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Is it Time to Add Colchicine to the CVD Cocktail?

Systemic inflammation appears to be an important contributor to atherosclerotic cardiovascular disease but, to date, no medications have been approved that specifically target systemic inflammation. Could colchicine, an anti-inflammatory drug that has been used for decades, move from “perhaps-do” to a “must-do” standard of care for patients with coronary artery disease (CAD)? Data from two previous trials have demonstrated colchicine’s positive impact on cardiovascular outcomes. The LoDoCo2 study asks us, again, to consider colchicine for patients with CAD.

Guest Authors:  Augustus (Rob) Hough, PharmD, BCCP and Taylor Huff, PharmD

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An Incli-ng of Benefit? Efficacy and Safety of Inclisiran for Elevated LDL

Lipid management continues to be an essential component in the prevention and treatment of atherosclerotic cardiovascular disease (ASCVD).  For the past decade, clinical practice guidelines have gone back and forth about optimal treatment goals but guidelines all agree that statins should be used as the preferred initial therapy. However, there is still a lack of clarity about the optimal add-on therapies. The newest LDL-lowering therapy is inclisiran, a small interfering RNA (siRNA) that targets the PCSK9 pathway.

Guest Authors:  Joshua O. Holmes, PharmD, MS and Amanda Schartel, PharmD, BCACP

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Let’s COLCOT to the Chase: Colchicine for Secondary Prevention of CV Events

Millions of Americans will have a myocardial infarction in their lifetime and 20% will have a recurrent fatal or non-fatal coronary heart disease event. Several modifiable risk factors, including elevated blood pressure, cholesterol, and glucose as well as tobacco use, can and should be addressed to reduce the risk of recurrent cardiovascular events. Systemic inflammation has also been associated with poor CV outcomes. Is systemic inflammation a modifiable CV risk factor? And if so, should an anti-inflammatory agent be added to the recommend post-MI drug cocktail to reduce the risk of morbidity and mortality?  That's the question that the COLCOT Study attempted to answer.

Guest Authors:  Jessica Wearden, PharmD and Augustus (Rob) Hough, PharmD, BCPS, BCCP

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Age is Just a Number: Discontinue Statins with Care

More than 14 million Americans age 75 years and older face a dilemma. They are at high risk for atherosclerotic cardiovascular disease (ASCVD). On the other hand, older adults are more susceptible to adverse effects associated with statins. Many adults, often in their 60s or early 70s, decide to initiate statin therapy for the primary prevention of ASCVD. However, at some point in a patient’s life, the potential benefits may no longer be so clear … or the risks and costs increase. Unfortunately, there is little information on the potential consequences of stopping statin in patients who are tolerating statins.

Guest Authors:  Maricar Conson, PharmD and W. Cheng Yuet, PharmD, BCACP

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Who CARES? Getting to the Heart of Allopurinol and Febuxostat CV Outcomes

Should we target uric acid levels when working to reduce cardiovascular risk? Cardiovascular (CV) disease remains the leading cause of death with many contributing risk factors, including hyperuricemia. Evidence suggests an elevation in uric acid levels is associated with and can lead to worse outcomes for individuals with CV disease and heart failure.  The Cardiovascular Safety of Febuxostat and Allopurinol in Patients with Gout and Cardiovascular Morbidities (CARES) trial was conducted to evaluate whether febuxostat was noninferior to allopurinol with regard to CV events in patients with gout and CV disease.

Guest Authors:  Sophia Dietrich, PharmD and Michael W. Nagy, PharmD, BCACP

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The Importance of a Healthy Mind in Patients with an Unhealthy Heart

Patients who have had acute coronary syndromes (ACS) are more likely to suffer from major depression than the general population with rates of clinically relevant symptoms of depression as high as 45%. Unfortunately, even if patients are routinely screened for depression with a PHQ-2 and PHQ-9 in primary care settings, appropriate treatments are often not initiated. Depression causes psychological stress which activates the sympathetic nervous system which leads to increased cortisol levels, inflammation, and platelet activation that can contribute to atherosclerosis and accelerate plaque formation. Thus, untreated depression may worsen cardiac outcomes.

Guest Authors: Hansita B. Patel, PharmD and Abigail L. Hulsizer, PharmD

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Cardiovascular Risk with Elevated Triglycerides - Does Icosapent Ethyl REDUCE-IT?

Although hypertriglyceridemia has consistently been associated with increased CV events, medications that lower triglycerides have failed to reel in a significant reduction in major CV events when combined with statin therapy. Could purified fish oil derivatives be the answer? Or just another red herring? The Reduction of CV Events with Icosapent-Ethyl Intervention Trial (REDUCE-IT) sought to clarify the utility of icosapent ethyl, a highly purified EPA derivative.

Guest Authors: Melissa Norton, PharmD and Elizabeth A. Cook, PharmD, AE-C, BCACP, CDE

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

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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Does a “One-Size-Fits-All” Aspirin Dosing Approach Still Hold WEIGHT?

Personalized medicine is at the forefront of health care today, focusing on how best to tailor the treatment approach to each person. But should we be thinking about personalizing the approach for prevention as well?  The one-dose-fits-all approach has been used in nearly all aspirin studies.  What is poorly understood is the influence of body weight.  Perhaps the reason why aspirin has resulted in only modest benefits in clinical trials might be related to under (and over) dosing based on patient weight.

Podcast Case:  Weight-based Dosing of Aspirin

Guest Author:  Marina Maes, PharmD, BCPS

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Where is the COMPASS Taking Us? Rivaroxaban, Aspirin, or Both for Stable CVD ?

Since the introduction of direct oral anticoagulants (DOACs) less than a decade ago, use of this class has expanded beyond the prevention and treatment of venous thromboembolism and stroke prevention in the setting of atrial fibrillation. The potential role of DOACs in the secondary prevention of coronary artery disease (CAD) has been of considerable interest. In the setting of CAD, warfarin has resulted in significant more major bleeding when given either alone or in combination with antiplatelet agents when compared to aspirin alone.  Therefore, clinicians have been reluctant to embrace the combination of an anticoagulant plus an antiplatelet agent. However, could DOACs have a role in stable CAD? The COMPASS trial aimed to find an answer.

Guest Authors:  Candyce Bryant, Pharm.D., Joy Hoffman, Pharm.D., and M. Shawn McFarland, Pharm.D.

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