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Gautier A, Danchin N, Ducrocq G, Rousseau A, Cottin Y, Cayla G, Prunier F, Durand-Zaleski I, Ravaud P, Angoulvant D, Coste P, Lemesle G, Bouleti C, Popovic B, Ferrari E, Silvain J, Dubreuil O, Lhermusier T, Goube P, Schiele F, Vanzetto G, Aboyans V, Gallet R, Eltchaninoff H, Thuaire C, Dillinger JG, Paganelli F, Gourmelen J, Steg PG, Simon T. Rationale and design of the FRENch CoHort of myocardial Infarction Evaluation (FRENCHIE) study. Arch Cardiovasc Dis 2024; 117:417-426. [PMID: 38821761 DOI: 10.1016/j.acvd.2024.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 04/12/2024] [Accepted: 04/15/2024] [Indexed: 06/02/2024]
Abstract
BACKGROUND Despite major advances in prevention and treatment, cardiovascular diseases - particularly acute myocardial infarction - remain a leading cause of death worldwide and in France. Collecting contemporary data about the characteristics, management and outcomes of patients with acute myocardial infarction in France is important. AIMS The main objectives are to describe baseline characteristics, contemporary management, in-hospital and long-term outcomes of patients with acute myocardial infarction hospitalized in tertiary care centres in France; secondary objectives are to investigate determinants of prognosis (including periodontal disease and sleep-disordered breathing), to identify gaps between evidence-based recommendations and management and to assess medical care costs for the index hospitalization and during the follow-up period. METHODS FRENCHIE (FRENch CoHort of myocardial Infarction Evaluation) is an ongoing prospective multicentre observational study (ClinicalTrials.gov Identifier: NCT04050956) enrolling more than 19,000 patients hospitalized for acute myocardial infarction with onset of symptoms within 48hours in 35 participating centres in France since March 2019. Main exclusion criteria are age<18 years, lack of health coverage and procedure-related myocardial infarction (types 4a and 5). Detailed information was collected prospectively, starting at admission, including demographic data, risk factors, medical history and treatments, initial management, with prehospital care pathways and medication doses, and outcomes until hospital discharge. The follow-up period (up to 20 years for each patient) is ensured by linking with the French national health database (Système national des données de santé), and includes information on death, hospital admissions, major clinical events, healthcare consumption (including drug reimbursement) and total healthcare costs. FRENCHIE is also used as a platform for cohort-nested studies - currently three randomized trials and two observational studies. CONCLUSIONS This nationwide large contemporary cohort with very long-term follow-up will improve knowledge about acute myocardial infarction management and outcomes in France, and provide a useful platform for nested studies and trials.
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Affiliation(s)
- Alexandre Gautier
- French Alliance for Cardiovascular Trials, Laboratory for Vascular Translational Science, Inserm U1148, hôpital Bichat, AP-HP, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Nicolas Danchin
- Hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France
| | - Gregory Ducrocq
- French Alliance for Cardiovascular Trials, Laboratory for Vascular Translational Science, Inserm U1148, hôpital Bichat, AP-HP, 75018 Paris, France; Université Paris Cité, 75006 Paris, France
| | - Alexandra Rousseau
- Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris (URC-CRC-CRB), French Alliance for Cardiovascular Trials, Hôpital Saint-Antoine, AP-HP, Sorbonne University, 75012 Paris, France
