cardiovascular disease

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

MeSH

alcohol drinking

frailty

aged

RPR Commentary: A review of the recognition, assessment, and treatment of older patients who regularly drink alcohol-containing beverages. James W. Mold, MD, MPH

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Clinical question
How do I evaluate and treat alcohol use in older
adult patients?
Bottom line
Although older adults generally drink less alcohol than
their younger counterparts,1 the consequences of use
are more severe. Older adults are more susceptible to
alcohol-related toxicity due to physiologic changes.2
The health impacts of heavy alcohol intake include
increased risks of cardiovascular disease, stroke, liver
disease, cancer, and mortality.3 Acute and chronic
alcohol use contributes to geriatric syndromes, such as
cognitive impairment, falls, frailty, and malnutrition.4

Author/s:

Frank, Chris, Molnar, Rummell, Sonja, Chan, Peter

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

Megan George — Tue, 10 Mar 2026 15:14:46 +0000

Date Added:

March 10, 2026

Journal/Publication:

Journal of the American Geriatric Society

Publication Date:

March 7, 2026

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1111/jgs.70375

Keywords

prevention

statins

PMID (1):

41793188

MeSH

female

Humans

Electronic Health Records

Proportional Hazards Models

retrospective studies

aged

Statins taken for primary prevention in adults over 80 were associated with a reduction in 4-year mortality rates of 31%. James W. Mold, MD, MPH

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Background: Evidence supporting the use of statins for primary prevention of cardiovascular disease (CVD) in individuals aged ≥ 80 years remains limited. This study aimed to evaluate the long-term clinical benefits and safety of statins for primary prevention in patients aged 80 years and older.

Methods: We conducted a population-based retrospective cohort study using electronic medical records and pharmacy dispensing data from Clalit Health Services in Israel, covering the period from January 2015 to December 2020. Patients aged ≥ 80 years without prior CVD who were persistent statin users were compared with similar patients not receiving statins. Exclusions included prior CVD, dialysis, or death within 1 year of follow-up. Outcomes included all-cause mortality, new coronary events, myopathy, dementia, and diabetes mellitus. Cox proportional hazards models, adjusted for potential confounders, were used to assess the association between statin use and clinical outcomes.

Results: Among 15,745 patients (mean age 84.5 years; 66% female), 8413 were statin users. Over a 4-year mean follow-up, statin use was associated with a 31% reduction in mortality (HR 0.69; 95% CI: 0.34-0.74; p < 0.001) and a 20% reduction in new coronary events (HR 0.80; 95% CI: 0.68-0.94; p = 0.008). No significant differences were observed in the incidence of myopathy, diabetes, or dementia. Benefits were not observed in patients who discontinued statins before age 80.

Conclusions: In patients aged ≥ 80 years, statin therapy for primary prevention was associated with reduced all-cause mortality and coronary morbidity, without increased risk of adverse events. Early discontinuation diminished these benefits.

Author/s:

Ophir Lavon, Wafaa Hamodi, Sameer Kassem

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

Nathan Hinkle — Mon, 09 Mar 2026 21:11:08 +0000

Date Added:

March 9, 2026

Journal/Publication:

Journal of the American Geriatrics Society

Publisher:

Wiley Periodicals LLC

Publication Date:

March 7, 2026

URL:

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1111/jgs.70375Digital Object Identifier (DOI)

Keywords

Geriatrics

Adults Aged 80 years or older

MeSH

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

follow-up studies

RPR Commentary: Statins taken for primary prevention in adults over 80 were associated with a reduction in 4-year mortality rates of 31%. James W. Mold, MD, MPH

