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Aims: This study aimed to analyse the initiation adherence phase to lipid‐lowering therapy for primary prevention of cardiovascular disease in a Spanish population aged 70 years or older. The secondary objective was to identify the determinants of initiation and early discontinuation. Methods: This was an observational study conducted in the CArdiovascular Risk factors for HEalth Service research (CARhES) cohort. People aged 70 and older with a first prescription of a lipid‐lowering drug and without a previous major adverse cardiovascular event (MACE) were selected (2018–2021). Data on sociodemographics, clinical conditions, drugs and use of health services were collected from clinical and administrative electronic databases. The study population was classified into: non‐initiation, early discontinuation (i.e., discontinuation after the first dispensing) and initiation with more than one dispensing. Their characteristics were compared. Determinants of initiation and early discontinuation were explored. Results: Among the 15 019 people studied, 80.2% initiated the medication, 11.2% showed an early discontinuation and 8.6% were non‐initiators. An older age or conditions such as dementia, diabetes or depression reduced the likelihood of initiation, while obesity and a high pharmacological burden increased it. People over 90 years of age or those prescribed a statin in combination were more likely to have an early discontinuation. Conclusions: Non‐initiation and early discontinuation are common among older people prescribed lipid‐lowering drugs as primary prevention of cardiovascular disease for the first time. The presence of chronic pathologies other than cardiovascular ones should be considered when assessing whether or not to prescribe these drugs in the elderly. [ABSTRACT FROM AUTHOR]

[Display omitted] • Primary prevention is complex and needs the consent of a patient without disease. • Primary prevention requires adoption of new behaviours or taking medications. • Reduction of LDL-C is an excellent target for reducing risk of a cardiovascular event. • The patient must be convinced that LDL-C is a key marker of cardiovascular risk. Low-density lipoprotein cholesterol has been established as a powerful cardiovascular risk factor; its reduction provides a clinical benefit in primary cardiovascular prevention, irrespective of the characteristics of the patients treated. It is useful to tailor low-density lipoprotein cholesterol targets according to the magnitude of cardiovascular risk (low, high or very high) in order to reduce the cardiovascular risk as fully as possible. In order to provide a uniform approach, it is necessary to propose recommendations for good practice, defining strategies for reducing low-density lipoprotein cholesterol. It is also necessary to know their merits, to analyse their practical limits and to propose adaptations, taking into account limitations and national specifics. This position paper aims to analyse the contribution and limits, as well as the adaptation to French practice, of 2019 and 2021 European Society of Cardiology recommendations for the management of lipid variables and cardiovascular prevention. [ABSTRACT FROM AUTHOR]

Purpose of reviewTo highlight mechanisms of elevated risk of atherosclerotic cardiovascular disease (ASCVD) among people living with HIV (PLWH), discuss therapeutic strategies, and opportunities for primary prevention.Recent findingsHIV-associated ASCVD risk is likely multifactorial and due to HIV-specific factors and traditional risk factors even in the setting of treated and suppressed HIV disease. Although a growing body of evidence suggests that inflammation and immune activation are key drivers of atherogenesis, therapies designed to lower inflammation including colchicine and low-dose methotrexate have not improved secondary cardiovascular endpoints among PLWH. Statins continue to be the mainstay of management of hyperlipidemia in HIV, but the impact of newer lipid therapies including proprotein convertase subtilisin/kexin type 9 inhibitors on ASCVD risk among PLWH is under investigation. Aside from the factors mentioned above, healthcare disparities are particularly prominent among PLWH and thus likely contribute to increased ASCVD risk.SummaryOur understanding of mechanisms of elevated ASCVD risk in HIV continues to evolve, and the optimal treatment for CVD in HIV aside from targeting traditional risk factors remains unknown. Future studies including novel therapies to lower inflammation, control of risk factors, and implementation science are needed to ascertain optimal ways to treat and prevent ASCVD among PLWH.

Objective: Personalizing preventive therapies for atherosclerotic cardiovascular disease (ASCVD) is particularly important for older adults, as they tend to have multiple chronic conditions, increased risk for medication adverse effects, and may have heterogenous preferences when weighing health outcomes. However, little is known about outcome preferences related to ASCVD preventive therapies in older adults. Methods: In May 2021, using an established online panel, KnowledgePanel, we surveyed older US adults aged 65-84 years without history of ASCVD on outcome preferences related to statin therapy (benefit outcomes to be reduced by the therapy: heart attack, stroke; adverse effects: diabetes, abnormal liver test, muscle pain) or aspirin therapy (benefit outcomes: heart attack, stroke; adverse effects: brain bleed, bowel bleed, stomach ulcer). We used standardized best-worst scores (range of -1 for “least worrisome” to +1 for “most worrisome”) and conditional logistic regression to examine the relative importance of the outcomes. Results: In this study, 607 ASCVD-free participants (median age 74, 46% male, 81% White) were included; 304 and 303 completed the statin and aspirin versions of the survey, respectively. For statin-related outcomes, stroke and heart attack were most worrisome (score 0.55; 95% CI 0.51, 0.60) and (0.53; 0.48, 0.58), followed by potential harms of diabetes (-0.07; -0.10, -0.03), abnormal liver test (-0.25; -0.29, -0.20), and muscle pain (-0.77; -0.82, -0.73). For aspirin-related outcomes, stroke and heart attack were similarly most worrisome (0.48; 0.43, 0.52) and (0.43; 0.38, 0.48), followed by brain bleed (0.30; 0.25, 0.34), bowel bleed (-0.31; -0.33, -0.28), and stomach ulcer (-0.90; -0.92, -0.87). Conditional logistic regression and subgroup analyses by age, sex, and race yielded similar results. Conclusions: Older adults generally consider outcomes related to benefits of ASCVD primary preventive therapies—stroke and heart attack—more important than their adverse effects. Integrating patient preferences with risk assessment is an important next step for personalizing ASCVD preventive therapies for older adults.