| | - Yves Cottin
- CHU François-Mitterrand, université de Bourgogne, 21000 Dijon, France
| | - Guillaume Cayla
- CHU de Nîmes, université de Montpellier, 30900 Nîmes, France
| | - Fabrice Prunier
- Équipe Carme, CNRS, Mitovasc, Inserm, CHU d'Angers, université d'Angers, 49100 Angers, France
| | - Isabelle Durand-Zaleski
- URC-Eco, service d'épidémiologie clinique, hôpital de l'Hôtel Dieu, AP-HP, CRESS, Inserm, INRAE, université Paris Cité, 75004 Paris, France; Santé Publique hôpital Henri-Mondor, 94000 Créteil, France
| | - Philippe Ravaud
- URC-Eco, service d'épidémiologie clinique, hôpital de l'Hôtel Dieu, AP-HP, CRESS, Inserm, INRAE, université Paris Cité, 75004 Paris, France
| | - Denis Angoulvant
- Service de cardiologie, CHRU de Tours, UMR Inserm 1327 ISCHEMIA, université de Tours, 37000 Tours, France
| | - Pierre Coste
- Service des maladies coronaires et vasculaires, hôpital cardiologique, CHU de Bordeaux, université de Bordeaux, 33604 Pessac, France
| | - Gilles Lemesle
- USIC et centre hémodynamique, institut cœur poumon, Institut Pasteur de Lille, INSERM UMR1011, French Alliance for Cardiovascular Trials, CHU de Lille, faculté de médecine de l'université de Lille, 59019 Lille, France
| | - Claire Bouleti
- Cardiology Department, Clinical Investigation Centre (Inserm 1204), CHU de Poitiers, 86000 Poitiers, France
| | - Batric Popovic
- Département de cardiologie, CHRU de Nancy, université de Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Emile Ferrari
- Service de cardiologie, hôpital Pasteur, CHU de Nice, 06000 Nice, France
| | - Johanne Silvain
- ACTION Group, Inserm UMRS 1166, Sorbonne université, hôpital Pitié-Salpêtrière, AP-HP, 75013 Paris, France
| | - Olivier Dubreuil
- USIC, service de cardiologie, hôpital Saint-Joseph Saint-Luc, 69007 Lyon, France
| | - Thibault Lhermusier
- Service de cardiologie, UFR Santé de Toulouse, université Toulouse III Paul-Sabatier, CHU de Toulouse, 31400 Toulouse, France
| | - Pascal Goube
- Service de cardiologie, CH Sud-Francilien, 91100 Corbeil-Essonnes, France
| | - François Schiele
- Department of Cardiology, University Hospital Jean Minjoz, EA3920, University of Burgundy Franche-Comte, 25000 Besançon, France
| | - Gérald Vanzetto
- Université Grenoble Alpes, Inserm U1039, CHU de Grenoble Alpes, 38700 La Tronche, France
| | - Victor Aboyans
- Department of Cardiology, Dupuytren-2 University Hospital, EpiMaCT, Inserm 1098/IRD270, Limoges University, 87042 Limoges, France
| | - Romain Gallet
- Service de cardiologie, hôpital Henri-Mondor, AP-HP, 94000 Créteil, France
| | - Hélène Eltchaninoff
- Inserm U955-IMRB, UPEC, 94010 Créteil, France; École nationale vétérinaire d'Alfort, 94700 Maisons-Alfort, France; Département de cardiologie, CHU de Rouen, Inserm U1096, université de Rouen Normandie, 76000 Rouen, France
| | | | - Jean-Guillaume Dillinger
- French Alliance for Cardiovascular Trials, Laboratory for Vascular Translational Science, Inserm U1148, hôpital Bichat, AP-HP, 75018 Paris, France; Department of Cardiology, hôpital Lariboisière, AP-HP, Inserm U-942, 75010 Paris, France
| | - Franck Paganelli
- Centre for CardioVascular and Nutrition Research (C2VN), INSERM, INRAE and Aix-Marseille University, 13005 Marseille, France
| | - Julie Gourmelen
- Inserm, UMS 011, Population-Based Epidemiological Cohorts, 94807 Villejuif, France
| | - Philippe Gabriel Steg
- French Alliance for Cardiovascular Trials, Laboratory for Vascular Translational Science, Inserm U1148, hôpital Bichat, AP-HP, 75018 Paris, France; Université Paris Cité, 75006 Paris, France; Institut universitaire de France, 75231 Paris, France.
