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Saad ALGhasab N, Fogacci F, Avagimyan A, Cicero AFG. Expanding therapeutic options: overview of novel pharmacotherapies for dyslipidemia. Expert Opin Pharmacother 2024; 25:1795-1805. [PMID: 39286934 DOI: 10.1080/14656566.2024.2406270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 08/18/2024] [Accepted: 09/16/2024] [Indexed: 09/19/2024]
Abstract
INTRODUCTION Dyslipidemia plays a crucial role in the development of atherosclerotic cardiovascular diseases. AREAS COVERED This article explores the emerging therapeutic targets for the treatment of dyslipidemia and provides novel insights into this field. Thus, it aims to contribute to the understanding and advancement of therapeutic options for managing dyslipidemia. EXPERT OPINION Optimizing the use of available first- and second-line lipid-lowering drugs allows us to adequately control low-density lipoprotein cholesterol (LDL-C) levels, even in statin-intolerant individuals and in patients at high and very high risk of developing cardiovascular diseases who must reach more aggressive LDL-C targets. The drugs under development will further improve our ability to manage the overall lipid-related cardiovascular disease risk and target other dyslipidemia biomarkers.
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Affiliation(s)
- Naif Saad ALGhasab
- Department of Internal Medicine, Medical College, Ha'il University, Ha'il, Saudi Arabia
- Department of Cardiology, Libin cardiovascular institute, Calgary University, Calgary, Canada
| | - Federica Fogacci
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Ashot Avagimyan
- Anatomical Pathology and Clinical Morphology Department, Yerevan State Medical University, Yerevan, Armenia
| | - Arrigo F G Cicero
- Hypertension and Cardiovascular Risk Research Center, Medical and Surgical Sciences Department, Alma Mater Studiorum University of Bologna, Bologna, Italy
- Cardiovascular Medicine Unit, IRCCS AOUBO, Bologna, Italy
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Berteotti M, Profili F, Nreu B, Casolo G, Zuppiroli A, Mannucci E, Marcucci R, Francesconi P. LDL-cholesterol target levels achievement in high-risk patients: An (un)expected gender bias. Nutr Metab Cardiovasc Dis 2024; 34:145-152. [PMID: 37996368 DOI: 10.1016/j.numecd.2023.09.023] [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: 04/19/2023] [Revised: 08/17/2023] [Accepted: 09/24/2023] [Indexed: 11/25/2023]
Abstract
BACKGROUND AND AIMS Lowering low-density lipoprotein cholesterol (LDL-C) is the cornerstone of cardiovascular disease prevention. Collection of epidemiological data is crucial for monitoring healthcare appropriateness. This analysis aimed to evaluate the proportion of high-risk patients who achieved guidelines recommended LDL-C goal, and explore the predictors of therapeutic failure, with a focus on the role of gender. METHODS AND RESULTS Health administrative and laboratory data from seven Local Health Districts in Tuscany were collected for residents aged ≥45 years with a history of major adverse cardiac or cerebrovascular event (MACCE) and/or type 2 diabetes mellitus (T2DM) from January 1, 2019, to January 1, 2021. The study aimed to assess the number of patients with optimal levels of LDL-C (<55 mg/dl for patients with MACCE and <70 mg/dl for patients with T2DM without MACCE). A cohort of 174 200 individuals (55% males) was analyzed and it was found that 11.6% of them achieved the target LDL-C levels. Female gender was identified as an independent predictor of LDL-C target underattainment in patients with MACCE with or without T2DM, after adjusting for age, cardiovascular risk factors, comorbidities, and district area (adjusted-IRR 0.58 ± 0.01; p < 0.001). This result was consistent in subjects without lipid-lowering therapies (adjusted-IRR 0.56 ± 0.01; p < 0.001). CONCLUSION In an unselected cohort of high-risk individuals, females have a significantly lower probability of reaching LDL-C recommended targets. These results emphasize the need for action to implement education for clinicians and patients and to establish clinical care pathways for high-risk patients, with a special focus on women.
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Affiliation(s)
- Martina Berteotti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
| | - Francesco Profili
- Epidemiology Unit, Regional Health Agency (ARS) of Tuscany, Florence, Italy
| | - Besmir Nreu
- Diabetology Unit, Careggi university hospital, Florence, Italy
| | | | - Alfredo Zuppiroli
- Former Department of Cardiology, Azienda Sanitaria di Firenze, Florence, Italy
| | - Edoardo Mannucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Diabetology Unit, Careggi university hospital, Florence, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Paolo Francesconi
- Epidemiology Unit, Regional Health Agency (ARS) of Tuscany, Florence, Italy
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Masana L, Díaz Moya G, Pérez de Isla L. Patients who suffer a first atherosclerotic cardiovascular event while taking statins are often far off of lipid targets. Nutr Metab Cardiovasc Dis 2024; 34:90-97. [PMID: 38092606 DOI: 10.1016/j.numecd.2023.09.022] [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: 03/31/2023] [Revised: 09/12/2023] [Accepted: 09/21/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND AND AIMS Despite considerable evidence that lipid-lowering therapies (LLTs) afford clinical benefit, the control of low-density lipoprotein cholesterol (LDL-C) is suboptimal, and available LLTs are underused, especially in patients at high and very high cardiovascular (CV) risk. This study assesses the real-world LDL-C target attainment rate in patients on LLT before experiencing a first major acute cardiovascular event (MACE). METHODS AND RESULTS The HEARTBEAT was a retrospective, multicentre observational study. From March to June 2021 a total of 334 patients on LLT who had a first MACE while being on statins were included in the study. Of these patients, 83.2 % had a high (40.7 %) or very high CV risk (29.0 %) prior to MACE. Overall, 87.5 % and 89.7 % of the patients at high and very high CV risk, respectively, failed to reach the LDL-C target. Regarding LLTs, only 11.8 % and 19.6 % of the patients at high and very high risk had received high-intensity LLTs prior to MACE. It was estimated that if these patients had reached their recommended LDL-C targets, the risk of MACE may have been reduced by a median of 24.5 % and 23.2 % in patients at high and very high risk respectively. CONCLUSIONS Patients who suffer a first MACE while on statin therapy often were at high/very high CV risk. Despite their risk, LDL-levels and being on statins they are undertreated, and too far from lipid targets. A proper use of high-intensity LLTs led to an increase attainment of LDL targets and lower CV events.
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Affiliation(s)
- Luis Masana
- Unidad Medicina Vascular y Metabolismo, Hospital Universitari Sant Joan, Universitat Rovira i Virgili, IISPV, CIBERDEM, Reus, Spain.
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Rizo Rivera GO, Valladares MJ, Toledo Vargas HM, Chavez E, Garcia de la Rocha AA, Urcuyo Hernandez LA, Meneses Mercado JD. Cholesterol goals, statin use and residual cardiovascular risk estimated by SMART score: Study of a Nicaraguan population. INTERNATIONAL JOURNAL OF CARDIOLOGY. CARDIOVASCULAR RISK AND PREVENTION 2023; 18:200192. [PMID: 37427093 PMCID: PMC10328960 DOI: 10.1016/j.ijcrp.2023.200192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
Introduction Adverse cardiovascular events that arise in patients with established cardiovascular disease have prompted researchers to seek variables that can help estimate residual cardiovascular risk and aid in its reduction. In Latin-America, there is limited data assessing this type of risk. Objective Estimate residual cardiovascular risk in ambulatory patients diagnosed with Chronic Coronary Syndrome (CCS) using the SMART-Score scale seen at five clinics in Nicaragua; determine the prevalence of patients that achieve a serum LDL level of <55 mg/dL; and describe the use of statins in these patients. Methods A total of 145 participants previously diagnosed with CCS seen regularly in ambulatory visits were enrolled. A survey was completed, including epidemiological variables that allowed the calculation of a SMART score. Data analysis was conducted using SPSS version 21.0. Results A 46.2% of participants were male, the average age was 68.7 years (11.4 SD), 91% had hypertension, 80.7% had a BMI ≥25. Under the SMART Score risk classification per Dorresteijn et al. the following risk distribution was found: 2.8% low, 31% moderate, 20% high, 13.1% very high and 33.1% extremely high. Per the risk classification of Kaasenbrood et al., 2.8% were in the 0-9% group, 31% in the 10-19%, 20% in 20-29% and 46.2% were in the ≥30% group. A 64.8% did not meet LDL goals. Conclusion There is an inadequate control of cLDL levels in patients with CCS, and the appropriate available therapeutic resources aren't being utilized. It is important to achieve a proper control of lipid levels in order to improve cardiovascular outcomes, despite currently being far from these goals.
