News in brief: Statin intolerance overdiagnosed; 162 genes implicated in CAD development; Extended use of DAPT common after PCI

Statin intolerance overestimated and overdiagnosed

Clinicians are being urged to evaluate symptoms of statin intolerance very carefully after new research shows adverse effects are overestimated and overdiagnosed.

A meta-analysis of 176 studies with more than 4 million patients found the global prevalence of statin intolerance was 9.1%.

The prevalence was even less when assessed against the National Lipid Association, International Lipid Expert Panel and European Atherosclerosis Society’s diagnostic criteria, at 7.0%, 6.7% and 5.9%, respectively, the paper, published in the European Heart Journal, showed.

“These results were not a surprise to me but they were for many other experts. They show that in most cases statin intolerance is overestimated and over-diagnosed, and they mean that around 93% of patients on statin therapy can be treated effectively, with very good tolerability and without any safety issues”, lead author, Professor Maciej Banach of the Medical University of Lodz and the University of Zielona Góra, Poland, said.

“Our findings mean that we should evaluate patients’ symptoms very carefully, firstly to see whether symptoms are indeed caused by statins, and secondly, to evaluate whether it might be patients’ perceptions that statins are harmful — so called nocebo or drucebo effect — which could be responsible for more than 50% of all symptoms, rather than the drug itself.”

162 genes implicated in coronary artery disease development

A study highlighting over 100 candidate causal coronary artery disease (CAD) genes could pave the way for new targeted therapies and more accurate screening, cardiology researchers say.

The study of 600 patients with CAD and 150 without implicated 162 genes in disease development — exerting their effect in one to seven “disease-relevant tissues/cell types, including the arterial wall, blood, liver, skeletal muscle, adipose, foam cells, and macrophages”.

PHACTR1 and CDKN2B were the top two drivers of CAD, primarily affecting the arterial wall, the study found after ranking genes “in order of priority for causing coronary heart disease”.

PHACTR1 is known to play a role in several vascular diseases, including migraine, fibromuscular dysplasia and and spontaneous coronary artery dissection, however, “scientists around the world have little idea of how PHACTR1 works”, lead author Professor Jason Kovacic, Executive Director of the Victor Chang Cardiac Research Institute said in a statement.

Further research could help uncover the genes’ roles in CAD development and their value as potential drug targets.

It could also lead to improved genetic testing, which “[isn’t] particularly accurate” at present, Professor Kovacic said.

The full study is available in Circulation: Genomic and Precision Medicine.

Extended use of DAPT common after PCI

Unwarranted extended use of dual antiplatelet therapy  (DAPT) after percutaneous coronary intervention (PCI) may be placing patients at risk of bleeding complications, a study from Queensland suggests.

While clinical guidelines define 12 months or less of DAPT as standard therapy post-PCI a study conducted at the Princess Alexandra Hospital, Brisbane found that two thirds of patients were still taking DAPT beyond a year.

The study reviewed data for 105 patients admitted for PCI who were subsequently readmitted at least 12 months later. It found that 70 patients (66%) were still taking DAPT on readmission.

In one third of these cases DAPT duration patients was compliant with the recommendations of guidelines or treating cardiologist, with 10%  and 57% being shorter and longer than recommendations of guidelines or treating cardiologist respectively, according to findings published in Pharmacy Practice and Research.

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