Lipid-lowering therapy has proven to be beneficial in reducing the risk of recurrent cardiovascular events in patients who have suffered a previous myocardial infarction (MI).1,5 However, it is unclear whether one statin is more effective versus another in reducing future incidence of acute MI and at what intensity is it beneficial.1,2 Myocardial infarction or acute myocardial infarction (AMI), also known as a heart attack, is due to a blood clot that occludes coronary arteries, which brings oxygen-rich blood to the heart.4,6 When there is a blockage in the arteries due to plaque build-up there is a decrease in blood flow to the heart impairing oxygen demand and supply.5,6 Reduction in the blood supply to the heart, if not treated …show more content…
The key terms searched include, secondary prevention, heart attack, atorvastatin, simvastatin, and pravastatin. The terms were combined with an “and” operator, and the following limits were applied: English language, human, and randomized controlled trial. The search returned 39 articles of which only 1 included a study which compared 2 different statins. The other articles were excluded because they were guidelines, review articles or were not specific to preventing a recurrence of myocardial infarction. Literature Analysis: The IDEAL study was a multi-centered, prospective, randomized, open-label, blinded endpoint classification trial (PROBE design).1,3 The study was conducted at 190 ambulatory care, and private specialist centers in Denmark, Finland, Iceland, the Netherlands, Norway, and Sweden.1,3 Recruitment and randomization was conducted from March 1999 to March 2001 and patients were followed up until March 2005.1,3 The objective of the IDEAL
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Many studies were conducted on coronary artery disease (CAD) because it is the leading cause of mortality and premature disability so studies investigated those at risk of coronary atherosclerosis aiming to provide early treatment (Kolovou et al., 2005), (Akhabue et al., 2014).
JF’s risk factors include her age (79), hypertension, and previous history of coronary arterial disease (NSTEMI about 10 years ago) (1). JF’s current medications do not contribute to her dyslipidemia (1). She does not have a family history of premature cardiovascular diseases. Secondary prevention of cardiovascular events and all-cause-mortality are the primary outcomes for JF’s lipid-lowering therapy. JF was previously stable on atorvastatin for many years and thus has not had lipid testing in the past year. JF recalls meeting her cholesterol targets previously (LDL ~2.0 mmol/L, HDL ~1.2 mmol/L, TG and TC unknown). The recommended target values for post-MI patients are LDL-C of <2.0 mmol/L, and HDL-C <2.6 mmol/L (1 ,2). However, no clinical studies thus far have directly evaluated the benefits of titrating statin dose to achieve target values. A different fix-dose approach involves giving patients the same doses that were shown to produce clinical benefits in trials regardless of how much LDL-C reduction was achieved (1, 2). Using this approach, lipid measurements are only used to monitor for adherence and safety (in case LDL-C too low) (1). Patients with prior history of CAD are considered high-risk (Framingham risk >20%) regardless of their lipid
A higher level of fats in the body puts the patient at higher risk for Cardiovascular diseases(CAD). The patient's' family has a history of CAD. Her mom and one of her sister have CAD (Lewis et al., 2014, pp. 733-734). The patient states that she has been taking her meds for cholesterol atorvastatin regularly. Her lipase level was 8272 on 11/11/16 and 2829 on 11/12/16 U/L 1069 on 11/13/16 (Ref range 73-393 U/L). Her HDL cholesterol level was 21 ( ref range>49 mg/dl), LDL Cholesterol level 148 ( ref range: <130 mg/dL). Patient statin drug was on hold because it is contradicted on the patient with an elevated level of ALT 80, 61(Ref range 0-50 U/L) and AST 61 on 11/12/16 and 64 on 11/13/16 (ref range 0-45 U/L). The uncontrolled level of could be the cause of concern for stroke or acute myocardial
Statins are also another type of medication prescribed if you have a high blood cholesterol level, this lowers cholesterol. This medicine blocks the formation of cholesterol and increasing the number of LDL receptors in the liver, which helps remove the LDL cholesterol from your blood. This helps slow the progression of CHD, and will make having a heart attack less likely. However, not everyone is suitable for this medicine.
The purpose of this paper is to present an analysis of a quantitative article using Melnyk & Fineout-Overholt’s (2015) rapid critical appraisal (RCA) for a randomized clinical trial. Topics included are the validity of the research, results of the research and how the information can be applied to the clinical care of my own patient population.