Purpose: To test the hypothesis that aerobic fitness is inversely related to the risk of atherosclerotic cardiovascular disease (ACVD) in athletes with locomotor impairments deriving from health conditions, such as spinal cord injury (SCI), lower limb amputation, cerebral palsy, poliomyelitis, and other health conditions different from the previous ones. Methods: A total of 68 male athletes who competed in either summer or winter Paralympic games were divided in two health conditions groups (35 with SCI, mean age 37.2 ± 8.0 years, and 33 with different health conditions, mean age 37.8 ± 9.9 years) and in four sport type groups (skill, power, intermittent—mixed metabolism—and endurance). They were evaluated through anthropometric and blood pressure measurements, laboratory blood tests, and graded cardiopulmonary maximal arm cranking exercise test, with oxygen uptake peak (VO2peak) measurement. Cardiovascular risk profile was assessed in each athlete. Results: The prevalence of ACVD-risk factors in the overall population was 20.6% for hypertension; 47% and 55.9% for high values of total and LDL cholesterol, respectively; 22.1% for reduce glucose tolerance; and 8.8% for obesity. No difference was found between athletes with and without SCI, while the prevalence of obesity was significantly higher in those practicing skill sports (22.7%, p = 0.035), which was the sport type group with Paralympic athletes with the lowest VO2peak (22.5 ± 5.70 ml kg−1 min−1). VO2peak was lower in athletes with SCI than those with different health conditions (28.6 ± 10.0 vs 33.6 ± 8.9 ml kg−1 min−1p = 0.03), and in those with 3–4 risk factors (19.09 ± 5.34 ml kg−1 min−1) than those with 2 risk factors (27.1 ± 5.50 ml kg−1 min−1), 1 risk factor (31.6 ± 8.55 ml kg−1 min−1), or none (36.4 ± 8.76 ml kg−1 min−1) (p < 0.001). Conclusions: The present study suggests that having higher VO2peak seems to offer greater protection against ACVD in individuals with a locomotor impairment. Prescribing physical exercise at an intensity similar to that of endurance and intermittent sports should become a fundamental tool to promote health among people with a locomotor impairment. [ABSTRACT FROM AUTHOR]

Prevention of cardiovascular disease remains a key-objective from a health care point of view. The present article focuses on primary prevention, i.e. to prevent a first cardiovascular event among at-risk people. The first step is to evaluate the cardiovascular risk level (low to moderate, high, very high), which allows to fix target goals. It is especially the case regarding the management of dyslipidaemias. Lipid abnormalities are considered as a major coronary risk factor (especially, LDL or even better non-HDL cholesterol according to recent guidelines). Theoretically, it is quite easy to control this risk factor thanks to available lipid-lowering drugs, yet this goal remains insufficiently reached in clinical practice. The second step is to prescribe, in addition to life-style measures, the best pharmacological treatment. In most cases, it is a statin that should be well titrated, eventually combined with ezetimibe and/or bempedoic acid, to reach the set objectives. Finally, it is important to convince the at-risk individual by providing the valuable information regarding the benefits/risks ratio of the therapy and to verify a good drug compliance in the long run. Indeed, as dyslipidaemia is asymptomatic, people in primary prevention too easily tend to neglect (and eventually stop) the valuable therapy, also because statins have been widely (yet unfairly) criticized by some people in recent years.

The efficacy of antiplatelet treatment with aspirin in the primary prevention of major cardiovascular events was questioned during 2018, following a new series of trials that we summarize here in a quick synoptic overview. The three studies involved are the ASPREE trial, the ASCEND study and the ARRIVE trial. These studies all have a double-blind randomized design, and 100 mg/day aspirin was administered with an intention-to-treat approach and against placebo. Age of the enrolled patients, prevalence of diabetes mellitus and geographical location of other studies are just some of the elements analyzed here, in addition to the different problems of cardiovascular events. The ASPREE study observed a marginal reduction of cardiovascular events with the use of aspirin, by approximately 5% with a confidence interval at risk of insignificancy. On the other hand, the increased risk of a hemorrhagic event appeared to be rather robust, resulting between 18% and 62%. The ASCEND study observed a reduction in cardiovascular events of around 12%, offset by an increase in the risk of major bleeding between 9% and 52%. The ARRIVE study did not detect any incidence of major cardiovascular events, while the risk of major bleeding appeared to even double. The evidences of the current literature push us to review a widespread conviction among professionals who fight the war against cardiovascular disease every day: the prescription of aspirin in the primary prevention can no longer happen systematically, and every single prescription need care between benefits and dangers connected to the treatment. [ABSTRACT FROM AUTHOR]

The article discusses the risk scores in the prevention of cardiovascular (CV) diseases. Topics include the basis for the derivation of the global risk scores and the commonly applied risk sores in Germany. It mentions the four criteria in assessing the performance of a prediction model including the discriminative power, reclassification and relative risk estimate.