#jamacardio

[medicowesome]

Cardiovascular complications of COVID-19

Hi everyone...

Virus infections are the most common cause of myocarditis. The previous severe acute respiratory syndrome (SARS) beta-coronavirus SARS-CoV-1 was associated with tachyarrhythmias, signs, and symptoms of heart failure.

Let's learn about SARS-CoV-2:

COVID-19 patients who died had higher levels of troponin, myoglobin, C-reactive protein, serum ferritin, and IL-6.

This is because of the high inflammatory burden in COVID-19.

Let’s find out and understand about CVS complications by COVID-19:

Mainly, vascular inflammation, myocarditis, and cardiac arrhythmias

The possible late phenomenon of the viral respiratory infection

Commonly observed in severe cases

Strongly associated with mortality

Cardiac MRI Findings in COVID-19:

⬆️ Wall thickness with diffuse biventricular hypokinesis (especially in the apical segments)

Severe LV dysfunction (LVEF < 35%)

Circumferential pericardial effusion ( notable around the right chambers)

Short tau inversion recovery and T2-mapping sequences:

Marked biventricular myocardial interstitial edema

Diffuse late gadolinium enhancement involving the entire biventricular wall

CVS complications as an important prognostic factor:

Patients who have high troponin levels showed a higher incidence of complications such as

ARDS

Malignant arrhythmias

Acute renal injury

Acute coagulopathy

Lastly, what are the major risk factors for COVID-19 mortality?

advanced age (>60 years)

male sex

Strong and independent risk factors:

the presence of comorbidities ( HTN, coronary artery disease)

cardiac injury, myocarditis, and ARDS

Thank you,

Written by Drashtant

References:

Inciardi RM, Lupi L, Zaccone G, et al. Cardiac Involvement in a Patient With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1096

Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol. Published online March 27, 2020. doi:10.1001/jamacardio.2020.1286

[deinheilpraktiker]

Kardiale Magnetresonanztomographie zeigt Entzündungen nach der Genesung von Covid-19 - BezugPuntmann VO, Carerj ML, Wieters I, et al. Ergebnisse der kardiovaskulären Magnetresonanztomographie bei Patienten, die sich kürzlich von der Coronavirus-Krankheit 2019 (COVID-19) erholt haben. JAMA Cardiol. 2020:e203557. doi:10.1001/jamacardio.2020.3557 .StudienzielUm festzustellen, ob eine... - #Covid19 #Entzündungen #Genesung #Kardiale #Magnetresonanztomographie #zeigt

[moleculardepot]

Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. A new interesting article has been published in JAMA Cardiol. 2020 Mar 25. doi: 10.1001/jamacardio.2020.0950. and titled:

[eathealthylivefree]

Obesity Risk: lifestyle or genetics?

For better and for worse, we all inherit particular characteristics from our parents. Maybe it’s our mother’s eyes, or maybe our father’s temper. Some of that is directly the result of the DNA we’ve received, and some of it comes from the influence they exerted in our environment. When it comes to our health and wellness, it can be challenging to determine whether nature or nuture has more of an impact. In some cases, it may not really matter. But when it causes you to feel powerless or apathetic about how much you can change your condition, it definitely matters.

Results of a long-term study were recently published in the Journal of the American Medical Association Cardiology. The study tracked data on more than 2,500 Americans who were followed from young adulthood in 1985 to 2010. One of their findings is that body mass index (BMI) as a young adult appears to be the best predictor of long-term obesity risk.

There have been other studies that have identified certain genes that have been shown to contribute to a person becoming overweight and obese. There are rare inherited causes of obesity, but this is not the case for most of the population. This recent study suggests that knowing our BMI is more beneficial than purchasing a genetic test.

Hopefully, this research can empower people to know that being obese doesn’t have to be someone’s destiny. Their healthy lifestyle choices – the foods they eat, their portion sizes, and physical activity – can result in a better quality of life.

