Statin use is associated with a small increased risk of developing diabetes. However, the cardiovascular benefits of statin therapy still outweigh the diabetes risk. Several studies have found that statin use leads to a 9-13% increased risk of diabetes, but the absolute increased risk is low. The number of patients needed to treat with statins to prevent a cardiovascular event is lower than the number needed to harm in terms of diabetes risk. Therefore, clinical practice for statin therapy for reducing cardiovascular risk should not change.
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
SGLT2 inhibitors in Heart failure: A prized addition to HF treatment optionsahvc0858
Early Diabetes and Dyslipidaemia Treatment Optimisation.
Presentation by Dr Chan Wan Xian
Cardiologist, Echocardiologist
Heart Failure Intensivist
Asian Heart & Vascular Centre
www.ahvc.com.sg
Among patients with or at high risk of CVD, use of an FDC strategy for blood pressure, cholesterol, and platelet control vs usual care resulted in significantly improved medication adherence.Polypill therapy significantly improved adherence, SBP and LDL-cholesterol in high risk patients compared with usual care, especially among those who were under-treated at baseline.
Presentations by Tawfiq Choudhury and Rocco Hadland from the second webinar of the Mastering Cholesterol webinar series on Thursday 11 May 2023, focusing on Statins.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
Statins are highly effective LDL-c lowering agents that actually reduce clinical cardiovascular events. The 2013 ACC/AHA guidelines on the management of blood cholesterol recommend high-intensity statin therapy in individuals with high cardiovascular risk as assessed by the 10-year atherosclerotic cardiovascular disease risk calculator. However, a significant number of individuals do not tolerate or respond adequately to statins, and continue to have residual risk in spite of high intensity statin therapy.
There are some exciting developments in the field of lipidology. This decade has been labeled “The PCSK9 decade”. A new class of monoclonal antibodies directed against the PCSK9 glycoproteins appears very promising in further lowering LDL cholesterol and thereby cardiovascular risk. Evolocumab and alirucomab are novel PCSK9 inhibitors that can be given subcutaneously once or twice in a month, and have the potential to reduce LDL-cholesterol to very low levels without any major adverse effects.
Other classes of drugs like Apo-B antisense oligonucleotides (mipomersen), CETP inhibitors (especially anacetrapib), microsomal transfer protein inhibitors (lomitapide) also hold some promise. The future of lipid lowering therapy looks reassuring with these new developments.
Shashikiran Umakanth presented this at the Egyptian Association of Endocrinology, Diabetes & Atherosclerosis (EAEDA) 2014 conference at Alexandria, Egypt. This conference was help in association with Endocrine Society, USA and the European Association for the Study of Diabetes (EASD).
Among patients with or at high risk of CVD, use of an FDC strategy for blood pressure, cholesterol, and platelet control vs usual care resulted in significantly improved medication adherence.Polypill therapy significantly improved adherence, SBP and LDL-cholesterol in high risk patients compared with usual care, especially among those who were under-treated at baseline.
Presentations by Tawfiq Choudhury and Rocco Hadland from the second webinar of the Mastering Cholesterol webinar series on Thursday 11 May 2023, focusing on Statins.
SGLT2I The paradigm change in diabetes managementPraveen Nagula
Just like ARNI, SGLT2I have changed the face of diabetes management and they have a good profile in multimodality management because of pleiotropic effects
Javed Butler, MD, MPH, MBA, discusses heart failure in this CME activity titled, "New Frontiers in Managing Heart Failure: Are SGLT2 Inhibitors the Next Leap Forward in Optimizing Patient Care?" For the full presentation, downloadable infographics, monograph, complete CME information, and to apply for credit, please visit us at http://bit.ly/2JG2v9l. CME credit will be available until May 29, 2020.
