Abstract:
Importance:Limited evidence is available regarding the benefit and hazard of higher-intensity treatment to lower lipid levels among patients 75 years or older. As a result, guideline recommendations differ for this age group compared with younger patients. Objective:To determine the effect on outcomes and risks of combination ezetimibe and simvastatin compared with simvastatin monotherapy to lower lipid levels among patients 75 years or older with stabilized acute coronary syndrome (ACS). Design, Setting, Participants:In this prespecified secondary analysis of the global, multicenter, prospective clinical randomized Improved Reduction of Outcomes: Vytorin Efficacy International Trial (IMPROVE-IT), outcomes and risks were compared by age among patients 50 years or older after a hospitalization for ACS. Data were collected from October 26, 2005, through July 8, 2010, with the database locked October 21, 2014. Data were analyzed May 29, 2015, through March 13, 2018, using Kaplan-Meier curves and Cox proportional hazards models. Interventions:Double-blind randomized assignment to combined simvastatin and ezetimibe or simvastatin and placebo with follow-up for a median of 6 years (interquartile range, 4.3-7.1 years). Main Outcomes and Measures:The primary composite end point consisted of death due to cardiovascular disease, myocardial infarction (MI), stroke, unstable angina requiring hospitalization, and coronary revascularization after 30 days. Individual adverse ischemic and safety end points and lipid variables were also analyzed. Results:Of 18 144 patients enrolled (13 728 men [75.7%]; mean [SD] age, 64.1 [9.8] years), 5173 (28.5%) were 65 to 74 years old, and 2798 (15.4%) were 75 years or older at randomization. Treatment with simvastatin-ezetimibe resulted in lower rates of the primary end point than simvastatin-placebo, including 0.9% for patients younger than 65 years (HR, 0.97; 95% CI, 0.90-1.05) and 0.8% for patients 65 to 74 years of age (hazard ratio [HR], 0.96; 95% CI, 0.87-1.06), with the greatest absolute risk reduction of 8.7% for patients 75 years or older (HR, 0.80; 95% CI, 0.70-0.90) (P = .02 for interaction). The rate of adverse events did not increase with simvastatin-ezetimibe vs simvastatin-placebo among younger or older patients. Conclusions and Relevance:In IMPROVE-IT, patients hospitalized for ACS derived benefit from higher-intensity therapy to lower lipid levels with simvastatin-ezetimibe compared with simvastatin monotherapy, with the greatest absolute risk reduction among patients 75 years or older. Addition of ezetimibe to simvastatin was not associated with any significant increase in safety issues among older patients. These results may have implications for guideline recommendations regarding lowering of lipid levels in the elderly. Trial Registration:ClinicalTrials.gov identifier: NCT00202878.
journal_name
JAMA Cardioljournal_title
JAMA cardiologyauthors
Bach RG,Cannon CP,Giugliano RP,White JA,Lokhnygina Y,Bohula EA,Califf RM,Braunwald E,Blazing MAdoi
10.1001/jamacardio.2019.2306subject
Has Abstractpub_date
2019-09-01 00:00:00pages
846-854issue
9eissn
2380-6583issn
2380-6591pii
2738104journal_volume
4pub_type
杂志文章,多中心研究,随机对照试验相关文献
JAMA Cardiology文献大全abstract:Importance:Myocardial replacement fibrosis has been reported to occur in one-third of patients with mitral valve prolapse (MVP) and significant mitral regurgitation (MR). However, it remains unknown whether there are detectable changes in myocardial metabolism suggestive of inflammation or ischemia that accompany the d...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2020.1555
更新日期:2020-09-01 00:00:00
abstract:Importance:There are major gaps in use of guideline-directed medical therapy (GDMT) for patients with heart failure (HF). Patient-reported data outlining patient goals and preferences associated with GDMT are not available. Objective:To survey patients with chronic HF to better understand their experiences and percept...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2019.4987
更新日期:2020-03-01 00:00:00
abstract:Importance:Strategies for reliable selection of high-risk patients with hypertrophic cardiomyopathy (HCM) for prevention of sudden cardiac death (SCD) with implantable cardioverter/defibrillators (ICDs) are incompletely resolved. Objective:To assess the reliability of SCD prediction methods leading to prophylactic ICD...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2019.1391
更新日期:2019-07-01 00:00:00
abstract:Importance:Data sharing is as an expanding initiative for enhancing trust in the clinical research enterprise. Objective:To evaluate the feasibility, process, and outcomes of a reproduction analysis of the THERMOCOOL SMARTTOUCH Catheter for the Treatment of Symptomatic Paroxysmal Atrial Fibrillation (SMART-AF) trial u...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2017.3808
更新日期:2017-12-01 00:00:00
abstract:Importance:The Department of Veterans Affairs (VA) operates a nationwide system of hospitals and hospital-affiliated clinics, providing health care to more than 2 million veterans with cardiovascular disease. While data permitting hospital comparisons of the outcomes of acute cardiovascular care (eg, myocardial infarct...