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Affiliation(s)
| | | | - Hildebrando M. Toledo Vargas
- UNAN-Managua, Centro Regional de Especialidades Médicas de Matagalpa, Nicaragua
- National Autonomous University of Nicaragua, Nicaragua
| | - Elibeth Chavez
- Dr. Serafín Ruiz de Zárate Ruiz, Villa Clara, Cardiocentro Ernesto Che Guevara, Santa Clara, Cuba
| | | | - Luis A. Urcuyo Hernandez
- National Autonomous University of Nicaragua, Nicaragua
- UNAN-Managua, Clínica de Diabetes y Pie Diabético, Estelí, Nicaragua
| | - Jose Daniel Meneses Mercado
- National Autonomous University of Nicaragua, Nicaragua
- Interventional Cardiology, Clínica del Valle, Managua, Nicaragua
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Kim MC, Ahn Y, Kim MH, Kim SY, Hong TJ, Rhee MY, Kim SH, Hong SJ, Kim H, Kim W, Chae IH, Kang DH, Kim BK, Kim HS. A Randomized, Multicenter, Double-blind, Placebo-Controlled Study to Evaluate the Efficacy and Safety of a Quadruple Combination of Amlodipine, Losartan, Rosuvastatin, and Ezetimibe in Patients with Concomitant Essential Hypertension and Dyslipidemia. Am J Cardiovasc Drugs 2023:10.1007/s40256-023-00590-9. [PMID: 37395974 DOI: 10.1007/s40256-023-00590-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/22/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND Few data are available regarding the efficacy and safety of a single-pill combination (SPC) consisting of four medications in patients with concomitant hypertension and dyslipidemia. OBJECTIVE We aimed to determine the efficacy and tolerability of a fixed-dose SPC consisting of 5 mg amlodipine, 100 mg losartan, 20 mg rosuvastatin, and 10 mg ezetimibe (A/L/R/E) in patients with concomitant hypertension and dyslipidemia. METHODS This was a 14-week, randomized, multicenter, double-blind, placebo-controlled, phase III clinical trial. In total, 145 patients were randomized to receive A/L/R/E, A/L, or L/R/E. The primary endpoints were the average change in the low-density lipoprotein cholesterol (LDL-C) level in the A/L/R/E and A/L groups and the sitting systolic blood pressure (sitSBP) in the A/L/R/E and L/R/E groups. The numbers of patients with adverse drug reactions (ADRs) were compared as safety variables. RESULTS The average percentage change in the LDL-C level as the least squares mean (LSM) from the baseline LDL-C level at the end of the 8-week treatment was - 59.0% in the A/L/R/E group and 0.2% in the A/L group (LSM difference - 59.2, 95% confidence interval [CI] - 68.1 to - 50.4; p < 0.0001). The average change in the sitSBP as the LSM was - 15.8 mmHg in the A/L/R/E group and -4.7 mmHg in the L/R/E group (LSM difference - 11.1, 95% CI - 16.8 to - 5.4; p = 0.0002). No ADRs occurred in the A/L/R/E group. CONCLUSIONS A/L/R/E as an SPC could be an effective treatment for patients with hypertension and dyslipidemia without significant safety issues. CLINICAL TRIALS REGISTRATION NCT04074551 (registered 30 August 2019).
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Affiliation(s)
- Min Chul Kim
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Youngkeun Ahn
- Division of Cardiology, Department of Internal Medicine, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Moo Hyun Kim
- Department of Cardiology, Dong-A University Medical School, Pusan, Republic of Korea
| | - Seok-Yeon Kim
- Department of Cardiology, Seoul Medical Center, Seoul, Republic of Korea
| | - Taek Jong Hong
- Division of Cardiology, Department of Internal Medicine, Pusan National University Medical School, Pusan, Republic of Korea
| | - Moo-Yong Rhee
- Cardiovascular Center, Dongguk University Ilsan Hospital, Goyang, Republic of Korea
| | - Sang-Hyun Kim
- Division of Cardiology, Department of Internal Medicine, SMG-SNU Seoul Boramae Hospital, Seoul National University Medical School, Seoul, Republic of Korea
| | - Soon-Jun Hong
- Department of Cardiology, Cardiovascular Center, Korea University College of Medicine, Seoul, Republic of Korea
| | - Hyungseop Kim
- Keimyung University Dongsan Medical Center, Daegu, Republic of Korea
| | - Weon Kim
- Division of Cardiovascular, Department of Internal Medicine, Kyung Hee University Hospital, Kyung Hee University Medical School, Seoul, Republic of Korea
| | - In Ho Chae
- Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University Hospital, Seongnam, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Byeong-Keuk Kim
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Hyo-Soo Kim
- Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital, Seoul National University Medical School, 101, Daehak-ro, Jongro-gu, Seoul, 03080, Republic of Korea.
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Ersbøll AK, Kristensen MS, Nybo M, Hede SM, Mikkelsen KH, Gislason G, Lytken Larsen M, Green A. Trends in low-density lipoprotein cholesterol goal achievement and changes in lipid-lowering therapy after incident atherosclerotic cardiovascular disease: Danish cohort study. PLoS One 2023; 18:e0286376. [PMID: 37256879 DOI: 10.1371/journal.pone.0286376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 05/15/2023] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND We aimed to investigate trends in low-density lipoprotein cholesterol (LDL-C) goal achievement (LDL-C<1.8 mmol/L, equivalent to 70 mg/dL), initiation of lipid-lowering therapy (LLT) and changes in LLT intensity in individuals with atherosclerotic cardiovascular disease (ASCVD) at very high risk of recurrent cardiovascular disease. METHODS A cohort study design was used including individuals with incident ASCVD and LDL-C≥1.8 mmol/L in 2010-2015. Data were obtained from national, population-based registers (patient, prescription, income, and laboratory). RESULTS We included 11,997 individuals. Acute myocardial infarction, ischemic stroke and stable angina pectoris accounted for 79.6% of the qualifying ASCVD events. At inclusion, 37.2% were in LLT. Mean LDL-C before or during ASCVD hospitalization was 3.1 mmol/L (120 mg/dL). LDL-C goal achievement increased within the first two years after inclusion from 40.5% to 50.6%. LLT initiation within the first 90 days increased from 48.6% to 56.0%. Initiation of intensive LLT increased from 9.6% to 32.8%. The largest change in LLT intensity was seen in the period 180 days before to 90 days after discharge with 2.2% in 2010 to 12.1% in 2015. CONCLUSION LDL-C goal achievement within the first 2 years after inclusion increased from 40.5% in 2010 to 50.6% in 2015. LLT initiation within the first year after inclusion increased, especially for intensive LLT, although only one third initiated intensive LLT in 2015. Despite trends show improvements in LDL-C goal achievement, 49.4% of individuals at very high risk of a CV event did not achieve the LDL-C goal within 2 years after ASCVD hospitalization.