| | - Tabassome Simon
- Department of Clinical Pharmacology and Clinical Research Platform of the East of Paris (URC-CRC-CRB), French Alliance for Cardiovascular Trials, Hôpital Saint-Antoine, AP-HP, Sorbonne University, 75012 Paris, France
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2
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Landmesser U, Pirillo A, Farnier M, Jukema JW, Laufs U, Mach F, Masana L, Pedersen TR, Schiele F, Steg G, Tubaro M, Zaman A, Zamorano P, Catapano AL. Lipid-lowering therapy and low-density lipoprotein cholesterol goal achievement in patients with acute coronary syndromes: The ACS patient pathway project. ATHEROSCLEROSIS SUPP 2020; 42:e49-e58. [PMID: 33589224 DOI: 10.1016/j.atherosclerosissup.2021.01.009] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Post-acute coronary syndrome (ACS) patients are at very high risk for recurrent events and mortality, despite the availability of effective pharmacological approaches. Aim of this survey was to evaluate the compliance to ESC/EAS guidelines during the management of ACS patients and the effectiveness of secondary prevention in seven European countries. METHODS By means of an online questionnaire, data on 2775 ACS patients (either acute case or follow-up patients) were collected, including data on lipid profile, medications, follow-up visit planning, screening for familial hypercholesterolemia. RESULTS Lipid profiles were obtained for 91% of ACS patients in the acute phase, mostly within the first day of hospitalization (73%). During hospitalization, 93% of the patients received a lipid-lowering treatment; at discharge, only 66% of the patients received a high intensity statin therapy. At the first follow-up, most of the patients (77.6%) had LDL-C >70 mg/dL; among them, 41% had no change in their lipid-lowering therapies. Similar data were obtained during the second follow-up visit. The analysis of a subgroup of patients with at least 2 follow-up visits and known LDL-C levels showed that the percentage of patients at goal increased from 9% to 32%, and patients with LDL-C <100 mg/dL raised from 23% to 72%. Among acute cases, 44 were admitted with a diagnosis of familial hypercholesterolemia (FH); only 18% of the remaining patients were screened for FH. CONCLUSIONS Contemporary lipid management of very high CV risk patients is sub-optimal despite available treatments. Greater efforts are warranted to optimize cardiovascular prevention.
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Affiliation(s)
- Ulf Landmesser
- Department of Cardiology, Charité University Medicine Berlin, German Center for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin Institute of Health (BIH), Berlin, Germany
| | - Angela Pirillo
- Center for the Study of Atherosclerosis, E. Bassini Hospital, Cinisello Balsamo, Milan, 3IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy
| | - Michel Farnier
- Lipid Clinic, Point Médical and University Hospital Dijon-Bourgogne, Department of Cardiology, Dijon, France
| | - J Wouter Jukema
- Dept of Cardiology, Leiden University Medical Center, Leiden, The Netherlands, Netherlands Heart Institute, Utrecht, the Netherlands
| | - Ulrich Laufs
- Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, 04103, Germany
| | - François Mach
- Cardiology Division, Geneva University Hospitals, Switzerland
| | - Luis Masana
- "Sant Joan" University Hospital, IISPV, CIBERDEM, Universitat Rovira I Virgili, Reus, Spain
| | - Terje R Pedersen
- Oslo University Hospital, Ulleval and Medical Faculty, University of Oslo, Norway
| | - François Schiele
- University Hospital Jean Minjoz, Department of Cardiology, Besançon, France, EA3920, University of Burgundy Franche-Comté, Besançon, France
| | - Gabriel Steg
- French Alliance for Cardiovascular Trials, Université de Paris, Assistance Publique-Hôpitaux de Paris, INSERM U1148, Paris, France
| | - Marco Tubaro
- Head of ICCU-Division of Cardiology, San Filippo Neri Hospital, Rome, Italy
| | - Azfar Zaman
- Freeman Hospital and Institute of Cellular Medicine, Newcastle University, Newcastle Upon Tyne, UK
| | | | - Alberico L Catapano
- Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, IRCCS MultiMedica, Sesto S. Giovanni, Milan, Italy.
