American Journal of Cardiovascular Drugs最新文献

{"title":"Benefits and Risks of Antihyperlipidemic Medication in Adults with Different Low-Density Lipoprotein Cholesterol Based on the Number Needed to Treat","authors":"Hong-Fei Wang,&nbsp;Yu-Cheng Mao,&nbsp;Su-Fen Qi,&nbsp;Xin-Yi Xu,&nbsp;Zi-Yan Zhang,&nbsp;Chang Geng,&nbsp;Kai Song,&nbsp;Qing-Bao Tian","doi":"10.1007/s40256-024-00651-7","DOIUrl":"10.1007/s40256-024-00651-7","url":null,"abstract":"<div><h3>Purpose</h3><p>The objective of this investigation is to examine the benefits and potential risks of these drugs in individuals by varying baseline low-density lipoprotein cholesterol (LDL-C) values, utilizing the concept of the number needed to treat (NNT).</p><h3>Methods</h3><p>We extensively searched electronic databases, such as PubMed, EMBASE, Cochrane, and Web of Science, up to 6 August 2023. Baseline LDL-C values were stratified into four categories: &lt; 100, 100–129, 130–159, and ≥ 160 mg/dL. Risk ratios (RRs) and NNT values were computed.</p><h3>Results</h3><p>This analysis incorporated data from 46 randomized controlled trials (RCTs), encompassing a total of 237,870 participants. The meta-regression analysis demonstrated an incremental diminishing risk of major adverse cardiovascular events (MACE) with increasing baseline LDL-C values. Statins exhibited a significant reduction in MACE [number needed to treat to benefit (NNTB) 31, 95% confidence interval (CI) 25–37], but this effect was observed only in individuals with baseline LDL-C values of 100 mg/dL or higher. Ezetimibe and PCSK9 inhibitors also were effective in reducing MACE (NNTB 18, 95% CI 11–41, and NNTB 18, 95% CI 16–24). Notably, the safety outcomes of statins and ezetimibe did not reach statistical significance, while the incidence of injection-site reactions with PCSK9 inhibitors was statistically significant [number needed to treat to harm (NNTH) 41, 95% CI 80–26].</p><h3>Conclusion</h3><p>Statins, ezetimibe, and PCSK9 inhibitors demonstrated a substantial capacity to reduce MACE, particularly among individuals whose baseline LDL-C values were relatively higher. The NNT visually demonstrates the gradient between baseline LDL-C and cardiovascular disease (CVD) risk.</p><h3>Systematic Review Registration</h3><p>Registration: PROSPERO identifier number: CRD42023458630.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 4","pages":"557 - 568"},"PeriodicalIF":2.8,"publicationDate":"2024-05-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141086655","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond Weight Loss: Evaluating Cardiovascular Advantages of GLP-1 Receptor Agonists","authors":"Teresa Vezza,&nbsp;Víctor M. Víctor","doi":"10.1007/s40256-024-00650-8","DOIUrl":"10.1007/s40256-024-00650-8","url":null,"abstract":"","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 4","pages":"505 - 507"},"PeriodicalIF":2.8,"publicationDate":"2024-05-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140920856","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular Benefits of GLP-1 Receptor Agonists in Patients Living with Obesity or Overweight: A Meta-analysis of Randomized Controlled Trials","authors":"Gustavo de Oliveira Almeida,&nbsp;Thiago Faraco Nienkötter,&nbsp;Caroline Cristine Almeida Balieiro,&nbsp;Eric Pasqualotto,&nbsp;Júlia Braga Cintra,&nbsp;Henrique Champs Porfírio Carvalho,&nbsp;Ana Laura Soares Silva,&nbsp;Júlia Camargo Kabariti,&nbsp;Bárbara Silvestre Minucci,&nbsp;Edmundo Damiani Bertoli,&nbsp;Camila Mota Guida","doi":"10.1007/s40256-024-00647-3","DOIUrl":"10.1007/s40256-024-00647-3","url":null,"abstract":"<div><h3>Background</h3><p>GLP-1 receptor agonists (GLP-1 RAs) have emerged as an effective therapeutic class for weight loss. However, the efficacy of these agents in reducing cardiovascular endpoints among patients living with obesity or overweight is unclear.