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Affiliation(s)
- Annette Kjær Ersbøll
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Marie Skov Kristensen
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
| | - Mads Nybo
- Department of Clinical Biochemistry, Odense University Hospital, Odense, Denmark
| | | | | | - Gunnar Gislason
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Department of Cardiology, The Cardiovascular Research Centre, Copenhagen University Hospital Herlev and Gentofte, Gentofte, Denmark
- Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
- The Danish Heart Foundation, Copenhagen, Denmark
| | | | - Anders Green
- Institute of Applied Economics and Health Research, Copenhagen, Denmark
- Steno Diabetes Center Odense, Odense University Hospital and University of Southern Denmark, Odense, Denmark
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Barrios V, Pintó X, Escobar C, Varona JF, Gámez JM. Real-World Attainment of Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Cardiovascular Disease Treated with High-Intensity Statins: The TERESA Study. J Clin Med 2023; 12:3187. [PMID: 37176627 PMCID: PMC10179558 DOI: 10.3390/jcm12093187] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 04/15/2023] [Accepted: 04/22/2023] [Indexed: 05/15/2023] Open
Abstract
Despite steady improvements in cardiovascular disease (CVD) prevention, a scarce proportion of patients achieve the recommended LDL-C goals, even under high-intensity lipid-lowering therapy (LLT). Our study aimed to evaluate the attainment rate of LDL-C targets recommended by the 2019 European guidelines, and to characterize potential factors associated with LDL-C goal achievement and change patterns in LLT. We conducted a retrospective, observational study on patients treated with high-intensity atorvastatin or rosuvastatin ± ezetimibe at cardiology and internal medicine clinics across Spain. It included 1570 evaluable patients (median age: 62 years; established CVD: 77.5% [myocardial infarction: 34.3%]; and 85.8% at very high cardiovascular risk). Rosuvastatin ± ezetimibe was the LLT in 52.2% of patients, and atorvastatin ± ezetimibe in 47.8%. LLT had been modified in 36.8% of patients (side effects: 10%), being the most common switch from atorvastatin- to rosuvastatin-based treatment (77.2%). The risk-based LDL-C goal attainment rate was 31.1%, with 78.2% high-risk and 71.7% very high-risk patients not achieving the recommended LDL-C targets. Established CVD and familial hypercholesterolemia were significantly associated with the non-achievement of LDL-C goals. Although having limitations, this study shows that the guideline-recommended LDL-C goal attainment rate is still suboptimal despite using high-intensity statin therapy in a real-world setting in Spain.
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Affiliation(s)
- Vivencio Barrios
- Department of Cardiology, University Hospital Ramón y Cajal, Alcalá University, 28034 Madrid, Spain
| | - Xavier Pintó
- Lipid and Vascular Risk Unit, Department of Internal Medicine, University Hospital of Bellvitge-Idibell-UB-CiberObn, 08907 L’Hospitalet de Llobregat, Spain;
| | - Carlos Escobar
- Department of Cardiology, University Hospital La Paz, 28046 Madrid, Spain;
| | - Jose F. Varona
- Department of Internal Medicine, University Hospital HM Monteprincipe, HM Hospitales, 28660 Madrid, Spain;
| | - José M. Gámez
- Department of Cardiology, University Hospital Son Llàtzer, 07198 Palma, Spain;
- CIBER de Fisiopatología de la Obesidad y la Nutrición (CIBEROBN CB 12/03/30038), Instituto de Salud Carlos III, 28029 Madrid, Spain
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Silla A, Fogacci F, Punzo A, Hrelia S, Simoni P, Caliceti C, Cicero AFG. Treatment with PCSK9 Inhibitor Evolocumab Improves Vascular Oxidative Stress and Arterial Stiffness in Hypercholesterolemic Patients with High Cardiovascular Risk. Antioxidants (Basel) 2023; 12:antiox12030578. [PMID: 36978827 PMCID: PMC10045769 DOI: 10.3390/antiox12030578] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 02/21/2023] [Accepted: 02/23/2023] [Indexed: 03/03/2023] Open
Abstract
Atherosclerosis and atherosclerotic-related cardiovascular diseases (ASCVD) are characterized by high serum levels of low-density lipoprotein cholesterol (LDL-C) that can promote the generation of reactive oxygen species (ROS). To answer the need for better LDL-C control in individuals at high and very high risk for CVD, a new injectable innovative family of lipid-lowering (LL) monoclonal antibodies against the protein convertase subtilisin/kexin type 9 (PCSK9) has been approved. However, the effect of these drugs on vascular function, such as ROS generation and arterial stiffness, has not already been extensively described. In this report, we present data from 18 males with high to very high CV risk undergoing LL treatment (LLT) with either statin and ezetimibe or ezetimibe monotherapy, who experienced, after a 2-month treatment with Evolocumab, a significant improvement in blood pressure (BP)-adjusted carotid–femoral pulse wave velocity (cfPWV) (p-value = 0.0005 in the whole cohort, p-value = 0.0046 in the sub-cohort undergoing background LLT with statin and ezetimibe, p-value = 0.015 in the sub-cohort undergoing background LLT with ezetimibe monotherapy), which was significantly associated with a decrease in freshly isolated leukocytes (PBMCS)-derived H2O2 production (p-value = 0.004, p-value = 0.02 and p-value = 0.05, respectively, in the whole cohort, in the statin + ezetimibe sub-cohort, and the ezetimibe sub-cohort). Our observations support the role of systemic oxidative stress in atherosclerosis and give a further rationale for using Evolocumab also for its effect in vascular disorders linked to oxidative processes.
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Affiliation(s)
- Alessia Silla
- Department for Life Quality Studies, University of Bologna, 40126 Bologna, Italy
| | - Federica Fogacci
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- IRCCS Policlinico S. Orsola-Malpighi di Bologna, 40138 Bologna, Italy
| | - Angela Punzo
- Department of Chemistry “Giacomo Ciamician”, University of Bologna, 40126 Bologna, Italy
| | - Silvana Hrelia
- Department for Life Quality Studies, University of Bologna, 40126 Bologna, Italy
| | - Patrizia Simoni
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- IRCCS Policlinico S. Orsola-Malpighi di Bologna, 40138 Bologna, Italy
| | - Cristiana Caliceti
- Department of Biomedical and Neuromotor Sciences—DIBINEM, University of Bologna, 40126 Bologna, Italy
- Istituto Nazionale Biosistemi e Biostrutture (INBB), 00136 Rome, Italy
- Interdepartmental Center of Industrial Research (CIRI)—Energy and Environment, Alma Mater Studiorum, University of Bologna, 40126 Bologna, Italy
- Correspondence:
| | - Arrigo F. G. Cicero
- Department of Medical and Surgical Sciences, University of Bologna, 40138 Bologna, Italy
- IRCCS Policlinico S. Orsola-Malpighi di Bologna, 40138 Bologna, Italy
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Kim KA, Park HJ. New Therapeutic Approaches to the Treatment of Dyslipidemia 2: LDL-C and Lp(a). J Lipid Atheroscler 2023; 12:37-46. [PMID: 36761062 PMCID: PMC9884549 DOI: 10.12997/jla.2023.12.1.37] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 09/07/2022] [Indexed: 01/26/2023] Open
Abstract
Dyslipidemia is an important risk factor for atherosclerotic cardiovascular disease (ASCVD). There are abundant and unequivocal data to indicate that low-density lipoproteins (LDL) are a cause of ASCVD. Reduction of plasma low-density lipoprotein cholesterol (LDL-C) by medical therapy such as statins, ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors have proven to significantly reduce the risk of cardiovascular events. However, for many reasons, many patients are not able to achieve LDL-C levels recommended by guidelines on currently available therapies. This has led to the development of new drugs lowering LDL-C, such as inclisiran, bempedoic acid, and evinacumab, in the hope of reducing cardiovascular (CV) risk. Drugs targeting lipoprotein (a) (Lp[a]) also have a role in the prevention of atherosclerosis, with genetic studies having established that 20%-30% of the human population inherits plasma Lp(a) levels in the atherogenic range. In this paper, we will review the recent progress made in the approaches to LDL-C and Lp(a) therapeutic modulation.