Statins are highly effective LDL-c lowering agents that actually reduce clinical cardiovascular events. The 2013 ACC/AHA guidelines on the management of blood cholesterol recommend high-intensity statin therapy in individuals with high cardiovascular risk as assessed by the 10-year atherosclerotic cardiovascular disease risk calculator. However, a significant number of individuals do not tolerate or respond adequately to statins, and continue to have residual risk in spite of high intensity statin therapy.
There are some exciting developments in the field of lipidology. This decade has been labeled “The PCSK9 decade”. A new class of monoclonal antibodies directed against the PCSK9 glycoproteins appears very promising in further lowering LDL cholesterol and thereby cardiovascular risk. Evolocumab and alirucomab are novel PCSK9 inhibitors that can be given subcutaneously once or twice in a month, and have the potential to reduce LDL-cholesterol to very low levels without any major adverse effects.
Other classes of drugs like Apo-B antisense oligonucleotides (mipomersen), CETP inhibitors (especially anacetrapib), microsomal transfer protein inhibitors (lomitapide) also hold some promise. The future of lipid lowering therapy looks reassuring with these new developments.
Shashikiran Umakanth presented this at the Egyptian Association of Endocrinology, Diabetes & Atherosclerosis (EAEDA) 2014 conference at Alexandria, Egypt. This conference was help in association with Endocrine Society, USA and the European Association for the Study of Diabetes (EASD).
Slides to Guide Reducing Cardiovascular Risk in Type 2 Diabetes: What I Do an...hivlifeinfo
Slides to Guide Reducing Cardiovascular Risk in Type 2 Diabetes: What I Do and Why.2018
Zachary T. Bloomgarden, MD, MACE
Program Director
Mikhail N. Kosiborod, MD
Pamela Kushner, MD, FAAFP
Format: Microsoft PowerPoint (.ppt)
File Size: 923 KB
Released: June 29, 2018
Treatment strategies in patients with statin intoleranceVishwanath Hesarur
Statins are among the most prescribed drugs in the world and are first-line therapy in the management of hyperlipidemia.
Their beneficial effects on cardiovascular morbidity and mortality have been demonstrated both in primary and in secondary prevention.
They are generally safe, but in some patients, statin therapy is stopped because of intolerance to the drug that may result in muscle aches and weakness, gastrointestinal symptoms, liver enzyme abnormalities, or other nonspecific discomforts.
The rate of reported statin-related events is about 5% to 10% in randomized, placebo controlled clinical trials.
Crimson Publishers: Insulin Therapy and Cardiovascular Outcome Trials (CVOTs)...CrimsonGastroenterology
The therapeutic management of diabetes may on its own increase the risk of cardiovascular (CV) risk markers – directly or indirectly – through their pharmacological actions (e.g. side effects as hypoglycaemia), or some metabolic changes (e.g. Weight-Gain, increased BP, etc.). As these risks may not have been anticipated or immediately noticed during clinical trials, 1 post hoc analyses and epidemiological follow up of clinical trials have raised concerns about the CV safety of some drugs used in the management of diabetes.
Memorias Conferencia Científica Anual sobre Síndrome Metabólico 2017 - Programa Científico
Futuro en el tratamiento de la DM2
Dr. Guillermo E. Umpierrez
Professor of Medicine in the Division of Endocrinology at Emory University School of Medicine, Section Head, Diabetes and Endocrinology. USA. Editor en Jefe del BJM Open Diabetes Research and Care
Diagnosticul si tratamentul TVP nu sunt intotdeauna usor de realizat. Din constelatia de antitrombotice, alegerea schemei si dozajului terapeutic pentru liza trombusului si/sau preventia secundara, pune serioase probleme in practica medicala
Colangiografie percutana transhepatica si drenaj biliar extern ALEXANDRU ANDRITOIU
colangiografie percutana transhepatica combinata cu drenaj biliar extern si drenaj peritoneal la un pacient cu ciroza hepatica atrofica, colangiocarcinom centrohilar si ascita refractara complicat a 5-a zi post-intervnetie cu colangita (angiocolita) si exitus
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Explore natural remedies for syphilis treatment in Singapore. Discover alternative therapies, herbal remedies, and lifestyle changes that may complement conventional treatments. Learn about holistic approaches to managing syphilis symptoms and supporting overall health.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
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Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...
