Article

Statin therapy and risks for death and hospitalization in chronic heart failure

Department of Medicine, University of California, San Francisco, San Francisco, California, United States
JAMA The Journal of the American Medical Association (Impact Factor: 30.39). 12/2006; 296(17):2105-11. DOI: 10.1001/jama.296.17.2105
Source: PubMed

ABSTRACT Whether statin therapy has beneficial effects on clinical outcomes in patients with heart failure is unclear.
To evaluate the association between initiation of statin therapy and risks for death and hospitalization among adults with chronic heart failure.
Propensity-adjusted cohort study of adults diagnosed with heart failure who were eligible for lipid-lowering therapy but had no previous known statin use, within an integrated health care delivery system in northern California between January 1, 1996, and December 31, 2004. Statin use was estimated from filled outpatient prescriptions in pharmacy databases.
All-cause death and hospitalization for heart failure during a median of 2.4 years of follow-up. We examined the independent relationships between statin therapy and risks for adverse events overall and stratified by the presence or absence of coronary heart disease after multivariable adjustment for potential confounders.
Among 24,598 adults diagnosed with heart failure who had no prior statin use, those initiating statin therapy (n = 12,648; 51.4%) were more likely to be younger, male, and have known cardiovascular disease, diabetes, and hypertension. There were 8235 patients who died. Using an intent-to-treat approach, incident statin use was associated with lower risks of death (age- and sex-adjusted rate of 14.5 per 100 person-years with statin therapy vs 25.3 per 100 person-years without statin therapy; adjusted hazard ratio, 0.76 [95% confidence interval, 0.72-0.80]) and hospitalization for heart failure (age- and sex-adjusted rate of 21.9 per 100 person-years with statin therapy vs 31.1 per 100 person-years without statin therapy; adjusted hazard ratio, 0.79 [95% confidence interval, 0.74-0.85]) even after adjustment for the propensity to take statins, cholesterol level, use of other cardiovascular medications, and other potential confounders. Incident statin use was associated with lower adjusted risks of adverse outcomes in patients with or without known coronary heart disease.
Among adults diagnosed with heart failure who had no prior statin use, incident statin use was independently associated with lower risks of death and hospitalization among patients with or without coronary heart disease.

0 Followers
 · 
79 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND Acute kidney injury (AKI) is a known complication after coronary revascularization, but few studies have directly compared the incidence of AKI after coronary artery bypass surgery (CABG) or after percutaneous coronary intervention (PCI) in similar patients. OBJECTIVES The aim of this study was to investigate whether multivessel CABG compared with PCI as an initial revascularization strategy is associated with a higher risk for AKI. METHODS A retrospective analysis of patients undergoing first documented coronary revascularization was conducted using 2 complementary cohorts: 1) Kaiser Permanente Northern California, a diverse, integrated health care delivery system; and 2) Medicare beneficiaries, a large, nationally representative older cohort. AKI was defined in the Kaiser Permanente Northern California cohort by an increase in serum creatinine of >= 0.3 mg/dl or >= 150% above baseline and in the Medicare cohort by discharge diagnosis codes and the use of dialysis. RESULTS The incidence of AKI was 20.4% in the Kaiser Permanente Northern California cohort and 6.2% in the Medicare cohort. The incidence of AKI requiring dialysis was <1%. CABG was associated with a 2- to3-fold significantly higher adjusted odds for developing AKI compared with PCI in both cohorts. CONCLUSIONS AKI is common after multivessel coronary revascularization and is more likely after CABG than after PCI. The risk for AKI should be considered when choosing a coronary revascularization strategy, and ways to prevent AKI after coronary revascularization are needed. (C) 2014 by the American College of Cardiology Foundation.
    Journal of the American College of Cardiology 09/2014; 64(10):985-94. DOI:10.1016/j.jacc.2014.04.077 · 15.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: The 2013 American College of Cardiology/American Heart Association guidelines for management of low-density lipoprotein cholesterol (LDL-C) to reduce atherosclerotic cardiovascular disease (ASCVD) risk identified four groups of adults (40-75 years of age) with significant evidence for benefit from statin therapy: presence of clinical ASCVD or diabetes, age ≥21 years and LDL-C >190 mg/dl, and 10-year risk of hard ASCVD events ≥7.5 % as determined by the new Cardiovascular Risk Calculator. However, clinicians are faced daily with at-risk patients who do not clearly match one of these statin-benefit groups. Understanding the limitations of available evidence and awareness of additional published guidelines for statin non-benefit groups will help practitioners make personalized decisions with patients and inform the clinician-patient discussion regarding potential risks and benefits of statin therapy.
    Current Atherosclerosis Reports 01/2015; 17(1):468. DOI:10.1007/s11883-014-0468-3 · 3.06 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objectives: To determine the prevalence, risk factors and the pattern of prescribing of antihypertensives in Abha. Methods: A survey of prevalence and prescribing pattern in patient with hypertension in primary care centres (Ballasmer General Hospital and Muhail General Hospital) of Abha, Kingdom of Saudi Arabia was conducted. Results: The data was collected from 2228 subjects and females constitute 53.09% of the population and the prevalence of hypertension was 64% in females (n=757) and 49.5% in males (n=517). Comorbidities were reported in 1274 patients including ischemic heart disease (27.2%), heart failure (10.2%), diabetes (21%) and hyperlipidemia (27.3%). Patients on mono therapy were treated with β-blockers (9% Vs 0 %), calcium channel blockers (0% Vs 10%), angiotensin-converting enzyme inhibitors (27.3% Vs 15%), and angiotensin II receptor blockers (0 % Vs 15%), diuretics (36.4% Vs 5%) and combination drug therapy (use of ≥ 2 antihypertensive drug classes) was highest in the Muhail General Hospital (55% Vs 27.3% in Ballasmer General Hospital). Conclusion: In conclusion it is evident from our study that hypertension is a common public health problem in Abha of Saudi Arabia, and is still on the rise and the pharmacotherapy of hypertension in patients in both hospitals were found in some instances not to conform to recommended guidelines and this warrant urgent attention along with modifiable risk factors such as physical activity and obesity to prevent hypertension. Key words: Hypertension, prevalence, risk factors.

Preview

Download
0 Downloads
Available from