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Affiliation(s)
- Kyung An Kim
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Hun-Jun Park
- Division of Cardiology, Department of Internal Medicine, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
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Gavina C, Carvalho DS, Pardal M, Afonso-Silva M, Grangeia D, Dinis-Oliveira RJ, Araújo F, Taveira-Gomes T. Cardiovascular Risk Profile and Lipid Management in the Population-Based Cohort Study LATINO: 20 Years of Real-World Data. J Clin Med 2022; 11:jcm11226825. [PMID: 36431309 PMCID: PMC9692709 DOI: 10.3390/jcm11226825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 11/09/2022] [Accepted: 11/12/2022] [Indexed: 11/22/2022] Open
Abstract
The rising prevalence of cardiovascular (CV) risk factors in Portugal has translated into more than 35,000 annual deaths due to CV diseases. We performed a multicenter observational cohort study encompassing clinical activities performed between 2000 and 2019 to characterize the CV risk profile and LDL-C management of patients in every CV risk category using electronic health records of a regional population in Portugal. We analyzed data from 14 health centers and 1 central hospital in the north of Portugal of patients between 40 and 80 years that had at least 1 family medicine appointment at these institutions. Living patients were characterized on 31 December 2019. CV risk assessment was computed according to the 2019 ESC/EAS Guidelines. Lipid-lowering therapy (LLT) and achievement of LDL-C targets were assessed. In total, the analysis included 78,459 patients. Patient proportions were 33%, 29%, 22%, and 17% for low, intermediate, high, and very high CV risk, respectively. Moderate-intensity statins were the most frequently used medication across all CV risk categories. High-intensity statins were used in 5% and 10% of high and very high CV risk patients, respectively. Ezetimibe was used in 6% and 10% of high and very high CV risk patients, respectively. LDL-C targets were achieved in 44%, 27%, 7%, and 3% of low, intermediate, high, and very high CV risk patients, respectively. For uncontrolled patients in the high and very high CV risk categories, a median LDL-C reduction of 44% and 53%, respectively, would be required to meet LDL-C targets. There are clear opportunities to optimize LDL-C management in routine clinical practice. The prescription of LLT according to CV risk represents an important missed treatment opportunity.
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Affiliation(s)
- Cristina Gavina
- Cardiology Department, Pedro Hispano Hospital, Senhora da Hora, 4464-513 Matosinhos, Portugal
- Department of Medicine, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | - Daniel Seabra Carvalho
- Cardiology Department, Pedro Hispano Hospital, Senhora da Hora, 4464-513 Matosinhos, Portugal
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
| | - Marisa Pardal
- Novartis Farma, Produtos Farmacêuticos S.A., 2740-255 Porto Salvo, Portugal
| | - Marta Afonso-Silva
- Novartis Farma, Produtos Farmacêuticos S.A., 2740-255 Porto Salvo, Portugal
| | - Diana Grangeia
- Novartis Farma, Produtos Farmacêuticos S.A., 2740-255 Porto Salvo, Portugal
| | - Ricardo Jorge Dinis-Oliveira
- MTG Research and Development Lab, 4200-604 Porto, Portugal
- TOXRUN–Toxicology Research Unit, Institute of Health Sciences, Advanced Polytechnic and University Cooperative (CESPU), CRL, 4585-116 Gandra, Portugal
- UCIBIO-REQUIMTE, Laboratory of Toxicology, Department of Biological Sciences, Faculty of Pharmacy, University of Porto, 4050-313 Porto, Portugal
- Department of Public Health and Forensic Sciences, and Medical Education, Faculty of Medicine, University of Porto, 4200-319 Porto, Portugal
| | | | - Tiago Taveira-Gomes
- Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, 4050-313 Porto, Portugal
- MTG Research and Development Lab, 4200-604 Porto, Portugal
- Center for Health Technology and Services Research (CINTESIS), 4200-450 Porto, Portugal
- Faculty of Health Sciences, University Fernando Pessoa (FCS-UFP), 4249-004 Porto, Portugal
- Correspondence:
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Cheng Y, Dong S, Shen P, Sun Y, Lin H, Zhai S. Achievement of low-density lipoprotein cholesterol targets in Chinese patients with atherosclerotic cardiovascular disease after receiving statins and ezetimibe. Front Cardiovasc Med 2022; 9:988576. [PMID: 36312234 PMCID: PMC9614052 DOI: 10.3389/fcvm.2022.988576] [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: 07/07/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background The importance of low-density lipoprotein cholesterol (LDL-C) lowering to reduce atherosclerotic cardiovascular disease (ASCVD) risk is strongly emphasized. If the LDL-C goals are not achieved with statin therapy, combination with ezetimibe is recommended. Studies revealed a substantial gap between obtained LDL-C levels and LDL-C target in ASCVD patients. However, little is known about the achievement of LDL-lowering treatment targets in ASCVD patients receiving ezetimibe in addition to statins. Materials and methods This was a retrospective cohort study based on EHR data from the regional health information system of Yinzhou, an eastern coastal area of China. ASCVD Patients stratified as very high risk, taking both statin and ezetimibe for lipid control, and had at least one lipid test after ezetimibe initiation were included between January 2013 and July 2020. Descriptive statistics were used to summarize the LDL-C values and target value (1.8 mmol/L according to the Chinese guideline, 1.4 mmol/L according to the European guideline) achievements. Multivariable logistic regression was used to explore the influencing factors of target achievement rate. Results A total of 1,727 patients were included. The median follow-up time was 15.0 months. Taking 1.8 mmol/L as the target value, the achievement rates of LDL-C over the first 3 follow up years were 50.6, 31.3, and 30.3%, respectively. Taking 1.4 mmol/L as the target value, the achievement rates were 25.6, 15.5, and 16.5%, respectively. Multivariable analysis suggested that male patients (OR = 1.78, 95%CI: 1.27-2.49), combined use of atorvastatin or rosuvastatin with ezetimibe (vs other statins, OR = 4.64, 95% CI: 1.83-11.76), better medication adherence (OR = 1.03, 95% CI: 1.01-1.04) and smoking cessation (vs smoking, OR = 2.26, 95% CI: 1.27-4.02) were associated with a higher achievement rate, while baseline LDL-C level (OR = 0.48, 95% CI: 0.41-0.56) and treatment course of statin before ezetimibe (OR = 0.93, 95% CI: 0.89-0.98) were negatively associated with achievement rate. Conclusion Long-term follow-up data based on a Chinese regional database shows that in very high-risk ASCVD patients taking ezetimibe in addition to statins, achievement rate of LDL-lowering treatment targets is still low and far from satisfactory in real-world setting. More efforts are needed to achieve optimal LDL-C levels.
