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Oikonomou, Evangelos K; Khera, Rohan
doi: 10.1093/eurheartj/ehae415pmid: 38976371
Graphical AbstractGraphical AbstractBridging the art of traditional clinical evaluation with data-driven insights from new artificial intelligence-enabled digital approaches. AI, artificial intelligence
Farmakis, Ioannis T; Christodoulou, Konstantinos C; Hobohm, Lukas; Konstantinides, Stavros V; Valerio, Luca
doi: 10.1093/eurheartj/ehae361pmid: 38874212
Background and AimsStudies have suggested that statins may be associated with reduced risk of venous thromboembolism (VTE). The aim of the current study was to assess the evidence regarding the comparative effect of all lipid-lowering therapies (LLT) in primary VTE prevention.MethodsAfter a systematic search of PubMed, CENTRAL, and Web of Science up until 2 November 2022, randomized controlled trials (RCT) of statins (high- or low-/moderate-intensity), ezetimibe, or proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were selected. An additive component network meta-analysis to compare VTE risk during long-term follow-up across different combinations of LLT was performed.ResultsForty-five RCTs (n = 254 933 patients) were identified, reporting a total of 2084 VTE events. Compared with placebo, the combination of PCSK9i with high-intensity statin was associated with the largest reduction in VTE risk (risk ratio [RR] 0.59; 95% confidence interval [CI] 0.43–0.80), while there was a trend towards reduction for high-intensity (0.84; 0.70–1.02) and low-/moderate-intensity (0.89; 0.79–1.00) statin monotherapy. Ezetimibe monotherapy did not affect the VTE risk (1.04; 0.83–1.30). There was a gradual increase in the summary effect of VTE reduction with increasing intensity of the LLT. When compared with low-/moderate-intensity statin monotherapy, the combination of PCSK9i and high-intensity statin was significantly more likely to reduce VTE risk (0.66; 0.49–0.89).ConclusionsThe present meta-analysis of RCTs suggests that LLT may have a potential for VTE prevention, particularly in high-intensity dosing and in combination therapy.
Nopp, Stephan; Ay, Cihan; Pabinger, Ingrid
doi: 10.1093/eurheartj/ehae492pmid: 39140442
Graphical AbstractGraphical AbstractClinical implications of lipid-lowering drugs in thrombosis prevention.
Iatan, Iulia; Akioyamen, Leo E; Ruel, Isabelle; Guerin, Amanda; Hales, Lindsay; Coutinho, Thais; Brunham, Liam R; Genest, Jacques
doi: 10.1093/eurheartj/ehae417pmid: 38976372
Background and AimsFamilial hypercholesterolaemia (FH) is a highly prevalent monogenic disorder characterized by elevated LDL cholesterol (LDL-C) levels and premature atherosclerotic cardiovascular disease. Sex disparities in diagnosis, lipid-lowering therapy, and achieved lipid levels have emerged worldwide, resulting in barriers to care in FH. A systematic review was performed to investigate sex-related disparities in treatment, response, and lipid target achievement in FH (PROSPERO, CRD42022353297).MethodsMEDLINE, Embase, The Cochrane library, PubMed, Scopus, PsycInfo, and grey literature databases were searched from inception to 26 April 2023. Records were eligible if they described sex differences in the treatment of adults with FH.ResultsOf 4432 publications reviewed, 133 met our eligibility criteria. In 16 interventional clinical trials (eight randomized and eight non-randomized; 1840 participants, 49.4% females), there were no differences between males and females in response to fixed doses of lipid-lowering therapy, suggesting that sex was not a determinant of response. Meta-analysis of 25 real-world observational studies (129 441 participants, 53.4% females) found that females were less likely to be on lipid-lowering therapy compared with males (odds ratio .74, 95% confidence interval .66–.85). Importantly, females were less likely to reach an LDL-C < 2.5 mmol/L (odds ratio .85, 95% confidence interval .74–.97). Similarly, treated LDL-C levels were higher in females. Despite this, male sex was associated with a two-fold greater relative risk of major adverse cardiovascular events including myocardial infarction, atherosclerotic cardiovascular disease, and cardiovascular mortality.ConclusionsFemales with FH were less likely to be treated intensively and to reach guideline-recommended LDL-C targets. This sex bias represents a surmountable barrier to clinical care.
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