As I reflect on my childhood, I watched my mother struggle with her weight. At one point in my early adolescence years, she lost a significant percentage of her body weight. This was mainly the result of strict dieting with little change to physical activity. Within a few years she had gained it all back and even more. She was obese for most of the years that I remember her.

My mom had a massive heart attack when she was 59-years-old. It forever changed my life and my brother’s life. She enjoyed being a grandmother to my son for 18 months, but her three granddaughters were born after her death.

None of us  know what the future may bring. We do know that research shows being overweight or obese increases your risk of developing heart disease, high blood pressure, type 2 diabetes, gallstones, breathing problems and certain cancers. The healthy steps we take to reduce and maintain our weight can mean a better quality of life for us and for our families. May this be an encouragement today that you can make changes in your life, even if you need a little help.

Sources:

Centers for Disease Control and Prevention (2013) Genes and obesity. at https://www.cdc.gov/genomics/resources/diseases/obesity/obesedit.htm

HealthDay: News for Healthier Living (2020) What matters more for obesity risk, genes of lifestyle? at https://consumer.healthday.com/vitamins-and-nutrition-information-27/obesity-health-news-505/what-matters-more-for-obesity-risk-genes-or-lifestyle-753678.html

Live Healthy Live Well Ohio State University Extension Family and Consumer Sciences (2019) Make healthy fast food choices. at https://livehealthyosu.com/2019/10/03/make-healthy-fast-food-choices/

National Heart, Lung, and Blood Institute (2020) Aim for a healthy weight. at https://www.nhlbi.nih.gov/health/educational/lose_wt/

“Polygenic Risk, Fitness, and Obesity in the Coronary Artery Risk Development in Young Adults (CARDIA) Study,” JAMA Cardiology. DOI: 10.1001/jamacardio.2019.5220

The Ohio State University Wexner Medical Center (2020) Nonsurgical weight management. at https://wexnermedical.osu.edu/weight-management/weight-management-nonsurgical

Photo credit: https://pixabay.com/photos/push-ups-exercise-fitness-workout-888024/

Written by: Emily Marrison, Family and Consumer Sciences Educator, OSU Extension Coshocton County

Reviewed by: Lorrissa Dunfee, Family and Consumer Sciences Educator, OSU Extension Belmont County

from Live Healthy Live Well https://ift.tt/38M3TQW

[jetdeer67-blog]

Lack of effect: Massive meta-analysis reports no heart benefits for vitamin D supplements

The comprehensive meta-analysis of randomised clinical trials, published in JAMA Cardiology​, combined data from more than 83,000 people in 21 clinical trials to investigate whether supplementation with vitamin D is linked to a lower risk of cardiovascular disease events like heart attack or stroke.

Previous observational studies have suggested a link between low blood serum levels of vitamin D and an increased risk of these sort of cardiovascular disease events, however the observational nature of these studies means causation could not be shown and unmeasured confounding was a possibility, said the team led by Dr Mahmoud Barbarawi at Michigan State University, USA.

“Although previous randomized clinical trials assessing vitamin D supplementation and cardiovascular disease have been limited and inconclusive, several recent large-scale trials have added substantial data to the evidence base,”​ wrote Barbarawi and colleagues. “Therefore, we conducted a meta-analysis of all RCTs to date that evaluate the efficacy of vitamin D supplementation in the prevention of cardiovascular disease.”​

The team reviewed data from 21 clinical trials, including more than 83,000 people, in which participants were given vitamin D supplements or a placebo. However, this meta-analysis of data showed no difference in the incidences of cardiovascular events or all causes of death between the two groups.

“We thought it would show some benefit,”​ commented Barbarawi, a clinical instructor in the MSU College of Human Medicine and chief resident physician at Hurley Medical Center in Flint, Michigan. “It didn’t show even a small benefit. This was surprising.”​

The findings are consistent for both men and women and for people of different ages, the scientists said. However, a limitation of the study is that the definition of major adverse cardiovascular events varied between the different clinical trials.

