Acute MI rates lower in men, women since Red Dress Campaign
American College of Cardiology 60th Annual Scientific Sessions
NEW ORLEANS – Since its inception in 2002, the National Heart, Lung and Blood Institute’s Red Dress Campaign has been associated with a decreased incidence of acute MI among both men and women, according to data presented here.
“Over the last few years there’s been a lot of awareness of women in public health and cardiovascular disease. Some research has been done to demonstrate the increase, and we wanted to see if this increase translated into improved outcomes in treatment patterns in women,” Liana M. Spano-Brennan, DO, cardiology fellow, told Cardiology Today.
Using the New Jersey Myocardial Infarction Data Acquisition System database, Spano-Brennan and colleagues at the University of Medicine and Dentistry of New Jersey’s Robert Wood Johnson Medical School identified 315,246 patients who presented to hospitals in New Jersey for acute MI between 1986 and 2007. Almost half (40.9%) of patients identified were female. The researchers examined the effect the campaign has had on acute MI incidence, management and outcomes.
The overall incidence of acute MI (per 100,000) decreased between 1986 and 2007, with the most notable decline observed in men (women: 321 to 197; P<.0001 and men: 598 to 311; P<.0001). According to the researchers, after 2002, the trend increased.
Over the observed period of 22 years, though the rate of left heart catheterization increased 5-fold for women and 3-fold for men, the likelihood of left heart catheterization was still low among women (OR=0.78; 95% CI, 0.77-0.79). The percent difference between men and women undergoing percutaneous coronary intervention increased from 2.2% in 1986 to 9.4% in 2007 (P<.0001), among those who received left heart catheterization.
Both in-hospital and one-year mortality was higher among women compared with men (OR=1.30; 95% CI, 1.27-1.34 for in-hospital and OR=1.10; 95% CI, 1.08-1.13 for one-year). However, the mortality rate did not decrease significantly after 2002.
__________________________________________________ _______________________
Combination ezetimibe, simvastatin plus niacin may benefit patients with hyperlipidemia
American College of Cardiology 60th Annual Scientific Sessions
NEW ORLEANS — Treatment with combination ezetimibe and simvastatin plus extended-release niacin may aid patients with hyperlipidemia in achieving target LDL cholesterol, non-HDL cholesterol and apolipoprotein B levels, according to data presented here.
To compare the efficacy of combination ezetimibe and simvastatin plus extended-release niacin with either treatment alone, researchers conducted a randomized, double blind study involving patients with type IIA and IIB hyperlipidemia.
“What we looked at in this combination with ezetimibe and the statin along with extended-release niacin how that supports the attainment of recommended LDL, non-HDL and apolipoprotein B goals and showing that the combination allows you in this patient population to get to significantly more patients to get to those goals,” Andrew M. Tershakovec, MD, MPH, researcher for Merck, told Cardiology Today.
Patients were randomly assigned to one of the following regimens:
10 mg/20 mg of combination ezetimibe and simvastatin plus up to 2 g of niacin for 64 weeks.
10 mg/20 mg of combination ezetimibe and simvastatin alone for 64 weeks.
Up to 2 g of niacin for 24 weeks then 10 mg/20 mg of combination ezetimibe and simvastatin plus up to 2 g of niacin for 40 weeks or more.
Up to 2 g of niacin for 24 weeks then 10 mg/20 mg of combination ezetimibe and simvastatin alone for 40 weeks or more.
Tershakovec and colleagues also assessed lipid outcomes in subgroups of patients with high risk for coronary heart disease, diabetes, metabolic syndrome and those without diabetes or metabolic syndrome.
Results revealed that considerably more patients receiving combination ezetimibe and simvastatin plus niacin reached concomitant LDL cholesterol, non-HDL cholesterol and apolipoprotein B levels when compared with those receiving niacin and combination ezetimibe and simvastatin at 24 weeks and combination ezetimibe and simvastatin at 64 weeks. In all subgroups, attainment rates remained higher for patients receiving the combination treatment plus niacin vs. niacin alone at 24 and 64 weeks. In addition, rates were generally greater with combination ezetimibe and simvastatin plus niacin vs. the combination treatment alone. Concomitant attainment of all three target lipid levels was most consistent with the single level attainment of non-HDL cholesterol.
“What this shows is that the combination of ezetimibe/statin and niacin is a very potent,” Tershakovec said. “I think niacin-based therapy has been around a long time, but the outcomes data are relatively limited. However, the data that do exist are positive.”
He noted that two large outcome studies examining the use of extended-release niacin will also provide physicians with more insight into how to implement these treatments into clinical practice.
“Seeing those outcomes data would be very informative on what the utility of therapies like this really are,” Tershakovec said. – by Melissa Foster
Disclosure: Dr. Tershakovec is an employee for Merck as well as a company stockholder.