetics, higher low-density lipoprotein cholesterol (LDL-C) levels (≥155 mg/dL versus ...
The American Journal of Cardiology, 2019
Despite strong evidence for the use of statins for patients with atherosclerotic cardiovascular disease (ASCVD), statin prescription is still suboptimal. We aimed to determine the rates and factors that influence statin prescription using national survey data. This is a cross-sectional retrospective study on 8,468 patients with clinical ASCVD who were drawn from the National Ambulatory Medical Care Survey (NAMCS) and the National Hospital Ambulatory Medical Care Survey (NHAMCS) from years 2011 to 2015. Survey-weighted analysis was conducted to estimate weighted prevalence and odds ratios (OR) for statin prescription. There was a significant increase in statin prescription from the years 2011 to 2015. Nevertheless, only 52% of ASCVD patients (55.4% in coronary heart disease and 37.7% in non-coronary heart disease) were prescribed a statin. Based on multivariable regression analysis, after adjusting for covariates, males had 1.28 (1.06, 1.55) higher odds of statin prescription, in coronary heart disease patients only. In the overall study population, Black Non-Hispanics had 31% lower odds of statin prescription comparted to White Non-Hispanics, and patients seen only by a healthcare provider other than a physician were 80% less likely to have a statin prescribed to them. In conclusion, the disparity in statin prescription in patients with ASCVD exists across minority groups, and our findings underscore existing variations in healthcare delivery.