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<recommendedContent xmlns="http://api.mspoke.com">
    <recommendedItem id="20100101_19_3199"
                     title="ESC: Simple Clinical Factors May Provide Clues to Future Ischemic Events (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21940?impressionId=1283456806917"
                     
      STOCKHOLM  --  Easily assessed clinical factors could help predict which atherothrombosis patients might have an increased risk of an ischemic event, according to results of a large international registry.&lt;br&gt;
&lt;br&gt;In four-year data, culled from among more than 32,000 patients, a composite of cardiovascular death, MI, or stroke during follow-up was predicted by diabetes (HR 1.44, 95% CI 1.36 to 1.53), an ischemic event within the past year (HR 1.71, 95% CI 1.57 to 1.85), and polyvascular disease (HR 1.99, 95% CI 1.78 to 2.24).&lt;br&gt;
&lt;br&gt;The findings were reported by Deepak Bhatt, MD, MPH, of Harvard, at the European Society of Cardiology Congress here and were simultaneously published online in the &lt;em&gt;Journal of the American Medical Association&lt;/em&gt;.&lt;p&gt;&lt;/p&gt;

&lt;p&gt;Cardiovascular risk stratification among patients with established atherosclerosis enables the intensity of preventive treatments to be tailored to individual patient groups,&quot; Bhatt said during his presentation.&lt;/p&gt;

&lt;p&gt;Identifying patients at the highest risk within an at-risk population may allow clinicians to more precisely direct novel preventive therapies  --  or enable researchers to design trials for those patients most likely to benefit from new treatments.&lt;/p&gt;
&lt;p&gt;&quot;New antiplatelet, anticoagulant, anti-atherosclerotic, and anti-inflammatory agents will probably be expensive and may have additional adverse effects,&quot; Bhatt and colleagues wrote. &quot;Thus, the ability to target these therapies to patients at highest ischemic risk will be desirable and likely would be cost-effective.&quot;&lt;/p&gt;
&lt;p&gt;The data analyzed came from patients participating in the REACH (Reduction of Atherothrombosis for Continued Health) Registry, which enrolled patients from 3,647 centers in 29 countries. Participants either had to have established coronary artery disease, cerebrovascular disease, or peripheral artery disease, or at least three risk factors for atherothrombosis.&lt;/p&gt;
&lt;p&gt;At baseline, the international registry covered 45,227 patients, but because of centers dropping out, four-year data were only available for 31,195 patients.&lt;/p&gt;
&lt;p&gt;During the follow-up period, between 2003 and 2008, 5,481 patients had at least one ischemic event, including 2,315 who died from cardiovascular causes, 1,228 who had MIs, 1,898 who had strokes, and 40 who had an MI and a stroke on the same day.&lt;/p&gt;
&lt;p&gt;The highest rate of the composite outcome of cardiovascular death, MI, or stroke occurred in patients who had a prior history of ischemic events at baseline (18.3%), followed by those with stable coronary, cerebrovascular, and peripheral artery disease without a history of ischemic events (12.2%) and those without established atherothrombosis but with multiple risk factors (9.1%) (&lt;em&gt;P&lt;/em&gt;&amp;lt;0.001 for all comparisons).&lt;/p&gt;
&lt;p&gt;Rates ranged from a low of 7.1% among patients who had only had cardiovascular risk factors but who were free from diabetes to 25% among patients with a history of ischemic events and polyvascular disease.&lt;/p&gt;
&lt;p&gt;&quot;This greater than three fold gradient in cumulative risk for cardiovascular death, myocardial infarction, or stroke illustrates that not all atherothrombosis is equal  --  an observation that the broad array of clinicians caring for these types of patients may find clinically relevant,&quot; Bhatt and his colleagues wrote in their paper.&lt;/p&gt;
&lt;p&gt;When cardiovascular hospitalization was added to the composite endpoint, rates ranged from 16.6% among patients who made it into the registry based on risk factors alone to 47.1% among those with a baseline history of ischemic events and polyvascular disease.&lt;/p&gt;
&lt;p&gt;The researchers did not find any evidence that their findings varied by geographical region  --  suggesting broad applicability, they noted.&lt;/p&gt;
