Journal ArticleDOI
Intensive versus moderate lipid lowering with statins after acute coronary syndromes.
Christopher P. Cannon,Eugene Braunwald,Carolyn H. McCabe,Daniel J. Rader,Jean L. Rouleau,Rene Belder,Steven V. Joyal,Karen A. Hill,Marc A. Pfeffer,Allan M. Skene +9 more
TLDR
Among patients who have recently had an acute coronary syndrome, an intensive lipid-lowering statin regimen provides greater protection against death or major cardiovascular events than does a standard regimen.Abstract:
background Lipid-lowering therapy with statins reduces the risk of cardiovascular events, but the optimal level of low-density lipoprotein (LDL) cholesterol is unclear. methods We enrolled 4162 patients who had been hospitalized for an acute coronary syndrome within the preceding 10 days and compared 40 mg of pravastatin daily (standard therapy) with 80 mg of atorvastatin daily (intensive therapy). The primary end point was a composite of death from any cause, myocardial infarction, documented unstable angina requiring rehospitalization, revascularization (performed at least 30 days after randomization), and stroke. The study was designed to establish the noninferiority of pravastatin as compared with atorvastatin with respect to the time to an end-point event. Follow-up lasted 18 to 36 months (mean, 24). results The median LDL cholesterol level achieved during treatment was 95 mg per deciliter (2.46 mmol per liter) in the standard-dose pravastatin group and 62 mg per deciliter (1.60 mmol per liter) in the high-dose atorvastatin group (P<0.001). Kaplan–Meier estimates of the rates of the primary end point at two years were 26.3 percent in the pravastatin group and 22.4 percent in the atorvastatin group, reflecting a 16 percent reduction in the hazard ratio in favor of atorvastatin (P=0.005; 95 percent confidence interval, 5 to 26 percent). The study did not meet the prespecified criterion for equivalence but did identify the superiority of the more intensive regimen. conclusions Among patients who have recently had an acute coronary syndrome, an intensive lipidlowering statin regimen provides greater protection against death or major cardiovascular events than does a standard regimen. These findings indicate that such patients benefit from early and continued lowering of LDL cholesterol to levels substantially below current target levels.read more
Citations
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Lifetime Prevalence and Age-of-Onset Distributions of DSM-IV Disorders in the National Comorbidity Survey Replication
Ronald C. Kessler,Patricia A. Berglund,Olga Demler,Robert Jin,Kathleen R. Merikangas,Ellen E. Walters +5 more
TL;DR: Lifetime prevalence estimates are higher in recent cohorts than in earlier cohorts and have fairly stable intercohort differences across the life course that vary in substantively plausible ways among sociodemographic subgroups.
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ESC Guidelines for the Management of Acute Myocardial Infarction in Patients Presenting With ST-Segment Elevation
Stefan James,Dan Atar,Luigi P. Badano,Carina Blomström Lundqvist,Michael A. Borger,Anthony H. Gershlick,Kurt Huber,Peter Jüni,Mattie J. Lenzen,Kenneth W. Mahaffey,Marco Valgimigli +10 more
TL;DR: The once-in-a-lifetime treatment with Abciximab Intracoronary for acute coronary syndrome and a second dose intravenously for atrial fibrillation is recommended for adults with high blood pressure.
Journal ArticleDOI
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines
Neil J. Stone,Jennifer G. Robinson,Alice H. Lichtenstein,C. Noel Bairey Merz,Conrad B. Blum,Robert H. Eckel,Anne C. Goldberg,David Lee Gordon,Daniel Levy,Donald M. Lloyd-Jones,Patrick E. McBride,J. Sanford Schwartz,Susan T. Shero,Sidney C. Smith,Karol E. Watson,Peter W.F. Wilson +15 more
TL;DR: Preamble and Transition to ACC/AHA Guidelines to Reduce Cardiovascular Risk S2 The goals of the …
Journal ArticleDOI
Implications of Recent Clinical Trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines
Scott M. Grundy,James I. Cleeman,C. Noel Bairey Merz,H. Bryan Brewer,Luther T. Clark,Donald B. Hunninghake,Richard C. Pasternak,Sidney C. Smith,Neil J. Stone +8 more
TL;DR: The trials confirm the benefit of cholesterol-lowering therapy in high-risk patients and support the ATP III treatment goal of low-density lipoprotein cholesterol (LDL-C) <100 mg/dL, and confirm that older persons benefit from therapeutic lowering of LDL-C.
Journal ArticleDOI
2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: Task Force for the Management of Acute Coronary Syndromes in Patients Presenting without Persistent ST-Segment Elevation of the European Society of Cardiology (ESC)
Marco Roffi,Carlo Patrono,Jean-Philippe Collet,Christian Mueller,Marco Valgimigli,Felicita Andreotti,Jeroen J. Bax,Michael A. Borger,Carlos Brotons,Derek P. Chew,Baris Gencer,Gerd Hasenfuss,Keld Kjeldsen,Patrizio Lancellotti,Ulf Landmesser,Julinda Mehilli,Debabrata Mukherjee,Robert F. Storey,Stephan Windecker +18 more
TL;DR: The current guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation are based on the findings of the ESC Task Force on 12 March 2015.