</p><h3>Methods</h3><p>We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing GLP-1 RAs versus placebo in patients with obesity or overweight. We searched PubMed, Cochrane, and Embase databases. A random-effects model was used to calculate risk ratios (RRs) and mean differences (MDs), with 95% confidence intervals (CIs).</p><h3>Results</h3><p>A total of 13 RCTs were included, with 30,512 patients. Compared with placebo, GLP-1 RAs reduced systolic blood pressure (MD − 4.76 mmHg; 95% CI − 6.03, − 3.50; <i>p</i> &lt; 0.001; <i>I</i>² = 100%) and diastolic blood pressure (MD − 1.41 mmHg; 95% CI − 2.64, − 0.17; <i>p</i> = 0.03; <i>I</i>² = 100%). GLP-1 RA significantly reduced the occurrence of myocardial infarction (RR 0.72; 95% CI 0.61, 0.85; <i>p</i> &lt; 0.001; <i>I</i>² = 0%). There were no significant differences between groups in unstable angina (UA; RR 0.84; 95% CI 0.65, 1.07; <i>p</i> = 0.16; <i>I</i>² = 0%), stroke (RR 0.91; 95% CI 0.74, 1.12; <i>p</i> = 0.38; <i>I</i>² = 0%), atrial fibrillation (AF; RR 0.49; 95% CI 0.17, 1.43; <i>p</i> = 0.19; <i>I</i>² = 22%), and deep vein thrombosis (RR 0.30; 95% CI 0.06, 1.40; <i>p</i> = 0.13; <i>I</i>² = 0%).</p><h3>Conclusions</h3><p>In patients living with obesity or overweight, GLP-1 RA reduced systolic and diastolic blood pressure and the occurrence of myocardial infarction, with a neutral effect on the occurrence of UA, stroke, AF, and deep vein thrombosis.</p><h3>Registration</h3><p>PROSPERO identifier number CRD42023475226.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 4","pages":"509 - 521"},"PeriodicalIF":2.8,"publicationDate":"2024-05-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140908302","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluating the Effectiveness and Safety of Evinacumab in Treating Hypercholesterolemia and Hypertriglyceridemia: A Systematic Review and Meta-analysis of Randomized Controlled Trials","authors":"Hussain Sohail Rangwala,&nbsp;Hareer Fatima,&nbsp;Mirha Ali,&nbsp;Muhammad Ashir Shafiq,&nbsp;Burhanuddin Sohail Rangwala,&nbsp;Vikash Virwani,&nbsp;Aashish Kumar,&nbsp;Syed Ali Arsal,&nbsp;Adarsh Raja,&nbsp;Sandesh Raja,&nbsp;Muhammad Saqlain Mustafa","doi":"10.1007/s40256-024-00649-1","DOIUrl":"10.1007/s40256-024-00649-1","url":null,"abstract":"<div><h3>Background</h3><p>Cardiovascular disease remains a significant global health concern, with high low-density lipoprotein cholesterol (LDL-C) levels contributing to an increased risk. Familial hypercholesterolemia (FH) further complicates its management, necessitating additional lipid-lowering therapies. Evinacumab, an angiopoietin-like protein 3 monoclonal antibody, has emerged as a potential treatment, particularly for patients with FH, by effectively reducing LDL-C and triglyceride levels. This meta-analysis aimed to evaluate the efficacy and safety of evinacumab across diverse patient populations.</p><h3>Methods</h3><p>Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, relevant randomized controlled trials (RCTs) were systematically retrieved from multiple databases until November 24, 2023. The inclusion criteria were studies comparing evinacumab (at doses of 5 and 15 mg) to placebo, with outcomes focusing on lipid levels and adverse events. Standardized protocols were employed for data extraction and quality assessment, and statistical analysis was conducted using RevMan software.</p><h3>Results</h3><p>Four RCTs, involving 270 patients, were included in the analysis. The analysis revealed significant reductions in lipid markers, particularly with the 15-mg dose of evinacumab, including triacylglycerols (standard mean difference [SMD] = −6.09, 95% confidence interval [CI] − 14.53 to 2.36, <i>P</i> = 0.16), total cholesterol (SMD = − 6.20, 95% CI − 11.53 to − 0.88, <i>P</i> = 0.02), high-density lipoprotein cholesterol (SMD = − 0.79, 95% CI − 1.27 to − 0.31, <i>P</i> = 0.001), LDL-C (SMD = − 4.58, 95% CI − 9.13 to − 0.03, <i>P</i> = 0.05), apolipoprotein (Apo) B (SMD = − 4.01, 95% CI − 7.53 to − 0.46, <i>P</i> = 0.03), and Apo C3 (SMD = − 7.67, 95% CI − 12.94 to − 2.41, <i>P</i> = 0.004). Adverse event analysis revealed no significant association, indicating good tolerability.