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Affiliation(s)
- Yinchu Cheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Shujie Dong
- Department of Pharmacy, Peking University Third Hospital, Beijing, China,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Peng Shen
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Yexiang Sun
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China,Hongbo Lin,
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China,*Correspondence: Suodi Zhai,
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Wolf S, Spirk D, Forgo G, Sebastian T, Voci D, Kucher N, Barco S. Prevalent use of high-intensity statin therapy and LDL-C target attainment among PAD patients undergoing angioplasty. VASA 2022; 51:357-364. [DOI: 10.1024/0301-1526/a001025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Summary: Background: The global burden of peripheral arterial disease (PAD) is substantial. Reducing the major modifiable risk factors for noncommunicable disease, including dyslipidaemia, represents a public health priority. Aim is to evaluate the prevalent adequate use of lipid-lowering therapy (LLT) and low-density lipoprotein cholesterol (LDL-C) attainment among patients with PAD of the lower extremities undergoing percutaneous transluminal angioplasty. Patients and methods: We screened PAD patients treated at the University Hospital Zurich (January 2012–December 2018). We excluded patients <18 years, without classifiable severity of PAD, or with missing LDL-C or medication data. In this cross-sectional study, we studied the prevalent LLT use and LDL-C values in target according to the most recent European guidelines. Available clinical data included demographic information, lipid profile, type and dose of LLT, characteristics of the artery obstruction and angioplasty. Results: A total of 2,148 angioplasties were performed in 956 patients: 614 (64%) were men; the mean age was 70.6 (SD 11.4) years. A total of 608 (64%) had a non-critical PAD (Fontaine stage I–IIb), whereas the remaining had a critical limb ischemia or a diabetic foot syndrome. Their median LDL-C value was 2.00 (Q1–Q3: 1.50–2.60) mmol/L. In accordance to the 2016 and 2019 European Society of Cardiology guidelines, the LDL-C target of 1.8 and 1.4 mmol/L was not reached in 63% (n=599) and in 79% (n=760) of patients, respectively. Only 41% (n=390) of patients were on high-intensity statin therapy. Conclusions: The attainment of LDL-C targets, as recommended by current European guidelines, and the use of high-intensity LLT were unsatisfactory in the majority of PAD patients.
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Affiliation(s)
- Simon Wolf
- Department of Angiology, University Hospital Zurich, Switzerland
| | - David Spirk
- Institute of Pharmacology, University of Bern, Switzerland
| | - Gabor Forgo
- Department of Angiology, University Hospital Zurich, Switzerland
| | - Tim Sebastian
- Department of Angiology, University Hospital Zurich, Switzerland
| | - Davide Voci
- Department of Angiology, University Hospital Zurich, Switzerland
| | - Nils Kucher
- Department of Angiology, University Hospital Zurich, Switzerland
| | - Stefano Barco
- Department of Angiology, University Hospital Zurich, Switzerland
- Center for Thrombosis and Hemostasis, Johannes Gutenberg University Mainz, Germany
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Hagen AN, Ariansen I, Hanssen TA, Lappegård KT, Eggen AE, Løchen ML, Njølstad I, Wilsgaard T, Hopstock LA. Achievements of primary prevention targets in individuals with high risk of cardiovascular disease: an 8-year follow-up of the Tromsø study. EUROPEAN HEART JOURNAL OPEN 2022; 2:oeac061. [PMID: 36284643 PMCID: PMC9583183 DOI: 10.1093/ehjopen/oeac061] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/11/2022] [Revised: 08/05/2022] [Accepted: 09/20/2022] [Indexed: 06/16/2023]
Abstract
Aims To study change over 8 years in cardiovascular risk, achievement of national guideline-based treatment targets of lipids, blood pressure (BP) and smoking in primary prevention of cardiovascular disease (CVD), medication use, and characteristics associated with target achievement among individuals with high CVD risk in a general population. Methods and results We followed 2524 women and men aged 40-79 years with high risk of CVD attending the population-based Tromsø study in 2007-08 (Tromsø6) to their participation in the next survey in 2015-16 (Tromsø7). We used descriptive statistics and regression models to study change in CVD risk and medication use, and characteristics associated with treatment target achievement. In total, 71.4% reported use of BP- and/or lipid-lowering medication at second screening. Overall, CVD risk decreased during follow-up, with a larger decrease among medication users compared with non-users. Treatment target achievement was 31.0% for total cholesterol <5 mmol/L, 27.3% for LDL cholesterol <3 mmol/L, 43.4% for BP <140/90 (<135/85 if diabetes) mmHg, and 85.4% for non-smoking. A total of 9.8% reached all treatment targets combined. Baseline risk factor levels and current medication use had the strongest associations with treatment target achievement. Conclusion We found an overall improvement in CVD risk factors among high-risk individuals over 8 years. However, guideline-based treatment target achievement was relatively low for all risk factors except smoking. Medication use was the strongest characteristic associated with achieving treatment targets. This study has demonstrated that primary prevention of CVD continues to remain a major challenge.
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Affiliation(s)
- Amalie Nilsen Hagen
- Department of Medicine, Nordland Hospital, Parkveien 96, Nordland, 8005 Bodø, Norway
| | - Inger Ariansen
- Department of Chronic Diseases and Ageing, Norwegian Institute of Public Health, Folkehelseinstituttet, Postboks 222 Skøyen, 0213 Oslo, Norway
| | - Tove Aminda Hanssen
- Department of Cardiology, University Hospital of North Norway, Universitetssykehuset Nord-Norge HF Postboks 100, 9038 Tromsø, Norway
- Department of Health and Care Sciences, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Knut Tore Lappegård
- Department of Medicine, Nordland Hospital, Parkveien 96, Nordland, 8005 Bodø, Norway
- Department of Clinical Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Anne Elise Eggen
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Maja-Lisa Løchen
- Department of Cardiology, University Hospital of North Norway, Universitetssykehuset Nord-Norge HF Postboks 100, 9038 Tromsø, Norway
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Inger Njølstad
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Tom Wilsgaard
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
| | - Laila Arnesdatter Hopstock
- Department of Community Medicine, UiT The Arctic University of Norway, UiT Noregs arktiske universitet Postboks 6050 Langnes, 9037 Tromsø, Norway
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Sarzani R, Laureti G, Gezzi A, Spannella F, Giulietti F. Single-pill fixed-dose drug combinations to reduce blood pressure: the right pill for the right patient. Ther Adv Chronic Dis 2022; 13:20406223221102754. [PMID: 35769133 PMCID: PMC9235298 DOI: 10.1177/20406223221102754] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Arterial hypertension is one of the major causes of cardiovascular morbidity and mortality worldwide. Effective and sustained reduction in blood pressure is essential to reduce individual cardiovascular risk. In daily clinical practice, single-pill fixed-dose combinations of different drug classes are important therapeutic resources that could improve both treatment adherence and cardiovascular risk management by targeting distinct pathophysiological mechanisms. The aim of this practical narrative review is to help physicians choosing the right single-pill fixed-dose combination for the right patient in the daily clinical practice, based on the individual clinical phenotype and cardiovascular risk profile.
