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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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Can VOYAGER Put PAD Patients Back on Their Feet?

Peripheral artery disease (PAD) impacts 8.5 million Americans age 40 years or older, often leading to acute limb ischemia, amputation, hospitalization, revascularization, major adverse cardiac events (MACE), and death. In addition to being at very high risk of MACE, more than 10% of PAD patients who had revascularization surgery are hospitalized for major adverse limb events, including acute limb ischemia leading to amputation. Could combination therapy, an antithrombotic regimen comprised of a direct oral anticoagulant and an antiplatelet agent, help prevent limb ischemia and cardiovascular (CV) events in these high-risk patients?

Guest Authors:  Navya Varshney, PharmD, BCPS and Rachel Lowe, PharmD, BCPS

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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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Secondary Stroke Prevention in A-Fib: Do DOACs PROSPER in High-Risk Patients?

Several guidelines now recommend direct oral anticoagulants (DOACs) as the preferred anticoagulants for patients with non-valvular atrial fibrillation (a-fib). However, the landmark clinical trials focused largely on the primary prevention of stroke.  Moreover, real-world data using DOACs for secondary prevention is lacking. Many have argued that warfarin might be a better choice in these high-risk patients because it requires routine monitoring and increases the patient’s contact with the healthcare system. Does the choice of anticoagulant make a difference in preventing recurrent stroke?

Guest Authors: Blaire White, PharmD; Amber Cizmic, PharmD, BCACP; and Tish Smith, PharmD, BCACP

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All for One and FOURIER for All!

Although statins have a proven benefit and are widely used, ASCVD continues to be the leading cause of death in the US.  In 2015, two proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors, alirocumab (Praluent®) and evolocumab (Repatha®), were approved to treat elevated cholesterol when added to maximally-tolerated statin therapy in patients with familial hypercholesterolemia or history of ASCVD.  However, the lack of long-term CV outcomes data, high cost, and uncertainty regarding place in therapy have limited their wide-spread use. The recently published FOURIER Study provides compelling new evidence.

Guest Author:  Kelly Starman, Pharm.D., BCPS

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Beyond Slip, Slop, Slap, and Wrap: Vitamin B3 for Skin Cancer Prevention

“Slip! Slop! Slap! And Wrap!®”, the slogan created by the American Cancer Society is a catchphrase intended to attract the public’s attention, raise awareness of the dangers of ultraviolet (UV) radiation, and promote prevention against skin cancer. Despite public awareness campaigns, the incident of non-melanoma skin cancer (NMSC), including both basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), continues to climb — quite rapidly. They are the most common cancers in the United States. Given the significant and growing morbidity, mortality, and economic burden ofNMSC, finding effective preventative measures are of great interest.

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