</p><h3>Conclusion</h3><p>High-dose evinacumab (15 mg) consistently demonstrated efficacy in reducing cholesterol and other lipid markers, with favorable tolerability. Further research is warranted to comprehensively assess its safety and clinical effectiveness, emphasizing the need for additional data to support its use in managing cardiovascular disease.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 4","pages":"523 - 535"},"PeriodicalIF":2.8,"publicationDate":"2024-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140847315","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Genitourinary Safety of In-class Sodium-Glucose Cotransporter-2 Inhibitors among Patients with Heart Failure with Preserved Ejection Fraction: A Cohort Study","authors":"Munaza Riaz,&nbsp;Jingchuan Guo,&nbsp;Steven M. Smith,&nbsp;Eric A. Dietrich,&nbsp;David E. Winchester,&nbsp;Haesuk Park","doi":"10.1007/s40256-024-00648-2","DOIUrl":"10.1007/s40256-024-00648-2","url":null,"abstract":"<div><h3>Purpose</h3><p>The American Heart Association recommended sodium-glucose cotransporter-2 inhibitors (SGLT2i) for the management of heart failure with preserved ejection fraction (HFpEF). However, little is known about their real-world in-class comparative safety in patients with HFpEF. We aimed to assess the comparative safety of SGLT2i in the risk of urinary tract infection (UTI) or genital infection separately or as a composite outcome among patients with HFpEF.</p><h3>Methods</h3><p>This cohort study using MarketScan^® Commercial and Medicare supplemental databases (2012–2020) included patients aged ≥ 18 years with a diagnosis of HFpEF who initiated SGLT2i therapy. Three pairwise comparison groups were established: cohort 1, dapagliflozin versus canagliflozin; cohort 2, empagliflozin versus canagliflozin; and cohort 3, dapagliflozin versus empagliflozin. After stabilized inverse probability treatment weighting, Cox proportional hazards regression was used to compare the risk of UTI or genital infection separately or as a composite outcome in each cohort.</p><h3>Results</h3><p>The risk of the composite outcome did not significantly differ between canagliflozin and dapagliflozin (adjusted hazard ratio [aHR] 0.64; 95% confidence interval [CI] 0.36–1.14) or between empagliflozin and canagliflozin (aHR 1.25; 95% CI 0.77–2.05). Similarly, there was no evidence of difference between dapagliflozin and empagliflozin in this risk (aHR 0.76; 95% CI 0.48–1.21). The results of analyses separately assessing UTI or genital infection were similar.</p><h3>Conclusions</h3><p>There was no significant difference in the risk of UTI or genital infection among patients with HFpEF who initiated canagliflozin, dapagliflozin, or empagliflozin.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"455 - 464"},"PeriodicalIF":2.8,"publicationDate":"2024-04-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140827517","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Differential Use of Glycoprotein IIb/IIIa Inhibitors with Bivalirudin in Patients with STEMI Undergoing PCI: A Systematic Review and Meta-Analysis","authors":"Hasan Mushahid,&nbsp;Syeda Ayesha Shah,&nbsp;Syed Husain Farhan,&nbsp;Muhammad Hamza Shuja,&nbsp;Kyle Balasingam,&nbsp;Asad Ali Siddiqui,&nbsp;Ishaque Hameed,&nbsp;Kamran Akram,&nbsp;Shayan Mushahid,&nbsp;Muhammad Shariq Usman","doi":"10.1007/s40256-024-00636-6","DOIUrl":"10.1007/s40256-024-00636-6","url":null,"abstract":"<div><h3>Aim</h3><p>The efficacy and safety of bivalirudin when used concurrently with glycoprotein IIb/IIIa inhibitors (GPI) is uncertain. In this systematic review and meta-analysis, we aimed to evaluate the efficacy and safety of bivalirudin versus heparin in patients with ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) and to explore the impact of differential use (greater and balanced) of GPI.