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Erin Michos, MD, MHS

Ciccarone Center Research

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Erin Michos, MD, MHS

Erin Michos, MD, MHS
Michos, Erin, MD, MHS

Erin Michos, MD, MHS, is the Associate Director of Preventive Cardiology and an Associate Professor of Medicine. Dr Michos is also Associate Professor of Epidemiology and an Associate Faculty of the Welch Center for Prevention, Epidemiology, and Clinical Research.

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Landmark Articles

Clinical utility of rosuvastatin and other statins for cardiovascular risk reduction among the elderly.

By: Long SB, Blaha MJ, Blumenthal RS, Michos ED.

Age is one of the strongest predictors of CVD risk. Treatment with statins can significantly reduce CVD events and mortality in both primary and secondary prevention. Yet despite the high CVD risk among the elderly, there is underutilization of statins in this population (ie, the treatment-risk paradox). Few studies have investigated the use of statins in the elderly, particularly for primary prevention and, as a result, guidelines for treating the elderly are limited. JUPITER is the largest primary prevention statin trial and enrolled a substantial number of elderly adults. Among the 5,695 JUPITER participants greater than or equal to 70 years of age, the absolute CVD risk reduction associated with rosuvastatin was actually greater than for younger participants. The implications of this JUPITER subanalysis and the broader role of statins among older adults is the subject of this review.

Clinical utility of statins for cardiovascular risk reduction in the among the elderly.

By: Long S, Blaha MJ, Blumenthal RS, Michos ED.
Age is one of the strongest predictors of cardiovascular disease (CVD) risk. Treatment with statins can significantly reduce CVD events and mortality in both primary and secondary prevention. Yet despite the high CVD risk among the elderly, there is underutilization of statins in this population (ie, the treatment-risk paradox). Few studies have investigated the use of statins in the elderly, particularly for primary prevention and, as a result, guidelines for treating the elderly are limited. This is likely due to: uncertainties of risk assessment in older individuals where the predictive value of individual risk factors is decreased; the need to balance the benefits of primary prevention with the risks of polypharmacy, health care costs, and adverse medication effects in a population with decreased life expectancy; the complexity of treating patients with many other comorbidities; and increasingly difficult social and economic concerns. As life expectancy increases and the total elderly population grows, these issues become increasingly important. JUPITER (Justification for the Use of statins in Prevention: an Intervention Trial Evaluating Rosuvastatin) is the largest primary prevention statin trial to date and enrolled a substantial number of elderly adults. Among the 5695 JUPITER participants greater than or equal to 70 years of age, the absolute CVD risk reduction associated with rosuvastatin was actually greater than for younger participants. The implications of this JUPITER subanalysis and the broader role of statins among older adults is the subject of this review.

Relation of aortic valve calcium detected by cardiac computed tomography to all-cause mortality.

By: Blaha MJ, Budoff MJ, Rivera JJ, Khan AN, Santos RD, Shaw LJ, Raggi P, Berman D, Rumberger JA, Blumenthal RS, Nasir K.
Aortic valve calcium (AVC) can be quantified on the same computed tomographic scan as CAC. Although CAC is an established predictor of cardiovascular events, limited evidence is available for an independent predictive value for AVC. We studied a cohort of 8,401 asymptomatic subjects (mean age 53 ± 10 years, 69% men), who were free of known coronary heart disease and were undergoing computed tomography for assessment of subclinical atherosclerosis. The patients were followed for a median of 5 years (range 1 to 7) for the occurrence of mortality from any cause. In conclusion, AVC was associated with increased all-cause mortality, independent of the traditional risk factors and the presence of CAC.

Should statin therapy be allocated on the basis of randomized trial evidence?

By: DeMazumder D, Hasan RK, Blumenthal RS, Michos ED, Jones S.
We questioned the utility of global risk assessment strategies based on the Framingham risk score for guiding statin therapy in light of current data that have become available from more recent and robust prospective randomized clinical trials since the publication of the National Cholesterol Education Program Adult Treatment Panel III guidelines. Moreover, the Adult Treatment Panel III guidelines do not support treatment of some patients who may benefit from statin therapy. In conclusion, we propose an alternative approach for incorporating more recent randomized trial data into future statin allocation algorithms and treatment guidelines.

Vitamin D in atherosclerosis, vascular disease, and endothelial function

By: Brewer LC, Michos ED, Reis JP
Large-scale, well-conducted, placebo-controlled clinical trials testing the efficacy of vitamin D supplementation in delaying, slowing, or reversing the atherosclerotic disease process have not yet been conducted. Until the results of these studies are available, we believe it is premature to recommend vitamin D as a therapeutic option in atherosclerosis.

Rosuvastatin is similarly effective for primary prevention of cardiovascular disease in women as in men

By: Leventhal A, Michos ED.

Statins for the primary prevention of cardiovascular events in women with elevated high-sensitivity C-reactive protein or dyslipidemia: results from the Justification for the Use of Statins in Prevention: An Intervention Trial Evaluating Rosuvastatin (JUPITER) and meta-analysis of women from primary prevention trials.

Comparison of the Framingham Heart Study hypertension model with blood pressure alone in the prediction of risk of hypertension: the Multi-Ethnic Study of Atherosclerosis.

By: Muntner P, Woodward M, Mann DM, Shimbo D, Michos ED, Blumenthal RS, Carson AP, Chen H, Arnett DK.
In this multi-ethnic cohort of U.S. adults, the Framingham Heart Study model was not substantially better than systolic blood pressure (SBP) alone for predicting hypertension.

Sex steroid hormone concentrations and risk of death in U.S. men.

By: Menke A, Guallar E, Rohrmann S, Nelson WG, Rifai N, Kanarek N, Feinleib M, Michos ED, Dobs A, Platz EA.
Men with low free and bioavailable testosterone levels may have a higher risk of mortality within 9 years of hormone measurement. Future studies should be conducted to fully characterize the association of low free and bioavailable testosterone concentrations and mortality in men and to describe the mechanism underlying the association.

The JUPITER and AURORA clinical trials for rosuvastatin in special primary prevention populations: perspectives, outcomes, and consequences.

By: Narla V, Blaha MJ, Blumenthal RS, Michos ED.
This review outlines the JUPITER and AURORA trials — which examined the effect of statins in two specific patient populations who currently do not meet the guidelines for statin treatment but are nonetheless at high cardiovascular risk — interprets the data and significance of the results, analyzes the drawbacks and impact of both trials, and delineates the potential for further clinical trials.

25-hydroxyvitamin D levels, race, and the progression of kidney disease.

By: Melamed ML, Astor B, Michos ED, Hostetter TH, Powe NR, Muntner P.
Low 25-hydroxyvitamin D, or 25(OH)D, levels are associated with development of end stage renal disease (ESRD), even after adjustment for multiple risk factors. Low 25(OH)D levels may account for a substantial proportion of the increased risk for ESRD experienced by black individuals.