&lt;p&gt;They acknowledged some limitations to their data, however, including the incomplete follow-up of the initial cohort because of dropouts and the fact that the endpoints were not adjudicated.&lt;/p&gt;
&lt;p&gt;Bhatt also said selection bias could not be ruled out.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The REACH Registry is sponsored by sanofi-aventis, Bristol-Myers Squibb, and the Waksman Foundation and is endorsed by the World Heart Foundation.&lt;/p&gt;&lt;p&gt;The design and conduct of the study were done by the academic executive committee in collaboration with the sponsors. The collection and management of the data were done by the sponsors under the direction of the academic executive committee. Analysis was done by the sponsors and independently verified by an academic statistician; the latter analyses were presented in the paper. The sponsors were able to review but not approve the study.&lt;/p&gt;&lt;p&gt;Bhatt reported having received institutional research support from AstraZeneca, Bristol-Myers Squibb, Eisai, Ethicon, Heartscape, sanofi-aventis, and The Medicines Company.&lt;/p&gt;&lt;p&gt;His co-authors reported numerous relationships with industry. One of the authors is employed by sanofi-aventis.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3195"
                     title="ESC: Hot Line Actually Only Lukewarm"
                     score="0.011"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21936?impressionId=1283456806917"
                     
      &lt;p&gt;STOCKHOLM  --  Intracoronary bone marrow cell transplantation extended survival in patients with chronic heart failure due to ischemic cardiomyopathy  --  that was the good news. The bad news was that the finding was not &quot;new&quot; at all  --  it had already been published.&lt;/p&gt;
&lt;p&gt;Late today the European Society of Cardiology said it would sanction the researcher who reported the stem cell study by barring him from presenting research at ESC congresses for two years.&lt;/p&gt;
&lt;p&gt;The ESC guidelines for Hot Line trials specifically state that the information submitted should be new, unpublished data. Yet, the STAR trial was accepted for presentation as a Hot Line trial at the ESC annual meeting here.&lt;/p&gt;
&lt;p&gt;When asked by &lt;em&gt;MedPage Today&lt;/em&gt; to point out the &quot;news&quot; in the Hot Line presentation, STAR lead investigator Bodo-Eckehard Strauer, MD, of the Heinrich Heine University of D&amp;#252;sseldorf, Germany, said the news was that bone marrow cell therapy significantly improved survival in patients with chronic cardiomyopathy, which he illustrated with a slide showing a Kaplan-Meier curve  --  the same graph that was published in the July issue of the &lt;em&gt;European Journal of Heart Failure.&lt;/em&gt; Moreover, every data slide in Strauer&apos;s presentation matched the tables in the published paper.&lt;/p&gt;
&lt;p&gt;Late today, the ESC acknowledged the breach of congress rules in a statement saying that it &quot;acknowledges that significant information pertaining to the results of the STAR Heart Study, presented today at ESC Congress 2010 as novel had already been published prior to [the] ESC Congress.&quot;&lt;/p&gt;
&lt;p&gt;The presentation therefore, &quot;clearly breaks ESC rules for Hot Line Sessions, which state that information must be first presented at ESC Congresses in order to qualify for presentation in a Hot Line session.&quot;&lt;/p&gt;
&lt;p&gt;The ESC said it was not informed of the publication before the meeting. As a result of the violation, the ESC said it would &quot;not accept abstracts from this investigator for a period of two years.&quot;&lt;/p&gt;
&lt;p&gt;According to information in the journal, Strauer and colleagues submitted their paper in February, revised it in April, and the journal accepted it in late April.&lt;/p&gt;
&lt;p&gt;It should be noted that the &lt;em&gt;European Journal of Heart Failure &lt;/em&gt;is a journal of the ESC.&lt;/p&gt;
&lt;p&gt;Immediately after the press briefing &lt;em&gt;MedPage Today&lt;/em&gt; asked Fausto Pinto, MD, PhD, the ESC program chair, and ESC President Roberto Ferrari, MD, why they had accepted the STAR paper as a Hot Line presentation. They said &quot;we thought there were new data.&quot;&lt;/p&gt;
