Top Ten Things Every Clinician Should Know About the 2018 Cholesterol Guidelines

January 9, 2019

The American Heart Association / American College of Cardiology (AHA/ACC) Task Force recently published the 2018 Guideline on the Management of Blood Cholesterol. The guidelines writing committee had representation from 12 organizations, including the National Lipid Association, American Diabetes Association, and the American Pharmacists Association — all of whom endorsed the guidelines. The previous guidelines (published in 2013) were intended to answer some specific clinical questions and significantly changed our approach to treatment. The 2018 guidelines provide a more comprehensive set of recommendations, akin to the (older) National Heart, Lung, and Blood Institute Adult Treatment Panel (ATP) III guidelines last published in 2002!

Guest Authors:  Dawn Fuke, Pharm.D., BCPS, and Zach Conroy, PharmD, BCACP

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Another Attempt to ARRIVE at an Answer Using Aspirin for Primary Prevention

December 14, 2018

Daily low-dose aspirin has long been considered a “wonder drug” for its cardioprotective effects, particularly in patients with pre-existing cardiovascular and cerebrovascular disease; however, despite decades of research, the use of aspirin to prevent a first event is less certain. In 2014, the Food and Drug Administration (FDA) responded to a citizen petition requesting the labeled indications for low dose aspirin be updated to include primary prevention. The FDA concluded that the evidence “fail[ed] to establish that aspirin reduces the risk of primary myocardial infarction (MI) in patients with a coronary heart disease (CHD) risk of 10% or more for over 10 years.” The Asprin to Reduce Risk of Initial Vascular Events (ARRIVE) study is intended to address this gap in our knowledge.

Guest Authors:  Amy St. Amand, PharmD, BCPS and Christine Borowy, PharmD, BCPS

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Aspirin for Primary Prevention of CV Events in Diabetes - Is the Evidence ASCENDing?

November 23, 2018

Aspirin is no doubt beneficial in patients with overt vascular disease for the secondary prevention of myocardial infarction, stroke, or cardiovascular death. However, evidence supporting use of aspirin for primary prevention in patients who have not had a cardiovascular event is far less compelling. The clinical uncertainty of aspirin use for the primary prevention of CV events in patients with diabetes is reflected in the different recommendations in current guidelines. The investigators of the ASCEND (A Study of Cardiovascular Events in Diabetes) trial set out to determine the safety and efficacy of daily aspirin use in patients with diabetes without known occlusive arterial disease.

Podcast Case:  ASA Use in DM - Evidence ASCENDing?

Guest Author:  Kirstie Perry, Pharm.D.

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Top Ten Things Every Clinician Should Know About the 2017 Hypertension Guidelines

December 15, 2017

We interview Eric MacLaughlin, Joseph Saseen, and Kristin Rieser about the ACC/AHA Guidelines for the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure in Adults released in November 2017.  Dr. MacLaughin, a member of the Guideline Writing Committee, gives a insiders view of the guidelines development process and explains the rationale for lower blood pressure goals.  Drs. Saseen and Rieser talk about some of the practical considerations that we all must consider as we move forward to making these recommendations a reality.

Guests:  Kristin Rieser, Pharm.D., Joseph Saseen, Pharm.D, and Eric MacLaughlin, Pharm.D.

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Are Statins ALL THAT for Primary Prevention in Older Adults? A Second Look at ALLHAT-LLT

August 25, 2017

Statins reduce atherosclerotic cardiovascular disease (ASCVD) risk. However, the utility of statin therapy in older adults — particularly in those age 75 years and older — remains controversial. The need for additional evidence to guide clinical practice is underscored by the fact that one-in-three older Americans report taking a statin.  Given the paucity of prospective data, a post-hoc analysis of the ALLHAT-LLT (Antihypertensive and Lipid Lowering treatment to prevent Heart Attack Trial - Lipid Lowering Trial) was recently published.  Does this new analysis really help inform the decision?

Guest Author:  Leo Buckley, Pharm.D.

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It’s All Relative: EINSTEIN CHOICE - Rivaroxaban for Extended Secondary Prevention of VTE

June 10, 2017

For the acute treatment of venous thromboembolism, the direct oral anticoagulants (DOACs) have increasingly replaced injectable anticoagulant therapy followed by warfarin.  For patients with an unprovoked deep vein thrombosis or pulmonary embolism who may benefit from long-term extended prophylaxis for the secondary prevention of VTE, the choice is less clear. Should a DOAC be used?  If so, which one and what's the best dose?  What about low-dose aspirin? Is extended therapy needed at all?  The EINSTEIN CHOICE study adds important new insights to the growing body of literature.

Guest Author: Sarah Anderson, PharmD, BCPS

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Peeling Back the Layers on Coated Aspirin

April 14, 2017

More than 15 million Americans have coronary heart disease and most should be taking aspirin daily.  Given aspirin’s ubiquity in cardiovascular medicine and patients’ pill boxes, it is shocking that there are still so many unanswered questions about aspirin use. Which dose and dosage forms should be prescribed?  How common is aspirin resistance?  What is the relationship between platelet inhibition and clinical outcomes?

Guest Author:  Daniela Valencia, Pharm.D.

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Antithrombotic Therapy Following Stent Placement in Patients with A-Fib: Should DOACs Be Preferred?

March 24, 2017

Many patients with atrial fibrillation (AF) received triple antithrombotic therapy after undergoing a percutaneous coronary intervention (PCI) and receiving cardiac stent. Triple therapy consists of warfarin plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and low-dose aspirin. But is triple therapy the best approach? This practice, while widely employed, is not entirely evidence-based. Moreover, the effectiveness and safety of the direct oral anticoagulants (DOACs) in this patient population is unknown.

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Sweetening the Deal: Effects of SGLT-2 Inhibitors on Kidney Disease Progression

November 11, 2016

Approximately one in three patients with diabetes in the United States have chronic kidney disease (CKD).  The Empagliflozin, Cardiovascular Outcomes, and Mortality in Type 2 Diabetes (EMPA-REG OUTCOME) trial, published in 2015, demonstrated a reduction in cardiovascular and all-cause mortality in patients treated with empagliflozin. More recent data from the EMPA-REG OUTCOME trial suggests that empagliflozin may also confer significant renal protection. 

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Liraglutide: the new LEADER for second line therapy in diabetes management?

September 2, 2016

According to the current (2016) ADA guidelines, no agent is “the preferred” second line therapy after metformin monotherapy — instead the benefits, risks, cost, and convenience of each option should be considered and treatment should be individualized.  The liraglutide and cardiovascular outcomes in type 2 diabetes (LEADER) trial, which assessed the long-term cardiovascular effects of liraglutide, a GLP-1 receptor agonist, comes at an interesting time shortly after the publication of the empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes (EMPA-REG OUTCOME) trial.  Both studies found a cardiovascular benefit. How, then, will the results of these trials affect the algorithm for type 2 diabetes management and more importantly, clinical practice?

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