1b) Patients with #diabetes #PWDs are of course at substantially increased risk of #CV disease, often in association with hyperlipidemia #HL. Therefore it's no surprise that a 🌶️topic at #ADA23 would be management of #HL and #CV disease prevention!#FOAMed @MedTweetorials
— cardio-met (@cardiomet_CE) June 24, 2023
3) Cardiovascular disease (#CVD) is #1 cause of ☠️in 🇺🇸 & 🇪🇺. #Dyslipidemia is one of the primary causal factors in development of #atherosclerotic CVD (#ASCVD), guidelines rec tx of dyslipidemia for both primary & secondary prevention of ASCVD. pic.twitter.com/dvt6nbam7H
— cardio-met (@cardiomet_CE) June 24, 2023
5) There are two areas of #prevention: #primary and #secondary: pic.twitter.com/zGRmwqpPeW
— cardio-met (@cardiomet_CE) June 24, 2023
7) Lowering #LDL–#cholesterol to improve #CV outcomes is one of the most evidence-based treatments known in medicine. For over 50 years, trials of multiple different interventions have shown benefit. pic.twitter.com/1dGLNDIOyd
— cardio-met (@cardiomet_CE) June 24, 2023
9a) Statin side effects complicate risk reduction strategies. Various #AEs are attributed to statins, but in randomized trials, 2 are significantly different – muscle symptoms & new onset #diabetes. Any symptom leading to pts d/c'ing statins is known as “statin intolerance.”
— cardio-met (@cardiomet_CE) June 24, 2023
9c) #CTC looked at all the statin trials and found modest but significant increase in the risk of muscle side effects with statins, mostly in the first year of use. pic.twitter.com/TLhepWcZLa
— cardio-met (@cardiomet_CE) June 24, 2023
10b) This doc defines #statin_intolerance as adverse effect/s assoc'd w/statin tx that resolve/improve w/ dose ⤵️or d/c, classified as complete inability to tolerate any dose of statin, or partial intolerance w/ inability to tolerate necessary dose to achieve pt's tx objective.
— cardio-met (@cardiomet_CE) June 24, 2023
10b) This doc defines #statin_intolerance as adverse effect/s assoc'd w/statin tx that resolve/improve w/ dose ⤵️or d/c, classified as complete inability to tolerate any dose of statin, or partial intolerance w/ inability to tolerate necessary dose to achieve pt's tx objective.
— cardio-met (@cardiomet_CE) June 24, 2023
12) The main #CLEAR_Outcomestrial comprised 14,014 pts (70% sec prevention, 30% primary randomized to #bempedoic acid or placebo. The study showed a highly significant 13% decrease in the primary endpoint of 4 point #MACE & 15% decrease in 3 point MACE.https://t.co/USdISGpcPm pic.twitter.com/SXC9d9Q0RT
— cardio-met (@cardiomet_CE) June 24, 2023
13b) Overall, #bempedoic acid was well tolerated with a slightly increased incidence of #gout (3.1% versus 2.1%) and cholelithiasis (2.2% versus 1.2%). The incidence of tendon rupture was low at 1.2%.
— cardio-met (@cardiomet_CE) June 24, 2023
14b) They applied the #CTT methodology & endpoint defs to #CLEAR_Outcomes to derive normalized HRs associated with #bempedoic_acid tx for the composite MVE endpoint (fatal #CHD, non-fatal MI, stroke, or revasc) & individual CV outcomes per 1 mmol/L #LDL-C reduction at 1 year.
— cardio-met (@cardiomet_CE) June 24, 2023
14d) They concluded: The #CV benefits achieved with #bempedoic acid are comparable to those obtained with #statins, being proportional to the magnitude of absolute reductions in LDL-C. pic.twitter.com/R8uXKaCvvW
— cardio-met (@cardiomet_CE) June 24, 2023
16a) To refresh your memory, the eligibility criteria for the #CLEAR_Outcomes trial were as follows:
— cardio-met (@cardiomet_CE) June 24, 2023
(🔓https://t.co/USdISGpcPm) pic.twitter.com/o1yESvr6CW
17) In the #primary_prevention cohort, more than half had of pts had diabetes (and were older age), and more than 40% had an elevated risk score. Only 3-4% of the cohort qualified by high #calcium_score.
— cardio-met (@cardiomet_CE) June 24, 2023
These measures were consistent across the #bempedoic acid & placebo groups. pic.twitter.com/8j6WfZs1MT
18b) As single #endpoints, benefit on MI was a 39% reduction with #bempedoic_acid. The effect on stroke was consistent with the primary endpoint effect, but with a small number of events. pic.twitter.com/oBeTY20hVb
— cardio-met (@cardiomet_CE) June 24, 2023
20) What about safety 🛟 findings in a #primary_prevention cohort? The #AE profile was similar to what was seen in the trial as a whole. #Bempedoic_acid was very well tolerated. pic.twitter.com/QENR4bpvvv
— cardio-met (@cardiomet_CE) June 24, 2023
21b) … #bempedoic acid was associated with
— cardio-met (@cardiomet_CE) June 24, 2023
a significant ⬇️in the primary composite end point of time to ☠️from #CV causes, nonfatal #MI, nonfatal #stroke, or coronary #revascularization.
21d) My own @cpcannon takeaway is that we now have a new evidence-based option for #LLT in #primary_prevention that goes beyond #statins. Stay with us as also from #ADA2023 I’ll post more, to put these new data in perspective with other/past primary prevention studies!
— cardio-met (@cardiomet_CE) June 24, 2023
22b) So the correct answer is b, #diabetes. Not a choice listed was #hypertension, which was the most common #cardiometabolic diagnosis in these pts, but is thought to have less impact than #DM. It couldn’t be d, prior MI—this is PRIMARY prevention!
— cardio-met (@cardiomet_CE) June 24, 2023
23b) It's d, #unstable_angina. All-cause death is too variable in attribution and therefore is not included in either #MACE definition.
— cardio-met (@cardiomet_CE) June 24, 2023
24) And, live from #ADA23, you just earned .75h 🆓CE/#CME! Claim your certificate at https://t.co/03d7bb18MJ, and FOLLOW @cardiomet_ce for the latest #cardiometabolic #MedEd delivered wholly on Twitter! @cpcannon & @academiccme thank you for joining us!
— cardio-met (@cardiomet_CE) June 24, 2023