Consider The Evidence: Med/Peds Journal Roundup

February 20, 2007

Statins and Heart Failure

Filed under: Cardiology, statins — medblog @ 3:06 pm

Circulation 2/6 – Treating to New Targets (TNT) was one of many recent statin trials investigating the utility of high-dose treatment with very low LDL-C goals for improving cardiac outcomes. In a recent issue of Circulation Khush et al. published a subgroup analysis of data related to exacerbations of heart failure among trial participants. The study examined the number of hospitalizations for heart failure among the subjects in both the intervention (high dose atorvastatin) and control (usual dose atorvastatin) group.

The investgators found that those with CHD were about 26% less likely to be hospitalized for HF in the intervention arm. Those with CHD and prior CHF were 41% less likely to be hospitalized for an exacerbation. The authors of the study noted that in most cases there was no preceeding ischemic event such as MI or UA prior to the exacerbation. This led them to conclude that the protective effect in heart failure is not simply from the reduction of coronary stenosis alone, but rather an independent effect of statins on heart failure.

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March 20, 2006

Plaque-busting with statins

Filed under: Cardiology, JAMA, statins — medblog @ 11:14 pm

JAMA 3/13 – Nissen et al. produce the latest, and largest of several trials documenting the effect of statin therapy on atherosclerotic plaques. The earlier studies suggested that intensive therapy with statins led to the decrease in atheroma volume. The authors of this study contend that their measurement parameters (taken via IVUS) were more rigorous than the past studies, allowing them to make a much more definitive conclusion on the issue.

A dramatic result of the study was the reduction median LDL-C levels by over 50% to approx 60mg/dl.“The achieved LDL-C levels were the lowest values ever observed in a statin atherosclerosis progression trial.” The mean change in atheroma volume in the most diseased 10-mm subsegment was –6.1 mm3. Change in total atheroma volume showed a 6.8% median reduction; with a mean reduction of –14.7 mm3. They conclude that, “When viewed in this context, the results of the current study demonstrate that there exists no apparent threshold LDL-C level beyond which the benefits of statin therapy are no longer evident. If regression of disease is the desired outcome, then lower LDL-C is better.”

Put them in the water…..

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February 17, 2006

Statins alter initial presentation of CAD

Filed under: annals of internal medicine, CHD, statins — medblog @ 11:49 am

AnnalsIM 2/21 – Clearly statins reduce the risk of CAD, and act in several ways to prevent the formation of unstable plaques. So theoretically, the initial presentation of cardiac disease in patients on statins would be less likely to be unstable angina/MI vs. stable angina. In this weeks Annals, Go et al. present a study that supports just that conclusion. (more…)

February 6, 2006

Statins for sepsis???

Filed under: critical care, lancet, sepsis, statins, Uncategorized — medblog @ 11:21 pm

Lancet 2/4 – They slice, they dice, they even make julienne fries…Adding to the list of potential uses of statins is sepsis. In this weeks Lancet, Hackam et al., (as well as an accompanying editorial) investigate the evidence supporting a lower risk of sepsis in those patients on statin treatment. (more…)

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