journal_title:JAMA cardiology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamacardio.2018.1115
更新日期:2018-07-01 00:00:00
abstract:IMPORTANCE:Reduced rates of cardiac catheterization, percutaneous coronary intervention (PCI), and coronary artery bypass graft (CABG) are an unintended consequence of public reporting of cardiogenic shock outcomes in New York. OBJECTIVES:To evaluate whether the referral rates for cardiac catheterization, PCI, or CABG...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2016.0785
更新日期:2016-09-01 00:00:00
abstract:Importance:Cardiovascular disease (CVD) is the leading cause of death in the United States, but regional variation within the United States is large. Comparable and consistent state-level measures of total CVD burden and risk factors have not been produced previously. Objective:To quantify and describe levels and tren...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2018.0385
更新日期:2018-05-01 00:00:00
abstract:Importance:With improved survival, heart failure (HF) has become a major complication for individuals with human immunodeficiency virus (HIV) infection. It is unclear if this risk extends to different types of HF in the antiretroviral therapy (ART) era. Determining whether HIV infection is associated with HF with reduc...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2017.0264
更新日期:2017-05-01 00:00:00
abstract:Importance:Women are at higher risk of drug-induced torsade de pointes (TdP) than men. Androgens are protective. Influence of oral contraception on drug-induced TdP and QT prolongation is controversial. Objective:To determine if the extent of sotalol-induced corrected QT (QTc) prolongation and specific T-wave morpholo...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2018.2251
更新日期:2018-09-01 00:00:00
abstract:Importance:Echocardiographic left ventricular global longitudinal strain (GLS) detects early subclinical ventricular dysfunction and can be used in patients receiving potentially cardiotoxic chemotherapy. A meta-analysis of the prognostic value of GLS for cancer therapy-related cardiac dysfunction (CTRCD) has not been ...
journal_title:JAMA cardiology
pub_type: 杂志文章,meta分析
doi:10.1001/jamacardio.2019.2952
更新日期:2019-10-01 00:00:00
abstract:Importance:Low-density lipoprotein cholesterol (LDL-C) is an important modifiable risk factor for atherosclerotic cardiovascular disease. It is unclear whether the percentage LDL-C lowering with pharmacotherapies differs on the basis of baseline LDL-C levels. Objective:To evaluate the association between baseline LDL-...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2020.6184
更新日期:2020-11-13 00:00:00
abstract:Importance:It is unknown whether coronary revascularization, when added to optimal medical therapy, improves prognosis in patients with stable ischemic heart disease (SIHD) at increased risk of cardiovascular events owing to moderate or severe ischemia. Objective:To describe baseline characteristics of participants en...
journal_title:JAMA cardiology
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1001/jamacardio.2019.0014
更新日期:2019-03-01 00:00:00
abstract:Importance:Accurate, real-time case identification is needed to target interventions to improve quality and outcomes for hospitalized patients with heart failure. Problem lists may be useful for case identification but are often inaccurate or incomplete. Machine-learning approaches may improve accuracy of identificatio...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2016.3236
更新日期:2016-12-01 00:00:00
abstract:Importance:Observational studies have reported an association between low serum vitamin D levels and elevated risk of cardiovascular disease (CVD) events, but such studies cannot prove causation because of possible unmeasured confounding. Objective:We conducted a meta-analysis of randomized clinical trials that tested...
journal_title:JAMA cardiology
pub_type: 杂志文章,meta分析
doi:10.1001/jamacardio.2019.1870
更新日期:2019-08-01 00:00:00
abstract:Importance:Bioresorbable scaffolds were designed to provide clinical benefits after their complete bioresorption. Prior studies demonstrated early risks with the Absorb polymeric bioresorbable vascular scaffold (BVS). Whether this risk profile changes over time during the course of its bioresorption is unknown. Object...
journal_title:JAMA cardiology
pub_type: 杂志文章,meta分析
doi:10.1001/jamacardio.2019.4101
更新日期:2019-12-01 00:00:00
abstract:Importance:The optimal conduits for coronary artery bypass grafting (CABG) remain controversial in multivessel coronary artery disease. Objective:To compare the long-term clinical outcomes of total arterial revascularization (TAR) vs non-TAR (CABG with at least 1 arterial and 1 saphenous vein graft) in a multicenter p...
journal_title:JAMA cardiology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamacardio.2019.6104
更新日期:2020-05-01 00:00:00
abstract:Importance:Recent data support percutaneous revascularization as an alternative to coronary artery bypass grafting in unprotected left main (ULM) coronary lesions. However, the relevance of these trials to current practice is unclear, as patterns and outcomes of ULM percutaneous coronary intervention (PCI) in contempor...
