1
|
Gouveia R, Madureira S, Elias C, Neves A, Soares PR, Soares-Carreira M, Pereira J, Ribeiro A, Amorim M, Almeida J, Araújo J, Lourenco P. Lower low density lipoprotein cholesterol associates to higher mortality in non-diabetic heart failure patients. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 18:200197. [PMID: 37521244 PMCID: PMC10374454 DOI: 10.1016/j.ijcrp.2023.200197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 06/17/2023] [Accepted: 07/13/2023] [Indexed: 08/01/2023]
Abstract
Background In patients with established heart failure (HF) low total cholesterol levels associate with worse prognosis. Evidence concerning the impact of Low-density lipoprotein cholesterol (LDL-c) in HF is scarce. We aimed to evaluate the prognostic impact of LDL-c in patients with HF, both with and without diabetes mellitus (DM). Methods We retrospectively analyzed outpatients with chronic HF with systolic dysfunction followed in our HF clinic from January/2012 to May/2018. LDL-c was calculated using the Friedewald's formula. Patients without a complete lipid profile were excluded. The endpoint under analysis was all-cause mortality. Patients were followed until January/2021. A Cox-regression analysis was used to study the prognostic impact of LDL-c. The LDL-c cut-off used was 100 mg/dL (mean value). Analysis was stratified according to the coexistence of DM. Multivariate models were built adjusting for age, sex, coronary artery disease, atherosclerotic non-coronary artery disease, arterial hypertension, smoking status, statin use, severity of systolic dysfunction, creatinine clearance and evidence-based therapy. Results We studied 522 chronic HF patients, mean age was 70 years, 66.5% males. Severe systolic dysfunction was present in 42.7%, 30.5% had coronary heart disease, 60.5% had arterial hypertension, 41.6% had DM. A total of 92.0% were treated with beta blocker, 87.5% with an ACEi/ARB and 29.1% with a MRA. During a median follow-up of 53 (interquartile range 33-73) months, 235 (45%) patients died. Patients with LDL-c ≤100 mg/dL presented increased multivariate-adjusted risk of all-cause mortality: HR = 1.58 (95% CI: 1.08-2.30), p = 0.02. When patients were stratified according to DM, LDL-c ≤100 mg/dL was independently associated with increased death risk - HR = 1.55 (95% CI:1.05-2.30), p = 0.03 in patients without DM; in patients with DM no association was detected - multivariate-adjusted HR = 1.18 (95% CI: 0.77-1.80), p = 0.44. Conclusion Non-DM HF patients with LDL-c>100 mg/dL have a 35% reduction in the mortality risk when compared with those with lower values. The "cholesterol paradox" in HF also applies to LDL-c in non-DM patients.
Collapse
Affiliation(s)
- R. Gouveia
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - S. Madureira
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - C. Elias
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - A. Neves
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - P. Ribeirinho Soares
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M. Soares-Carreira
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - J. Pereira
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Porto University, Portugal
| | - A. Ribeiro
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - M. Amorim
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
| | - J. Almeida
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Cardiovascular R&D Centre, Faculty of Medicine, Porto University, Portugal
| | - J.P. Araújo
- Faculty of Medicine, Porto University, Portugal
- Cardiovascular R&D Centre, Faculty of Medicine, Porto University, Portugal
| | - P. Lourenco
- Internal Medicine Department, Centro Hospitalar e Universitário de São João, Porto, Portugal
- Heart Failure Clinic, Internal Medicine Department, Centro Hospitalar Universitário de São João, Porto, Portugal
- Faculty of Medicine, Porto University, Portugal
- Cardiovascular R&D Centre, Faculty of Medicine, Porto University, Portugal
| |
Collapse
|
2
|
Brüne M, Emmel C, Meilands G, Andrich S, Droste S, Claessen H, Jülich F, Icks A. Self-reported medication intake vs information from other data sources such as pharmacy records or medical records: Identification and description of existing publications, and comparison of agreement results for publications focusing on patients with cancer - a systematic review. Pharmacoepidemiol Drug Saf 2021; 30:531-560. [PMID: 33617072 DOI: 10.1002/pds.5210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Accepted: 02/18/2021] [Indexed: 11/10/2022]
Abstract
PURPOSE To identify and describe publications addressing the agreement between self-reported medication and other data sources among adults and, in a subgroup of studies dealing with cancer patients, seek to identify parameters which are associated with agreement. METHODS A systematic review including a systematic search within five biomedical databases up to February 28, 2019 was conducted as per the PRISMA Statement. Studies and agreement results were described. For a subgroup of studies dealing with cancer, we searched for associations between agreement and patients' characteristics, study design, comparison data source, and self-report modality. RESULTS The literature search retrieved 3392 publications. Included articles (n = 120) show heterogeneous agreement. Eighteen publications focused on cancer populations, with relatively good agreement identified in those which analyzed hormone therapy, estrogen, and chemotherapy (n = 11). Agreement was especially good for chemotherapy (proportion correct ≥93.6%, kappa ≥0.88). No distinct associations between agreement and age, education or marital status were identified in the results. There was little evaluation of associations between agreement and study design, self-report modality and comparison data source, thus not allowing for any conclusions to be drawn. CONCLUSION An overview of the evidence available from validation studies with a description of several characteristics is provided. Studies with experimental design which evaluate factors that might affect agreement between self-report and other data sources are lacking.