</p><h3>Methods</h3><p>Online databases were queried from inception to March 2023 to identify eight randomized controlled trials (<i>n</i> = 22,483) for inclusion. The primary outcomes included all-cause mortality, major bleeding, major adverse cardiovascular events (MACE), and net adverse clinical events (NACE). Secondary efficacy endpoints included cardiac death, reinfarction, stent thrombosis (ST), and stroke. Data were pooled using a random-effects model to derive risk ratios (RRs) and 95% confidence intervals (CIs).</p><h3>Results</h3><p>When compared to heparin, bivalirudin was associated with a significant reduction in all-cause mortality (RR 0.83; 95% CI 0.72–0.97; <i>P</i> = 0.02), major bleeding (RR 0.73; 95% CI 0.57–0.93; <i>P</i> = 0.01), cardiac death (RR 0.79; 95% CI 0.66–0.94; <i>P</i> = 0.01), and NACE (RR 0.80; 95% CI 0.72–0.89; <i>P</i> &lt; 0.0001). However, while the bivalirudin arm showed an increased likelihood of ST in the greater GPI subgroup (RR 1.70; 95% CI 1.13–2.56; <i>P</i> = 0.01), it was associated with a decreased likelihood of ST in the balanced GPI subgroup (RR 0.40; 95% CI 0.24–0.65; <i>P</i> = 0.0003).</p><h3>Conclusion</h3><p>Overall, our findings suggest that bivalirudin may be a more efficacious intervention than heparin for reducing certain adverse events in patients with STEMI undergoing primary PCI.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"385 - 398"},"PeriodicalIF":2.8,"publicationDate":"2024-04-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140809486","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cost–Utility Analysis of Vericiguat in Heart Failure with Reduced Ejection Fraction After Worsening Heart Failure Events in China","authors":"Penglei Chen,&nbsp;Yixiang Wang,&nbsp;Xin Liu,&nbsp;Jiaqi Yu,&nbsp;Xuwei Zheng","doi":"10.1007/s40256-024-00637-5","DOIUrl":"10.1007/s40256-024-00637-5","url":null,"abstract":"<div><h3>Objective</h3><p>Vericiguat is a new medication to demonstrate clinical efficacy in heart failure with reduced ejection fraction (HFrEF) after worsening heart failure (WHF) events, but its cost–utility was unknown. We aimed to assess the cost–utility of combining the application of vericiguat with standard treatment in HFrEF patients who had WHF events.</p><h3>Methods</h3><p>A multistate Markov model was implemented to mimic the economic results of HFrEF patients who had WHF events in China after receiving vericiguat or placebo. An analysis of cost–utility was conducted; most parameters were set according to the published studies and related databases. All the utilities and costs were decreased at a rate of 5% annually. The incremental cost-effectiveness ratios (ICERs) were the primary outcome measure. We also conducted sensitivity analyses.</p><h3>Results</h3><p>Over a 20 year lifetime horizon, additional use of vericiguat led to an elevated cost from US$9725.03 to US$20,660.76 at the current vericiguat costs. This was related to increased quality-adjusted life years (QALYs) from 2.50 to 2.66, along with an ICER of US$65,057.24 per QALY, which was over the willingness-to-pay (WTP) threshold of US$36,096.30 per QALY. If the vericiguat costs were discounted at 80%, it contributed to an ICER of US$12,226.77 per QALY. Additional use of vericiguat for patients with plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) of ≤ 5314 pg per ml produced an ICER of US$23,688.46 per QALY. The outcomes of the one-way sensitivity analysis showed the risk of death from cardiovascular disease in both groups was variable with the highest sensitivity. The probabilistic sensitivity analysis showed that 41.6% of the mimicked population receiving vericiguat combined with standard therapy was cost-effective at the WTP threshold of US$36,096.30 per QALY.</p><h3>Conclusions</h3><p>From the perspective of Chinese public healthcare system, the combined use of vericiguat and standard treatment in patients with HFrEF following WHF events did not generate advantages in cost–utility in China but was a cost-effective therapeutic strategy for those who with plasma NT-proBNP of ≤ 5314 pg per ml.