Updated analysis​

The new findings provide an update to previous meta-analyses, which also reported that supplementation with vitamin D was not associated with reduced rates of CVD.

While the updated analysis extended the earlier findings to include several recent RCTs, it did not find any fresh link between vitamin D supplementation and heart conditions, said the authors – who noted that the inclusion criteria were randomised clinical trials that reported the effect of long-term (greater than one year) vitamin D supplementation on CVD events and all-cause mortality.

According to the findings of the new analysis vitamin D supplementation was not associated with reduced risks of major adverse cardiovascular events, myocardial infarction, stroke, cardiovascular disease mortality, or all-cause mortality compared with placebo.

“These results suggest that vitamin D supplementation may not confer cardiovascular protection and may not be indicated for this purpose,”​ said Barbarawi and his team, who noted that even though the findings showed no effect on heart health, some patients, such as those being treated for osteoporosis, still might benefit from the supplements.

Other factors at play?​

Since some studies have found a link between low levels of the vitamin and an increased risk of adverse cardiovascular events, Barbarawi suggests that other factors, such as outdoor physical activity and nutritional status, might explain the association.

“Observational studies are susceptible to uncontrolled confounding by outdoor physical activity, nutritional status, and prevalent chronic disease, which may influence serum 25 hydroxyvitamin D levels,”​ the team noted.

“In this updated meta-analysis, vitamin D supplementation was not associated with reduced major adverse cardiovascular events, individual CVD end points (myocardial infarction, stroke, CVD mortality), or all-cause mortality,”​ concluded the team. “The findings suggest that vitamin D supplementation does not confer cardiovascular protection.”​

However, the team added that additional trials of higher-dose vitamin D supplementation, perhaps targeting members of older age groups and with attention to other CVD end points such as heart failure, ‘are of interest.’

Source: JAMA Cardiology​ Published online ahead of print, doi: 10.1001/jamacardio.2019.1870​ “Vitamin D Supplementation and Cardiovascular Disease Risks in More Than 83 000 Individuals in 21 Randomized Clinical Trials: A Meta-analysis”​ Authors: Mahmoud Barbarawi, et al​

Source: https://www.nutraingredients.com/Article/2019/06/25/Lack-of-effect-Massive-meta-analysis-reports-no-heart-benefits-for-vitamin-D-supplements

[bharatiyamedia-blog]

Can cardio, resistance train cut back extra fats across the coronary heart?

http://tinyurl.com/y5hwgk7o Backside Line: Extreme fats tissue across the coronary heart could also be a threat issue for heart problems. This examine checked out what impact cardio and resistance train had on this fats tissue referred to as epicardial and pericardial adipose tissue. This was a secondary evaluation of a randomized scientific trial that included 50 bodily inactive adults with stomach weight problems who had 12 weeks of high-intensity endurance or resistance coaching or no train as a management group for comparability. Change in fats tissue across the coronary heart was measured by magnetic resonance imaging. Researchers report endurance and resistance coaching decreased epicardial adipose tissue mass however pericardial adipose tissue mass was decreased solely by resistance coaching in contrast with no train. The examine has a number of limitations to contemplate, together with its small dimension. These findings have to be replicated in different bigger research. Authors: Regitse Højgaard Christensen, M.D., College of Copenhagen, Denmark, and coauthors (doi:10.1001/jamacardio.2019.2074) Editor’s Observe: The article consists of battle of curiosity and funding/help disclosures. Please see the article for added data, together with different authors, creator contributions and affiliations, monetary disclosures, funding and help, and so on. ### Embed this hyperlink to supply your readers free entry to the full-text article This hyperlink shall be reside on the embargo time: https://jamanetwork.com/journals/jamacardiology/fullarticle/2737412?guestAccessKey=6da7cf54-315d-4698-9a0e-ab698b077d0a&utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_content=tfl&utm_term=070319 Disclaimer: AAAS and EurekAlert! will not be chargeable for the accuracy of stories releases posted to EurekAlert! by contributing establishments or for using any data via the EurekAlert system. Source link

[kidneygram]

Comparison of 5 🖐🏼 recent trials of BP lowering from @JAMACardio #Nephpearls #SPRINTHTNhttps://t.co/x9qtr9AZTw pic.twitter.com/g53GU1OcTv

— Edgar V. Lerma 🇵🇭 (@edgarvlermamd) September 8, 2016

[mariebenz]

How Best to Measure Patient Persistence with Medications? Self Report or Pharmacy Fill?

