Cardiovascular Prevention and Pharmacotherapy

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Special Article

Update on the Pharmacotherapy of Heart Failure with Reduced Ejection Fraction: Eui-Soon Kim, Jong-Chan Youn, Sang Hong Baek; Cardiovasc Prev Pharmacother. 2020;2(4):113-133. Published online October 31, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e17

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Abstract PDF: Heart failure (HF) is an important cardiovascular disease because of the increasing prevalence, high morbidity and mortality, and rapid expansion of health care costs. Over the past decades, efforts have been made to modify the prognosis of patients with HF. Regarding HF with reduced ejection fraction (HFrEF), several drugs have shown to improve mortality and morbidity, based on large-scale randomized controlled trials, leading to a critical paradigm shift in its pharmacological treatment. The paradigm of HFrEF pathophysiology has shifted from cardiorenal disease to hemodynamic changes, and neurohormonal activation is currently considered the prime pathophysiological mechanism of HFrEF. This review summarizes evidence on the pharmacological management of HFrEF derived from major randomized controlled trials, which have accomplished improvements in survival benefits.

Review Article

Recent Technology-Driven Advancements in Cardiovascular Disease Prevention: Jisan Lee, Hun-Sung Kim, Dai-Jin Kim; Cardiovasc Prev Pharmacother. 2019;1(2):43-49. Published online October 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e7

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Abstract PDF Supplementary Material: Recent dramatic developments in information and communication technologies have been widely applied to medicine and healthcare. In particular, biometric sensors in wearable devices linked to smartphones are collecting vast amounts of personal health data. To best use these accumulated data, personalized healthcare services are emerging, and digital platforms are being developed and studied to enable data integration and analysis. The implementation of biometric sensors and smartphones for cardiovascular and cerebrovascular healthcare emerged from the research on the feasibility and efficacy of the devices in the clinical environment. It is important to understand the recent research trends in data generation, integration, and application to prevent and treat cardiovascular and cerebrovascular diseases. This paper describes these recent developments in treating cardiovascular diseases.

Original Article

Aspirin Has a Neutral Effect in Preventing Future Cardiovascular Events in Vasospastic Angina: Kwan Yong Lee, Dong Il Shin, Sung Ho Her, Seung Hwan Han, Youngkeun Ahn, Dong-Soo Kim, Dong-Ju Choi, Hyuck Moon Kwon, Hyeon-Cheol Gwon, Seung-Woon Rha, Sang-Ho Jo, Sung Cil Lim, Jun-Pyo Myong, Sang Hong Baek; Cardiovasc Prev Pharmacother. 2019;1(1):30-42. Published online July 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e4; Correction in: Cardiovasc Prev Pharmacother 2020;2(1):31

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Abstract PDF: Background
The aim of this multi-center prospective registry study was to evaluate the clinical efficacy of low-dose aspirin in vasospastic angina (VA) patients for the prevention of future cardiovascular events.
Methods
A total of 1,717 patients with positive and intermediate results of an intracoronary ergonovine provocation test in the VA in Korea registry (n=2,960) were classified into 100 mg/day aspirin intake (aspirin, n=743) and no-aspirin intake (control, n=974) groups. The primary end-point was a composite of major adverse cardiac events (MACEs) including cardiac death, new-onset arrhythmia, and acute coronary syndrome.
Results
The median follow-up duration was 2.0 years (25–75th, interquartile range 0.9–3.0 years). Cumulative composite MACE in the propensity score matched-pair cohort (n=1,028) was 3.6%. There was no significant difference in composite MACE between the aspirin and control groups (3.1% vs. 4.1%; hazard ratio [HR], 1.18; 95% confidence interval [CI], 0.61–2.26; p=0.623). A sensitivity analysis of only the VA-positive population showed these results to be consistent. Even for patients with minimal organic stenosis (n=369), aspirin usage was not related to the incidence of a composite MACE (HR, 1.61; 95% CI, 0.55–4.72; p=0.380).
Conclusions
Low-dose aspirin does not protect against future cardiovascular events in VA patients, even patients who combine with minimal coronary artery stenosis.

Special Articles

Geriatric Considerations in the Management of Elderly Patients with Cardiovascular Diseases: Doo Soo Jeon; Cardiovasc Prev Pharmacother. 2021;3(2):38-46. Published online April 30, 2021; DOI: https://doi.org/10.36011/cpp.2021.3.e6

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Abstract PDF: Cardiovascular disease (CVD) is the most frequently diagnosed disease as well as the leading cause of death in the elderly. It usually results from long-term effects of cardiovascular risk factors as well as the aging process itself. Elderly people commonly have geriatric syndrome, which is an age-specific problem that is complicated by the presence of cardiovascular, cognitive, and physical dysfunction and is accompanied by many other chronic diseases. While caring for the elderly, in addition to CVD, various inherent problems must be considered. The patient-centered approach, instead of evidence-based guidelines that are designed for young adult patients, is the most important concept when it comes to elderly patients with CVD and multiple comorbidities. This approach should be used to maintain the functionality, independence, quality of life, and dignity of these patients.