Statins and diabetes risk
1. Statin s and
Diabet es
between risks and benefits
Alexandru Andritoiu
Military Hospital Craiova, MD, MPh
2. Drugs that induce diabetes
Drugs that cause diabetes by interfering with insulin production and secretion
Vacor
Tacrolimus
Didansoine
β-receptor antagonists
L-asparaginase
Diphenylhydantoin
Diazoxide
Drugs that cause diabetes by reducing the effectiveness of insulin to regulate metabolism
Steroids
Glucocorticoids
Megasterol acetate
β-receptor agonists
Growth hormone
Protease inhibitors
Drugs that act on both insulin secretion and insulin sensitivity
Thiazide diuretics
Cyclosporine
Atypical antipsychotic medications
Treatments that induce diabetes by increasing nutrient flux
Nicotinic acid
Total parenteral nutrition
Richard J Coli D. Diabetes Melitus: A Fundamental and Clinical Text. 3rd Edition 2004
3. FDA Expands Advice on Statin Risks
(2012)
Routine monitoring of liver enzymes in the blood, once considered
standard procedure for statin users, is no longer needed. Such
monitoring has not been found to be effective in predicting or
preventing the rare occurrences of serious liver injury associated
with statin use.
Cognitive (brain-related) impairment, such as memory loss,
forgetfulness and confusion, has been reported by some statin
users.
People being treated with statins may have an increased risk of
raised blood sugar levels and the development of Type 2
diabetes.
Some medications interact with lovastatin (brand names include
Mevacor) and can increase the risk of muscle damage.
4. FDA Adds Diabetes, Memory Loss Warnings to Statins Reuters
Safety Alerts Cite Cholesterol Drugs’ Side Effects The New York
Times
Statin Labels will Come with New Safety Warnings CNN
FDA Adds Safety Warnings to Statins HealthDay
FDA Adds Diabetes Warning to Statin Label MedPage Today
5. To prescribe or not to prescribe:
That is the statin question
Blumenthal RS. Redberg R.
Should healthy people take cholesterol drugs to prevent
heart disease? Wall Street Journal, January 23, 2012.
6.
7.
8. The Diabetes Dilemma for Statin Users
ERIC J. TOPOL
Published: March 4, 2012
,,We need to find out why statins cause diabetes and, ideally,
through genomics we could determine who is at risk for this
important side effect.
But to date nothing has been done to sort this out — despite
the fact that the market for statins is well over $20 billion per
year.
There are thousands of blood samples sitting in company
freezers around the world that could potentially provide the
answers”
9.
10. The Lancet, Volume 380, Issue 9841,
Pages 565 - 571, 11 August 2012
Cardiovascular benefits and diabetes
risks of statin therapy in primary
prevention: an analysis from the
JUPITER trial
Paul M Ridker, et al
11. In the JUPITER primary prevention trial,
the cardiovascular and mortality benefits
of statin therapy exceed the diabetes
hazard, including in participants at high
risk of developing diabetes.
12. Diabetes Care
October 2009; vol. 32: no.10: 1924-1929
Statin Therapy and Risk of Developing
Type 2 Diabetes: A Meta-Analysis
Swapnil N. Rajpathak, Dharam J. Kumbhani, Jill Crandall,
Nir Barzilai, Michael Alderman, Paul M. Ridker.
RESULTS
In the meta-analysis of the hypothesis-testing trials,
we observed a small increase in diabetes risk
(RR 1.13 [95% CI 1.03–1.23])
14. June 22; 2011, Vol 305, No. 2
Risk of Incident Diabetes With Intensive-Dose
Compared With Moderate-Dose Statin Therapy
A Meta-analysis
David Preiss, Sreenivasa Rao Kondapally Seshasai,
Paul Welsh, Sabina A. Murphy, Jennifer E. David D.