&lt;p&gt;Ferrari then added, &quot;We were snookered.&quot;&lt;/p&gt;

    </recommendedItem>
    <recommendedItem id="20100101_19_3191"
                     title="ESC: It&apos;s Not Butter and It&apos;s Not Better (CME/CE)"
                     score="0.011"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21921?impressionId=1283456806917"
                     
      STOCKHOLM  --  Adding margarine enriched with omega-3 fatty acids as a dietary intervention did not prevent second heart attacks in older men and women at risk for worsening heart disease, researchers said here.&lt;br&gt;
&lt;br&gt;The study results are doubly disappointing since the margarine intervention did initially reduce events, but by 30 months the evidence of that benefit had disappeared, said Daan Kromhout, MPH, PhD, of Wageningen University in the Netherlands.&lt;br&gt;
&lt;br&gt;After more than 40 months, consumption of the omega-3 fatty acid fortified margarines &quot;had no effect on the rate of major cardiovascular events,&quot; he reported at a Hot Line session today at the European Society of Cardiology meeting. The findings were simultaneously published online by the &lt;em&gt;New England Journal of Medicine.&lt;/em&gt;&lt;/p&gt;
&lt;p&gt;The ALPHA-OMEGA trial randomized 4,837 MI survivors, 60 to 80 years old, to margarine supplemented with a combination of eicosapentaenoic acid and docosahexaenoic acid (EPA and DHA), or with 2 grams of the plant-derived fatty acid alpha-linolenic acid (ALA), or a third supplemented with all three versus a placebo margarine.&lt;/p&gt;
&lt;p&gt;The primary endpoint was the combined rate of fatal and non-fatal cardiovascular events and cardiac interventions.&lt;/p&gt;
&lt;p&gt;Neither EPA-DHA nor ALA reduced this endpoint, the researchers reported (hazard ratio with EPA-DHA, 1.01; 95% confidence interval 0.87 to 1.17, &lt;em&gt;P &lt;/em&gt;=0.93).&lt;/p&gt;
&lt;p&gt;A prespecified subgroup analysis in women found that use of the ALA-fortified margarine reduced the rate of cardiovascular events compared with placebo or with the EPA-DHA margarine, but the difference failed to reach statistical significance (HR 0.73, 95% CI 0.51 to 1.03, &lt;em&gt;P&lt;/em&gt;=0.07).&lt;/p&gt;
&lt;p&gt;Alfred Bove, MD, of Temple University in Philadelphia, said the findings surprised him &quot;because most of the data on omega-3 fatty acids come from epidemiologic studies and those were positive.&quot;&lt;/p&gt;
&lt;p&gt;He likened the situation to hormone therapy, which had been widely recommended to reduce cardiovascular risk in postmenopausal women based on data from epidemiologic studies.&lt;/p&gt;
&lt;p&gt;That hypothesis was initially questioned when a randomized controlled trial (Estrogen/Progestin Replacement Study [HERS]) linked hormones to increased risk of events. The HERS finding was confirmed in the landmark Women&apos;s Health Initiative trial in which ischemic events were more common among women randomized to estrogen/progestin.&lt;/p&gt;
&lt;p&gt;R. Scott Wright, MD, of the Mayo Clinic in Rochester, Minn., told &lt;em&gt;MedPage Today&lt;/em&gt; that the trial design was faulty, in that margarine was a bad choice of vehicle for omega-3 fatty acids.&lt;/p&gt;
&lt;p&gt;&quot;It needs to be combined with another food  --  bread,&quot; he said. &quot;So this not a good option for Americans because it would mean eating more bread, which is likely to lead to weight gain and bread is high in sodium, so blood pressure would be a factor.&quot;&lt;/p&gt;
&lt;p&gt;Wright noted that the ALPHA-OMEGA study did not include information on weight or blood pressure, so he considered the findings at best incomplete.&lt;/p&gt;
&lt;p&gt;All of the patients received &quot;state-of-the-art antihypertensive, antithrombotic, and lipid-modifying therapy,&quot; according to Kromhout and colleagues, in addition to margarine, and it may have been that optimal therapy that limited the potential for an omega-3 benefit.&lt;/p&gt;
&lt;p&gt;Statin therapy, along with other improvements in cardiovascular care, means &quot;a beneficial effect of low doses of EPA-DHA is difficult to prove,&quot; the authors wrote.&lt;/p&gt;
&lt;p&gt;Wright said he wasn&apos;t persuaded by that explanation since, even after optimal therapy, there is about a 30% residual risk. &quot;There is plenty of room to show a benefit,&quot; he declared.&lt;/p&gt;