Tafamidis for Cardiac Transthyretin Amyloidosis: Darae Kim, Jin-Oh Choi, Eun-Seok Jeon; Cardiovasc Prev Pharmacother. 2021;3(1):1-9. Published online January 31, 2021; DOI: https://doi.org/10.36011/cpp.2021.3.e1

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Abstract PDF: Transthyretin amyloid (ATTR) cardiomyopathy is a progressive disease caused by the infiltration of ATTR fibrils in the myocardium. Although it is a rare disease, ATTR cardiomyopathy is an important cause of heart failure with preserved ejection fraction, and its incidence is increasing due to improved diagnostic imaging tools. There has been a breakthrough in the field of transthyretin amyloidosis, which opens a new therapeutic door for the patients. In this review, an overview of tafamidis therapy in ATTR cardiomyopathy with recent results from clinical trials will be discussed.

Logistic Regression and Least Absolute Shrinkage and Selection Operator: Hyunyong Lee, Hun-Sung Kim; Cardiovasc Prev Pharmacother. 2020;2(4):142-146. Published online October 31, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e15

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Abstract PDF: Logistic regression, a model that forms a binary dependent variable and one or more independent variable(s), is used especially in epidemiological studies. By understanding the logistic model and its applications, such as odds ratio (OR) and performance efficiency, the concept of logistic regression can be easily grasped. The purpose of this article is to 1) introduce logistic regression, including odds and OR, 2) present predictive efficiency, such as area under the curve, and 3) explain the caution of logistic regression analysis.

Original Article

Changes in Target Achievement Rates after Statin Prescription Changes at a Single University Hospital: Seon Choe, Jiwon Shinn, Hun-Sung Kim, Ju Han Kim; Cardiovasc Prev Pharmacother. 2020;2(3):103-111. Published online July 31, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e14

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Abstract PDF: Background
We investigated the changes in low-density lipoprotein cholesterol (LDL-C) target achievement rates (<70 and <100 mg/dL) when the prescription changed from various statins to Lipilou^®, a generic formulation of atorvastatin.
Methods
This was a retrospective cohort study of patients who had been prescribed Lipilou^® for more than 3 months at Seoul National University Hospital from 2012 to 2018. For patients who were treated with a previous statin before the prescription of Lipilou^®, changes in target achievement rates of LDL-C less than 70 and less than 100 mg/dL were confirmed 3–6 months after the prescription of Lipilou^®.
Results
Among the 683 enrolled patients, when their prescription was changed to Lipilou^®, the target achievement rate of LDL-C significantly increased for LDL-C less than 70 mg/dL (from 22.1% to 66.2%, p<0.001) and less than 100 mg/dL (from 26.8% to 75.3%, p<0.001). In particular, when a moderate-low potency statin was changed to Lipilou^® (10 mg), the target achievement rates for LDL-C less than 70 mg/dL (from 28.9% to 66.7%, p<0.001) and less than 100 mg/dL (from 42.2% to 86.7%, p<0.001) significantly increased. The change from a moderate-high potency statin to Lipilou^® (20 mg) showed an increased target achievement rates for LDL-C <70 mg/dL (from 33.3% to 80.0%, p=0.008) and 100 mg/dL (from 40.0% to 73.3%, p<0.025).
Conclusions
We cannot simply conclude that Lipilou^® is superior to other statins. However, when the target LDL-C was not reached with previous statin treatments, a high target achievement rate could be achieved by changing the prescription to Lipilou^®. Physicians should always consider aggressive statin prescription changes for high target achievement rates.

Special Articles

Pragmatic Clinical Trials for Real-World Evidence: Concept and Implementation: Na-Young Jeong, Seon-Ha Kim, Eunsun Lim, Nam-Kyong Choi; Cardiovasc Prev Pharmacother. 2020;2(3):85-98. Published online July 31, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e12

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Abstract PDF: The importance of real-world evidence (RWE) has been highlighted in recent years, and the limitations of the classical randomized controlled trials, also known as explanatory clinical trials (ECTs), have been emphasized. Post-marketing observational studies have several problems, such as biases and incomparability between patient groups, and RWE can only be obtained after a certain period. Therefore, pragmatic clinical trials (PCTs) have garnered attention as an alternative to obtaining scientifically robust RWE in a relatively short time. PCTs are clinical trials that have a pragmatic concept, i.e., the opposite of ECTs and are intended to help decision makers by evaluating the effectiveness of interventions in routine clinical practice. The characteristics of PCTs are the inclusion of various patients in clinical practice, recruitment of patients in heterogeneous settings, and comparison with actual clinical treatments rather than a placebo. Thus, the results of PCTs are likely to be generalized and can have a direct impact on clinical and policy decision-making. This study aimed to describe the characteristics and definitions of PCTs compared with those of ECTs and to highlight the important considerations in the planning process of PCTs. To perform PCTs for the purpose of obtaining RWE, the contents covered in this study will be helpful.