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"445 - 454"},"PeriodicalIF":2.8,"publicationDate":"2024-04-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140611171","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of the Lifetime Benefits of Metformin and SGLT2 Inhibitors in Type 2 Diabetes Mellitus Patients with Cardiovascular Disease: A Systematic Review and Two-Stage Meta-Analysis","authors":"Hon Jen Wong,&nbsp;Norman H. Lin,&nbsp;Yao Neng Teo,&nbsp;Nicholas L. Syn,&nbsp;Yao Hao Teo,&nbsp;Ching-Hui Sia","doi":"10.1007/s40256-024-00640-w","DOIUrl":"10.1007/s40256-024-00640-w","url":null,"abstract":"<div><h3>Background</h3><p>Metformin and sodium-glucose cotransporter-2 (SGLT2) inhibitors have demonstrated cardiovascular benefits but their comparative effects on mortality in type 2 diabetes mellitus (T2DM) patients with cardiovascular disease (CVD) are unknown. Hence, we evaluated and compared lifetime benefits arising from metformin or SGLT2 inhibitors in T2DM patients with CVD.</p><h3>Materials and Methods</h3><p>Studies published in the PubMed, EMBASE and CENTRAL databases before 28 October 2023 were retrieved. Treatment effects of metformin against US FDA-approved SGLT2 inhibitors in T2DM patients with CVD were evaluated and lifetime gains in event-free survival were estimated from our primary endpoints of all-cause and cardiovascular mortality. Risk ratios were derived to assess their impact on secondary outcomes such as major adverse cardiovascular events and hospitalizations for heart failure.</p><h3>Results</h3><p>Overall, 14 studies were included. Five studies published Kaplan–Meier curves for the primary outcome of all-cause mortality. Individual participant data were reconstructed from these Kaplan–Meier curves, from which we conducted our two-stage meta-analysis. Participants receiving metformin and SGLT2 inhibitors experienced a reduction in the risk for all-cause mortality as compared with those not taking metformin and placebo. However, participants receiving SGLT2 inhibitors had a higher all-cause mortality (hazard ratio 1.308, 95% confidence interval 1.103–1.550) versus metformin. Treatment with metformin was estimated to offer an additional 23.26 months of survival free from all-cause mortality versus 23.04 months with SGLT2 inhibitors.</p><h3>Conclusions</h3><p>In patients with T2DM and CVD, metformin and SGLT2 inhibitors were associated with substantially lower all-cause mortality rates and slightly longer life expectancies than in patients without. Metformin presented an advantage over SGLT2 inhibitors in reducing all-cause mortality.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"371 - 383"},"PeriodicalIF":2.8,"publicationDate":"2024-04-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140581986","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Trends in Oral Anticoagulant Use and Individual Expenditures Across the United States from 2014 to 2020","authors":"Omar S. Alkhezi,&nbsp;Leo F. Buckley,&nbsp;John Fanikos","doi":"10.1007/s40256-024-00638-4","DOIUrl":"10.1007/s40256-024-00638-4","url":null,"abstract":"<div><h3>Background</h3><p>Landmark clinical trials have expended the indications for the direct oral anticoagulants (DOACs), but contemporary data on usage and expenditure patterns are lacking.</p><h3>Objective</h3><p>This study aimed to assess annual trends in oral anticoagulant (OAC) utilization and expenditure across the United States (US) from 2014 to 2020.</p><h3>Methods</h3><p>We utilized the Medical Expenditure Panel Survey (MEPS) to study the trends of use and expenditures of warfarin, dabigatran, rivaroxaban, apixaban, and edoxaban between 2014 and 2020 in the US. Survey respondents reported OAC use within the past year, which was verified against pharmacy records. Payment information was obtained from the respondent’s pharmacy and was categorized as third-party or self/out-of-pocket. Potential indications and medical conditions of interest for OAC therapy were identified from respondent-reported medical conditions. We estimated the national number of OAC users and total expenditures across age, sex, race, ethnicity, insurance, and medical condition subgroups. Trends of OAC users’ characteristics, expenditure, and number of prescriptions were evaluated using the Mann–Kendall test for trends.