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ABSTRACT Background: Evidence supporting the use of statins for primary prevention of cardiovascular disease (CVD) in individuals aged≥ 80 years remains limited. This study aimed to evaluate the long-term clinical benefits and safety of statins for primary prevention in patients aged 80 years and older. Methods: We conducted a population-based retrospective cohort study using electronic medical records and pharmacy dispensing data from Clalit Health Services in Israel, covering the period from January 2015 to December 2020. Patients aged ≥ 80 years without prior CVD who were persistent statin users were compared with similar patients not receiving statins. Exclusions included prior CVD, dialysis, or death within 1 year of follow-up. Outcomes included all-cause mortality, new coronary events, myopathy, dementia, and diabetes mellitus. Cox proportional hazards models, adjusted for potential confounders, were used to assess the association between statin use and clinical outcomes. Results: Among 15,745 patients (mean age 84.5 years; 66% female), 8413 were statin users. Over a 4-year mean follow-up, statin use was associated with a 31% reduction in mortality (HR 0.69; 95% CI: 0.34–0.74; p < 0.001) and a 20% reduction in new coronary events (HR 0.80; 95% CI: 0.68–0.94; p = 0.008). No significant differences were observed in the incidence of myopathy, diabetes, or dementia. Benefits were not observed in patients who discontinued statins before age 80. Conclusions: In patients aged ≥ 80 years, statin therapy for primary prevention was associated with reduced all-cause mortality and coronary morbidity, without increased risk of adverse events. Early discontinuation diminished these benefits.

Author/s:

Wafaa Hamodi, Ophir Lavon, Samir Kassem

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

Nathan Hinkle — Mon, 09 Mar 2026 21:10:43 +0000

Date Added:

March 9, 2026

Journal/Publication:

Journal of the American Geriatrics Society

Publisher:

Wiley Periodicals LLC

Publication Date:

March 7, 2026

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1111/jgs.70375Digital Object Identifier (DOI)

Keywords

Geriatrics

Adults Aged 80 years or older

MeSH

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

follow-up studies

RPR Commentary: Statins taken for primary prevention in adults over 80 were associated with a reduction in 4-year mortality rates of 31%. James W. Mold, MD, MPH

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Author/s:

Wafaa Hamodi, Ophir Lavon, Samir Kassem

Statin Therapy for Primary Prevention and Clinical Outcomes in Adults Aged 80 and Older: A Retrospective Comparative Cohort Study

Nathan Hinkle — Mon, 09 Mar 2026 21:10:39 +0000

Date Added:

March 9, 2026

Journal/Publication:

Journal of the American Geriatrics Society

Publisher:

Wiley Periodicals LLC

Publication Date:

March 7, 2026

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

https://doi.org/10.1111/jgs.70375Digital Object Identifier (DOI)

Keywords

Geriatrics

Adults Aged 80 years or older

MeSH

Aspirin Use to Prevent Cardiovascular Disease US Preventive Services Task Force Recommendation Statement

follow-up studies

RPR Commentary: Statins taken for primary prevention in adults over 80 were associated with a reduction in 4-year mortality rates of 31%. James W. Mold, MD, MPH

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Author/s:

Wafaa Hamodi, Ophir Lavon, Samir Kassem

Aspirin Use to Prevent Cardiovascular Disease US Preventive Services Task Force Recommendation Statement

Saige Blanchard — Tue, 10 May 2022 05:00:00 +0000

Date Added:

May 10, 2022

Journal/Publication:

Journal of the American Medical Association

Publisher:

American Medical Association

Publication Date:

April 26, 2022

Issue:

Volume:

327

Pages:

1577-1584

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2022.4983

Keywords

aspirin

USPSTF

mortality

PMID (1):

35471505

MeSH

Adult

Dietary recommendations for prevention of atherosclerosis

incidence

Ulcer

primary prevention

Current USPSTF recommendations regarding the use of low-dose aspirin for primary prevention of adverse cardiovascular events. James W. Mold, MD, MPH

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Importance: Cardiovascular disease (CVD) is the leading cause of mortality in the US, accounting for more than 1 in 4 deaths. Each year, an estimated 605 000 people in the US have a first myocardial infarction and an estimated 610 000 experience a first stroke.

Objective: To update its 2016 recommendation, the US Preventive Services Task Force (USPSTF) commissioned a systematic review on the effectiveness of aspirin to reduce the risk of CVD events (myocardial infarction and stroke), cardiovascular mortality, and all-cause mortality in persons without a history of CVD. The systematic review also investigated the effect of aspirin use on colorectal cancer (CRC) incidence and mortality in primary CVD prevention populations, as well as the harms (particularly bleeding) associated with aspirin use. The USPSTF also commissioned a microsimulation modeling study to assess the net balance of benefits and harms from aspirin use for primary prevention of CVD and CRC, stratified by age, sex, and CVD risk level.