Collapse
Affiliation(s)
- Manuela Brüne
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Carina Emmel
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Gisela Meilands
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Silke Andrich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Sigrid Droste
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Heiner Claessen
- Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| | - Fabian Jülich
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,Institute for Health Services Research and Health Economics, German Diabetes Center, Leibniz Center for Diabetes Research at the Heinrich-Heine-University Düsseldorf, Düsseldorf, Germany.,German Center for Diabetes Research (DZD), München-Neuherberg, Germany
| |
Collapse
|
3
|
Greene SJ, Tan X, Yeh YC, Bernauer M, Zaidi O, Yang M, Butler J. Factors associated with non-use and sub-target dosing of medical therapy for heart failure with reduced ejection fraction. Heart Fail Rev 2021; 27:741-753. [PMID: 33471236 DOI: 10.1007/s10741-021-10077-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/06/2021] [Indexed: 01/06/2023]
Abstract
In clinical practice, many patients with heart failure with reduced ejection fraction (HFrEF) are either not prescribed guideline-directed medical therapies for which they are eligible or are prescribed therapies at sub-target doses. The objective of this study was to examine the factors associated with not receiving guideline-directed medical therapies or receiving sub-target doses. We conducted a systematic review of articles published between January 2014 and May 2019 that described dosing patterns and factors associated with non-use and sub-target dosing of HFrEF therapies in clinical practice. Thirty-seven studies were included. The percentages of patients reaching target doses for angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, sacubitril/valsartan, beta-blockers, and mineralocorticoid receptor antagonists ranged from 4 to 55%, 11 to 87%, 4 to 60%, and 22 to 80%, respectively. Older age and worsening renal function were associated with non-use and sub-target dosing, lower body mass index was commonly associated with non-use, and hyperkalemia and hypotension were commonly associated with sub-target dosing. In conclusion, several common patient characteristics are associated with non-use and sub-target dosing of medical therapy for HFrEF. These high-risk groups are in particular need of further studies to improve implementation of available medications and to define the role of novel therapies.
Collapse
Affiliation(s)
- Stephen J Greene
- Duke Clinical Research Institute, Durham, NC, USA.,Division of Cardiology, Duke University School of Medicine, Durham, NC, USA
| | - Xi Tan
- Merck & Co., Inc, Kenilworth, NJ, USA
| | - Yu-Chen Yeh
- Pharmerit - an OPEN Health Company, Newton, MA, USA
| | | | - Omer Zaidi
- Pharmerit - an OPEN Health Company, Newton, MA, USA
| | - Mei Yang
- Merck & Co., Inc, Kenilworth, NJ, USA
| | - Javed Butler
- Department of Medicine, University of Mississippi Medical Center, 2500 N. State Street, Jackson, MS, 39216, USA.
| |
Collapse
|
4
|
Kosuma P, Jedsadayanmata A. Prevalence and Predictors of Statin Treatment Among Patients With Chronic Heart Failure at a Tertiary-Care Center in Thailand. CLINICAL MEDICINE INSIGHTS-CARDIOLOGY 2019; 13:1179546819855656. [PMID: 31217695 PMCID: PMC6558538 DOI: 10.1177/1179546819855656] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 05/15/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Statins play important roles in the prevention of atherosclerotic vascular diseases; however, their beneficial effects in patients with chronic heart failure (CHF) are uncertain. This study aimed to investigate the prevalence and predictors of treatment with statins to better understand their prescribing patterns in CHF patients. METHODS We conducted a cross-sectional study in patients with first-time diagnoses of CHF receiving care in the outpatient clinics affiliated with a tertiary-care teaching hospital in Thailand. Data were retrieved from electronic claims database. Multivariable logistic regression was used to identify independent predictors of treatment with statins. RESULTS A total of 3445 patients were included in this study. Among them, 1908 (55.4%) were prescribed statins, with most of them (89.7%) receiving simvastatin 20 mg daily. Factors independently associated with the statin treatment include the following: being male (odds ratio [OR] = 1.21, 95% confidence interval [CI] = 1.02-1.44, P = .03); diagnoses of dyslipidemia (OR = 4.88, 95% CI = 3.88-6.14, P < .001), ischemic heart disease (OR = 2.71, 95% CI = 2.18-3.36, P < .001), diabetes (OR = 1.95, 95% CI = 1.55-2.46, P < .001), or cerebrovascular disease (OR = 1.64, 95% CI = 1.12-2.40, P = .01); and receipt of angiotensin-converting enzyme inhibitors (OR = 3.44, 95% CI = 2.87-4.13, P < .001), aspirin (OR = 2.79, 95% CI = 2.30-3.40, P < .001), non-dihydropyridine calcium channel blockers (OR = 2.35, 95% CI = 1.30-4.24, P = .004), organic nitrates (OR = 2.04, 95% CI = 1.16-3.58, P = .01), beta-blockers (OR = 1.51, 95% CI = 1.23-1.84, P < .001), and digoxin (OR = 0.65, 95% CI = 0.50-0.86, P = .002). CONCLUSIONS Statins were prescribed to more than half of the newly diagnosed CHF patients. Independent predictors of statin treatments include hypercholesterolemia and comorbidities indicative of high atherosclerotic vascular risk as well as drugs recommended as cardiovascular protective therapy for CHF patients.
Collapse
Affiliation(s)
- Pattamawan Kosuma
- Faculty of Pharmaceutical Sciences,
Naresuan University, Phitsanulok, Thailand
| | - Arom Jedsadayanmata
- Faculty of Pharmacy, Thammasat
University, Pathum Thani, Thailand
- Drug Information and Consumer Protection
Center, Faculty of Pharmacy, Thammasat University, Pathum Thani, Thailand
- Center of Excellence in Pharmacy
Practice and Management Research, Faculty of Pharmacy, Thammasat University, Pathum
Thani, Thailand
| |
Collapse
|