MedicalResearch.com Interview with:

Dr. Fanaroll Alexander C. Fanaroff, MD, MHS Assistant Professor of Medicine, Division of Cardiovascular Medicine University of Pennsylvania MedicalResearch.com: What is the background for this study? Response: This is a secondary analysis of the ARTEMIS, a cluster randomized trial of copayment assistance for P2Y12 inhibitors in patients that had myocardial infarction. One of the primary endpoints of ARTEMIS was persistence with P2Y12 inhibitors: Did the patient continue to take a P2Y12 inhibitor over the entire 1 year following MI? In ARTEMIS, we captured persistence data in two ways, patient report and pharmacy fill records. What we did in this study was to look at the agreement between persistence as measured by these two methods. MedicalResearch.com: What are the main findings? Response: Overall, 15% of patients self-reported non-persistence, but 48% of patients were non-persistent by pharmacy fill data. When we looked at agreement between the methods, the two methods quite frequently did not agree:  50% of patients were persistent by both methods, 13.5% were non-persistent by both methods, 34.8% reported that they were persistent but were non-persistent by pharmacy fill, and 1.8% reported that they were non-persistent but were actually persistent by pharmacy fill records. Both methods are subject to bias: Self-report is subject to social desirability bias (where patients misrepresent medication taking behavior to please investigators) and recall bias (where patients don't remember their medications). Pharmacy fill data is subject to missing data if a pharmacy is not included in the database, or other reasons. Because of these biases, we next tried to understand which method of measuring persistence -- pharmacy fill records or self-report -- was "correct."  To do this, we used two other methods of measuring persistence that were captured in ARTEMIS: copayment assistance vouchers and P2Y12 inhibitor serum drug levels. We had serum drug levels for a random sample of patients in ARTEMIS, and we found limited agreement beyond chance between serum drug levels and persistence as measured by pharmacy fill and patient report, which did not help sort out which method was more "correct." In the intervention arm, patients used vouchers to have copayments for P2Y12 inhibitors waived, and we were able to track when vouchers were used. Using the voucher data, 20% of patients that self-reported persistence but were characterized by pharmacy fill data as non-persistent actually were persistent, suggesting that pharmacy fill data underestimates persistence by roughly that amount. Lastly, we looked at clinical outcomes by persistence category, and found that patients persistent by both methods had the best outcomes, patients non-persistent by both methods had the worst outcomes, and patients with discordant persistence had outcomes intermediate between concordantly persistent and non-persistent patients. MedicalResearch.com: What should readers take away from your report? Response: Electronic health records increasingly have a mechanism for enabling physicians to check pharmacy fill records for patients to track persistence with medications. Our results show that this data is important, as it identifies more patients than self-report, but that it needs to be interpreted somewhat cautiously: Many patients non-persistent by pharmacy fill are actually persistent. The best way to understand persistence is to incorporate both patient self-report and pharmacy fill data, recognizing that patients non-persistent by both methods will have the worst outcomes.   MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: Currently, health systems employ a number of  interventions to increase medication persistence. Future research should look at the best way to target these interventions to patients that are non-persistent with medications, including methods that use both patient report and pharmacy fill data. No disclosures relevant to this research Citation:  Fanaroff AC, Peterson ED, Kaltenbach LA, et al. Agreement and Accuracy of Medication Persistence Identified by Patient Self-report vs Pharmacy Fill: A Secondary Analysis of the Cluster Randomized ARTEMIS Trial. JAMA Cardiol. Published online March 04, 2020. doi:10.1001/jamacardio.2020.0125   Last Modified:       The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

