Statin use and adverse effects among adults \u3e 75 years of age: Insights from the Patient and Provider Assessment of Lipid Management (PALM) registry

Background: Current statin use and symptoms among older adults in routine community practice have not been well characterized since the release of the 2013 American College of Cardiology/American Heart Association guideline. Methods and results: We compared statin use and dosing between adults \u3e75 and ≤75 years old who were eligible for primary or secondary prevention statin use without considering guideline-recommended age criteria. The patients were treated at 138 US practices in the Patient and Provider Assessment of Lipid Management (PALM) registry in 2015. Patient surveys also evaluated reported symptoms while taking statins. Multivariable logistic regression models examined the association between older age and statin use and dosing. Among 6717 people enrolled, 1704 (25%) were \u3e75 years old. For primary prevention, use of any statin or high-dose statin did not vary by age group: any statin, 62.6% in those \u3e75 years old versus 63.1% in those ≤75 years old (P=0.83); high-dose statin, 10.2% versus 12.3% in the same groups (P=0.14). For secondary prevention, older patients were slightly less likely to receive any statin (80.1% versus 84.2% [P=0.003]; adjusted odds ratio, 0.81; 95% confidence interval, 0.66-1.01 [P=0.06]), but were much less likely to receive a high-intensity statin (23.5% versus 36.2% [PP=0.0001]). Among current statin users, older patients were slightly less likely to report any symptoms (41.3% versus 46.6%; P=0.003) or myalgias (27.3% versus 33.3%; Conclusions: Overall use of statins was similar for primary prevention in those aged \u3e75 years versus younger patients, yet older patients were less likely to receive high-intensity statins for secondary prevention. Statins appear to be similarly tolerated in older and younger adult

Patient-reported reasons for declining or discontinuing statin therapy: Insights from the PALM registry

Background: Many adults eligible for statin therapy for cardiovascular disease prevention are untreated. Our objective was to investigate patient‐reported reasons for statin underutilization, including noninitiation, refusal, and discontinuation.Methods and Results: This study included the 5693 adults recommended for statin therapy in the PALM (Patient and Provider Assessment of Lipid Management) registry. Patient surveys evaluated statin experience, reasons for declining or discontinuing statins, and beliefs about statins and cardiovascular disease risk. Overall, 1511 of 5693 adults (26.5%) were not on treatment. Of those not on a statin, 894 (59.2%) reported never being offered a statin, 153 (10.1%) declined a statin, and 464 (30.7%) had discontinued therapy. Women (relative risk: 1.22), black adults (relative risk: 1.48), and those without insurance (relative risk: 1.38) were most likely to report never being offered a statin. Fear of side effects and perceived side effects were the most common reasons cited for declining or discontinuing a statin. Compared with statin users, those who declined or discontinued statins were less likely to believe statins are safe (70.4% of current users vs. 36.9% of those who declined and 37.4% of those who discontinued) or effective (86.3%, 67.4%, and 69.1%, respectively). Willingness to take a statin was high; 67.7% of those never offered and 59.7% of patients who discontinued a statin would consider initiating or retrying a statin.Conclusions: More than half of patients eligible for statin therapy but not on treatment reported never being offered one by their doctor. Concern about side effects was the leading reason for statin refusal or discontinuation. Many patients were willing to reconsider statin therapy if offered

Measurement of low‐density lipoprotein cholesterol levels in primary and secondary prevention patients: Insights from the PALM registry

Background The 2013 American College of Cardiology/American Heart Association Guideline on the Treatment of Blood Cholesterol to Reduce Atherosclerotic Cardiovascular Risk in Adults recommended testing low-density lipoprotein cholesterol ( LDL -C) to identify untreated patients with LDL -C ≥190 mg/dL, assess lipid-lowering therapy adherence, and consider nonstatin therapy. We sought to determine whether clinician lipid testing practices were consistent with these guidelines. Methods and Results The PALM (Patient and Provider Assessment of Lipid Management) registry enrolled primary and secondary prevention patients from 140 US cardiology, endocrinology, and primary care offices in 2015 and captured demographic data, lipid treatment history, and the highest LDL -C level in the past 2 years. Core laboratory lipid levels were drawn at enrollment. Among 7627 patients, 2787 (36.5%) had no LDL -C levels measured in the 2 years before enrollment. Patients without chart-documented LDL -C levels were more often women, nonwhite, uninsured, and non-college graduates (all P\u3c0.01). Patients without prior lipid testing were less likely to receive statin treatment (72.6% versus 76.0%; P=0.0034), a high-intensity statin (21.5% versus 24.3%; P=0.016), nonstatin lipid-lowering therapy (24.8% versus 27.3%; P=0.037), and had higher core laboratory LDL -C levels at enrollment (median 97 versus 92 mg/dL; P\u3c0.0001) than patients with prior LDL -C testing. Of 166 individuals with core laboratory LDL -C levels ≥190 mg/dL, 36.1% had no LDL -C measurement in the prior 2 years, and 57.2% were not on a statin at the time of enrollment. Conclusions In routine clinical practice, LDL -C testing is associated with higher-intensity lipid-lowering treatment and lower achieved LDL -C level