Population: Adults 40 years or older without signs or symptoms of CVD or known CVD (including history of myocardial infarction or stroke) who are not at increased risk for bleeding (eg, no history of gastrointestinal ulcers, recent bleeding, other medical conditions, or use of medications that increase bleeding risk).

Evidence assessment: The USPSTF concludes with moderate certainty that aspirin use for the primary prevention of CVD events in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk has a small net benefit. The USPSTF concludes with moderate certainty that initiating aspirin use for the primary prevention of CVD events in adults 60 years or older has no net benefit.

Recommendation: The decision to initiate low-dose aspirin use for the primary prevention of CVD in adults aged 40 to 59 years who have a 10% or greater 10-year CVD risk should be an individual one. Evidence indicates that the net benefit of aspirin use in this group is small. Persons who are not at increased risk for bleeding and are willing to take low-dose aspirin daily are more likely to benefit. (C recommendation) The USPSTF recommends against initiating low-dose aspirin use for the primary prevention of CVD in adults 60 years or older. (D recommendation).

Author/s:

US Preventive Services Task Force

Dietary recommendations for prevention of atherosclerosis

Saige Blanchard — Mon, 28 Feb 2022 06:00:00 +0000

Date Added:

February 28, 2022

Journal/Publication:

Cardiovascular Research

Publisher:

European Society of Cardiology

Publication Date:

July 6, 2021

Volume:

173

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1093/cvr/cvab173

Keywords

Atherosclerosis

Coronary Heart Disease

diet

PMID (1):

34229346

MeSH

The Unrecognized Prevalence of Primary Aldosteronism

A review of the current evidence regarding dietary strategies for lowering cardiovascular disease risk. James W. Mold, MD, MPH

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This review aims at summarizing updated evidence on cardiovascular disease (CVD) risk associated with consumption of specific food items to substantiate dietary strategies for atherosclerosis prevention. A systematic search on PubMed was performed to identify meta-analyses of cohort studies and RCTs with CVD outcomes. The evidence is highly concordant in showing that, for the healthy adult population, low consumption of salt and foods of animal origin, and increased intake of plant-based foods—whole grains, fruits, vegetables, legumes, and nuts—are linked with reduced atherosclerosis risk. The same applies for the replacement of butter and other animal/tropical fats with olive oil and other unsaturated-fat-rich oil. Although the literature reviewed overall endorses scientific society dietary recommendations, some relevant novelties emerge. With regard to meat, new evidence differentiates processed and red meat—both associated with increased CVD risk—from poultry, showing a neutral relationship with CVD for moderate intakes. Moreover, the preferential use of low-fat dairies in the healthy population is not supported by recent data, since both full-fat and low-fat dairies, in moderate amounts and in the context of a balanced diet, are not associated with increased CVD risk; furthermore, small quantities of cheese and regular yogurt consumption are even linked with a protective effect. Among other animal protein sources, moderate fish consumption is also supported by the latest evidence, although there might be sustainability concerns. New data endorse the replacement of most high glycemic index (GI) foods with both whole grain and low GI cereal foods. As for beverages, low consumption not only of alcohol, but also of coffee and tea is associated with a reduced atherosclerosis risk while soft drinks show a direct relationship with CVD risk. This review provides evidence-based support for promoting appropriate food choices for atherosclerosis prevention in the general population.

The Unrecognized Prevalence of Primary Aldosteronism

John Bayhi — Tue, 26 May 2020 21:01:14 +0000

Date Added:

May 26, 2020

Journal/Publication:

Annals of Internal Medicine

Publisher:

American College of Physicians

Publication Date:

May 26, 2020

Volume:

Online ahead of print

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.7326/M20-0065

Keywords

primary aldosteronism

hypertension

PMID (1):

32449886

MeSH

Essential Hypertension

Cross-Sectional Studies

prevalence

Blood Pressure Determination

Hyperaldosteronism

hypertension

Hypoakalemia

Academic Medical Centers

Potassium

Sodium

This study suggests (confirming what Dr. David Kem at OU has long taught) that primary aldosteronism is much more common than generally thought, occurring in as many as 11% of people with normal BP and 22% of those with hard to control HTN. Usual diagnostic tests aren’t very accurate. We should probably be using spironolactone more often. James W. Mold, MD, MPH

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Background:

Primary aldosteronism is a nonsuppressible renin-independent aldosterone production that causes hypertension and cardiovascular disease.