&lt;p&gt;Most of the patients in ALPHA-OMEGA were men (78%) and 24% were obese, but they differed from the typical high-risk American in at least one way: at baseline they consumed about three times more fish than does the typical American, a median of 15 grams a day.&lt;/p&gt;
&lt;p&gt;According to a report from the Environmental Protection Agency, average fish consumption in the U.S. works out to 4.58 &amp;#177; 0.42 grams a day.&lt;/p&gt;
&lt;p&gt;The authors conducted a post hoc exploratory analysis in patients with diabetes, finding significant reductions in events among patients in the EPA-DHA group. But the authors noted that &quot;[the] results with respect to patients with diabetes are only hypothesis-generating and do not permit definitive conclusions to be drawn.&quot;&lt;/p&gt;
&lt;p&gt;Bove, a former president of the American College of Cardiology, added that the results from the subset analysis in diabetics was reassuring, since patients with diabetes and elevated triglycerides are the patients that &quot;we have believed would be most likely to benefit&quot; from omega-3 fatty acids.&lt;/p&gt;
&lt;p&gt;The margarines used in the trial were supplied by Unilever, an international maker of food and consumer goods, and included the well-known &quot;I Can&apos;t Believe It&apos;s Not Butter,&quot; which contains 420 mg of ALA per serving.&lt;/p&gt;

&lt;p&gt;In a statement released after the ALPHA-OMEGA trial findings were presented, Unilever said the &quot;study outcome for EPA and DHA is surprising considering the weight of evidence published to date. This could be the result of methodological issues such as the relatively low daily dosage compared with previous studies or the fact that in this study serious cardiovascular events were much lower than in studies performed in the past. This is probably due to extensive drug treatment that is nowadays applied. The finding needs further study, but given the totality of evidence does not immediately impact the current advice on fish and fish oil consumption for prevention of cardiovascular disease.&quot;&lt;/p&gt;

&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;The trial was supported by the Netherlands Heart Foundation, the National Institutes of Health, and Unilever.&lt;/p&gt;&lt;p&gt;Kromhout reported that his institution received grant support form Unilever to cover distribution of the trial margarines to patients. His institution also received a grant from the Product Board for Margarine Fats and Oils to support research on polyunsaturated fats and cardiovascular diseases done by a PhD student.&lt;/p&gt;&lt;p&gt;Bove said he had no financial conflicts.&lt;/p&gt;&lt;p&gt;Wright said he consults for Roche and Genentech and conducts trial work for 3M/Littman.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3180"
                     title="ESC: ECG Not Much Help for Screening Athletes&apos; Hearts (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21911?impressionId=1283456806917"
                     
      STOCKHOLM  --  While hypertrophic cardiomyopathy is the most common cause of sudden death in competitive soccer players, when pro players were screened for the problem with electrocardiography (ECG), the positive results all turned out to be false positives, according to a small study.&lt;br&gt;
&lt;br&gt;The study of 30 pro soccer players who underwent 12-lead ECG screening showed that nearly 60% displayed abnormalities suggestive of cardiac hypertrophy  --  but none were confirmed with MRI scans, according to Jose Angel Cabrera, MD, of Hospital Quiron in Madrid, Spain, and colleagues.&lt;br&gt;
&lt;br&gt;In an abstract scheduled for presentation here at the European Society of Cardiology (ESC) annual meeting, the researchers indicated that recommendations for routine ECG-based screening of athletes &quot;should be reevaluated.&quot;&lt;p&gt;&lt;/p&gt;
&lt;p&gt;Some earlier studies, particularly from Italy, had indicated that 12-lead ECG screening &lt;a href=&quot;http://www.medpagetoday.com/MeetingCoverage/ESCCongress/10738&quot; mce_href=&quot;http://www.medpagetoday.com/MeetingCoverage/ESCCongress/10738&quot; target=&quot;_blank&quot;&gt;could identify athletes&lt;/a&gt; with hypertrophic cardiomyopathy, putting them at risk for sudden cardiac death. Making such screening routine in Italy was said to &lt;a href=&quot;http://www.medpagetoday.com/Cardiology/Arrhythmias/4230&quot; mce_href=&quot;http://www.medpagetoday.com/Cardiology/Arrhythmias/4230&quot; target=&quot;_blank&quot;&gt;reduce cardiac arrests&lt;/a&gt; among athletes by 90%.&lt;/p&gt;
