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https://www.readbyqxmd.com/read/27924723/clinical-management-of-diabetes-mellitus-in-the-older-adult-patient
#1
Nana Yaw Adu-Sarkodie
BACKGROUND: In 2009, approximately 40 million people were 65 years or older. Majority of persons over the age of 65 have at least one chronic medical condition. In 2002-2003, the most frequently occurring conditions among older adults were hypertension (51%), arthritis (48%), heart disease (31%), cancer of any type (21%), and diabetes (16%). The cost of diabetes care, both direct and indirect, was $245 billion in 2012. Fifty-nine percent of the direct medical cost was for the population aged 65 and over...
December 6, 2016: Current Diabetes Reviews
https://www.readbyqxmd.com/read/27908345/determining-when-to-add-nonstatin-therapy-a-quantitative-approach
#2
Jennifer G Robinson, Roeland Huijgen, Kausik Ray, Jane Persons, John J P Kastelein, Michael J Pencina
BACKGROUND: Costs and uncertainty about the benefits of nonstatin therapies limit their use. OBJECTIVES: The authors sought to identify patients who might benefit from the addition of a nonstatin to background statin therapy. METHODS: We performed systematic reviews of subgroup analyses from randomized trials and observational studies with statin-treated participants to determine estimated 10-year absolute risk of atherosclerotic cardiovascular disease (ASCVD) and to define high-risk and very high-risk patients...
December 6, 2016: Journal of the American College of Cardiology
https://www.readbyqxmd.com/read/27904029/coronary-artery-calcium-and-carotid-artery-intima-media-thickness-and-plaque-clinical-use-in-need-of-clarification
#3
Maryam Zaid, Akira Fujiyoshi, Aya Kadota, Robert D Abbott, Katsuyuki Miura
Atherosclerosis begins in early life and has a long latent period prior to onset of clinical disease. Measures of subclinical atherosclerosis, therefore, may have important implications for research and clinical practice of atherosclerotic cardiovascular disease (ASCVD). In this review, we focus on coronary artery calcium (CAC) and carotid artery intima-media thickness (cIMT) and plaque as many population-based studies have investigated these measures due to their non-invasive features and ease of administration...
December 1, 2016: Journal of Atherosclerosis and Thrombosis
https://www.readbyqxmd.com/read/27901333/fractional-flow-reserve-lessons-from-platform-and-future-perspectives
#4
Gianluca Pontone, Patrizia Carità, Massimo Verdecchia, Dario Buccheri, Daniele Andreini, Andrea I Guaricci, Mark Rabbat, Mauro Pepi
In the treatment of stable coronary artery disease (CAD) the identification of patients who may gain the highest benefit from further invasive treatments is of pivotal importance for the healthcare system. In this setting, it has been established that an ischemia-guided revascularization strategy yields improved clinical outcomes in a cost- effective fashion compared with anatomy-guided revascularization alone. Invasive fractional flow reserve (FFR) is considered the gold standard, especially in the intermediate-range atherosclerotic lesions, for assessing lesion specific ischemia at the time of invasive coronary angiography and has now become the standard of reference for studies assessing the diagnostic performance of the various non-invasive stress tests...
November 30, 2016: Minerva Cardioangiologica
https://www.readbyqxmd.com/read/27878791/new-concepts-in-the-management-of-dyslipidaemiaa
#5
Baris Gencer, Nicolas Rodondi, Francois Mach
Recently, the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) published a consensus paper giving guidance on the definition and management of statin-associated muscle symptoms (SAMS), as well as the use of proprotein convertase subtilisin kexin 9 (PCSK9) inhibitors in very high-risk patients. The occurrence of SAMS can have a major negative impact on treatment adherence and, consequently, on the prognosis of cardiovascular diseases. In addition, both the ESC guidelines on the prevention of cardiovascular disease (CVD) in clinical practice with sections addressing global strategies to minimise the burden of CVD at population and individual levels, and the 2016 ESC/EAS guideline for the management of dyslipidaemias, focus on evaluation and treatment of SAMS...
