An international perspective on cardiovascular risk management: recommendations for high-risk patientsD Duhot, E McGregor, Diana Gorog, C Packard
Looking at evidence with detached objectivity
An international perspective on cardiovascular risk management: recommendations for high-risk patients
Bariatric surgery: an effective quick fix to prevent the complications of morbid obesity or prelude to long-term problems?
Smoking cessation 4: antidepressants for smoking cessation – bupropion and nortriptyline
Atrial fibrillation: which patients should be managed in primary, secondary and tertiary care?
If at first you don’t succeed, try, try again!
An international perspective on cardiovascular risk management: recommendations for moderate- to low-risk patients
Making sense of HDL cholesterol
Involving patients in decisions about preventive medication: a focus group study
People living in deprived areas show three times the risk of stroke deaths
People living in deprived areas are around three times more likely to die from a stroke than those in the least deprived, according to a report from the Stroke Association and the British Heart Foundation, which shows that death rates from stroke vary with social and economic conditions.
The report, which is the first comprehensive collection of national statistics on the burden of stroke, confirms that the stroke mortality rate for men and women of working age (under 65) has fallen consistently since the late 1970s. However, it shows that the rate has fallen more quickly in adults of higher social classes, resulting in an increase in inequalities in stroke death rates. The data show that stroke mortality increases with deprivation for both men and women. For premature mortality, the rate in the most deprived 5% of the population in England and Wales is more than three and a half times higher for men, and over two and a half times higher for women, than for those in the least deprived sector.
The statistics also show that people from lower social economic backgrounds are more likely to have major risk factors of stroke, including cigarette smoking and obesity. Professor Peter Weissberg, Medical Director at the British Heart Foundation said: “The picture these data on stroke present strongly mirrors figures for heart disease, which is also much more common in deprived communities. Many of the risk factors for heart disease and stroke, such as smoking and high blood pressure, are the same and potentially modifiable. The statistics argue for a concerted effort to identify and modify risk factors, by lifestyle and drug interventions, in those communities with the highest risks.-
New treatment option for comprehensive management of LDL-C, HDL-C and triglycerides
Tredaptive (nicotinic acid/laropiprant) has been launched as a new treatment option for dyslipidaemia. It is indicated for patients with combined mixed dyslipidaemia or primary hypercholesterolaemia, and should be used in combination with a statin when the cholesterol-lowering effect of statin monotherapy is inadequate, or as monotherapy when statins are considered inappropriate or not tolerated.
An efficacy study showed that treatment with the drug, with or without a statin, lowered LDL-C levels by 18% and triglycerides by 26% and raised HDL-C levels by 20% (placebo-adjusted) for a 24-week period. “Many patients do not achieve sufficient LDL cholesterol lowering on a statin alone and a significant CVD residual risk remains in some patients,” commented Dr Marc Evans, Consultant Diabetologist, Llandough. “Furthermore, low HDL-C and high triglyceride levels also contribute to cardiovascular risk and are particularly prevalent in certain patient groups, such as those with diabetes and people of South Asian origin,” he added.
Dr Evans considered that a new treatment option that can address the wider lipid profile is welcome, and will be particularly useful for secondary prevention patients and those patients with dyslipidaemia at ‘high risk’. Nicotinic acid has been widely recognised as an effective lipid-modifying therapy for over 50 years, but its use has been limited due to a flushing sideeffect. The laropiprant component in Tredaptive is an anti-flushing agent. Treatment with Tredaptive is associated with significantly lower percentages of patients with moderate or greater flushing than extended-release nicotinic acid, and any flushing that does occur subsides over time, according to trials. This reduction in flushing has led to patients on Tredaptive being less likely to discontinue treatment due to flushing compared to those on extended-release nicotinic acid (10.2% vs 22.2%, respectively; p <0.001).
Tredaptive contains 1,000 mg of nicotinic acid and 20 mg of laropiprant in each tablet. The starting dose is one tablet once a day. After four weeks, it is recommended that patients be advanced to the maintenance dose of 2,000 mg/ 40 mg taken as two tablets once daily.
