Despite rising prevalence of heart disease in China, primary preventive treatment rates remain low

1. Despite rising prevalence of heart disease in China, primary preventive treatment rates remain low

Abstract: http://annals.org/aim/article/doi/10.7326/M18-1932

Editorial: http://annals.org/aim/article/doi/10.7326/M18-3301

URLs go live when the embargo lifts

About one in 10 middle-aged adults in China are at high risk for cardiovascular disease (CVD), yet use of risk reduction therapies is strikingly low. Findings from a Chinese national screening project are published in Annals of Internal Medicine.

CVD accounted for 40 percent of all deaths in China in 2015 and this burden is expected to increase because of the aging of the Chinese population and an increase in the prevalence of risk factors, such as hypertension, diabetes, and smoking. Identifying and modifying risk factors for persons at high risk for CVD would have a considerable impact on population health, but nationwide information is lacking about the prevalence and treatment of high CVD risk.

Researchers from the National Center for Cardiovascular Diseases in China investigated the prevalence, features, and treatment of high CVD risk among 1.7 million persons from the China PEACE Million Persons Project, which is a government-funded, community-based, national project of CVD screening and management conducted in the mainland of China. Among nearly 1.7 million participants aged 35-75 years, 9.5 percent had a high risk for CVD. Of those with high CVD risk, only 0.6 percent and 2.4 percent reported using statins and aspirin, respectively. According to the authors, these findings indicate that an immense opportunity exists for risk mitigation in Chinese population.

The authors of an accompanying editorial from Tulane University, CVD prevalence estimates reported in the study very likely underrepresent the true burden of illness due to CVD in China. They suggest that this study is an important call-to-action for highly populated middle- and low-income countries where the CVD risk factor profile is worsening faster than the current health sector can respond to it. There appears to be an urgent need for diagnosis and medical treatment of CVD.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Jiapeng Lu, MD, PhD, can be contacted directly at jiapeng.lu@fwoxford.org.

2. Zoster recombinant vaccine provides better value and better protection against shingles

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2347

Editorial: http://annals.org/aim/article/doi/10.7326/M19-0141

URLs go live when the embargo lifts

Vaccination with the new recombinant zoster vaccine (RZV) provides greater protection against shingles and is cost-effective compared with zoster vaccine live (ZVL) or no vaccination. Findings from a cost-effectiveness study are published in Annals of Internal Medicine.

The U.S. Advisory Committee on Immunization Practices (ACIP) recently developed recommendations for use of the new RZV for prevention of the herpes zoster virus in adults. The newer vaccine has shown higher efficacy than ZVL in clinical trials.

Researchers from the University of Michigan and the Centers for Disease Control and Prevention (CDC) developed a simulation model using U.S. epidemiologic, clinical, and cost data to evaluate the cost-effectiveness of vaccination with RZV compared with ZVL and no vaccination. They also looked at the cost-effectiveness of vaccination with RZV for persons who had previously received ZVL, and whether RZV should be preferentially recommended over ZVL from an economic perspective. The researchers found that vaccination with RZV was cost-effective compared with ZVL under a wide range of conditions and yielded greater projected health benefits at lower costs under most conditions among persons aged 60 and older, and also was the preferred strategy for those aged 50 to 59, in more than 95 percent of simulations. These research findings were reported to ACIP and subsequently RZV was recommended and included in its most recent Recommended Immunization Schedule for Adults.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Lisa A. Prosser, PhD, please contact Beata Mostafavi at bmostafa@med.umich.edu.

3. Clinicians should consider using PCSK9 inhibitors to lower cholesterol in patients with statin-associated autoimmune myopathy

Editorial: http://annals.org/aim/article/doi/10.7326/L18-0705

URLs go live when the embargo lifts

Clinicians should consider using PCSK9 inhibitors to lower cholesterol in patients with statin-associated autoimmune myopathy. Findings from a case report are published in Annals of Internal Medicine.

Beyond its toxic effect, statin use has been associated with a rare, but potentially severe and disabling, type of muscle disease known as statin-associated autoimmune myopathy. Its distinguishing feature are the persistence after withdrawal of statins and its association with antibodies against 3-hydroxy-3methylglutaryl coenzyme A reductase (HMGCR). Management usually requires steroids and other immunosuppressive therapies. Other cholesterol-lowering medications and dietary supplements can cause or worsen this myopathy, which makes decreasing cholesterol levels very challenging in these patients. Treatment with PCSK9 monoclonal antibodies is a relatively new way to decrease cholesterol levels and cardiovascular morbidity and mortality in high-risk patients.

Researchers from University Hospital Principe de Asturias, Madrid, Spain, treated two male patients with hypercholesterolemia and severe, diffuse coronary artery disease who received prolonged treatment with a statin and developed an insidious and necrotizing autoimmune myopathy. Both patients were treated with steroids, immunosuppressive drugs, and intravenous immunoglobulins and all myopathy manifestations gradually resolved. Because the patients still needed cholesterol treatment, they were given evolocumab, a monoclonal antibody against PCSK9. Their LDL cholesterol levels decreased 55 percent in one patient and 56.4 percent in the other and neither had a recurrence of myopathy. According to the researchers, its specific mechanism of action and these findings suggest that clinicians should consider using PCSK9 inhibitors in patients who develop statin-associated autoimmune myopathy and need treatment to decrease their cholesterol levels because of their high risk for coronary artery disease.

Media contact: For an embargoed PDF, please contact Lauren Evans at laevans@acponline.org. To interview the lead author, Dr. Juan de Dios García-Díaz, please contact at juandedios.garcia@uah.es.

Also New in this issue:

Are Requirements to Deposit Data in Research Repositories Compatible With the European Union's General Data Protection Regulation?

Deborah Mascalzoni, PhD; Heidi Beate Bentzen, LLM; Isabelle Budin-Ljøsne, PhD; Lee Andrew Bygrave, LLD; Jessica Bell, PhD; Edward S. Dove, PhD; Christian Fuchsberger, PhD; Kristian Hveem, MD, PhD; Michaela Th. Mayrhofer, PhD; Viviana Meraviglia, PhD; David R. O'Brien, JD; Cristian Pattaro, PhD; Peter P. Pramstaller, MD; Vojin Rakic, PhD; Alessandra Rossini, PhD; Mahsa Shabani, PhD; Dan Jerker B. Svantesson, PhD; Marta Tomasi, PhD; Lars Ursin, PhD; Matthias Wjst, MD; and Jane Kaye, DPhil

Ideas and Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2854

Balancing Protection and Free Movement of Personal Data: The New European Union General Data Protection Regulation

Heidi Beate Bentzen, LLM, and Njål Høstmælingen, LLM

Ideas and Opinions

Abstract: http://annals.org/aim/article/doi/10.7326/M18-2782

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