Effects of Low-Carbohydrate, High-Fat Diets on Weight Loss, Cardiovascular Health and Mortality: Bo-Yeon Kim; Cardiovasc Prev Pharmacother. 2020;2(2):43-49. Published online April 30, 2020; DOI: https://doi.org/10.36011/cpp.2020.2.e7

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Abstract PDF: Obesity is a worldwide health challenge. The clinical consequences of obesity include nonalcoholic fatty liver disease, type 2 diabetes, and coronary heart disease. Numerous diets have been developed to reduce the incidence of cardiovascular diseases and induce weight loss. Low-carbohydrate, high-fat diets (LCHFDs) have become increasingly popular for weight loss. LCHFDs have led to weight loss in some clinical studies. However, the safety of LCHFDs and their long-term effects on the human body are still controversial. In this review, I will discuss the effects of LCHFDs on weight loss, cardiovascular health, and mortality.

Review Articles

Challenges and Future in Precision Cardiovascular Medicine: Sang Hong Baek; Cardiovasc Prev Pharmacother. 2019;1(1):10-18. Published online July 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e3

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Abstract PDF: Cardiovascular disease (CVD) still remains the global leading cause of mortality and also impose major burdens on morbidity, quality of life, and societal costs despite of the remarkable progress of cardiovascular (CV) treatment over the past 50 years. CVD therapy improves CV outcomes in less than half of patients. Precision medicine is an attractive and advancing strategy to enhance for disease prevention, diagnosis, and tailored treatment and allocate limited resources more wisely and effectively. We are now in the middle of fourth industrial revolution by a robust confluence of biotechnology, physical science and information technologies. This approach is in its premature so far, but has begun to yield useful information that moves from the conventional ‘average response’ approach to more specific and targeted approaches governed by individual variability. This review aims to how precision medicine, genomics, and epigenetics work together to create a new era of CV precision medicine.

Asian Cohort Studies on Cardiovascular Risk Factors in Childhood: Sun Jae Jung, Hyeon Chang Kim, Il Suh; Cardiovasc Prev Pharmacother. 2019;1(1):3-9. Published online July 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e2

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Abstract PDF: Long-term cohort studies have shown that cardiovascular risk factors measured during childhood were associated with levels of adult cardiovascular risk factors and also with the lifetime risk of cardiovascular disease (CVD). However, most of the epidemiologic evidence was from Western studies and relatively small in the Asian population. From the literature, we identified and reviewed 8 Asian cohort studies focusing on cardiovascular risk factors among children. The Asian cohort studies have confirmed that childhood risk factors can predict later levels of adult risk factors. Besides, it has been shown that childhood risk factors are associated with intermediate phenotypes, such as metabolic disturbance and degenerative vascular changes, in adulthood. These findings reaffirmed the importance of screening and managing cardiovascular risk factors from early life in Asia. However, there is little evidence on CVD incidence and mortality because there is no Asian cohort study, which observed from childhood until middle-aged or old ages. Longer follow-up data are required to measure the impact of childhood cardiovascular risk factors, especially since obesity and other cardiovascular risk factors are increasing in Asian children and adolescents.

Role of Novel Oral Anticoagulant for Patient with Atrial Fibrillation Underwent Percutaneous Coronary Intervention: Jang-Whan Bae; Cardiovasc Prev Pharmacother. 2019;1(1):19-29. Published online July 31, 2019; DOI: https://doi.org/10.36011/cpp.2019.1.e1

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Abstract PDF: Atrial fibrillation (AF) is very common arrhythmic disorder especially in elderly population, and makes higher major adverse cardiac events (MACEs) in the patients with acute coronary syndrome (ACS) or underwent percutaneous coronary intervention (PCI). Pivotal drug for AF patients to reduce systemic embolism was warfarin, and certain duration of dual antiplatelet therapy (DAPT) is important after PCI with stent. But, best regimen of antithrombotic agent after PCI in AF is unclear especially in the clinical use of novel oral anticoagulant (NOAC). This manuscript will deal those clinical studies to indicate optimal regimen and duration of NOAC use for AF patients underwent PCI. NOAC use on DAPT significantly reduces major or minor bleeding compared to warfarin in AF patients with ACS or underwent PCI. But, the duration of NOAC use is still unclear, and there is exist clear contraindication to use it in clinical field. NOAC use reduced major or minor bleeding significantly compared to warfarin, but the incidence of MACEs was similar between warfarin and NOAC. Physician should understand the advantage or disadvantage of NOAC use, and be able to tailor the regimen and duration of antithrombotics including NOAC in this higher risk patient population.

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