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Affiliation(s)
- Riccardo Sarzani
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, via della Montagnola 81, 60127 Ancona, Italy
| | - Giorgia Laureti
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, Ancona, Italy
| | - Alessandro Gezzi
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, Ancona, Italy
| | - Francesco Spannella
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, Ancona, Italy
| | - Federico Giulietti
- Internal Medicine and Geriatrics, 'Hypertension Excellence Centre' of the European Society of Hypertension, IRCCS, INRCA, Ancona, Italy
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Perrone V, Giacomini E, Sangiorgi D, Andretta M, Bartolini F, Lupi A, Ferrante F, Palcic S, Re D, Degli Esposti L. Evaluation of the Therapeutic Pattern and Pharmaco-Utilization in Hypercholesterolemic Patients Treated with Statins: A Retrospective Study on Italian Real-World Data. Risk Manag Healthc Policy 2022; 15:1483-1489. [PMID: 35923556 PMCID: PMC9342867 DOI: 10.2147/rmhp.s358015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Accepted: 07/08/2022] [Indexed: 12/02/2022] Open
Abstract
Purpose The study aimed to analyze, in hypercholesterolemic patients under statin medication, patient characteristics and their lipid profile at baseline, the therapeutic pathway, and the pharmaco-utilization, using real-world data in Italy. Patients and Methods A retrospective study was conducted using administrative databases of a sample of entities covering 6.5 million health-assisted individuals. Between January 2010 and June 2019, patients with non-familial hypercholesterolemia (nFH) were identified by 1) ≥1 low-density lipoprotein cholesterol (LDL-C) measurement (LDL-C assessment date was the index-date) and 2) statin prescription during 6 months before the index-date (pharmaco-utilization period). FH patients were defined by LDL-C evaluation, statin treatment during the pharmaco-utilization period, and a score ≥6 according to the Dutch Lipid Clinic Network criteria. nFH patients were divided into four exclusive cohorts based on CV-risk class: 1) with previous CV disease (CVD); 2) with diabetes mellitus; 3) with mixed-dyslipidemia diagnosis; 4) in primary-prevention. Based on LDL-C index values, patient was defined with LDL-C “controlled” if its levels were ≤70mg/dl (CVD), ≤100mg/dl (diabetes, FH), ≤130mg/dl (mixed-dyslipidemia, primary-prevention). Results Overall 164,161 nFH patients were included (mean age 72 years, 51% male); of these, 46,782 (28.5%) were CVD (mean age 74 years, 66% male), 34,803 (21.2%) were diabetic (mean age 72 years, 51% male), 1617 (1%) were with mixed-dyslipidemia (mean age 71 years, 48% male) and 80,959 (49.3%) were in primary-prevention (mean age 71 years, 42% male). The proportion of nFH patients with controlled LDL-C was 41.2% for CVD, 73.6% for diabetic, 80.7% for mixed-dyslipidemia, and 79.5% for primary-prevention patients; 49% of nFH patients were adherent to therapy. Overall, 1287 FH patients (mean age 64 years, 42% male) were included; in 39.2% of the patients, LDL-C was controlled, and 44% of the patients were adherent to therapy. Conclusion The results of this study highlighted non-optimal therapeutic management of hypercholesterolemic patients in Italian clinical practice, with a notable quote of patients non-adherent to therapy.
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Affiliation(s)
- Valentina Perrone
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
- Correspondence: Valentina Perrone, CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Via Murri 9, Bologna, 40137, Italy, Tel +39 3450316494, Email
| | - Elisa Giacomini
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
| | - Diego Sangiorgi
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
| | - Margherita Andretta
- UOC Assistenza Farmaceutica Territoriale, Azienda ULSS 8 Berica, Vicenza, Italy
| | | | | | | | - Stefano Palcic
- Azienda Sanitaria Universitaria Integrata Giuliano-Isontina (ASUGI), Trieste, Italy
| | - Davide Re
- U.O.C. Servizio Assistenza Farmaceutica Territoriale, ASL Teramo, Teramo, Italy
| | - Luca Degli Esposti
- CliCon S.r.l. Società Benefit – Health, Economics & Outcome Research, Bologna, Italy
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Role of Traditional Cardiovascular Risk Factors after Initiation of Statin Therapy: A PharmLines Inception Cohort Study. Cardiovasc Ther 2022; 2022:6587165. [PMID: 35676913 PMCID: PMC9155967 DOI: 10.1155/2022/6587165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 05/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Multiple studies and meta-analyses examined the role of traditional risk factors for cardiovascular events in statin treatment-naive patients. Nowadays, millions receive such therapy for the primary prevention of cardiovascular events (CVE). Objective CVEs still occur in patients on primary preventive statin therapy. Therefore, further risk stratification within these patients is urgently needed. Methods Using the unique linkage between biomedical data and prescription data from the PharmLines Initiative, we assessed the role of several risk factors used in cardiovascular risk models, using a time-dependent Cox PH model, in the occurrence of drug treatment of CVEs after initiation of statin therapy. Results Among 602 statin therapy starters, 11% received drug treatment for CVE within an average follow-up period of 832 days. After multivariable modelling, cholesterol levels and blood pressure at baseline were no longer associated, whereas self-reported diabetes and increasing age were highly associated with the outcome when on statin therapy (hazard ratio (HR): 3.01, 95% confidence interval (95% CI): 1.48-6.12 and 1.04; 95% CI: 1.01-1.07, respectively). Males, smokers, and nonadherent patients had increased risks (HR 1.6, 1.12, and 1.18, resp.), though not statistically significant. Conclusion Drug treatment for CVEs after statin initiation is increased in patients with diabetes type 2, in aged patients, males, smokers, and those with poor adherence, while there was no association with baseline cholesterol levels and blood pressure. These factors should be taken into account during the monitoring of statin therapy and may lead to changes in statin treatment or risk-related lifestyle factors.
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García-Fernández-Bravo I, Torres-Do-Rego A, López-Farré A, Galeano-Valle F, Demelo-Rodriguez P, Alvarez-Sala-Walther LA. Undertreatment or Overtreatment With Statins: Where Are We? Front Cardiovasc Med 2022; 9:808712. [PMID: 35571155 PMCID: PMC9105719 DOI: 10.3389/fcvm.2022.808712] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 03/29/2022] [Indexed: 12/26/2022] Open
Abstract
Statins, in addition to healthy lifestyle interventions, are the cornerstone of lipid-lowering therapy. Other low-density lipoprotein (LDL)-lowering drugs include ezetimibe, bile acid sequestrants, and PCSK9 inhibitors. As new evidence emerges from new clinical trials, therapeutic goals change, leading to renewed clinical guidelines. Nowadays, LDL goals are getting lower, leading to the "lower is better" paradigm in LDL-cholesterol (LDL-C) management. Several observational studies have shown that LDL-C control in real life is suboptimal in both primary and secondary preventions. It is critical to enhance the adherence to guideline recommendations through shared decision-making between clinicians and patients, with patient engagement in selecting interventions based on individual values, preferences, and associated conditions and comorbidities. This narrative review summarizes the evidence regarding the benefits of lipid-lowering drugs in reducing cardiovascular events, the pleiotropic effect of statins, real-world data on overtreatment and undertreatment of lipid-lowering therapies, and the changing LDL-C in targets in the clinical guidelines of dyslipidemias over the years.
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Affiliation(s)
| | - Ana Torres-Do-Rego
- Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Grupo (departamento) de investigación Riesgo cardiovascular y lípidos, Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio López-Farré
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Francisco Galeano-Valle
- Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Grupo (departamento) de investigación Riesgo cardiovascular y lípidos, Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Pablo Demelo-Rodriguez
- Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Grupo (departamento) de investigación Riesgo cardiovascular y lípidos, Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis A. Alvarez-Sala-Walther
- Internal Medicine, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- Grupo (departamento) de investigación Riesgo cardiovascular y lípidos, Instituto de investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
- Department of Medicine, School of Medicine, Universidad Complutense de Madrid, Madrid, Spain
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Bosso G, De Luca M, Alma G, Carbone V, Ferrara F, Fimiani B, Guarnaccia F, Iandolo A, Murolo S, Olivares M, Romeo E, Santoro G, Valvano A, Zito G, Oliviero U. ALERT-LDL: adherence to guidelines in the treatment of patients with dyslipidemia. Intern Emerg Med 2022; 17:387-395. [PMID: 34302611 PMCID: PMC8964538 DOI: 10.1007/s11739-021-02809-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
The association between LDL-c levels and cardiovascular outcomes suggests tailoring lipid-lowering therapies according to total cardiovascular risk. We aimed to evaluate the adherence to guidelines-oriented dyslipidaemia's treatment in an outpatient population referring to ARCA cardiologists, and assess the efficacy of treatment's optimization for each specific level of risk. Three thousand seventy-five patients enrolled in this prospective study were classified according to cardiovascular risk category, and their therapies were optimized. At the beginning and the 3 month follow-up visit, LDL-c data were collected, and further therapies were prescribed to the patients that did not reach the target. A significant LDL-c reduction was observed in all subgroups at different cardiovascular risk at the end of the study (p < 0.05). The number of patients assuming statins, both in monotherapy and in combination with ezetimibe, increased during the follow-up (63% at the enrollment vs 89% after 12 months). At the enrollment, only 1.4% of patients were treated with PCSK-9 inhibitors while after 12 months the percentage increased both in high (5.8%) and very high-risk (18.4%) patients. At the beginning of the study, only 698/3075 patients (22.7%) reached lipid targets. At the end of the study, carried out by the referring cardiologists in the pertaining healthcare districts and specifically aimed to control the lipid profile, the percentage of patients on target increased in all risk categories (68.5%). Our results suggest carefully implementing measures that encourage outpatients and their cardiologists to achieve the targeted lipid profile according to cardiovascular risk.