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Wang K, Chen L, Liu L, Cui Y, Zhang X, Jiang J. The effects of atorvastatin on interventional therapy in patients with acute myocardial infarction. Minerva Med 2019; 110:101-106. [DOI: 10.23736/s0026-4806.18.05633-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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4
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Anti-Inflammatory Treatment. Coron Artery Dis 2018. [DOI: 10.1016/b978-0-12-811908-2.00013-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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5
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Schiele F, Farnier M, Krempf M, Bruckert E, Ferrières J, Angoulvant D, Boccara F, Bonnet J, Bonnet JL, Bruckert E, Cayla G, Chatot M, Chopard R, Collet JP, Danchin N, Ducrocq G, Elbaz M, Ferrari E, Galinier M, Farnier M, Ferrières J, Gerbaud E, Guedj D, Kownator S, Krempf M, Lemesle G, Levai L, Mansencal N, Mansourati J, Meune C, Morel O, Paillard F, Piot C, Probst V, Puymirat E, Roubille F, Sabouret P, Schiele F, Teiger E. A consensus statement on lipid management after acute coronary syndrome. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2016; 7:532-543. [DOI: 10.1177/2048872616679791] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
In patients admitted for acute coronary syndrome (ACS), the guidelines of the European Society of Cardiology give a Class I, Level A recommendation for the prescription of high-intensity statins to be initiated as early as possible, regardless of the low-density lipoprotein cholesterol (LDL-C) level. Although statins are widely prescribed after ACS, the intensity of therapy and the proportion of patients achieving target LDL-C values are often not in line with recommendations due to a lack of compliance with guidelines by the physicians, a lack of compliance with treatment or poor tolerance by patients, and poor dose adaptation. In this context, a group of French physicians came together to define strategies to facilitate and improve the management of lipid-lowering therapy after ACS. This paper outlines the scientific rationale for the use of statins at the acute phase of ACS, the utility of ezetimibe, the measurement of LDL-C during the course of ACS, the opportunities for detecting familial hypercholesterolaemia and the results of the consensus for the management of lipid-lowering therapy, illustrated in two decision-making algorithms.
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Affiliation(s)
- François Schiele
- Department of Cardiology, EA3920, University Hospital Jean Minjoz, Besançon, France
| | | | | | - Eric Bruckert
- Endocrinologie métabolisme et prevention cardiovasculaire, Institut E3M et IHU cardiométabolique, Groupe hospitalier Pitié-Salpétrière, Paris, France
| | - Jean Ferrières
- Service de Cardiologie B, CHU Rangueil, Toulouse, France
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Séguro F, Taraszkiewicz D, Bongard V, Bérard E, Bouisset F, Ruidavets JB, Ferrières J. Ignorance of cardiovascular preventive measures is associated with all-cause and cardiovascular mortality in the French general population. Arch Cardiovasc Dis 2016; 109:486-93. [DOI: 10.1016/j.acvd.2016.02.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Revised: 02/15/2016] [Accepted: 02/27/2016] [Indexed: 11/17/2022]
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7
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Zhang Y, Liu J, Li S, Xu RX, Sun J, Tang Y, Li JJ. Proprotein convertase subtilisin/kexin type 9 expression is transiently up-regulated in the acute period of myocardial infarction in rat. BMC Cardiovasc Disord 2014; 14:192. [PMID: 25519174 PMCID: PMC4279995 DOI: 10.1186/1471-2261-14-192] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Accepted: 12/11/2014] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND The proprotein convertase subtilisin/kexin type 9 (PCSK9) has been confirmed as a major factor regulating cholesterol homeostasis and has low-density lipoprotein receptor (LDLR) independent effects. In addition, the pathogenesis of acute myocardial infarction (AMI) involves lipids alteration and other acute phase responses. It remains unknown whether the PCSK9 expression is influenced by the impact of AMI. The present study aimed to investigate the changes of PCSK9 concentration using AMI