&lt;p&gt;However, the new Spanish study suggests that instituting such screening may also involve a great deal of waste  --  since positive findings typically result in expensive follow-up evaluations.&lt;/p&gt;
&lt;p&gt;Cabrera and colleagues reported on their experience with 30 professional soccer players, mean age 31 (SD 4), who underwent 12-lead ECG screening conducted and interpreted according to proposed ESC guidelines.&lt;/p&gt;
&lt;p&gt;The participants also underwent MRI cardiac scans and genotyping for mutations in nine genes known to be associated with various types of heart disease.&lt;/p&gt;
&lt;p&gt;ECG results in 17 of the players showed abnormalities that, under the guidelines, were indicative of cardiac hypertrophy warranting follow-up.&lt;/p&gt;
&lt;p&gt;But the MRI results in all 17 showed normal left ventricular wall thickness and no signs of systolic anterior mitral valve motion or left ventricular outflow obstruction.&lt;/p&gt;
&lt;p&gt;On the other hand, the evaluations failed to identify minor pericardial effusion in two players and persistent ductus arteriosus in another.&lt;/p&gt;
&lt;p&gt;None of the participants had risk-associated genotype findings.&lt;/p&gt;
&lt;p&gt;Alfred Bove, MD, of Temple University in Philadelphia and past president of the American College of Cardiology, told &lt;em&gt;MedPage Today&lt;/em&gt; in an interview that the findings are plausible but at the same time pose a conundrum for clinical practice.&lt;/p&gt;
&lt;p&gt;&quot;It&apos;s a tough call,&quot; he said. &quot;How do you find these kids [with serious cardiac abnormalities]? It&apos;s very small numbers, one in 100,000 or something like that. How many do you screen with expensive tests to find the one kid  --  it becomes a big issue.&quot;&lt;/p&gt;
&lt;p&gt;He noted that ECG screening is relatively cheap and easy to perform, and there is nothing else available for mass use that would not cost substantially more.&lt;/p&gt;
&lt;p&gt;But Bove agreed that relying on ECG causes problems, particularly in the U.S. where rates of actual cardiac abnormalities are much lower than in northern Italy, where the research underlying the current recommendations was conducted.&lt;/p&gt;
&lt;p&gt;&quot;The Italians have convinced the world that everybody should have an electrocardiogram,&quot; he quipped.&lt;/p&gt;
&lt;p&gt;Bove, who said he sometimes helps evaluate young athletes with suspected heart problems, indicated that, as a result, it&apos;s common to see one athlete &quot;with a very bizarre-looking electrocardiogram  --  perfectly normal kid, playing excellent sports, no history of anything ... and everybody gets all upset.&quot;&lt;/p&gt;
&lt;p&gt;He said these athletes can get &quot;million-dollar workups&quot; that, most times, show nothing abnormal other than the &quot;weird&quot; ECG.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;No external funding for the study was reported.&lt;/p&gt;&lt;p&gt;Cabrera had no conflict of interest disclosures.&lt;/p&gt;&lt;p&gt;Bove said he had no relationships with commercial entities relevant to the research.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
    <recommendedItem id="20100101_19_3177"
                     title="ESC: Switching Statins Often Leads to Wrong Doses (CME/CE)"
                     score="0.01"
                     href="http://www.medpagetoday.com/MeetingCoverage/ESCCongress/tb/21906?impressionId=1283456806917"
                     
      &lt;p&gt;STOCKHOLM  --  A third of patients on lipid-lowering therapy received inadequate doses of generic simvastatin after being switched from atorvastatin (Lipitor), an analysis of a large pharmacy database showed.&lt;/p&gt;
&lt;p&gt;On the basis of atorvastatin&apos;s 2:1 potency ratio versus simvastatin, fewer than half of patients received equipotent doses after the switch. The switching occurred after a government-mandated change in rules for using branded statins in the Netherlands.&lt;/p&gt;