[mariebenz]

Atrial Fibrillation Common After TAVR and Aortic Valve Replacement

MedicalResearch.com Interview with: Rajat Kalra, MBCh Cardiovascular Division University of Minnesota, Minneapolis MedicalResearch.com: What is the background for this study? Response: New-onset atrial fibrillation after aortic valve procedures is thought to occur frequently after aortic valve procedures, such as transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (AVR). However, the incidence estimates and implications of this new-onset atrial fibrillation in the contemporary era are unclear. We sought to examine the incidence of atrial fibrillation after aortic valve procedures, compare the incidence between TAVI and AVR, and evaluate the associated morbidity and mortality implications using a ‘big data’ approach. This big data approach employed the National Inpatient Sample and was validated in the New York State Inpatient Database. Both are publicly available datasets that are developed as part of the Healthcare Cost and Utilization Project, a federal-state-industry partnership that is sponsored by the Agency for Healthcare Research and Quality.  MedicalResearch.com: What are the main findings? Response: We found that the incidence of atrial fibrillation was ~50% in TAVI and AVR hospitalizations in the National Inpatient Sample cohort. The hospitalizations with new-onset atrial fibrillation had increased length of stay, odds of in-hospital stroke, and odds of in-hospital mortality. In our validation cohort, we found that new-onset atrial fibrillation occurred in ~15% of TAVI procedures and ~30% of AVR procedures. While the incidence estimates of new-onset atrial fibrillation were lower, the odds of in-hospital mortality were very similar in the validation cohort.  MedicalResearch.com: What should readers take away from your report? Response: Atrial fibrillation is commonly associated with TAVI and AVR and has important morbidity and mortality implications. Clinicians should consider discussing the possibility of atrial fibrillation as a post-procedural complication as part of the shared decision-making process prior to aortic valve procedures. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: New-onset atrial fibrillation is likely due to a combination of patient-based and procedural factors. Now that our group and others have highlighted the importance of peri-procedural atrial fibrillation, the next step for our field is to identify preventive strategies to limit the incidence of new-onset atrial fibrillation after aortic valve procedures and the associated morbidity and mortality burden. At this stage, may be difficult since many of these factors are not modifiable. However, the evolution of valve design and peri-procedural management strategies may offer important advances in atrial fibrillation prevention. MedicalResearch.com: Is there anything else you would like to add? Response: Our findings also reiterate the urgent need to find a balanced approach for peri-procedural anticoagulation for aortic valve procedures. This is an area that is already rife with debate in modern-day cardiovascular medicine, given the prognostic associations of atrial fibrillation that we (and others) have demonstrated and the emerging data regarding transcatheter aortic valve thrombosis. Citation: Kalra R, Patel N, Doshi R, Arora G, Arora P. Evaluation of the Incidence of New-Onset Atrial Fibrillation After Aortic Valve Replacement. JAMA Intern Med. Published online June 03, 2019. doi:10.1001/jamainternmed.2019.0205   The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

[deinheilpraktiker]

Kardiale Magnetresonanztomographie zeigt Entzündungen nach der Genesung von Covid-19

Kardiale Magnetresonanztomographie zeigt Entzündungen nach der Genesung von Covid-19

Bezug Puntmann VO, Carerj ML, Wieters I, et al. Ergebnisse der kardiovaskulären Magnetresonanztomographie bei Patienten, die sich kürzlich von der Coronavirus-Krankheit 2019 (COVID-19) erholt haben. JAMA Cardiol. 2020:e203557. doi:10.1001/jamacardio.2020.3557 [Epub ahead of print]. Studienziel Um festzustellen, ob eine Myokardverletzung und/oder Entzündung nach der Genesung von kürzlich…

[moleculardepot]

An Acute Respiratory Infection Runs Into the Most Common Noncommunicable Epidemic-COVID-19 and Cardiovascular Diseases.