rat model. METHODS AMI (n = 6-8 at each time point) or sham operated (n = 6) adult male rats model were used. Whole blood and liver tissue were collected at 1, 3, 6, 9, 12, 24, 48, and 96 hour (h) post infarction. The plasma PCSK9 concentration was measured by ELISA and lipid profiles were measured by enzymatic assay. The liver mRNA levels of PCSK9, LDLR, sterol response element binding protein-2 (SREBP-2) and hepatocyte nuclear factor 1α (HNF1α) were measured by quantitative real-time PCR. RESULTS The plasma PCSK9 concentration was increased from 12 h to 96 h (P < 0.05 vs. control). Paralleled with the enhanced plasma PCSK9 concentration, the hepatic PCSK9 mRNA expression was up-regulated by 2.2-fold at 12 h and 4.1-fold at 24 h. Hepatic mRNA levels of LDLR, SREBP-2 and HNF1α were all increased and lipid profiles underwent great changes at this acute period. CONCLUSIONS We firstly demonstrated that PCSK9 was transiently up-regulated in the acute period of AMI, which is also driven by transcriptional factors, SREBP-2 and HNF1α, suggesting that the role of PCSK9 in myocardial injury may be needed further study.
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Affiliation(s)
| | | | | | | | | | - Yue Tang
- Division of Dyslipidemia, State Key Laboratory of Cardiovascular Disease, FuWai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, BeiLiShi Road 167, Beijing 100037, China.
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8
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Treating influenza with statins and other immunomodulatory agents. Antiviral Res 2013; 99:417-35. [PMID: 23831494 DOI: 10.1016/j.antiviral.2013.06.018] [Citation(s) in RCA: 128] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2013] [Revised: 06/19/2013] [Accepted: 06/25/2013] [Indexed: 12/28/2022]
Abstract
Statins not only reduce levels of LDL-cholesterol, they counteract the inflammatory changes associated with acute coronary syndrome and improve survival. Similarly, in patients hospitalized with laboratory-confirmed seasonal influenza, statin treatment is associated with a 41% reduction in 30-day mortality. Most patients of any age who are at increased risk of influenza mortality have chronic low-grade inflammation characteristic of metabolic syndrome. Moreover, differences in the immune responses of children and adults seem responsible for the low mortality in children and high mortality in adults seen in the 1918 influenza pandemic and in other acute infectious and non-infectious conditions. These differences probably reflect human evolutionary development. Thus the host response to influenza seems to be the major determinant of outcome. Outpatient statins are associated with reductions in hospitalizations and deaths due to sepsis and pneumonia. Inpatient statins are also associated with reductions in short-term pneumonia mortality. Other immunomodulatory agents--ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), PPARγ and PPARα agonists (glitazones and fibrates) and AMPK agonists (metformin)--also reduce mortality in patients with pneumonia (ACEIs, ARBs) or in mouse models of influenza (PPAR and AMPK agonists). In experimental studies, treatment has not increased virus replication. Thus effective management of influenza may not always require targeting the virus with vaccines or antiviral agents. Clinical investigators, not systems biologists, have been the first to suggest that immunomodulatory agents might be used to treat influenza patients, but randomized controlled trials will be needed to provide convincing evidence that they work. To guide the choice of which agent(s) to study, we need new types of laboratory research in animal models and clinical and epidemiological research in patients with critical illness. These studies will have crucial implications for global public health. During the 2009 H1N1 influenza pandemic, timely and affordable supplies of vaccines and antiviral agents were unavailable to more than 90% of the world's people. In contrast, statins and other immunomodulatory agents are currently produced as inexpensive generics, global supplies are huge, and they would be available to treat patients in any country with a basic health care system on the first pandemic day. Treatment with statins and other immunomodulatory agents represents a new approach to reducing mortality caused by seasonal and pandemic influenza.
