1 / 11

Statins ( the only group with all-cause mortality evidence )

Who benefits most? Differences: Evidence? DI’s? Potency?. Statins ( the only group with all-cause mortality evidence ). Watch for toxicity: hepatic/myopathy. 2  Prevention Simvastatin 20-40mg/d. 1  Prevention Pravastatin 40mg/d. % patinets. NNT=30. NNT=12. NNT=?111. NNT=42.

sutton
Télécharger la présentation

Statins ( the only group with all-cause mortality evidence )

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Who benefits most? Differences: Evidence? DI’s? Potency? Statins (the only group with all-cause mortality evidence) Watch for toxicity: hepatic/myopathy. 2 Prevention Simvastatin 20-40mg/d 1 Prevention Pravastatin 40mg/d % patinets NNT=30 NNT=12 NNT=?111 NNT=42

  2. HPS Lancet 2003 n=20,536 5yr Evidence for diabetes, stroke, age<80, women, LDL<3 • No benefit for Vitamins E 600mg, C 250mg, or beta-carotene • Questions remaining: safety/efficacy of aggressive pursuit of targets, combination therapies, low-risk patients with  LDL. 2 & High-risk 1 Prevention (CHD, PVD, Diabetes, HTN, Male/Female, Age 40-80) Simvastatin 40mg/d Benefits similar despite lower vs higher initial LDL % patinets NNT=62 NNT=57 NNT=18 Well tolerated after ~10,000pts excluded!

  3. What about younger diabetics with no risk factors??

  4. IDEALJAMA,Nov 2005 n=8888 4.8yr • Intensive lipid lowering in previous MI pts (open label trial) • LDL: 3.14 baseline mmol/L 2.1atorv80mg vs 2.7 simv 20-40mg;Age<80, ~62 • 1o Primary: Coronary Death, nonfatal MI or cardiac resusc.9.3 vs 10.4% NS • 2o Major vascular events (1o & stroke) NNT=59/4.8yr;MI6 vs 7.2% NNT=84 • LFT's NNH=112; All-cause death8.2 vs 8.4% or CV death5 vs4.9 butat least  non-CV death 3.2 vs 3.5 NS Atorvastatin 80mg/d $87 vs Simv 20-40mg/day $41 % patients NNT=59 / 4.8yr (RRR=13%) NNT=NS NNT=NS LFTs 3xNNH=112 -not powered to detect NOdifferenceinprimary endpoint orall-causedeath;CV+strokeevents; ADRs causing discontinuation

  5. ASCOTLancet,April 2003 n=10,305 • Evidence for:primary prevention of CHD and stroke in highrisk, • middle aged, hypertensive, male patients with TC <6.5mmol/L • Questions remaining: women n=1942; adverse & long term effects; • safety and efficacy of titrating dose to attain targets & magnitude/$ 1o Prevention in high risk (Average 3.7 risk factors in addition to HTN) (HTN,male/female,age~63 40-79,TC<6.5mmol/L) Atorvastatin 10mg/d over average 3.3yrs NNT=NS NNT=91 NNT=143 Older males with multiple risk factors benefit.

  6. TNTNEJM,April 2005 n=10,001 4.9yr • Intensive lipid lowering in stable CHD (n=15,464 - 8wk run-in) • LDL: 3.9 baseline mmol/L 2.0atorv80mg vs 2.6 atorv 10mg;Age 35-75, ~61 • 1oend point: “CHD Death, CV Event or Procedure, Stroke” • CV & Stroke events; NNT=46 / 4.9yr; • LFT's NNH=100; All-cause death5.7 vs 5.6% BUT non-CV death 3.2 vs 2.5 NS Atorvastatin 80mg/d $87 vs 10mg/day $67 % patients NNT=26 / 4.9yr (RRR=20%) NNH=NS LFTs 3xNNH=100  CV events;  ADRs; NO difference in all-cause death

  7. For patients with low HDL, high TG, but low LDL (e.g. common in diabetes) NO evidence yet for mortality benefit ADRs: Dyspepsia/abdom pain; gallstones, myopathy Differences: Evidence? Potency? Cost? Fibrates 2 Prevention Gemfibrozil 600mg/bid 1 Prevention Gemfibrozil 600mg/bid % patinets  NS NNT=14 NS NNT=28

  8. FIELD StudyIs a fibrate useful in Type 2 DM? Not really • 9795 patients age 50-75 with Type 2-DM; RCT • Fenofibrate 200mg OD vs Placebo (~5yr) • No  in coronary events 1 Endpoint; did  CV events. {Meta-analysis:  in all-cause mortality with fibrates(NNH=132 over 4.4yrs)Studer 2005 Arch Int Med; FIELDconsistent.} NNT=NS NNT=69 NNH=NS Lancet 2005;366:1849-61.

  9. RxFiles Charts Book

  10. Newsletters, Links, Email Updates... www.RxFiles.ca It’s all in the detail!

  11. Risks from lipid lowering?Rhabdomyloysis NNH=10 RR 5.4x NNH=1,670 NNH =22,700 1) Graham DJ, et al. Incidence of hospitalized rhabdomyolysis in patients treated with lipid-lowering drugs. JAMA. Dec 2004 (24 cases of rhabdo / 252,000 pts) 2) Bandolier: Rhabdomyloysis with statins Jan 2005;131-2. http://www.jr2.ox.ac.uk/bandolier/

More Related