Waters, David A. DeMicco, Philip Barter, Christopher P.
Cannon, Marc S. Sabatine, Eugene Braunwald, John J.
P. Kastelein, James A. de Lemos, Michael A. Blazing,
Terje R. Pedersen,Matti J. Tikkanen, Naveed Sattar,
Kausik K. Ray.
15. INTERPRETATION:
Statin therapy is associated with a slightly
increased risk of development of diabetes, but
the risk is low both in absolute terms and when
compared with the reduction in coronary events.
Clinical practice in patients with moderate or
high cardiovascular risk or existing
cardiovascular disease should not change.
16. Results
In 5 statin trials with 32.752 participants without diabetes at
baseline, 2749 developed diabetes (1449 assigned intensive-dose
therapy, 1300 assigned moderate-dose therapy, representing 2.0
additional cases in the intensive-dose group per 1000 patientyears) and 6684 experienced cardiovascular events (3134 and
3550, respectively, representing 6.5 fewer cases in the intensivedose group per 1000 patient-years) over a weighted mean (SD)
follow-up of 4.9 (1.9) years.
Odds ratios were 1.12 (95% confidence interval [CI], 1.041.22; I2 = 0%) for new-onset diabetes and 0.84 (95% CI, 0.750.94; I2 = 74%) for cardiovascular events for participants receiving
intensive therapy compared with moderate-dose therapy.
As compared with moderate-dose statin therapy, the number
needed to harm per year for intensive-dose statin therapy was 498
for new-onset diabetes while the number needed to treat per year
for intensive-dose statin therapy was 155 for cardiovascular events.
Conclusion: In a pooled analysis of data from 5 statin trials, intensivedose statin therapy was associated with an increased risk of new-onset
diabetes compared with moderate-dose statin therapy.
19. Statins and risk of incident diabetes:
a collaborative meta-analysis of
randomised statin trials
Sattar N et al.- Lancet 2010;27;375:735-742
20. 13 statin trials
91.140 participants, of whom 4278 (2226 assigned statins and 2052
assigned control treatment) developed diabetes during a mean of 4
years.
Statin therapy was associated with a 9% increased risk for incident
diabetes (odds ratio [OR] 1·09; 95% CI 1·02—1·17), with little
heterogeneity (I2=11%) between trials.
Meta-regression showed that risk of development of diabetes with
statins was highest in trials with older participants, but neither
baseline body-mass index nor change in LDL-cholesterol
concentrations accounted for residual variation in risk.
Treatment of 255 (95% CI 150—852) patients with statins for 4
years resulted in one extra case of diabetes.
Interpretation
Statin therapy is associated with a slightly increased risk of
development of diabetes, but the risk is low both in absolute terms
and when compared with the reduction in coronary events.
Clinical practice in patients with moderate or high
cardiovascular risk or existing cardiovascular disease should
not change.
Sattar N et al. Lancet 2010
21. Statin Use and Risk of Diabetes
Mellitus in Postmenopausal Women
Annie L. Culver, et al. - Arch Intern Med.
Published online January 9, 2012
22. Study links statins to higher diabetes in
older women
Culver AL, Ockene IS, Balasubramanian R
Statin use and risk of diabetes mellitus in
postmenopausal women in the Women's
Health Initiative.
Arch Intern Med 2012;
23.
Results
This investigation included 153 840
women without DM and no missing
data at baseline. At baseline, 7.04%
reported taking statin medication.
There were 10 242 incident cases of
self-reported DM over 1 004 466
person-years of follow-up.
Statin use at baseline was associated
with an increased risk of DM (hazard
ratio [HR], 1.71; 95% CI, 1.61-1.83).
This association remained after
adjusting for other potential
confounders (multivariate-adjusted
HR, 1.48; 95% CI, 1.38-1.59) and was
observed for all types of statin
medications.