2016: Swiss Medical Weekly
https://www.readbyqxmd.com/read/27867302/current-and-emerging-uses-of-statins-in-clinical-therapeutics-a-review
#6
REVIEW
Jonathan T Davies, Spencer F Delfino, Chad E Feinberg, Meghan F Johnson, Veronica L Nappi, Joshua T Olinger, Anthony P Schwab, Hollie I Swanson
Statins, a class of cholesterol-lowering medications that inhibit 3-hydroxy-3-methyl-glutaryl-coenzyme A reductase, are commonly administered to treat atherosclerotic cardiovascular disease. Statin use may expand considerably given its potential for treating an array of cholesterol-independent diseases. However, the lack of conclusive evidence supporting these emerging therapeutic uses of statins brings to the fore a number of unanswered questions including uncertainties regarding patient-to-patient variability in response to statins, the most appropriate statin to be used for the desired effect, and the efficacy of statins in treating cholesterol-independent diseases...
2016: Lipid Insights
https://www.readbyqxmd.com/read/27846641/prevalence-and-prognostic-implications-of-coronary-artery-calcification-in-low-risk-women-a-meta-analysis
#7
Maryam Kavousi, Chintan S Desai, Colby Ayers, Roger S Blumenthal, Matthew J Budoff, Amir-Abbas Mahabadi, M Arfan Ikram, Aad van der Lugt, Albert Hofman, Raimund Erbel, Amit Khera, Marie H Geisel, Karl-Heinz Jöckel, Nils Lehmann, Udo Hoffmann, Christopher J O'Donnell, Joseph M Massaro, Kiang Liu, Stefan Möhlenkamp, Hongyan Ning, Oscar H Franco, Philip Greenland
Importance: The role of coronary artery calcium (CAC) testing for guiding preventive strategies among women at low cardiovascular disease (CVD) risk based on the American College of Cardiology and American Heart Association CVD prevention guidelines is unclear. Objective: To assess the potential utility of CAC testing for CVD risk estimation and stratification among low-risk women. Design, Setting, and Participants: Women with 10-year atherosclerotic CVD (ASCVD) risk lower than 7...
November 22, 2016: JAMA: the Journal of the American Medical Association
https://www.readbyqxmd.com/read/27846007/carotid-intima-media-thickness-as-a-cardiovascular-risk-factor-and-imaging-pathway-of-atherosclerosis
#8
Osmar Antonio Centurión
Assessment of carotid intima-media thickness (IMT) has emerged as a simple and noninvasive technique for measuring atherosclerotic burden. Although serum biomarkers have been linked to the risk of developing atherosclerosis, carotid IMT has the theoretical advantage of directly visualizing a final consequence of the disease itself, namely atherosclerosis in the vessel wall. The current widespread application of carotid IMT measurements has been based on the validity, standardization, and reproducibility of the measurement and the evidence that an increased carotid IMT can be regarded as an attractive biomarker of atherosclerosis and of increased cardiovascular risk, potentially useful as a therapeutic target in those at increased cardiovascular risk...
December 2016: Critical Pathways in Cardiology
https://www.readbyqxmd.com/read/27816944/plaque-imaging-to-refine-indications-for-emerging-lipid-lowering-drugs
#9
Mohammad Alkhalil, Joshua T Chai, Robin P Choudhury
Statins have been effective in reducing adverse cardiovascular events. Their benefits have been proportional to the level of plasma LDL-cholesterol reduction and seem to extend to patients with 'normal' levels of cholesterol at outset. Statins are also inexpensive and have a favourable side effect profile. As a result, they are used widely (almost indiscriminately) in patients with atherosclerotic vascular disease, and in those at risk of disease.Next generation lipid-modifying drugs seem unlikely to offer the same simplicity of application...