&lt;p&gt;Statistical models suggested inadequate dosing would lead to a 5.6% increase in LDL cholesterol, possibly increasing the risk of cardiovascular events, according to a study that will be reported here at the European Society of Cardiology meeting next week.&lt;/p&gt;
&lt;p&gt;&quot;The predicted net effect of this would be at least a 5% to 6% increase in low-density lipoprotein cholesterol, which translates to a 3% average increase in the risk of heart disease and stroke,&quot; Danny Liew, MD, of the University of Melbourne in Australia, said in a statement.&lt;/p&gt;
&lt;p&gt;&quot;Our study highlights the need for health policymakers to be conscious of the potential adverse and unintended consequences of policy changes and for clinicians to be aware of dose equivalences among statins,&quot; Liew added in an e-mail to &lt;em&gt;MedPage Today&lt;/em&gt;.&lt;/p&gt;
&lt;p&gt;Patients on higher doses of atorvastatin were more likely to be switched to less than equipotent doses of simvastatin, he said.&lt;/p&gt;
&lt;p&gt;The findings came from an analysis of a nationwide pharmacy database and included 39,031 patients switched from atorvastatin to simvastatin during the first quarter of 2009. The switches occurred after the Dutch government began requiring physicians to justify prescriptions for branded statins.&lt;/p&gt;
&lt;p&gt;Liew and colleagues conducted the analysis after prescription data suggested that switching often resulted in simvastatin doses that did not have potency equivalent to that of atorvastatin. They determined relative potency on the basis of a published meta-analysis of randomized clinical trials comparing the two drugs (&lt;em&gt;Clin Ther&lt;/em&gt; 2007; 29: 242-252).&lt;/p&gt;
&lt;p&gt;Their analysis showed that 33.7% of patients received less than equipotent doses of simvastatin after switching from atorvastatin, 19.1% received more potent doses of simvastatin, and 47.2% received equipotent doses. The weighted-average initial doses were 19.6 mg for atorvastatin and 32.9 mg of simvastatin.&lt;/p&gt;
&lt;p&gt;Among the subgroup of patients switched to less potent doses of simvastatin, the initial dose averaged 28.9 mg for atorvastatin and 27.8 mg for simvastatin.&lt;/p&gt;
&lt;p&gt;&quot;Patients on higher doses of initial atorvastatin were more likely to switch to less potent doses of simvastatin,&quot; Liew commented. &quot;It may be that clinicians may be reluctant to prescribe high doses of simvastatin.&quot;&lt;/p&gt;
&lt;p&gt;A recent meta-regression study showed that every 25 mg/dL (0.65 mmol/L) reduction in LDL lowers the risk of any CVD event by 14%, a coronary event by 16%, stroke by 10%, and cardiovascular death by 11% (&lt;em&gt;Curr Ther&lt;/em&gt; 2009; 31: 236-244). Given that inadequate simvastatin dosing was modeled to lead to a 5.6% increase in LDL, the investigators estimated that inadequate dosing of simvastatin would increase cardiovascular risk by 3%.&lt;/p&gt;
&lt;p&gt;The magnitude of the increase in risk varied by baseline LDL value and the type of CVD event assessed. The estimated added risk ranged from a 1.7% increase in stroke for patients with a baseline LDL of 2.0 mmol/L to a 5.5% increase in coronary events among patients with a baseline LDL of 4.0 mmol/L.&lt;/p&gt;
&lt;p&gt;A U.S. cardiologist echoed Liew&apos;s cautionary statements regarding the possible risks associated with switching to an inadequate statin dose.&lt;/p&gt;
&lt;p&gt;&quot;The consequences of switching from Lipitor to simvastatin on LDL cholesterol on any CVD event, coronary event, stroke, and CVD death in the Dutch population are noteworthy and of concern,&quot; said Robert Eckel, MD, of the University of Colorado. &quot;Despite the cost-saving benefits of such a change, the increased risk demands better guidance on how to prescribe equipotent doses.&quot;&lt;/p&gt;
&lt;p&gt;Eckel is a spokesperson for the American Heart Association and was not involved in the study.&lt;/p&gt;
&lt;div style=&quot;float:left;border-style:solid;border-width:1px;border-color:#8dabbc;font-family:arial;font-size:12px;background-color:#DBE9F2;padding:5px;&quot;&gt;&lt;p&gt;Liew and Eckel reported no relevant disclosures. Liew&apos;s co-investigators included employees of Pfizer.&lt;/p&gt;&lt;/div&gt;&lt;div style=&quot;clear:both;&quot;&gt;&lt;/div&gt;
    </recommendedItem>
</recommendedContent>