Conclusions
Statin medication use in
postmenopausal women is
associated with an increased
risk for DM.
This may be a medication
class effect.
Further study by statin type
and dose may reveal varying
risk levels for new-onset DM in
this population.
Subset analyses evaluating the
association of self-reported DM with
longitudinal measures of statin use in
125 575 women confirmed these
findings.
Arch Intern Med. Published online January 9, 2012
24. Statins raise risk of Type 2 diabetes in older women
Post-menopausal women who take statins to ward off heart attacks are more
likely to develop Type 2 diabetes than those who do not, research indicates.
January 10, 2012
By Melissa Healy, Los Angeles Times
25.
26. Diabetes/statin link probed in EFFECT cohort
World Congress of Cardiology 2012
,,The message for the public is that statins have
documented benefits over many years. The risk of
developing diabetes with a statin vs placebo is probably
there, but when we talk about dose relationships, we can't
find any evidence of a difference between doses,"
Dr Altayyeb Yousef
(Institute for Clinical Evaluative Sciences, Toronto)
27. END POINTS
deaths, deaths or ACS, or new-onset diabetes in
the EFFECT study cohort—all patients who had
been hospitalized for acute MI.
CONCLUSIONS
Comparing results among 2870 matched
patients, they found no significant differences in
any of those three end points out to five years.
At each year out to five years, the risk of
diabetes was actually lower, numerically, among
the intensive-statin group as compared with the
moderate-dose group, although differences were
not statistically significant.
28. Rautio N, Jokelainen J, Oksa H, et al.
BMJ 2012
Do statins interfere with lifestyle intervention
in the prevention of diabetes in primary
healthcare? One-year follow-up of the
FIN-D2D project
29.
This is the first study examining the association of lifestyle
intervention on the risk of type 2 diabetes according to the use of
statins. This question is of utmost clinical importance, since we now
know that type 2 diabetes is preventable by lifestyle changes.
Fasting glucose increased by 0.08 mmol/L in statin users but
remained unchanged in nonusers. This was a significant difference
and remained so after adjustment for age, sex, baseline fasting
glucose, presence of CVD, use of antihypertensive and/or CAD
medication, weight, and one-year weight change.
An increase in fasting glucose in statin users suggests deterioration
in insulin secretion capacity, but added that two-hour glucose
values, which reflect insulin sensitivity, were similarly decreased in
statin users and nonusers.
30.
"The message for clinicians is that patients who
have multiple components of the metabolic
syndrome need to try to further improve their
lifestyle habits to combat the possible rise in
glucose when a statin is begun. This paper
suggests that statins may have unfavorable
effects on glucose metabolism in certain people,
so compliance with lifestyle improvements will
be very important. We look forward to more
prospective studies on this topic."
Dr Nina Rautio -BMJ ; September 13, 2012
31. Statins, Risk of Diabetes, and
Implications on Outcomes in the
General Population
Kang-Ling Wang, et al.
J Am Coll Cardiol. 2012;60(14):1231-1238
32. Objectives
This study aimed to evaluate the
association of statin exposure and incident
diabetes, and subsequent outcomes in the
general population.
Kang-Ling Wang, et al. - J Am Coll Cardiol. 2012;60(14):1231-1238.
33. Results
Over a median of 7.2 years, annual rates of
diabetes were significantly higher in statin
users
(2.4% vs. 2.1%; p < 0.001)
MACE
HR: 0.82; CI 0.68-0.98 for myocardial infarction
HR: 0.94; CI 0.86-1.03 for ischemic stroke
HR: 0.91; CI:0.84-0.99 for MACE
In-hospital mortality
HR: 0.61; CI:0.55-0.67
Kang-Ling Wang, et al. - J Am Coll Cardiol. 2012;60(14):1231-1238.
34. The risk–benefit analyses
Statin treatment was favorable in high-risk and
secondary prevention populations.