November 4, 2016: European Heart Journal. Cardiovascular Pharmacotherapy
https://www.readbyqxmd.com/read/27810296/safety-and-efficacy-of-vorapaxar-in-secondary-prevention-of-atherosclerotic-disease-a-meta-analysis-of-randomized-control-trials
#10
Abhishek Sharma, Gérard Helft, Aakash Garg, Sahil Agrawal, Saurav Chatterjee, Carl J Lavie, Sunny Goel, Debabrata Mukherjee, Jonathan D Marmur
OBJECTIVE: To study the cumulative evidence for vorapaxar use in patients with atherosclerotic cardiovascular disease. METHODS: A systematic review of randomized control trials in MEDLINE, EMBASE, EBSCO, CINAHL, Web of Science and Cochrane databases comparing vorapaxar with placebo was performed. Pre-specified efficacy endpoints were all-cause mortality, CV mortality, myocardial infarction (MI), ischemic stroke and repeat revascularization. The pre-specified safety endpoint was intracranial hemorrhage (ICH) and a composite of TIMI major and minor bleeding...
October 29, 2016: International Journal of Cardiology
https://www.readbyqxmd.com/read/27785772/a-systematic-review-of-cardiovascular-outcomes-based-cost-effectiveness-analyses-of-lipid-lowering-therapies
#11
REVIEW
Ching-Yun Wei, Ruben G W Quek, Guillermo Villa, Shravanthi R Gandra, Carol A Forbes, Steve Ryder, Nigel Armstrong, Sohan Deshpande, Steven Duffy, Jos Kleijnen, Peter Lindgren
BACKGROUND: Previous reviews have evaluated economic analyses of lipid-lowering therapies using lipid levels as surrogate markers for cardiovascular disease. However, drug approval and health technology assessment agencies have stressed that surrogates should only be used in the absence of clinical endpoints. OBJECTIVE: The aim of this systematic review was to identify and summarise the methodologies, weaknesses and strengths of economic models based on atherosclerotic cardiovascular disease event rates...
October 27, 2016: PharmacoEconomics
https://www.readbyqxmd.com/read/27757045/pharmacogenomics-of-statins-understanding-susceptibility-to-adverse-effects
#12
Joseph P Kitzmiller, Eduard B Mikulik, Anees M Dauki, Chandrama Murkherjee, Jasmine A Luzum
Statins are a cornerstone of the pharmacologic treatment and prevention of atherosclerotic cardiovascular disease. Atherosclerotic disease is a predominant cause of mortality and morbidity worldwide. Statins are among the most commonly prescribed classes of medications, and their prescribing indications and target patient populations have been significantly expanded in the official guidelines recently published by the American and European expert panels. Adverse effects of statin pharmacotherapy, however, result in significant cost and morbidity and can lead to nonadherence and discontinuation of therapy...
2016: Pharmacogenomics and Personalized Medicine
https://www.readbyqxmd.com/read/27755114/proprotein-convertase-subtilisin-kexin-type-9-inhibitors-update-from-clinical-trials-to-real-world-experience
#13
Michel Farnier
PURPOSE OF REVIEW: After the approval of alirocumab and evolocumab, the first two monoclonal antibodies (mAbs) targeting proprotein convertase subtilisin kexin type 9 (PCSK9), this review provides an update on recent PCSK9 inhibitors data and describes recommendations for the use before the results of the ongoing cardiovascular endpoint trials. RECENT FINDINGS: New studies and complementary analysis of phase III trials have consistently shown that alirocumab and evolocumab are highly effective in reducing LDL-cholesterol and to some extent lipoprotein (a)...
December 2016: Current Opinion in Lipidology
https://www.readbyqxmd.com/read/27753805/ssa-02-4-disparities-in-hypertension-management-of-ckd-in-south-asia
#14
Tazeen Jafar
Chronic kidney disease (CKD) defined as reduced estimated glomerular filtration rate (eGFR) or presence of albuminuria, progresses to end stage renal disease (ESRD), needing dialysis or kidney transplant to sustain life, and is associated with increased risks of premature cardiovascular disease (CVD) and mortality. CKD ranked 18 leading (and most rapidly rising cause of mortality by the Global Burden of Disease Study 2010. The social and economic consequences of CKD are far worse in low and middle income countries (LMICs) including India, Pakistan, Bangladesh, and Sri Lanka...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27642932/ssa-02-4-disparities-in-hypertension-management-of-ckd-in-south-asia
#15
Tazeen Jafar
Chronic kidney disease (CKD) defined as reduced estimated glomerular filtration rate (eGFR) or presence of albuminuria, progresses to end stage renal disease (ESRD), needing dialysis or kidney transplant to sustain life, and is associated with increased risks of premature cardiovascular disease (CVD) and mortality. CKD ranked 18 leading (and most rapidly rising cause of mortality by the Global Burden of Disease Study 2010. The social and economic consequences of CKD are far worse in low and middle income countries (LMICs) including India, Pakistan, Bangladesh, and Sri Lanka...
