Researchers presented several new findings about statins and non-statins at ACC.16. This brief roundup summarizes these and other noteworthy reports.
Cutting-edge advances and updates in cardiovascular care was the promise from ACC.16, the American College of Cardiology’s 65th Annual Scientific Session, held in Chicago over the weekend.
Here are highlights of the clinical findings presented at the meeting.
Study: Use More Statins in Intermediate Risk Patients
• Lowering cholesterol with statins significantly reduced adverse CV events in persons with average cholesterol and blood pressure levels who were considered to be at intermediate risk for heart disease.
• The use of blood pressure-lowering medications was beneficial only in those with higher blood pressure levels.
• The trial, HOPE-3, is the first to assess outcomes of preventative treatment with cholesterol and blood pressure-lowering drugs in a large, globally diverse population at intermediate risk for CVD.
• The researchers concluded that statins are safe and effective and recommended more widespread use, particularly for patients with hypertension.
“Statin Re-challenge” for Muscle Related Adverse Effects
• A blinded, placebo-controlled “statin re-challenge” in patients with a history of muscle-related adverse effects investigated statin-associated muscle symptoms.
• Of 491 participants, 42.6% reported muscle-related adverse effects while taking atorvastatin but not while taking placebo.
• Patients with confirmed statin intolerance given evolocumab showed a 52.8% reduction in LDL cholesterol vs a 16.7% reduction for patients who received ezetimibe.
• For average change in LDL cholesterol for weeks 22 and 24, patients taking evolocumab and ezetimibe showed 54.5% and 16.7% reductions, respectively.
• Evolocumab substantially lowered LDL cholesterol, with few patients experiencing muscle symptoms.
Non-Statin Therapy Guidelines Released
• Just before the meeting, the ACC released expert consensus guidance for using non-statin therapies to lower cholesterol in high-risk patients.
• The new document provides practical guidance for clinicians and patients in situations not covered by the evidence-based 2013 guideline. Looking first at lifestyle issues (eg, diet, exercise, and smoking) and then at statin therapy is recommended as in the earlier document.
• The writing committee supports consideration of adding ezetimibe, 10 mg/d, as the first non-statin agent for many higher-risk patient groups.
• The writing committee chair noted that evidence-based statin therapy remains the first-line standard of care for patients at risk for atherosclerotic CVD.
• Discussion of disease risk-reduction benefits and potential harms between clinicians and patients before the start of combination therapy was recommended.
Cholesterol Gene Mutation Elevates Coronary Artery Disease Risk
• Few persons who have very high cholesterol can attribute it to a genetic mutation related to familial hypercholesterolemia, but those who do are at high risk for early-onset coronary artery disease.
• Persons with LDL ≥ 190 but no familial hypercholesterolemia mutation have a 6X higher risk of early-onset CAD than those with LDL < 130. The risk for persons who have the mutation: 22X higher.
• Genetic screening could help identify and prevent early CVD in affected persons-and their relatives.
Death and Stroke Rates Equal for Surgery and Valve Replacement
• The rates of death and disabling strokes after 2 years in intermediate-risk patients with severe aortic stenosis are similar with minimally invasive transcatheter aortic valve replacement (TAVR) and with standard open heart surgical replacement.
• Patients who received TAVR had shorter hospital stays and a lower incidence of some major complications than those who underwent surgery.
• TAVR yielded significantly lower rates of acute kidney injury, severe bleeding events, and new onset atrial fibrillation. The surgery group had fewer major vascular complications and leakage around the valve.
• Conclusion: TAVR is at least as safe and effective as surgery in these patients.
Chest Pain Tool Facilitates Shared Decision-making
• Patients who visited a hospital ED with chest pain and engaged with their physician in shared decision-making with the Chest Pain Choice tool showed better knowledge of their health status and follow-up care options than patients who received only standard counseling.
• The tool, the first to facilitate shared decision-making between patients who have chest pain and their physicians, uses a 1-page printable information sheet that depicts a patient’s specific risk profile and health management options.
• The decision aid substantially improved patient engagement and reduced the use of stress tests, with no adverse effects.