Objective:

To characterize the prevalence of nonsuppressible renin-independent aldosterone production, as well as biochemically overt primary aldosteronism, in relation to blood pressure.

Design:

Cross-sectional study.

Setting:

4 U.S. academic medical centers.

Participants:

Participants with normotension (n = 289), stage 1 hypertension (n = 115), stage 2 hypertension (n = 203), and resistant hypertension (n = 408).

Measurements:

Participants completed an oral sodium suppression test, regardless of aldosterone or renin levels, as a confirmatory diagnostic for primary aldosteronism and to quantify the magnitude of renin-independent aldosterone production. Urinary aldosterone was measured in participants in high sodium balance with suppressed renin activity. Biochemically overt primary aldosteronism was diagnosed when urinary aldosterone levels were higher than 12 µg/24 h.

Results:

Every blood pressure category had a continuum of renin-independent aldosterone production, where greater severity of production was associated with higher blood pressure, kaliuresis, and lower serum potassium levels. Mean adjusted levels of urinary aldosterone were 6.5 µg/24 h (95% CI, 5.2 to 7.7 µg/24 h) in normotension, 7.3 µg/24 h (CI, 5.6 to 8.9 µg/24 h) in stage 1 hypertension, 9.5 µg/24 h (CI, 8.2 to 10.8 µg/24 h) in stage 2 hypertension, and 14.6 µg/24 h (CI, 12.9 to 16.2 µg/24 h) in resistant hypertension; corresponding adjusted prevalence estimates for biochemically overt primary aldosteronism were 11.3% (CI, 5.9% to 16.8%), 15.7% (CI, 8.6% to 22.9%), 21.6% (CI, 16.1% to 27.0%), and 22.0% (CI, 17.2% to 26.8%). The aldosterone–renin ratio had poor sensitivity and negative predictive value for detecting biochemically overt primary aldosteronism.

Limitation:

Prevalence estimates rely on arbitrary and conventional thresholds, and the study population may not represent nationwide demographics.

Conclusion:

The prevalence of primary aldosteronism is high and largely unrecognized. Beyond this categorical definition of primary aldosteronism, there is a prevalent continuum of renin-independent aldosterone production that parallels the severity of hypertension. These findings redefine the primary aldosteronism syndrome and implicate it in the pathogenesis of “essential” hypertension.

Primary Funding Source:

National Institutes of Health.

Author/s:

Brown, JM, Siddiqui, M, Calhoun, DA, Carey, RM, Hopkins, PN, Williams, GH, Vaidya, A

Primary Prevention of Cardiovascular Disease

John Bayhi — Sat, 05 Oct 2019 14:48:41 +0000

Date Added:

October 5, 2019

Journal/Publication:

JAMA

Publisher:

American Medical Association

Publication Date:

October 4, 2019

URL:

Primary Prevention of Cardiovascular Disease

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1001/jama.2019.15915

Keywords

CAD

coronary artery disease

guidelines

American Heart Association

American College of Cardiology

CVD

The effects of sleep extension on cardiometabolic risk factors: A systematic review.

primary prevention

PMID (1):

31584604

The most recent ACC/AHA Guideline regarding primary prevention of coronary artery disease. James W. Mold, MD, MPH

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Atherosclerotic CVD remains the leading cause of death for people of most racial/ethnic groups. In 2010, the AHA suggested metrics of ideal cardiovascular health in 7 domains (blood pressure, physical activity, cholesterol, diet, weight, smoking, and blood glucose). There have since been multiple related guideline updates and scientific statements. In 2017, the ACC/AHA Task Force on Clinical Practice Guidelines commissioned an updated guideline integrating existing and new recommendations into a unified and “user-friendly” document on primary prevention of ASCVD.

