secondary prevention

Hydroxymethylglutaryl-CoA Reductase Inhibitors

cardiovascular disease

statin therapy

risk factors

PMID (1):

31132793

MeSH

Aspirin for the Primary Prevention of Cardiovascular Disease: Weighing Up the Evidence

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

Aspirin for the Primary Prevention of Cardiovascular Disease: Weighing Up the Evidence

Jeffrey Wilson — Mon, 18 Mar 2019 14:43:45 +0000

Date Added:

March 18, 2019

Journal/Publication:

The American Journal of Medicine

Publisher:

Elsevier

Publication Date:

March 12, 2019

URL:

Type:

Meta-analyses, Reviews, and Guidelines

Format:

Article

DOI (1):

10.1016/j.amjmed.2019.02.025

Keywords

cardiovascular events

PMID (1):

30871925

MeSH

cardiovascular diseases

A nice review of the effectiveness of aspirin for primary prevention of CV events with a particular focus on the question of weight-based dosing. Bottom line is that primary prevention of CV events with aspirin, regardless of dose, is rarely justifiable.

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Aspirin is one of the most universally recognized and commonly prescribed medications worldwide. It is estimated that 48.7 million U.S. adults are taking aspirin for cardiovascular disease prevention; the majority (~73%) for primary prevention. The benefit of aspirin for secondary prevention of cardiovascular disease is well-established, with meta-analysis results favoring low dose (75–150 mg/day) over high dose (>150 mg/day) aspirin given similar efficacy but lower bleeding risk. In contrast, the role of aspirin in primary cardiovascular disease prevention is more controversial; historical trials found benefit but trials since 2008 have shown either null effects on all-cause and cardiovascular disease mortality or a signal for increased mortality in the context of excess bleeding.

Author/s:

Murphy, Sean, McCarthy, Cian P., McEvoy, John W.

Aspirin Use 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

MeSH

disease, cardiovascular

This is the material used in the Healthy Hearts for OK project to update clinicians on the role of low-dose aspirin for prevention of cardiovascular events.

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An update for clinicians on the role of low-dose aspirin for prevention of cardiiovascular events from the Healthy Hearts for OK project.

Author/s:

Mold, James W.

Aspirin Use in Primary Care

Jeffrey Wilson — Wed, 05 Sep 2018 15:37:53 +0000

Date Added:

September 5, 2018

Journal/Publication:

Healthy Hearts for Oklahoma

Publisher:

Agency for Healthcare Research and Quality

Type:

Clinical Decision Aids

Keywords

cardiovascular disease

MeSH

disease, cardiovascular