(2016). Apsirin use for the primary prevention of cardiovascular disease and colorectal cancer: U.S. preventive services task force rocommendation statement. Annals of Internal Medicine, 164(12), 836-846.
The author considers the simplest way of finding out best practice is by using guidelines. According to Field & Lohr (1992) guidelines are “systematic developed statements to assist practitioners and patients decisions for specific clinical circumstances.” Evidence is always current and a generous collection of many different systematic research reviews with multiple random control trials are available (AGREE, 2000). These types of trials are graded at the top level of hierarchy (Guyatt et al 2002).Nevertheless in contrast Devereaux and Yusuf (2005) argue that top level hierarchy is not a guaranteed deviation from the truth in randomized trials. The clinical guidance used is the National Institute of Clinical Guidance (NICE 2009) is based in the author’s homeland and is an independent organisation responsible for providing guidelines. The ethos behind NICE (2009) is to promote and prevent poor health nationally involving the public, health professionals and patients in the process (NICE 2009).
The study was a systematic review of scientific papers selected by a search of the SciELO, Cochrane, MEDLINE, and LILACS-BIREME databases. Among the 2169 articles found, 12 studies proved relevant to the issue and presented an evidence strength rating of B. No publications rated evidence strength A. Seven of the studies analyzed were prospective cohorts and 5 were cross-sectional studies.
In 2012, the phase 1 trials were published in The Journal of the American College of Cardiology. The phase 1 trials had two arms. Phase 1a were healthy subjects and phase 1b has subjects with hypercholestemia receiving stable statin therapy. The aim of this study was to evaluate the safety, tolerability and effects of AMG 145. Phase 1a had 56 subjects at 1 U.S. center, who were randomized to either get a single dose of placebo, 7mg to 420mg of AMG 145 subcutaneously or 21mg or 420mg via a one hour intravenous infusion. Percentagewise 69% of the subjects in the AMG 145 group experienced a treatment-emergent adverse event compared to 71% of the subjects in the placebo group. There was zero discontinuation due to adverse events in this arm of
The database utilized in the search was the Shapiro Library and EBSCOhost search engine for relevant articles. The inclusion criteria contained: peer reviewed scholarly, academic journals and date range of 2013 to 2017. Limiting the search criteria for recent relevant articles which had been validated by peers produces data that has trustworthiness and merit. The final sample was determined based on the population in the study, staffing levels and patient quality outcomes.
Coronary heart disease (CHD), also known as ischemic heart disease is the most prevalent form of cardiovascular disease in Australia (Australian Institute of Health and Welfare, 2014). While over 20,000 of deaths in 2011 were attributed to CHD. There were estimated 590,000 Australians 18 years old and above diagnosed with CHD in 2011-2012 (AIHW, 2014; Craft, 2014, pg. 596). Myocardial ischaemia is a common form of CHD. A sufficient coronary artery blood flow is essential to supply oxygen for normal cardiac activities. Myocardial ischaemia develops when there is an insufficient supply of blood and oxygen to support the function of myocardial cells (Craft, 2014, pg. 599). A decrease in blood supply can led to the formation of atherosclerotic plaques by narrowing or occluding the arteries. Other conditions such as hypotension, coronary spasm, dysthymias, hypoxemia and anaemia can also decrease the blood and oxygen supply to the myocardial cells (McCance & Huether, 2014, pg. 1153)
ASSESMENT OF THE EFFECT OF STATINS IN LOWRING THE RISK OF STROKE AND PREVENTING CEREBRAL ISCHEMIA IN PATIENTS WITH HYPERCHOLESTEROLEMIA
Statins has multiple organ effects by affecting the liver, musculoskeletal system and the nervous system, controlled clinical trials with randomized blinded assignment of treatment groups to patients treated with statins and placebo was conducted, hence valid data about adverse effects of statins were obtained (doc1.pdf- ). The Stroke Prevention by Aggressive Reduction in Cholesterol Levels (SPARCL) Investigators conducted a study in which patients with history of transient ischemic attack or thrombotic stroke were allocated into two groups, one treated with statin and the other group with placebo, after conducting this study
7. Study is to compare toxicity of drug to avoid renal damage and hypertension, efficacy endpoint, treatment response, patient reported outcomes.