Author/s:

Jain, A, Davis, AM

The effects of sleep extension on cardiometabolic risk factors: A systematic review

Brian Desmarais — Wed, 19 Jun 2019 20:20:01 +0000

Date Added:

June 19, 2019

Journal/Publication:

The Journal of Sleep Research

Publisher:

European Sleep Research Society

Publication Date:

June 5, 2019

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

https://doi.org/10.1111/jsr.12865

Keywords

non-communicable diseases

insulin sensitivity

metabolic syndrome

MeSH

2018 Cholesterol Clinical Practice Guidelines: Synopsis of the 2018 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline.

overweight

Noncommunicable Diseases

Sugars

Insulin Resistance

risk factors

This systematic review found that increasing sleep duration improves direct and indirect measures of insulin sensitivity,

decreased leptin and peptide tyrosine‐tyrosine, and reductions in overall appetite, desire for sweet and salty foods, intake of daily free sugar, and percentage of daily

caloric intake from protein. James W. Mold, MD, MPH

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Studies have shown bidirectional relationships between short- or long-sleep duration and risk for obesity, non-communicable diseases, all-cause mortality and cardiovascular disease mortality. Increasing sleep duration may be an appropriate strategy to reduce cardiometabolic riskin short-sleeping individuals. The aim is to review the effects of sleep extension interventions on cardiometabolic risk in adults. The PubMed and Scopus databases were searched for relevant, English, peer-reviewed scientific publications (until August 2018). Seven studies that aimed to increase sleep duration in adults by any sleep extension intervention and described at least one cardiometabolic risk factor were included. These studies had a combined sample size of 138 participants who were either healthy (n = 14), healthy short-sleeping (n = 92), overweight short-sleeping (n = 10), or pre- or hypertensive short-sleeping (n = 22) individuals. The durations of the sleep extensioninterventions ranged from 3 days to 6 weeks, and all successfully increased total sleep time by between 21 and 177 min. Sleep extensionwas associated with improved direct and indirect measures of insulin sensitivity, decreased leptin and peptide tyrosine-tyrosine, and reductions in overall appetite, desire for sweet and salty foods, intake of daily free sugar, and percentage of daily caloric intake from protein. This review provides preliminary evidence for a role for sleep extension to improve cardiometabolic outcomes and directive towards future studies in the field of cardiometabolic health and sleep.

Author/s:

Henst, R.H.P., Pienaar, P.R., Roden, L.C., Rae, D.E.

2018 Cholesterol Clinical Practice Guidelines: Synopsis of the 2018 American Heart Association/American College of Cardiology/Multisociety Cholesterol Guideline

Tracy Ashby — Wed, 29 May 2019 05:00:00 +0000

Date Added:

May 29, 2019

Journal/Publication:

Annals of Internal Medicine

Publisher:

The American College of Physicians

Publication Date:

May 28, 2019

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.7326/M19-0365

Keywords

cholesterol

primary prevention

risk factors

PMID (1):

31132793

MeSH

A Randomized Trial of Intensive versus Standard Blood-Pressure Contro

secondary prevention

This is the 2018 version of the AHA/ACC Guideline on cholesterol management. James W. Mold, MD, MPH

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Description:

In November 2018, the American Heart Association and American College of Cardiology (AHA/ACC) released a new clinical practice guideline on cholesterol management. It was accompanied by a risk assessment report on primary prevention of atherosclerotic cardiovascular disease (ASCVD).

Methods:

A panel of experts free of recent and relevant industry-related conflicts was chosen to carry out systematic reviews and meta-analyses of randomized controlled trials (RCTs) that examined cardiovascular outcomes. High-quality observational studies were used for estimation of ASCVD risk. An independent panel systematically reviewed RCT evidence about the benefits and risks of adding nonstatin medications to statin therapy compared with receiving statin therapy alone in persons who have or are at high risk for ASCVD.