Disponibilidad y costos de producción de biomasa forestal como materia prima para la producción de bioetanol

La biomasa forestal es una alternativa ecológica y económicamente viable para la generación de bioetanol debido a que su fuente es abundante, renovable y contribuye a la reducción de gases efecto invernadero. En este estudio, se propone y analiza una metodología para la estimación de la disponibilidad y costos de producción del uso potencial de la biomasa forestal como materia prima para la producción de bioetanol en bosques de pinos del estado de Durango, México. Se usó información del Inventario Forestal Periódico, programas de manejo forestal y datos de empresas de aserraderos e industriales forestales para estimar la biomasa forestal que incluye los restos de aprovechamientos forestales (puntas, ramas) y desperdicios industriales (aserrín, costeras). Se utilizaron simulaciones Monte Carlo para estimar costos de producción de la recolección, extracción y transporte de la biomasa a centros de transformación. Los resultados indican que alrededor de 322.000 toneladas pueden utilizarse para la producción de 38 millones de litros de etanol por año. Las simulaciones Monte Carlo indican que el costo promedio de residuos forestales es de US $23,8 por tonelada (US$0,20 L–1 etanol) mientras que el de residuos industriales es de US $22,6 por tonelada (US$0,19 L–1 etanol). Los factores más importantes en el análisis de sensibilidad fueron el costo pagado a dueños del material, eficiencia tecnológica y distancia de transporte. En el corto plazo, el uso de la biomasa forestal para la generación de biocombustibles tiene varios retos entre los que se encuentran los costos de transporte y la competencia generada por industrias similares como pulpa, papel y tableros aglomerados. Como alternativa se encuentra el desarrollo de biorefinerías integradoras y el uso de medios de transporte más eficientes.La biomasa forestal es una alternativa ecológica y económicamente viable para la generación de bioetanol debido a que su fuente es abundante, renovable y contribuye a la reducción de gases efecto invernadero. En este estudio, se propone y analiza una metodología para la estimación de la disponibilidad y costos de producción del uso potencial de la biomasa forestal como materia prima para la producción de bioetanol en bosques de pinos del estado de Durango, México. Se usó información del Inventario Forestal Periódico, programas de manejo forestal y datos de empresas de aserraderos e industriales forestales para estimar la biomasa forestal que incluye los restos de aprovechamientos forestales (puntas, ramas) y desperdicios industriales (aserrín, costeras). Se utilizaron simulaciones Monte Carlo para estimar costos de producción de la recolección, extracción y transporte de la biomasa a centros de transformación. Los resultados indican que alrededor de 322.000 toneladas pueden utilizarse para la producción de 38 millones de litros de etanol por año. Las simulaciones Monte Carlo indican que el costo promedio de residuos forestales es de US $23,8 por tonelada (US$0,20 L–1 etanol) mientras que el de residuos industriales es de US $22,6 por tonelada (US$0,19 L–1 etanol). Los factores más importantes en el análisis de sensibilidad fueron el costo pagado a dueños del material, eficiencia tecnológica y distancia de transporte. En el corto plazo, el uso de la biomasa forestal para la generación de biocombustibles tiene varios retos entre los que se encuentran los costos de transporte y la competencia generada por industrias similares como pulpa, papel y tableros aglomerados. Como alternativa se encuentra el desarrollo de biorefinerías integradoras y el uso de medios de transporte más eficientes

Using Seroprevalence and Immunisation Coverage Data to Estimate the Global Burden of Congenital Rubella Syndrome, 1996-2010: A Systematic Review.