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9
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Fedson DS. Influenza Vaccination or Treatment for Influenza-Associated Myocardial Infarction. J Infect Dis 2012; 205:1618-9. [DOI: 10.1093/infdis/jis245] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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10
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Balci B. The modification of serum lipids after acute coronary syndrome and importance in clinical practice. Curr Cardiol Rev 2011; 7:272-6. [PMID: 22758629 PMCID: PMC3322446 DOI: 10.2174/157340311799960690] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2011] [Revised: 01/25/2012] [Accepted: 02/13/2012] [Indexed: 01/25/2023] Open
Abstract
Atherosclerosis is a pathology characterized by low-grade vascular inflammation rather than a mere accumulation of lipids. Inflammation is central at all stages of atherosclerosis. Acute coronary syndrome significantly affects the concentration and composition of the lipids and lipoproteins in plasma. Plasma triglyceride and very low density lipoprotein levels increase, while high density lipoprotein, low density lipoprotein and total cholesterol levels decrease. Early treatment of hyperlipidemia provides potential benefits. However, post-event changes in lipid and lipoproteins lead to delays in the choice of the treatment. This review focuses on the mechanism and the clinical importance of the relevant changes.
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Affiliation(s)
- Bahattin Balci
- The University of Kafkas, Faculty of Medicine, Department of Cardiology, 36100, KARS, Turkey.
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12
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Biasucci LM, Biasillo G, Stefanelli A. Inflammatory markers, cholesterol and statins: pathophysiological role and clinical importance. Clin Chem Lab Med 2010; 48:1685-91. [PMID: 20868311 DOI: 10.1515/cclm.2010.277] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Statins are one of the most important medications in cardio-vascular diseases since they block cholesterol synthesis by inhibiting the 3-hydroxy-3-methylglutaryl coenzyme A reductase and thus reduce low density lipoprotein concentrations. In the last years, numerous pleiotropic properties of statins have been described, beyond their well-known lipid lowering function. In particular, they are able to modulate inflammation, which plays a pivotal role in the atherosclerotic process. Several trials have shown a direct correlation between statin therapy and lower C-reactive protein concentrations. Moreover, a large body of pathophysiological studies has demonstrated that statins lower cytokine concentrations and inhibit recruitment, migration and cell adhesion to endothelium by attenuating chemokine production. They also inhibit inflammatory pathways regulated by proteins as Ras and Rho, and increase nitric oxide production which exerts a protective effect on endothelium. In addition to reducing inflammation in coronary atherosclerosis, statins also have beneficial effects in chronic inflammatory and autoimmune diseases, such as psoriasis, and they could induce clinical improvement. Statins seem to exert benefits even in settings of infection. These results suggest that initiating and monitoring statin therapy on the basis of inflammatory markers, in particular C-reactive protein, may improve cardiovascular prevention and treatment.
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Austin PC. Primer on statistical interpretation or methods report card on propensity-score matching in the cardiology literature from 2004 to 2006: a systematic review. Circ Cardiovasc Qual Outcomes 2010; 1:62-7. [PMID: 20031790 DOI: 10.1161/circoutcomes.108.790634] [Citation(s) in RCA: 124] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Propensity-score matching is frequently used in the cardiology literature. Recent systematic reviews have found that this method is, in general, poorly implemented in the medical literature. The study objective was to examine the quality of the implementation of propensity-score matching in the general cardiology literature. METHODS AND RESULTS A total of 44 articles published in the American Heart Journal, the American Journal of Cardiology, Circulation, the European Heart Journal, Heart, the International Journal of Cardiology, and the Journal of the American College of Cardiology between January 1, 2004, and December 31, 2006, were examined. Twenty of the 44 studies did not provide adequate information on how the propensity-score-matched pairs were formed. Fourteen studies did not report whether matching on the propensity score balanced baseline characteristics between treated and untreated subjects in the matched sample. Only 4 studies explicitly used statistical methods appropriate for matched studies to compare baseline characteristics between treated and untreated subjects. Only 11 (25%) of the 44 studies explicitly used statistical methods appropriate for the analysis of matched data when estimating the effect of treatment on the outcomes. Only 2 studies described the matching method used, assessed balance in baseline covariates by appropriate methods, and used appropriate statistical methods to estimate the treatment effect and its significance. CONCLUSIONS Application of propensity-score matching was poor in the cardiology literature. Suggestions for improving the reporting and analysis of studies that use propensity-score matching are provided.
