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Showing posts with label patients. Show all posts

Statins reduce CV events in CAD patients with very low LDL C

Tuesday, May 6, 2014

Aggressive treatment with statins reduces the risk of subsequent cardiovascular events in patients with coronary artery disease even if they have very low LDL cholesterol levels, reveals research presented at ESC Congress 2013 today by Dr. Emi Nakano from Japan.

Dr Nakano said: "Many randomised clinical trials, such as Treating to New Targets (TNT) and PROVE IT-TIMI, have shown that aggressive cholesterol lowering with statins improves clinical outcomes in patients with CAD and high LDL-C levels.1,2 But until now it was not known whether aggressive lipid lowering with statins would also benefit CAD patients with very low LDL-C levels."

The current study used the Ibaraki Cardiovascular Assessment Study (ICAS), a registry of 2,238 patients from 12 hospitals in the Ibaraki region of Japan, who between 0 and 1 month underwent percutaneous coronary interventions. Based on serum LDL-C levels at initial presentation participants were classified into three groups: very low (<70 mg/dl, n=214); low (71-100 mg/dl, n=669); and high (>101 mg/dl, n= 1,355). Decisions of whether to prescribe statins or not, as well as the type and dose, were left to the discretion of treating physicians.

Patients were followed up for a maximum of 3 years. The efficacy of statin treatment was analysed on the composite outcome of Major Cardiovascular Events (MACE), defined as all cause mortality, non-fatal myocardial infarction and non-fatal stroke.

Statins were prescribed in 68% of patients (143) with very low LDL-C, 67% of patients (450) with low LDL-C and 67% of patients (913) with high LDL-C. A total of 204 patients experienced MACE during the median follow-up of 404 days.

The results of a Kaplan-Meier estimate show that three years of statin treatment produced significant reductions in the incidence of MACE in all three groups (p<0.001 for all groups). A Cox regression hazard analysis adjusted for age and gender showed that statins were the main determinant of better outcome regardless of the LDL-C level (p<0.01).

Dr Nakano said: "Our study shows that CAD patients with very low LDL-C levels at initial presentation also benefit from statin treatment. We speculate that statins prevent the enlargement of atherosclerotic plaques and plaque disruption in these patients."

She added: "Some doctors have been hesitant to prescribe statins in patients with very low LDL-C because of uncertain benefit and the risk of side effects with statins. But our findings suggest that all CAD patients should receive statins to reduce their risk of future cardiovascular events."

Dr Nakano concluded: "The next step should now be to initiate a randomised controlled trial of statin use in patients with CAD and very low LDL-C levels. This trial should be designed to confirm the benefits of statins for preventing future cardiovascular events in these patients, and to identify which type and dose of statins are most beneficial."

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Friday, December 20, 2013

I think a lot about patients rights, and expectations; about what the most ideal medical care should look like for a person with diabetes. Ive often thought of putting together a post regarding these thoughts, but I never quite had a catalyst to really help me organize together all the elements.

The time I spent at Medicine X really got me thinking more in that direction, and contextualizing my vision. Some of these might seem like basic tenets, but others are quite revolutionary.

When I advocate, I feel I usually do so, subconsciously, from some of these starting points... and I suppose they could apply to just about any other health condition. These are what patients want from their clinicians:

To Be Afforded Humanity... With:

Respect and Freedom: As a partner in a journey of self discovery. An equal who is allowed the freedom to disagree, respectfully, and to make a different (informed) choice from what the provider would have chosen. Not as a civilian kept under the inflexible regime of the provider, nor as a subordinate, ignorant layperson, or petulant child.
Dignity and empathy: As potential mothers, fathers, daughters, sons, sisters, brothers, significant others; people with potential hopes and dreams, fears and anxieties, just like them. Not as cold hardware to be tested, and prodded.
Encouragement: As persons in need of perspective, and hope, from those who have the positive power to guide us into better health. Not recrimination, or scolding, whenever we fail at meeting a goal.
Acknowledgement: As partners deserving of their full attention, concern, praise or recognition. Not ignored when we present our health concerns, or when we reach an important milestone in care, or when we work hard to achieve goals. It is, sometimes, incredibly hard to jump through some of the hoops and obstacle courses which you demand of us... so please, give praise and positive feedback when we achieve them!

To Be Afforded Effective Communication... With:

Patient Education: As partners fully capable of learning, understanding, and being challenged and tested, we deserve to be taught about our health conditions, and how to manage them, either by our clinicians, or by referral to those who can properly educate us and guide us into better health choices. There will be levels of education which each patient can handle, but we can all handle something. Not being told you have x condition, and sent on our own, with nothing else to cope or fight back.
Access to our data: As patients, and persons responsible for intimately managing a health condition, we should be allowed to know where we stand, with truth and honesty. Not to be left in the dark about ones condition, and progress... with only the provider being privy to the facts.
Proper Feedback: As patients needing guidance, at times when we may not feel safe making our own decisions, by returning our calls, e-mails, or messages, promptly. Not by relegating our most important concerns to other, less informed health assistants or personnel, nor by ignoring our efforts to contact you. If you openly make yourself available to patients, please honor that commitment.
The whole story: As partners and patients who need ALL the information (and proper diagnostic testing) when it comes to choices for treatments, medications, and tools. Not being limited to a clinicians predilections, or the predilections of the company that might be paying them to promote certain tests, procedures, drugs, or tools. [We will gladly listen to your predilections (and sometimes choose them), because after all -- you are the medical professionals -- but you must understand that we are the experts at living with our condition, and need ALL the variables to be able to make informed decisions that might impact the fate of our future health, and our families.]

To Be Afforded Quality Care... With:

Continuous Education: As patients receiving exclusive care from a clinician or provider, we expect that they keep on top of new emerging technologies, new research, new data, and new approaches to managing illness. Not to take the minimal continuous education courses, and keep practicing on potentially outdated methods from when they first graduated medical school, which could fail to improve a health condition, or even make it worse.
Embracing the researching patient: As partners, we expect to be embraced with respect when bringing in new data that can be studied, together, as a team. Not being chided for doing online research. Medical research is growing by leaps and bounds, so it would be impossible for a provider to keep on top of all the information on their own... so why not partner up? We could solve a puzzle together, rather than against each other. This is not about who has the diploma; its about who ultimately gets to live with the decisions.
Referrals to Specialists: As humans who know and understand that not everyone has all the answers and information to everything, and that sometimes its best to embrace those who may provide additional insight or more specialized care. Not negating, out of ego or greed, the chance to expand ones medical team and "think tank," in order to find positive answers to puzzling health problems.
Committed Advocacy: As advocates for one another, by being our strong voice to health insurance companies, government, and especially the media, or those who might be ignorant to our condition, and thus seek to curtail our needs, and cut down our most essential and basic of services, remaining true to the Hippocratic Oath. Not by remaining silent to our needs, or cowering to the all-mighty dollar, because a businessman, with no medical knowledge, coerced you.

For as many things as can be said about the healthcare field, and as much as times may change, I dont feel many are more important than these basic pillars, rights, and expectations. These are very essential, basic principles that we can all embrace and pursue in our futures. Often, we as patients can be difficult as well... and there should be some mutual expectations of cooperation, trust, and respect as "partners" and not subjugates. As the "Healthcare Street" is usually kept as a "One Way" road, I throw these out there as a sort of Patients Manifesto of Rights and Expectations.