BACKGROUND: The burden of Congenital Rubella Syndrome (CRS) is typically underestimated in routine surveillance. Updated estimates are needed following the recent WHO position paper on rubella and recent GAVI initiatives, funding rubella vaccination in eligible countries. Previous estimates considered the year 1996 and only 78 (developing) countries. METHODS: We reviewed the literature to identify rubella seroprevalence studies conducted before countries introduced rubella-containing vaccination (RCV). These data and the estimated vaccination coverage in the routine schedule and mass campaigns were incorporated in mathematical models to estimate the CRS incidence in 1996 and 2000-2010 for each country, region and globally. RESULTS: The estimated CRS decreased in the three regions (Americas, Europe and Eastern Mediterranean) which had introduced widespread RCV by 2010, reaching <2 per 100,000 live births (the Americas and Europe) and 25 (95% CI 4-61) per 100,000 live births (the Eastern Mediterranean). The estimated incidence in 2010 ranged from 90 (95% CI: 46-195) in the Western Pacific, excluding China, to 116 (95% CI: 56-235) and 121 (95% CI: 31-238) per 100,000 live births in Africa and SE Asia respectively. Highest numbers of cases were predicted in Africa (39,000, 95% CI: 18,000-80,000) and SE Asia (49,000, 95% CI: 11,000-97,000). In 2010, 105,000 (95% CI: 54,000-158,000) CRS cases were estimated globally, compared to 119,000 (95% CI: 72,000-169,000) in 1996. CONCLUSIONS: Whilst falling dramatically in the Americas, Europe and the Eastern Mediterranean after vaccination, the estimated CRS incidence remains high elsewhere. Well-conducted seroprevalence studies can help to improve the reliability of these estimates and monitor the impact of rubella vaccination

Intensity of lipid lowering with statin therapy in patients with cerebrovascular disease versus coronary artery disease: Insights from the PALM Registry

Background Current treatment guidelines strongly recommend statin therapy for secondary prevention. However, it remains unclear whether patients\u27 perceptions of cardiovascular risk, beliefs on cholesterol, or the intensity of prescribed statin therapy differs for patients with coronary artery disease (CAD) versus cerebrovascular disease (CeVD) versus both CAD and CeVD (CAD&CeVD). Methods and Results The PALM (Patient and Provider Assessment of Lipid Management) registry collected data on statin use, intensity, and core laboratory low-density lipoprotein cholesterol levels for 3232 secondary prevention patients treated at 133 US clinics. Among individuals with CeVD only (n=403), CAD only (n=2202), and CeVD&CAD (n=627), no significant differences were observed in patient-perceived cardiovascular disease risk, beliefs on cholesterol lowering, or perceived effectiveness and safety of statin therapy. However, patients with CeVD only were less likely to receive any statin therapy (76.2% versus 86.2%; adjusted odds ratio 0.64, 95% CI 0.45-0.91), or guideline-recommended statin intensity (34.6% versus 50.4%; adjusted odds ratio 0.60, 95% CI 0.45-0.81) than those with CAD only. Individuals with CeVD only were also less likely to achieve low-density lipoprotein cholesterol \u3c100 mg/dL (59.2% versus 69.7%; adjusted odds ratio 0.79, 95% CI 0.64-0.99) than individuals with CAD alone. There were no significant differences in the use of any statin therapy or guideline-recommended statin intensity between individuals with CAD&CeVD and those with CAD only. Conclusions Despite lack of significant differences in patient-perceived cardiovascular risk or statin beliefs, patients with CeVD were significantly less likely to receive higher intensity statin or achieve low-density lipoprotein cholesterol \u3c100 mg/dL than those with CAD only

Aldosterone Antagonists in Monotherapy Are Protective against Streptozotocin-Induced Diabetic Nephropathy in Rats