September 2016: Journal of Hypertension
https://www.readbyqxmd.com/read/27605323/pharmacist-prescribing-practices-in-a-clinical-pharmacy-cardiac-risk-service
#16
Brittany A Todd, Donald G Lamprecht, Sheila L Stadler
PURPOSE: Prescribing practices within a clinical pharmacy cardiac risk service (CPCRS) and their impact on treatment outcomes in patients with atherosclerotic cardiovascular disease (ASCVD) are described. SUMMARY: National healthcare reforms have increased the population of insured patients and placed increased demands on physicians and other providers. Pharmacists are well trained and positioned to aid in patient care by providing expertise in medication management and patient safety that can result in pharmacotherapy optimization and cost savings...
September 15, 2016: American Journal of Health-system Pharmacy: AJHP
https://www.readbyqxmd.com/read/27585206/the-role-of-a-coronary-artery-calcium-scan-in-type-1-diabetes
#17
Mark R Burge, R Philip Eaton, David S Schade
The coronary artery calcium (CAC) scan has recently emerged as a reproducible noninvasive test to detect asymptomatic atherosclerotic coronary artery disease. It has several advantages over the traditional cardiac stress testing modalities, including lower cost, greater sensitivity for nonobstructing coronary artery lesions, and excellent prognostic value when combined with the Framingham risk parameters. Its chief disadvantage is that it does not identify obstructing coronary artery lesions or noncalcified coronary artery plaque...
September 2016: Diabetes Technology & Therapeutics
https://www.readbyqxmd.com/read/27581390/a-novel-approach-to-diagnosing-coronary-artery-disease-acoustic-detection-of-coronary-turbulence
#18
Joseph L Thomas, Simon Winther, Robert F Wilson, Morten Bøttcher
Atherosclerotic disease within coronary arteries causes disruption of normal, laminar flow and generates flow turbulence. The characteristic acoustic waves generated by coronary turbulence serve as a novel diagnostic target. The frequency range and timing of microbruits associated with obstructive coronary artery disease (CAD) have been characterized. Technological advancements in sensor, data filtering and analytic capabilities may allow use of intracoronary turbulence for diagnostic and risk stratification purposes...
August 31, 2016: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/27581271/progress-in-the-care-of-familial-hypercholesterolaemia-2016
#19
Damon A Bell, Gerald F Watts
Familial hypercholesterolaemia (FH) is the most common autosomal dominant condition, with a prevalence of between one in 200 and one in 350 people in the general population. Untreated FH is associated with premature atherosclerotic cardiovascular disease (CVD). The prevalence of homozygous or compound heterozygous FH is now considered to be about one in 300 000 people. Treating children with FH reduces progression of atherosclerotic CVD and future CVD events. Most individuals with FH are undiagnosed, which together with the recent frequency data in the population and in individuals with premature coronary disease creates a public health challenge and mandates a key role for primary care...
September 5, 2016: Medical Journal of Australia
https://www.readbyqxmd.com/read/27539170/assessing-the-impact-of-medication%C3%A2-adherence-on-long-term-cardiovascular-outcomes
#20
Sameer Bansilal, Jose Maria Castellano, Ester Garrido, Henry G Wei, Allison Freeman, Claire Spettell, Fernando Garcia-Alonso, Irene Lizano, Renee J G Arnold, Jay Rajda, Gregory Steinberg, Valentin Fuster
BACKGROUND: Although guideline-recommended therapies reduce major adverse cardiovascular events (MACE) in patients after myocardial infarction (MI) or those with atherosclerotic disease (ATH), adherence is poor. OBJECTIVES: The goal of this study was to determine the association between medication adherence levels and long-term MACE in these patients. METHODS: We queried the claims database of a large health insurer for patients hospitalized for MI or with ATH...
August 23, 2016: Journal of the American College of Cardiology
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