Recommendation:

The guideline endorses a heart-healthy lifestyle beginning in childhood to reduce lifetime risk for ASCVD. It contains several new features compared with the 2013 guideline. For secondary prevention, patients at very high risk may be candidates for adding nonstatin medications (ezetimibe or proprotein convertase subtilisin/kexin type 9 [PCSK9] inhibitors) to statin therapy. In primary prevention, a clinician–patient risk discussion is still strongly recommended before a decision is made about statin treatment. The AHA/ACC risk calculator first triages patients into 4 risk categories. Those at intermediate risk deserve a focused clinician–patient discussion before initiation of statin therapy. Among intermediate-risk patients, identification of risk-enhancing factors and coronary artery calcium testing can assist in the decision to use a statin. Compared with the 2013 guideline, the new guideline gives more attention to percentage reduction in low-density lipoprotein cholesterol as a treatment goal and to long-term monitoring of therapeutic efficacy. To simplify monitoring, nonfasting lipid measurements are allowed.

Author/s:

Grundy, Scott M, Stone, Neil J., Guideline Writing Committee for the 2018 Cholesterol Guidelines

A Randomized Trial of Intensive versus Standard Blood-Pressure Control

Tracy Ashby — Fri, 22 Feb 2019 06:00:00 +0000

Date Added:

February 22, 2019

Journal/Publication:

The New England Journal of Medicine

Publisher:

Massachusetts Medical Society

Publication Date:

November 26, 2015

Issue:

Volume:

373

Pages:

2103-16

URL:

Type:

Clinical Research Results

Format:

Article

DOI (1):

10.1056/nejmoa1511939

Keywords

blood pressure

diabetes

risk factors

PMID (1):

26551272

MeSH

blood pressure

diabetes mellitus

Prediction of individual life-years gained without cardiovascular events from lipid, blood pressure, glucose, and aspirin treatment based on data of more than 500 000 patients with Type 2 diabetes mellitus.

myocardial infarction

acute coronary syndrome

heart failure

This is the SPRINT trial that showed additional reductions in adverse cardiovascular events from lowering BP to 120 systolic.

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BACKGROUND

The most appropriate targets for systolic blood pressure to reduce cardiovascular morbidity and mortality among persons without diabetes remain uncertain.

METHODS

We randomly assigned 9361 persons with a systolic blood pressure of 130 mm Hg or higher and an increased cardiovascular risk, but without diabetes, to a systolic blood-pressure target of less than 120 mm Hg (intensive treatment) or a target of less than 140 mm Hg (standard treatment). The primary composite outcome was myocardial infarction, other acute coronary syndromes, stroke, heart failure, or death from cardiovascular causes.

RESULTS

At 1 year, the mean systolic blood pressure was 121.4 mm Hg in the intensive-treatment group and 136.2 mm Hg in the standard-treatment group. The intervention was stopped early after a median follow-up of 3.26 years owing to a significantly lower rate of the primary composite outcome in the intensive-treatment group than in the standard-treatment group (1.65% per year vs. 2.19% per year; hazard ratio with intensive treatment, 0.75; 95% confidence interval [CI], 0.64 to 0.89; P<0.001). All-cause mortality was also significantly lower in the intensive-treatment group (hazard ratio, 0.73; 95% CI, 0.60 to 0.90; P=0.003). Rates of serious adverse events of hypotension, syncope, electrolyte abnormalities, and acute kidney injury or failure, but not of injurious falls, were higher in the intensive-treatment group than in the standard-treatment group.

CONCLUSIONS

Among patients at high risk for cardiovascular events but without diabetes, targeting a systolic blood pressure of less than 120 mm Hg, as compared with less than 140 mm Hg, resulted in lower rates of fatal and nonfatal major cardiovascular events and death from any cause, although significantly higher rates of some adverse events were observed in the intensive-treatment group. (Funded by the National Institutes of Health; ClinicalTrials.gov number, NCT01206062.)

Author/s:

The SPRINT Research Group

Prediction of individual life-years gained without cardiovascular events from lipid, blood pressure, glucose, and aspirin treatment based on data of more than 500 000 patients with Type 2 diabetes mellitus

Jeffrey Wilson — Sun, 03 Feb 2019 21:22:07 +0000

Date Added:

February 3, 2019

Journal/Publication:

European Heart Journal

Publisher:

Oxford University Press

Publication Date:

January 9, 2019

URL:

Type:

Clinical Decision Aids

DOI (1):

10.1093/eurheartj/ehy839

Keywords

diabetes mellitus, type 2

cardiovascular events

PMID (1):

30629157

MeSH

glycated hemoglobin, A

lipoprotein cholesterol

blood pressure

insulin

glucose

RPR Commentary: The authors have developed and validated several calculators that predict lifetime risk of CV events based upon age, gender, smoking, blood pressure, lipids, A1c, and use of antiplatelet agents. They can be accessed at www.U-Prevent.com.

