Tag Archives: statins

ARISTOTLE: apixaban superior to warfarin in AF patients Another oral anticoagulant has shown good results in comparison to warfarin for use in the prevention of stroke in patients with atrial fibrillation (AF). The new oral factor Xa inhibitor, apixaban, was superior to warfarin in preventing stroke or systemic embolism and was also associated with less bleeding and lower mortality than warfarin in the ARISTOTLE trial. Apixaban is the third of the new generation of oral anticoagulants to be tested in this indication, and seems to have performed the best. The other two agents – dabigatran and rivaroxaban – have also been shown to be viable

The study (Lancet 2010;376:1916–22) assessed whether long-term (three year) statin treatment (mainly atorvastatin) is safe and effective in patients thought to have NAFLD. Overall, liver-related adverse effects such as increased levels of liver enzymes or serum transaminases like alanine aminotransferase (ALT) occurred no more often in the group who were given statins. Over three years follow-up, ALT improved or normalised in patients who were given statins, but in the group not taking statins liver tests worsened.

They note that trials of statin therapy have had conflicting findings on the risk of development of diabetes. They therefore performed a meta-analysis of published and unpublished data to look at this issue further. They included 13 statin trials with 91,140 participants in total, of whom 4,278 had diabetes during a mean of four years. Treatment of 255 patients with statins for four years resulted in one extra case of diabetes. They conclude that the risk of developing diabetes with statin therapy is low both in absolute terms and when compared with the reduction in coronary events, and that “Clinical practice in patients with moderate or h

Polypill could cut cardiovascular risk by half The strategy of giving a ‘polypill’, consisting of three antihypertensive drugs, a statin, and aspirin, to vast amounts of people who have not yet developed heart disease, could cut cardiovascular risk by half, according to the first major clinical trial of such an approach. The Indian Polycap Study (TIPS), presented at the ACC meeting by Dr Salim Yusuf (McMaster University, Hamilton, Ontario, Canada), included 2,053 patients aged 45–80 years without cardiovascular disease but with one risk factor (type 2 diabetes, high blood pressure, smoker within the past five years, increased waist-to-

Cholesterol and cardiovascular disease Cholesterol has the Jekyll and Hyde characteristics of being both essential to life as a constituent of the body’s cells and of being the prime initiator of atherosclerosis, a process characterised by the formation of cholesterol-rich plaques in arteries. This disorder is the major cause of cardiovascular disease, mainly coronary heart disease and stroke, from which 11 million people die in the world each year. The most common single cause of death in Britain, its eradication is given a high priority by the government. Numerous studies have identified cholesterol, specifically low-density lipoprotein (

Introduction About 10 million deaths in the world are caused each year by coronary heart disease (CHD) and stroke.1 Comparative statistics in Britain2 are on a smaller scale but in relative terms, similar. Total mortality in the UK is approximately 600,000 annually, 36% of which is due to cardiovascular disease. Half of the latter is from CHD, a quarter from stroke and it is the main cause of premature mortality in both men and women. Recently it was estimated that the major modifiable risk factor, raised serum cholesterol, accounted for 45% of all myocardial infarcts in Western Europe.3 The introduction of statins 20 years ago has revolution

New editorial board member We welcome general practitioner and diabetologist, Dr Neil Munro (left) to the BJC editorial board.Dr Munro has been a general practitioner in Surrey since 1984. He is also an Associate Specialist in Diabetes at the Chelsea and Westminster Hospital, London, and has worked in specialist hospital-based diabetes clinics since 1985. In addition, he has provided diabetes services for the practice for over two decades. He was research officer for the St Vincent’s Declaration Primary Care Diabetes Group in 1999 and Chairman of Primary Care Diabetes Europe (PCDE) from 2000–2005. His appointment underlines the BJC’s

Introduction Coronary heart disease (CHD) is responsible for over 100,000 deaths annually in the UK.1 Epidemiology studies have long supported that cholesterol is a key risk factor for cardiovascular disease (CVD).2 In both primary and secondary prevention, statin therapy trials have shown that there is a clear relationship between lowering cholesterol and reducing cardiovascular risk in both primary and secondary prevention.3 However, The World Health Report 2002 estimates that over 50% of CHD globally is still due to elevated blood cholesterol levels.4 Table 1. Recommended targets for total cholesterol (TC) and low-density lipoprotein chol

Momentous achievements The changes made in the diagnosis and management of cardiovascular disease over the past 10 years, led by primary care, were described as “momentous” by Primary Care Cardiovascular Society (PCCS) past chairman and board member Professor Richard Hobbs (Department of General Practice and Primary Care, University of Birmingham). Presenting the opening address ‘A decade of advances in cardiovascular disease’ at the two-day annual scientific meeting, he said: “Primary care teams have led advances in the treatment of cardiovascular disease and cardiovascular risk factors. They should feel very proud of the contribut

A total of 2,511 switch patients and 9,009 controls were identified. The risk of death or first major cardiovascular event was significantly associated with switching therapy (hazard ratio = 1.30, 95% confidence interval: 1.02–1.64) compared with patients who did not switch. Major cardiovascular events and stroke were also significantly associated with switching. There was no significant difference in all-cause mortality.  While recognising the observational nature of database research, this study has highlighted the potential for poorer cardiovascular outcomes in patients switching statin therapy, compared with patients maintained on thei