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Affiliation(s)
- Giorgio Bosso
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | - Mariarosaria De Luca
- Department of Translational Medical Sciences, University Federico II, Via Pansini, 5, 80131, Naples, Italy
| | - Giovanni Alma
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | - Vincenzo Carbone
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | | | - Biagio Fimiani
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | - Franco Guarnaccia
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | | | - Sabato Murolo
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | - Maurizio Olivares
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | - Emanuele Romeo
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | - Giosuè Santoro
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | - Antonio Valvano
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | - Giovanni Zito
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy
| | - Ugo Oliviero
- ARCA (Associazioni Regionali Cardiologi Ambulatoriali), Campania, Italy.
- Department of Translational Medical Sciences, University Federico II, Via Pansini, 5, 80131, Naples, Italy.
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Gong Y, Li X, Ma X, Yu H, Li Y, Chen J, Zhang G, Wang B, Qi X, Meng H, Wang X, Mu J, Hu X, Wang J, Liu S, Liu G, Yang Z, Zhou Y, Kong X, Yan Y, Wang C, Wang JA, Wang L, Fu G, Wei L, Peng D, Zhang S, Li R, Mao A, Bian R, Tang W, Ran Y, Jiang J, Huo Y. Lipid goal attainment in post-acute coronary syndrome patients in China: Results from the 6-month real-world dyslipidemia international study II. Clin Cardiol 2021; 44:1575-1585. [PMID: 34651329 PMCID: PMC8571548 DOI: 10.1002/clc.23725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 08/20/2021] [Accepted: 09/03/2021] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Dyslipidemia International Study II (DYSIS II)-China was conducted to determine the low-density lipoprotein cholesterol (LDL-C) goal (<1.8 mmol/L) attainment rate in patients with post-acute coronary syndrome (ACS). HYPOTHESIS Compliance with treatment guideline recommendations improves the LDL-C goal attainment rate in post-ACS patients. METHODS This multicenter prospective observational study conducted at 28 tertiary hospitals determined the LDL-C goal attainment rates at admission and 6-month follow-up in patients on lipid-lowering treatment (LLT) for ≥3 months and those not on LLT (LLT-naive or off LLT for ≥3 months) at admission. Predictors of goal attainment at 6 months were identified using multivariate logistic regression. RESULTS The LDL-C goal attainment rate at admission in 1102/1103 enrolled patients was 17.1%; it was 41.2% among 752 patients with available lipid results at 6 months. The distance to goal was 0.7 mmol/L at 6 months. Statin monotherapy was the most prescribed LLT. Only 7.7% of patients were receiving statin + ezetimibe and 8.4% of patients were receiving an atorvastatin-equivalent dose of ≥40 mg/day at 6 months. Being male (odds ratio [OR] 1.7, 95% confidence interval [CI] 1.1-2.6) and undergoing percutaneous coronary intervention during index hospitalization (OR 1.5, 95% CI 1.1 to 2.1) were the independent predictors for LDL-C goal attainment. CONCLUSIONS This real-world DYSIS II study in China reports a low LDL-C goal attainment rate in post-ACS patients even after 6 months of LLT. Lack of intensification of statin therapy and underutilization of combinations suggest gaps between real-world treatment practices and guideline recommendations.
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Nakao S, Ishihara T, Tsujimura T, Iida O, Hata Y, Toyoshima T, Higashino N, Mano T. Effectiveness of hospital lipid-lowering protocol of intensive lipid-lowering therapy for patients with acute coronary syndrome. J Cardiol 2021; 79:391-399. [PMID: 34706839 DOI: 10.1016/j.jjcc.2021.10.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 09/27/2021] [Accepted: 09/30/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND AND AIMS The achievement of a target low-density lipoprotein cholesterol (LDL-C) level in clinical settings is often insufficient. A hospital lipid-lowering protocol (HLP) could be effective for providing the optimal lipid-lowering therapy. Herein we determined the effectiveness of a HLP for acute coronary syndrome (ACS) patients. METHODS We retrospectively analyzed 1,497 patients who underwent successful percutaneous coronary intervention for ACS at our hospital (November 2011 to May 2020). In December 2018, we introduced a HLP that included the prescription of the maximum tolerated dose of statin, ezetimibe, and eicosapentaenoic acid. We compared the lipid profile and clinical outcomes at 12 months between before (Control group: 1,219 patients) and after the HLP's introduction (HLP group: 278 patients). The primary outcome was the achievement rate of LDL-C < 1.8 mmol/L (70 mg/dL). The key secondary outcomes were the change value and ratio of LDL-C plus the major adverse cardiac events (MACE), defined as a composite of cardiac death, myocardial infarction, target vessel revascularization, and stent thrombosis. RESULTS The achievement rate of LDL-C < 1.8 mmol/L was significantly higher in the HLP group than in the Control group (58% vs. 27%, p < 0.01). The HLP group's change ratio and LDL-C values were significantly lower than those of the Control group (-39.5 [-55.1, -13.2]% vs. -20.4 [-38.4, 0]%, p < 0.001; -41 [-69, -11] mg/dL vs. -21 [-38, 0] mg/dL, p < 0.001). MACE was similar between the groups (16.9 vs. 15.5%, p = 0.66). CONCLUSION Implementing a HLP for ACS patients improved the achievement of target LDL-C at 12 months.
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Affiliation(s)
- Sho Nakao
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, Japan
| | - Takayuki Ishihara
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, Japan.
| | - Takuya Tsujimura
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, Japan
| | - Osamu Iida
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, Japan
| | - Yosuke Hata
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, Japan
| | - Taku Toyoshima
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, Japan
| | - Naoko Higashino
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, Japan
| | - Toshiaki Mano
- Kansai Rosai Hospital Cardiovascular Center, 3-1-69 Inabaso, Amagasaki, Hyogo, Japan
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21
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Real-world Evidence for Adherence and Persistence with Atorvastatin Therapy. Cardiol Ther 2021; 10:445-464. [PMID: 34586613 PMCID: PMC8555050 DOI: 10.1007/s40119-021-00240-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Indexed: 12/17/2022] Open
Abstract
Atorvastatin, which has been approved by regulatory agencies for primary- and secondary-prevention patients with dyslipidemia, has historically been the most commonly prescribed statin and is now widely available in generic formulations. Despite widespread statin usage, many patients fail to attain recommended (LDL-C) targets. While several factors impact the successful treatment of dyslipidemia, suboptimal patient adherence is a major limiting factor to medication effectiveness. In this narrative review we sought to investigate patient adherence and persistence with atorvastatin in a real-world setting and to identify barriers to LDL-C goal attainment and therapy outcomes beyond the realm of clinical trials. Moreover, in light of growing generic usage, we carried out targeted literature searches to investigate the impact of generic atorvastatin availability on patient adherence/persistence, and on lipid and efficacy outcomes, compared with branded formulations. Unsurprisingly, real-world data suggest that patient adherence/persistence to atorvastatin is suboptimal, but few studies have attempted to address factors impacting adherence. Data from studies comparing adherence/persistence in patients prescribed branded or generic atorvastatin are limited and show no clear evidence that initiation of a specific preparation of atorvastatin impacts adherence/persistence. Furthermore, results from studies comparing adherence/persistence of patients who switched from the branded to the generic drug are conflicting, although they do suggest that switching may negatively impact adherence over the long term. Additional real-world studies are clearly required to understand potential differences in adherence and persistence between patients initiating treatment with branded versus generic atorvastatin and, moreover, the factors that influence adherence. Targeted education initiatives and additional research are needed to understand and improve patient adherence in a real-world setting.