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AIMS:

Although group-level effectiveness of lipid, blood pressure, glucose, and aspirin treatment for prevention of cardiovascular disease (CVD) has been proven by trials, important differences in absolute effectiveness exist between individuals. We aim to develop and validate a prediction tool for individualizing lifelong CVD prevention in people with Type 2 diabetes mellitus (T2DM) predicting life-years gained without myocardial infarction or stroke.

METHODS AND RESULTS:

We developed and validated the Diabetes Lifetime-perspective prediction (DIAL) model, consisting of two complementary competing risk adjusted Cox proportional hazards functions using data from people with T2DM registered in the Swedish National Diabetes Registry (n = 389 366). Competing outcomes were (i) CVD events (vascular mortality, myocardial infarction, or stroke) and (ii) non-vascular mortality. Predictors were age, sex, smoking, systolic blood pressure, body mass index, haemoglobin A1c, estimated glomerular filtration rate, non- high-density lipoprotein cholesterol, albuminuria, T2DM duration, insulin treatment, and history of CVD. External validation was performed using data from the ADVANCE, ACCORD, ASCOT and ALLHAT-LLT-trials, the SMART and EPIC-NL cohorts, and the Scottish diabetes register (total n = 197 785). Predicted and observed CVD-free survival showed good agreement in all validation sets. C-statistics for prediction of CVD were 0.83 (95% confidence interval: 0.83-0.84) and 0.64-0.65 for internal and external validation, respectively. We provide an interactive calculator at www.U-Prevent.com that combines model predictions with relative treatment effects from trials to predict individual benefit from preventive treatment.

CONCLUSION:

Cardiovascular disease-free life expectancy and effects of lifelong prevention in terms of CVD-free life-years gained can be estimated for people with T2DM using readily available clinical characteristics. Predictions of individual-level treatment effects facilitate translation of trial results to individual patients.

Author/s:

Berkelmans, Gijs F N, Gudbjörnsdottir, Soffia, Visseren, Frank L J, Wild, Sarah H, Franzen, Stefan, Chalmers, John, Davis, Barry R, Poulter, Neil R, Spijkerman, Annemieke M, Woodward, Mark, Pressel, Sara L, Gupta, Ajay K, van der Schouw, Yvonne T, Svensson, Ann-Marie

Cholesterol Management in Primary Care

Tracy Ashby — Fri, 25 Jan 2019 06:00:00 +0000

Date Added:

January 25, 2019

Journal/Publication:

Healthy Hearts for Oklahoma (H2O)

Publisher:

The Oklahoma Cooperative

Publication Date:

January 25, 2019

Type:

Clinical Decision Aids

Format:

Article

Keywords

cardiovascular events

statins

MeSH

disease, cardiovascular

Effect of glycaemic control on cardiovascular disease in individuals with type 2 diabetes with pre-existing cardiovascular disease: A systematic review and meta-analysis

This is the material used in the Healthy Hearts for OK project to update clinicians on the use of statins to prevent cardiovascular events.

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An update for clinicians on the use of statins to prevent cardiiovascular events from the Healthy Hearts for OK project.

Author/s:

Mold, James W.

Effect of glycaemic control on cardiovascular disease in individuals with type 2 diabetes with pre-existing cardiovascular disease: A systematic review and meta-analysis

Tracy Ashby — Sun, 06 Jan 2019 06:00:00 +0000

Date Added:

January 6, 2019

Journal/Publication:

Diabetes, Obesity and Metabolism

Publisher:

John Wiley & Sons, Inc.

Publication Date:

November 13, 2018

Pages:

1-4

URL:

Type:

Meta-analyses, Reviews, and Guidelines, Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1111/dom.13581

Keywords