Among diabetic patients, prior statin use was
associated with fewer MACE
In-hospital deaths were similar in statin-related
diabetes among high-risk and secondary
prevention subjects compared with nondiabetic
controls.
Conclusions
Risk of diabetes was increased after statins,
but outcomes were favorable.
Kang-Ling Wang, et al. - J Am Coll Cardiol. 2012;60(14):1231-1238
35. Kaplan-Meier Curves for Outcomes
Among Statin and Control Groups
(A) Cumulative incidences for newly developed
diabetes in the statin and control groups
were 22.7% and 20.8%, respectively.
(B) Cumulative incidences for major adverse
cardiovascular (CV) events (the composite
of myocardial infarction [MI] and ischemic
stroke) in the statin and control groups
were 11.6% and 12.6%,
(C) Cumulative incidences for in-hospital death
from all causes in the statin and control
groups were 8.8% and 13.8%.
Kang-Ling Wang, et al. - J Am Coll Cardiol. 2012;60(14):1231-1238.
36. J Am Coll Cardiol. 2011;57(14):1535-1545
Predictors of New-Onset Diabetes in
Patients Treated with Atorvastatin
Results From 3 Large Randomized Clinical Trials
David D. Waters, Jennifer E. Ho, David A.
DeMicco, Andrei Breazna,Benoit J.
Arsenault, Chuan-Chuan Wun, John J.
Kastelein, Helen Colhoun, Philip Barter
37. Predictors of New-Onset Diabetes
in Patients Treated With
Atorvastatin: Results From 3
Large Randomized Clinical Trials
J Am Coll Cardiol. 2011;57(14):1535-1545
38. Incident Diabetes According to
Number of Risk Factors
Incident diabetes in (A) the TNT trial, (B) the
IDEAL trial, and (C) the SPARCL trial
according to number of risk factors and
treatment group.
Atorva. = atorvastatin; ATV10 = atorvastatin 10
mg; ATV80 = atorvastatin 80 mg; Simva =
simvastatin;
J Am Coll Cardiol 2011;57(14):1535-1545
39. Conclusions
High-dose atorvastatin treatment
(80mg/day) compared with placebo in the
SPARCL trial is associated with a slightly
increased risk of new-onset T2DM.
Baseline fasting glucose level and
features of the metabolic syndrome are
predictive of new-onset T2DM across the
3 trials.
Waters DD et al. J Am Coll Cardiol. 2011;57(14):1535-1545
41. Most people with diabetes
'have poor cholesterol control'
Almost three-fifths of people
with diabetes do not meet their
cholesterol targets
An analysis by Diabetes UK found that
more than nine out of ten (91.6 per
cent) people with diabetes in England
now receive an annual check.
Yet almost 60 per cent of patients are
still not meeting their targets, the
research revealed.
42.
43. How effective are statins for people with diabetes?
Collaborative Atorvastatin Diabetes
Study (CARDS)
This study involved nearly 3000 people
with Type 2 diabetes aged 40-75.
It looked at the benefits of taking a 10mg
dose of atorvastatin daily.
None of the participants had heart disease
at the start of the trial, but they did
have an extra risk factor for developing
it, such as smoking, high blood
pressure, diabetic retinopathy or
protein in the urine indicating diabetic
kidney disease.
For those taking the statin, the risk of heart
attack reduced by 37 per cent and
stroke by 48 per cent.
These benefits were seen regardless of
age, sex or whether the cholesterol
level was high or low.
The trial's success meant it was halted two
years early.
The Heart Protection Study (HPS)
The HPS study involved nearly 6000
people with diabetes aged 40-80.
It looked at the benefits of taking a 40mg
dose of simvastatin each day. Just
under half of the participants showed
signs of cardiovascular disease, while
half did not.
It found this routine use of statins cut the
number of heart attacks and strokes in
both groups by a third.
46. High-Dose Statins May Increase
Diabetes Risk
but,
Experts Say Most Heart Disease
Patients Are Better Off Taking a Statin,
Despite Increased Diabetes Risk