</p><h3>Results</h3><p>Between 2014 and 2020, the number of warfarin users decreased from 3.8 million (70% of all OAC users) to 2.2 million (<i>p </i>= 0.007) [29% of all OAC users], while the number of DOAC users increased from 1.6 million (30% of all OAC users) to 5.4 million (<i>p </i>= 0.003) [70% of all OAC users]. The total expenditure of OACs in the US increased from $3.4 billion in 2014 to $17.8 billion in 2020 (<i>p </i>= 0.003), which was driven by the increase in DOAC expenditures (<i>p </i>= 0.003).</p><h3>Conclusions</h3><p>DOACs have replaced warfarin as the preferred OAC in the US. The increased costs associated with DOAC use may decline when generic formulations are approved.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"433 - 444"},"PeriodicalIF":2.8,"publicationDate":"2024-04-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140602154","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative Safety and Efficacy of Low/Moderate-Intensity Statin plus Ezetimibe Combination Therapy vs. High-Intensity Statin Monotherapy in Patients with Atherosclerotic Cardiovascular Disease: An Updated Meta-Analysis","authors":"Ishaque Hameed,&nbsp;Syeda Ayesha Shah,&nbsp;Ashnah Aijaz,&nbsp;Hasan Mushahid,&nbsp;Syed Husain Farhan,&nbsp;Muhammad Dada,&nbsp;Adam Bilal Khan,&nbsp;Reeha Amjad,&nbsp;Fawad Alvi,&nbsp;Mustafa Murtaza,&nbsp;Zaid Zuberi,&nbsp;Mohammad Hamza","doi":"10.1007/s40256-024-00642-8","DOIUrl":"10.1007/s40256-024-00642-8","url":null,"abstract":"<div><h3>Aim</h3><p>Statin therapy is considered the gold standard for treating hypercholesterolemia. This updated meta-analysis aims to compare the efficacy and safety of a low/moderate-intensity statin in combination with ezetimibe compared with high-intensity statin monotherapy in patients with atherosclerotic cardiovascular disease (ASCVD).</p><h3>Methods</h3><p>A systematic search of two databases (PubMed and Cochrane CENTRAL) was conducted from inception to January 2023 and a total of 21 randomized clinical trials (RCTs) were identified and included in the analysis. Data were pooled using Hedges’s <i>g</i> and a Mantel–Haenszel random-effects model to derive standard mean differences (SMDs) and 95% confidence intervals (Cis). The primary outcome studied was the effect of these treatments on lipid parameters and safety events.</p><h3>Results</h3><p>The results revealed that combination therapy was more effective in reducing low-density lipoprotein cholesterol (LDL-C) levels (SMD= − 0.41; CI − 0.63 to − 0.19; <i>P</i> = 0.0002). There was no significant change in the levels of high-density lipoprotein cholesterol (HDL-C), total cholesterol (TC), triglyceride (TG), high-sensitivity C-reactive protein (hs-CRP), Apo A1, or Apo B. The safety of these treatments was assessed by the following markers alanine aminotransferase (ALT), aspartate aminotransferase (AST), and creatine phosphokinase (CK), and a significant difference was only observed in CK (SMD: − 0.81; CI − 1.52 to − 0.10; <i>P</i> = 0.02).</p><h3>Conclusion</h3><p>This meta-analysis demonstrated that the use of low/moderate-intensity statin combination therapy significantly reduced LDL-C levels compared with high-intensity statin monotherapy, making it preferable for patients with related risks. However, further trials are encouraged to evaluate potential adverse effects associated with combined therapy.</p></div>","PeriodicalId":7652,"journal":{"name":"American Journal of Cardiovascular Drugs","volume":"24 3","pages":"419 - 431"},"PeriodicalIF":2.8,"publicationDate":"2024-04-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140581813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}