An Acute Respiratory Infection Runs Into the Most Common Noncommunicable Epidemic-COVID-19 and Cardiovascular Diseases.

A new interesting article has been published in JAMA Cardiol. 2020 Mar 25. doi: 10.1001/jamacardio.2020.0934. [Epub ahead of print] and titled: An Acute Respiratory Infection Runs Into the Most Common Noncommunicable Epidemic-COVID-19 and Cardiovascular Diseases.

Authors of this article are:

Yang C, Jin Z.

A summary of the article is shown below:

See link below Check out the article’s website…

[moleculardepot]

Association of Race With Disease Expression and Clinical Outcomes Among Patients With Hypertrophic Cardiomyopathy. A new interesting article has been published in JAMA Cardiol. 2019 Dec 4. doi: 10.1001/jamacardio.2019.4638. and titled:

[mariebenz]

Blood Pressure Variability in Mid-Life Associated With Greater Cardiovascular Risk

MedicalResearch.com Interview with:

Dr. Yano Yuichiro Yano MD Assistant Professor in Family Medicine and Community Health Duke University  MedicalResearch.com: What is the background for this study? Response: The blood pressure (BP) guideline in the US recommend using an “average” of multiple BP measurements over time for screening for and management of high BP in young adults. While it is well known that BP varies across visits, that “variability” (i.e., visit-to-visit blood pressure variability) is dismissed as a random fluctuation in the clinical setting. Little is known regarding the clinical relevance of visit-to-visit blood pressure variability over time in young adults. MedicalResearch.com: What are the main findings? Response: This is a prospective cohort study of 3,394 African Americans and whites; the mean (±standard deviation) age of the participants was 35.1±3.6 years, 45.9% were African American, 55.7% were female, and 3% were taking antihypertensive medication. Higher long-term visit-to-visit systolic BP variability from young adulthood to midlife was associated with an increased risk for cardiovascular disease events (hazard ratio 1.23 per standard deviation higher level) and all-cause mortality (hazard ratio 1.26) by middle age. These associations were independently of average systolic BP levels during young adulthood and a single systolic blood pressure measure in midlife. MedicalResearch.com: What should readers take away from your report? Response: Our research was significant because the findings contribute to improved assessment of blood pressure-related risk in young adults by focusing not only on individual average BP level but also its variability over time.  MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: At least two different types of research are required. First, our results require further testing in an independent cohort to determine whether the assessment of visit-to-visit systolic BP variability in clinical practice improves detection and subsequent medical management of young adults at higher risk for cardiovascular disease events. In the clinical setting, electronic health record systems could be programmed to calculate a person’s visit-to-visit BP variability over time, which could help clinicians identify individuals at high risk for cardiovascular disease events. Second, from this study, it remains uncertain whether higher visit-to-visit BP variability is a causal driver for cardiovascular disease events or a marker of poor health. Some meta-analyses that included post hoc studies from randomized controlled trials have suggested that changes in visit-to-visit BP variability attributed to intensification of antihypertensive medication were associated with greater reduction in stroke risk, independently of changes in average BP levels. Calcium channel blockers have a stronger effect in reducing visit-to-visit BP variability compared to other classes of antihypertensive medication (e.g., angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta blockers).Thus, persons with high visit-to-visit BP variability may benefit more when prescribed calcium channel blockers instead of other classes of antihypertensive medication. No disclosures Citation: Yano Y, Reis JP, Lewis CE, et al. Association of Blood Pressure Patterns in Young Adulthood With Cardiovascular Disease and Mortality in Middle Age. JAMA Cardiol. Published online January 22, 2020. doi:10.1001/jamacardio.2019.5682   Last Modified:       The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article

[moleculardepot]