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Affiliation(s)
- Peter C Austin
- Institute for Clinical Evaluative Sciences, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario M4N 3M5, Canada.
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14
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Morrissey RP, Diamond GA, Kaul S. Statins in Acute Coronary Syndromes. J Am Coll Cardiol 2009; 54:1425-33. [DOI: 10.1016/j.jacc.2009.04.093] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Revised: 03/25/2009] [Accepted: 04/14/2009] [Indexed: 11/26/2022]
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Ferrières J. [Statins in coronary patients: a solved issue?]. Ann Cardiol Angeiol (Paris) 2008; 57 Suppl 1:16-23. [PMID: 18472029 DOI: 10.1016/s0003-3928(08)70522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Statin prescription in patients with coronary artery disease is justified by numerous randomized controlled trials. These trials were conducted in various clinical conditions such as acute coronary syndrome and stable angina. Statin therapy was nearly always associated with better clinical outcomes. These benefits were highly significant in stable coronary patients with hypercholesterolemia and less striking in the first days of acute coronary syndrome. However, in patients with or without acute coronary syndrome, long-term prognosis was favorably influenced in patients on statin therapy. In patients with coronary artery disease, physicians must prescribe a well-tolerated statin as soon as possible, and verify long-term compliance in every patient.
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Affiliation(s)
- J Ferrières
- Service de Cardiologie B, CHU Rangueil, TSA 50032, 31059 Toulouse cedex 9, France.
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Effects of rosuvastatin and atorvastatin on the apolipoprotein B/apolipoprotein A-1 ratio in patients with an acute coronary syndrome: The CENTAURUS trial design. Arch Cardiovasc Dis 2008; 101:399-406. [DOI: 10.1016/j.acvd.2008.05.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2008] [Revised: 03/10/2008] [Accepted: 05/14/2008] [Indexed: 11/21/2022]
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Pitt B, Loscalzo J, Yčas J, Raichlen JS. Lipid Levels After Acute Coronary Syndromes. J Am Coll Cardiol 2008; 51:1440-5. [DOI: 10.1016/j.jacc.2007.11.075] [Citation(s) in RCA: 99] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2007] [Revised: 11/01/2007] [Accepted: 11/14/2007] [Indexed: 12/20/2022]
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Danchin N. [Optimizing long-term therapy: dawn of a new era]. Am J Cardiovasc Drugs 2007; 7 Spec No 1:13-6. [PMID: 19839183 DOI: 10.1007/bf03262468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The combination of a beta-blocker, a platelet inhibitor, a statin and an ACE inhibitor (B.A.S.I.C. regimen) provides major therapeutic benefits in the management of coronary patients. In patients receiving the quadruple combination, the overall mortality risk is 75% lower than for patients receiving none of these four therapies. According to the data from the PREVENIR III study, the combination of a statin and a platelet inhibitor reduces the risk of recurrent coronary events by 71%, the risk of recurrent vascular events by 65% and the risk of death from all causes taken together by 68%, when compared with the absence of these two medications. In the French USIC 2000 survey, prescription of the triple combination of platelet inhibitor, statin and beta-blocker is also associated with a 50% reduction in overall mortality. However, although the B.A.S.I.C. strategy is of major therapeutic value, it markedly increases the number of tablets to be taken every day. Treatment compliance, which is a predictive factor for overall mortality in diabetic coronary patients, diminishes markedly as the number of medications to be taken every day increases. The availability of fixed combinations, e.g. statin-acetylsalicylic acid, thus makes it possible to reduce the number of tablets to be taken at any one time, thus potentially increasing treatment compliance and the efficacy of the treatment administered.