journal_title:JAMA cardiology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamacardio.2018.4376
更新日期:2019-02-01 00:00:00
abstract:Importance:Levels of proprotein convertase subtilisin kexin type 9 (PCSK9) vary markedly across the population and are influenced by genetic and nongenetic factors. Evolocumab is a fully human, monoclonal antibody against PCSK9 that reduces low-density lipoprotein cholesterol (LDL-C) levels by 55% to 75%. Whether the e...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2016.5395
更新日期:2017-05-01 00:00:00
abstract:Importance:Hutchinson-Gilford progeria syndrome (HGPS) is an ultrarare disorder associated with premature death due to cardiovascular events during the second decade of life. However, because of its rarity (107 identified living patients), the natural history of cardiac disease remains uncharacterized. Therefore, meani...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2017.5235
更新日期:2018-04-01 00:00:00
abstract:Importance:Hospitalizations for worsening heart failure (WHF) represent an enormous public health and financial burden, with physicians, health systems, and payers placing increasing emphasis on hospitalization prevention. In addition, maximizing time out of the hospital is an important patient-centered outcome. In thi...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2017.5250
更新日期:2018-03-01 00:00:00
abstract:Importance:In clinical trials, transcatheter aortic valve replacement (TAVR) has been shown to improve symptoms and quality of life. As this technology moves into general clinical practice, evaluation of the health status outcomes among unselected patients treated with TAVR is of critical importance. Objective:To exam...
journal_title:JAMA cardiology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamacardio.2016.5302
更新日期:2017-04-01 00:00:00
abstract:Importance:Cardiac stress testing is often performed prior to noncardiac surgery, although trends in use of preoperative stress testing and the effect of testing on cardiovascular outcomes are currently unknown. Objective:To describe temporal trends and outcomes of preoperative cardiac stress testing from 2004 to 2017...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2020.4311
更新日期:2021-01-01 00:00:00
abstract:Importance:Use of transcatheter aortic valve replacement (TAVR) for severe aortic stenosis is growing rapidly. However, to our knowledge, the durability of these prostheses is incompletely defined. Objective:To determine the midterm hemodynamic performance of balloon-expandable transcatheter heart valves. Design, Set...
journal_title:JAMA cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamacardio.2017.3306
更新日期:2017-11-01 00:00:00
abstract:Importance:Sustained reductions in low-density lipoprotein cholesterol (LDL-C) with lipid-lowering therapies that require frequent dosing are reliant on patient adherence, and poor adherence is associated with worse clinical outcomes. Objective:To determine whether inclisiran, a small interfering RNA, reduces mean LDL...
journal_title:JAMA cardiology
pub_type: 杂志文章,随机对照试验
doi:10.1001/jamacardio.2019.3502
更新日期:2019-11-01 00:00:00
abstract:Importance:Racial differences are recognized in multiple cardiovascular parameters, including left ventricular hypertrophy and heart failure, which are 2 major manifestations of hypertrophic cardiomyopathy. The association of race with disease expression and outcomes among patients with hypertrophic cardiomyopathy is n...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2019.4638
更新日期:2020-01-01 00:00:00
abstract:Importance:If we assume that women and men exhibit variations of the same fundamental vascular physiology, then conventional analyses of subclinical measures would suggest that women catch up to men by midlife in the extent of potentially important vascular disease. Alternatively, under the assumption that vascular phy...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2019.5306
更新日期:2020-03-01 00:00:00
abstract:Importance:Medicare Advantage (MA), a private insurance plan option, now covers one-third of all Medicare beneficiaries. Although patients with cardiovascular disease enrolled in MA have been reported to receive higher quality of care in the ambulatory setting than patients enrolled in fee-for-service (FFS) Medicare, i...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2020.3638
更新日期:2020-09-02 00:00:00
abstract:Importance:Cardiac resynchronization therapy (CRT) provides significant reduction in morbidity and mortality in select patients with left ventricular systolic dysfunction and specific parameters of electrocardiographic evidence of dyssynchrony. Relative to the 2012 American College of Cardiology/American Heart Associat...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2019.1755
更新日期:2019-08-01 00:00:00
abstract:Importance:Electronic health record (EHR) biobanks containing clinical and genomic data on large numbers of individuals have great potential to inform drug discovery. Individuals with interleukin 6 receptor (IL6R) single-nucleotide polymorphisms (SNPs) who are not receiving IL6R blocking therapy have biomarker profiles...
journal_title:JAMA cardiology
pub_type: 杂志文章
doi:10.1001/jamacardio.2018.2287
更新日期:2018-09-01 00:00:00
abstract:Importance:Persons with human immunodeficiency virus (HIV) that is treated with antiretroviral therapy have improved longevity but face an elevated risk of myocardial infarction (MI) due to common MI risk factors and HIV-specific factors. Despite these elevated MI rates, optimal methods to predict MI risks for HIV-infe...
journal_title:JAMA cardiology
pub_type: 杂志文章,多中心研究
doi:10.1001/jamacardio.2016.4494
更新日期:2017-02-01 00:00:00