Systolic Blood Pressure and Risk of Valvular Heart Disease: A Mendelian Randomization Study. A new interesting article has been published in JAMA Cardiol. 2019 Jul 10. doi: 10.1001/jamacardio.2019.2202. and titled:

[moleculardepot]

Association of Silent Myocardial Infarction and Sudden Cardiac Death. A new interesting article has been published in JAMA Cardiol. 2019 Jul 10. doi: 10.1001/jamacardio.2019.2210. and titled:

[mariebenz]

Lowered Price of Repatha® (evolocumab) Translates to Cost Effectiveness for Range of Heart Conditions in Some High Risk Patients

MedicalResearch.com Interview with: Dr. Gregg Fonarow Gregg C. Fonarow, MD, FACC, FAHA Eliot Corday Professor of Cardiovascular Medicine and Science Director, Ahmanson-UCLA Cardiomyopathy Center Co-Chief of Clinical Cardiology, UCLA Division of Cardiology Co-Director, UCLA Preventative Cardiology Program David Geffen School of Medicine at UCLA Los Angeles, CA  MedicalResearch.com: What is the background for this study? Response: Last year, Amgen made the PCSK-9 inhibitor evolocumab available at a reduced list price of $5,850 per year This 60% reduction was aimed at improving patient access by lowering patient copays, especially for Medicare beneficiaries. Additionally, the treatment landscape for PCSK9 inhibitors was further defined in 2018 when the American College of Cardiology/American Heart Association Multisociety Clinical Guideline on the Management of Blood Cholesterol recommended PCSK9 inhibitors for, among other patient populations, patients with very high-risk (VHR) ASCVD whose low-density lipoprotein cholesterol levels remain at 70 mg/dL or more  despite a heart-healthy lifestyle and treatment with standard background therapy. MedicalResearch.com: What are the main findings?  Response: The analysis presented in JAMA Cardiology reassess the cost-effectiveness of evolocumab in light of these two important developments. Findings show that, at its current list price, the addition of evolocumab to standard background therapy meets accepted cost-effectiveness thresholds across a range of cardiovascular event rates in patients with very high-risk atherosclerotic cardiovascular disease, as defined by the 2018 ACC/AHA guidelines. Importantly, for the range of baseline CV event rates evaluated in very high-risk ASCVD, all incremental cost-effectiveness ratios were within what the 2018 ACC/AHA guidelines consider high or intermediate value  MedicalResearch.com: What should readers take away from your report?  Response: This analysis adds to the growing body of evidence that underscores the critical role of PCSK9 inhibitors in treating high-risk atherosclerotic cardiovascular disease (ASCVD) patients and reinforces that economic value  should not be a barrier to appropriate patients getting access to these important medicines. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: . These results highlight the importance of future analyses that more precisely quantify the baseline CV event rates estimated from patients with VHR ASCVD in the real world to further understand the cost-effectiveness of evolocumab.  MedicalResearch.com: Is there anything else you would like to add?  Response: This study was sponsored by Amgen Inc. The sponsor provided funding for the study and, via employee coauthors, input into the design and conduct of the study; collection, management, and analysis of the data; and interpretation of the data. The sponsor reviewed and approved the manuscript prior to submission, but the coauthors prepared, provided final approval for, and decided to submit the manuscript for publication. Dr Fonarow reports consulting for Abbott, Amgen, Bayer, Janssen, and Novartis. Dr van Hout reports consulting for Amgen. Drs Villa and Arellano are employees and stockholders of Amgen Inc. Dr Lindgren reports consulting and/or advisory board participation for Amgen, Janssen, MSD, Novartis, and Sanofi. No other disclosures were reported.  Citation: Fonarow GC, van Hout B, Villa G, Arellano J, Lindgren P. Updated Cost-effectiveness Analysis of Evolocumab in Patients With Very High-risk Atherosclerotic Cardiovascular Disease. JAMA Cardiol. Published online June 05, 2019. doi:10.1001/jamacardio.2019.1647   The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.   Read the full article