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Affiliation(s)
- Nicolas Danchin
- Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015 Paris, France.
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Abstract
The pharmacologic management of the patient post myocardial infarction (MI) aims to achieve several goals. Chief among these is to prevent subsequent events, which include death, reinfarction, and rehospitalization. Secondary goals include preventing arrhythmias, minimizing left ventricular (LV) remodeling, and preventing progression to heart failure. This review describes practical algorithms for use in the pharmacologic management of the patient post MI based on American Heart Association/American College of Cardiology guidelines. The intensity of drug treatment is determined guided by the degree of LV dysfunction and the presence or absence of ischemia and arrhythmic risk markers. All patients post MI require an angiotensin-converting enzyme (ACE) inhibitor and antiplatelet therapy, usually with aspirin. In individuals who cannot tolerate an ACE inhibitor, an angiotensin receptor blocker (ARB) is an adequate substitute. Numerous studies document the efficacy of ACE inhibitors, which decrease mortality and the risk of heart failure and stroke. Aldosterone blockade is recommended long-term for patients post MI with an LV ejection fraction < or = 40% and either symptomatic heart failure or diabetes. Use of a beta blocker is an important addition to most post-MI drug regimens. Beta blockers decrease mortality and are especially effective in patients with impaired LV function. Among the beta blockers, carvedilol, which also has alpha-adrenergic receptor blocking activity, was found to decrease mortality significantly in patients with low ejection fractions and heart failure. Another drug therapy of value in post-MI treatment is use of calcium-channel blockers. These are restricted to patients with conserved LV function in whom congestion is absent and in whom beta blockers are contraindicated. Current guidelines also recommend that patients post MI with elevated cholesterol levels should be prescribed lipid therapy with a statin at hospital discharge.
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Affiliation(s)
- James A Reiffel
- Cardiology Division, Department of Medicine, Columbia University, New York, New York, USA.
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Cournot M, Cambou JP, Quentzel S, Danchin N. Key factors associated with the under-prescription of statins in elderly coronary heart disease patients: Results from the ELIAGE and ELICOEUR surveys. Int J Cardiol 2005; 111:12-8. [PMID: 16046011 DOI: 10.1016/j.ijcard.2005.06.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2005] [Revised: 06/07/2005] [Accepted: 06/11/2005] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The reasons why statins are under-utilized in elderly patients remain poorly understood. The aim of this study was to identify the reasons given by cardiologist for the non-prescription of statins in elderly CHD patients. METHODS Two cross-sectional pharmaco-epidemiological surveys were carried out among French cardiologists. The sample consisted of 1148 coronary patients aged 35 to 69 years and 1489 patients aged > or =70 years. Patients' risk factors, medical history, treatments, lipid values and the physicians' various motives for the non-prescription of statins were recorded. RESULTS Patients not treated with statins reached 37% in the age-group > or =70 years and 14% in the age-group 35-69 years. The main reason given for statin non-prescription was the lack of a medical indication (2.5% of the age-group 35-69 years and 14% of the age-group > or =70 years). Among patients > or =70 years, the lack of indication was more often cited in the following conditions: 1) in very old patients (36% of lack of indication in the age-group >85 years vs. 10% in 70-75 years), 2) when lipid values were not available (20% when data were not available vs. 9%) and 3) when the patient had no prior history of myocardial infarction (MI) (20% when no history of MI vs. 7%). These factors were not associated with lack of indication among patients <70 years. History of intolerance or side effect was given for 1.3% and 14% of patients for each of the groups (35-69 and > or =70) and poor overall patient adherence was cited in 1% and 2%, respectively. CONCLUSION The primary reason for the under-prescription of statins in elderly coronary patients is the perceived lack of indication, which stresses the need of extensive guidelines for prescription in elderly patients. Several factors associated with this perception seem to be specific to the elderly.
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Affiliation(s)
- Maxime Cournot
- Département d'épidémiologie, INSERM U558, 37, allées Jules Guesdes, 31073 Toulouse cedex, France.
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