References
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The Effect of Pravastatin on Coronary Events after Myocardial Infarction in Patients with Average Cholesterol Levels
Frank M. Sacks,Marc A. Pfeffer,Lemuel A. Moyé,Jean L. Rouleau,John D. Rutherford,Thomas G. Cole,Lisa E. Brown,J. W. Warnica,J. M. O. Arnold,Chuan Chuan C Wun,Barry R. Davis,Eugene Braunwald +11 more
TL;DR: It is demonstrated that the benefit of cholesterol-lowering therapy extends to the majority of patients with coronary disease who have average cholesterol levels and was also greater in patients with higher pretreatment levels of LDL cholesterol.
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Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. West of Scotland Coronary Prevention Study Group
J. Shepherd,Stuart M. Cobbe,Ian Ford,C. G. Isles,AR Lorimer,Peter W. Macfarlane,J. H. Mckillop,Christopher J. Packard +7 more
TL;DR: Treatment with pravastatin significantly reduced the incidence of myocardial infarction and death from cardiovascular causes without adversely affecting the risk of death from noncardiovascular causes in men with moderate hypercholesterolemia and no history of my Cardiac Infarction.
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Primary Prevention of Acute Coronary Events With Lovastatin in Men and Women With Average Cholesterol Levels: Results of AFCAPS/TexCAPS
John R. Downs,Michael Clearfield,Stephen E. Weis,Edwin J. Whitney,Deborah R. Shapiro,Polly A. Beere,Alexandra Langendorfer,Evan A. Stein,William Kruyer,Antonio M. Gotto +9 more
TL;DR: Lovastatin reduces the risk for the first acute major coronary event in men and women with average TC and LDL-C levels and below-average HDL- C levels and supports the inclusion of HDL-C in risk-factor assessment and the need for reassessment of the National Cholesterol Program guidelines.
Journal ArticleDOI
Prevention of cardiovascular events and death with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels
Andrew Tonkin,P. Alyward,David Colquhoun,Paul Glasziou,P. Harris,D. Hunt,Anthony C Keech,Stephen MacMahon,P. Magnus,D. Newel,P. Nestel,N. Sharpe,J. Shaw,R. J. Simes,P. Thompson,Alexis A. Thompson,Malcolm J. West,H. White,S. Simes,Wendy Hague,Sue Caleo,Jane Hall,Andrew J. Martin,S. Mulray,Philip J. Barter,Lawrence J. Beilin,Rory Collins,John J McNeil,Petra Meier,H. Willimott,D. Smithers,P. Wallace,J. Baker,M. Hobbs,David R. Sullivan,N. Anderson,Graeme J. Hankey,John D.G. Watson,M. Arulchelvam,S. Chup,John Daly,J. Hanna,A. Leach,M. Lee,J. Loughhead,H. Lundie-Jenkin,J. Morrison,S. Netting,A. Nguyen,H. Pater,R. Philip,G. Pinna,D. Rattos,S. Ryerson,V. Sazhin,Richard Walsh,A. Claque,M. Mackie,Julie Jane Yallop,K. Boss,M. Shepard,J. Leach,M. Gandy,J. Joughin,J. Seabrook,R. Abraham,J. Allen,F. Bates,I. Beinart,E. Breed,D. Brown,N. Bunyan,D. Calvert,T. Campbell,D. Condon-Paoloni,B. Conway,Lucy A. Coupland,J. Crowe,N. Cunio,B. Cuthbert,N. Cuthbert,S. D'Arcy,Patricia M. Davidson,B. Dwyer,J. England,C. Friend,Greg Fulcher,S. Grant,K. Hellestrand,M. Kava,Leonard Kritharides,D. McGill,H. McKee,Allan J. McLean,M. Neaverson,G. Nelson,M. O'Neill,C. Onuma,F. O'Reilly +98 more
TL;DR: Pravastatin therapy reduced mortality from coronary heart disease and overall mortality, as compared with the rates in the placebo group, as well as the incidence of all prespecified cardiovascular events in patients with a history of myocardial infarction or unstable angina who had a broad range of initial cholesterol levels.
Journal ArticleDOI
ACC/AHA guidelines for the management of patients with unstable angina and non-ST-segment elevation myocardial infarction: Executive summary and recommendations: A report of the American College of Cardiology/American Heart Association task force on practice guidelines (committee on the management of patients with unstable angina)
Eugene Braunwald,Elliott M. Antman,John W. Beasley,Robert M. Califf,Melvin D. Cheitlin,Judith S. Hochman,Robert H. Jones,Dean J. Kereiakes,Joel Kupersmith,Thomas N. Levin,Carl J. Pepine,John W. Schaeffer,Earl E. Smith,David E Steward,Pierre Theroux,Raymond J. Gibbons,Joseph S. Alpert,David P. Faxon,Valentin Fuster,Gabriel Gregoratos,Loren F. Hiratzka,Alice K. Jacobs,Sidney C. Smith +22 more
TL;DR: The present guidelines supersede the 1994 guidelines and summarize both the evidence and expert opinion and provide final recommendations for both patient evaluation and therapy.
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