Angiotensin converting enzyme inhibitors (ACEi) and angiotensin II receptor blockers (ARB) are the standard clinical therapy of diabetic nephropathy (DN), while aldosterone antagonists are only used as adjuncts. Previously in experimental DN we showed that Na/K ATPase (NKA) is mislocated and angiotensin II leads to superimposed renal progression. Here we investigated the monotherapeutic effect of aldosterone blockers on the progression of DN and renal NKA alteration in comparison to ACEi and ARBs. Streptozotocin-diabetic rats developing DN were treated with aldosterone antagonists; ACEi and ARB. Renal function, morphology, protein level and tubular localization of NKA were analyzed. To evaluate the effect of high glucose per se; HK-2 proximal tubular cells were cultured in normal or high concentration of glucose and treated with the same agents. Aldosterone antagonists were the most effective in ameliorating functional and structural kidney damage and they normalized diabetes induced bradycardia and weight loss. Aldosterone blockers also prevented hyperglycemia and diabetes induced increase in NKA protein level and enzyme mislocation. A monotherapy with aldosterone antagonists might be as, or more effective than ACEi or ARBs in the prevention of STZ-induced DN. Furthermore the alteration of the NKA could represent a novel pathophysiological feature of DN and might serve as an additional target of aldosterone blockers

Congenital rubella syndrome and autism spectrum disorder prevented by rubella vaccination - United States, 2001-2010

<p>Abstract</p> <p>Background</p> <p>Congenital rubella syndrome (CRS) is associated with several negative outcomes, including autism spectrum disorders (ASDs). The objective of this study was to estimate the numbers of CRS and ASD cases prevented by rubella vaccination in the United States from 2001 through 2010.</p> <p>Methods</p> <p>Prevention estimates were calculated through simple mathematical modeling, with values of model parameters determined from published literature. Model parameters included pre-vaccine era CRS incidence, vaccine era CRS incidence, the number of live births per year, and the percentage of CRS cases presenting with an ASD.</p> <p>Results</p> <p>Based on our estimates, 16,600 CRS cases (range: 8300-62,250) were prevented by rubella vaccination from 2001 through 2010 in the United States. An estimated 1228 ASD cases were prevented by rubella vaccination in the United States during this time period. Simulating a slight expansion in ASD diagnostic criteria in recent decades, we estimate that a minimum of 830 ASD cases and a maximum of 6225 ASD cases were prevented.</p> <p>Conclusions</p> <p>We estimate that rubella vaccination prevented substantial numbers of CRS and ASD cases in the United States from 2001 through 2010. These findings provide additional incentive to maintain high measles-mumps-rubella (MMR) vaccination coverage.</p

Tracking the solid-state incorporation of Sn into the framework of dealuminated zeolite beta, and consequences for catalyst design

Sn-Beta has emerged as a state-of-the-art catalyst for a range of sustainable chemical transformations. Conventionally prepared by bottom-up hydrothermal synthesis methods, recent research has demonstrated the efficiency of several top-down methods of preparation. One attractive top-down approach is Solid-State Incorporation, where a dealuminated Beta zeolite is physically mixed with a solid Sn precursor, in particular Sn(II) acetate, prior to heat treatment at 550 °C. This procedure is fast and benign, and metal incorporation requires no solvents and hence produces no aqueous Sn-containing waste streams. Although the performances of these catalysts have been well explored in recent years, the mechanism of heteroatom incorporation remains unknown, and hence, opportunities to improve the synthetic procedure via a molecular approach remain. Herein, we use a range of in situ spectroscopic techniques, alongside kinetic and computational methods, to elucidate the mechanisms that occur during preparation of the catalyst, and then improve the efficacy of the synthetic protocol. Specifically, we find that successful incorporation of Sn into the lattice occurs in several distinct steps, including (i) preliminary coordination of the metal ion to the vacant lattice sites of the zeolite during physical grinding; (ii) partial incorporation of the metal ion into the zeolite framework upon selective decomposition of the acetate ligands, which occurs upon heating the physical mixture in an inert gas flow from room temperature to 550 °C; and (iii) full isomorphous substitution of Sn into the lattice alongside its simultaneous oxidation to Lewis acidic Sn(IV), when the physically mixed material is exposed to air during a short (<1 h) isotherm period. Long isotherm steps are shown to be unnecessary, and fully oxidised Sn(IV) precursors are shown to be unsuitable for successful incorporation into the lattice. We also find that the formation of extra-framework Sn oxides is primarily dependent on the quantity of Sn present in the initial physical mixture. Based on these findings, we demonstrate a faster synthetic protocol for the preparation of Sn-Beta materials via Solid-State Incorporation, and benchmark their catalytic performance for the Meerwein-Ponndorf-Verley transfer hydrogenation reaction and the isomerisation of glucose to fructose

Crowdfunding in the Cultural Industries

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