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22
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Morieri ML, Perrone V, Veronesi C, Degli Esposti L, Andretta M, Plebani M, Fadini GP, Vigili de Kreutzenberg S, Avogaro A. Improving statin treatment strategies to reduce LDL-cholesterol: factors associated with targets' attainment in subjects with and without type 2 diabetes. Cardiovasc Diabetol 2021; 20:144. [PMID: 34271920 PMCID: PMC8283985 DOI: 10.1186/s12933-021-01338-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 07/06/2021] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND This cross-sectional study aimed to identify actionable factors to improve LDL-cholesterol target achievement and overcome underuse of lipid-lowering treatments in high- or very-high-cardiovascular risk patients. METHODS We evaluated healthcare records of 934,332 subjects from North-Italy, including subjects with available lipid profile and being on statin treatments up to December 2018. A 6-month-period defined adherence with proportion-of-days-covered ≥ 80%. Treatment was classified as high-intensity-statin (HIS) + ezetimibe, HIS-alone, non-HIS (NHIS) + ezetimibe or NHIS alone. RESULTS We included 27,374 subjects without and 10,459 with diabetes. Among these, 30% and 36% were on secondary prevention, respectively. Adherence was high (78-100%) and increased with treatment intensity and in secondary prevention. Treatment intensity increased in secondary prevention, but only 42% were on HIS. 2019-guidelines LDL-cholesterol targets were achieved in few patients and more often among those with diabetes (7.4% vs. 10.7%, p < 0.001). Patients in secondary prevention had mean LDL-cholesterol levels aligned slightly above 70 mg/dl (range between 68 and 73 mg/dl and between 73 and 85 mg/dl in patients with and without diabetes, respectively). Moreover, the differences in mean LDL-cholesterol levels observed across patients using treatments with well-stablished different LDL-lowering effect were null or much smaller than expected (HIS vs. NHIS from - 3 to - 11%, p < 0.001, HIS + ezetimibe vs. HIS-from - 4 to + 5% n.s.). These findings, given the observational design of the study, might suggest that a "treat to absolute LDL-cholesterol levels" approach (e.g., targeting LDLc of 70 mg/dl) was mainly used by physicians rather than an approach to also achieve the recommended 50% reduction in LDL-cholesterol levels. Our analyses suggested that female sex, younger age, higher HDL-c, and elevated triglycerides are those factors delaying prescription of statin treatments, both in patients with and without diabetes and in those on secondary prevention. CONCLUSIONS Among patients on statin treatment and high adherence, only a small proportion of patients achieved LDL-cholesterol targets. Late initiation of high-intensity treatments, particularly among those with misperceived low-risk (e.g., female subjects or those with high HDL-cholesterol), appears as pivotal factors needing to be modified to improve CVD prevention.
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Affiliation(s)
- Mario Luca Morieri
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy. .,University Hospital of Padova , Padova, Italy.
| | | | - Chiara Veronesi
- CliCon S.R.L. Health Economics & Outcomes Research, Bologna, Italy
| | | | | | - Mario Plebani
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy
| | - Gian Paolo Fadini
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.,University Hospital of Padova , Padova, Italy
| | - Saula Vigili de Kreutzenberg
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.,University Hospital of Padova , Padova, Italy
| | - Angelo Avogaro
- Department of Medicine, University of Padova, Via Giustiniani 2, 35128, Padua, Italy.,University Hospital of Padova , Padova, Italy
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23
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Cicero AFG, Fogacci F, Patrono D, Mancini R, Ramazzotti E, Borghi C, D'Addato S. Application of the Sampson equation to estimate LDL-C in children: Comparison with LDL direct measurement and Friedewald equation in the BLIP study. Nutr Metab Cardiovasc Dis 2021; 31:1911-1915. [PMID: 33962827 DOI: 10.1016/j.numecd.2021.02.034] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 02/08/2021] [Accepted: 02/27/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND AND AIMS In epidemiological trials and in clinical practices, it is relevant to have affordable and reliable methods to measure the main lipid cardiovascular risk factors, and in particular low-density lipoprotein cholesterol (LDL-C) plasma level. In this context, we aimed to compare the reliability of the Friedewald's (LDL-Cf) and Sampson's (LDL-Cs) equations with the LDL-value dosed by a validated dosage method (LDL-Cd) in a large cohort of children. METHODS AND RESULTS We considered the lipid values of 145 infants, 278 preschoolers, 810 scholar children, and 1372 adolescents (Total N. 2605, 1291 males, 1314 females), with mean total cholesterol (TC) = 169.8 ± 39.7 mg/dL, HDL-Cholesterol = 50.8 ± 12.7 mg/dL, non HDL-Cholesterol = 118.9 ± 35.9 mg/dL, Triglycerides (TG) = 90.3 ± 77.9 mg/dL, LDL-Cd = 106.2 ± 29.9 mg/dL, LDL-Cf = 100.9 ± 33.8 mg/dL, and LDL-Cs = 102.2 ± 33.4 mg/dL. Comparing the distance to the LDL-Cd, Friedewald's equation mildly but significantly underestimated in infants (3.4 ± 5.3 mg/dL), preschoolers (1.5 ± 7.1 mg/dL). Children (1.2 ± 2.2 mg/dL) and adolescents (1.1 ± 5.9 mg/dL) compared to Sampson's equation (all comparisons, p < 0.001). CONCLUSIONS Our analysis, being carried out on a large population sample, shows that Sampson's equation is more reliable than Friedewald's one at each considered age class and even for extreme TG values.
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Affiliation(s)
- Arrigo F G Cicero
- Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy.
| | - Federica Fogacci
- Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Daniela Patrono
- Unified Metropolitan Laboratory (LUM), AOU S. Orsola-Malpighi, Bologna, Italy
| | - Rita Mancini
- Unified Metropolitan Laboratory (LUM), AOU S. Orsola-Malpighi, Bologna, Italy
| | - Eric Ramazzotti
- Unified Metropolitan Laboratory (LUM), AOU S. Orsola-Malpighi, Bologna, Italy
| | - Claudio Borghi
- Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy
| | - Sergio D'Addato
- Medical and Surgical Sciences Dept., Alma Mater Studiorum University of Bologna, Bologna, Italy
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24
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Santi RL, Martinez F, Baranchuk A, Liprandi AS, Piskorz D, Lorenzatti A, Santi MPL, Kaski JC. Management of Dyslipidaemia in Real-world Clinical Practice: Rationale and Design of the VIPFARMA ISCP Project. Eur Cardiol 2021; 16:e16. [PMID: 33995586 PMCID: PMC8117136 DOI: 10.15420/ecr.2020.42] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 12/15/2020] [Indexed: 12/13/2022] Open
Abstract
Dyslipidaemia plays a major role in the pathogenesis of atherosclerosis. Every year, scientific institutions publish cardiovascular prevention guidelines with updated goals and recommendations based on new evidence. However, medical barriers exist that make achieving these goals difficult and gaps between guidelines and best daily clinical practice still persist. The International Society of Cardiovascular Pharmacotherapy designed the Surveillance of Prescription Drugs in the Real World Project (VIPFARMA ISCP), a survey for physicians who manage lipid disorders in high-risk patients. Seven clusters of questions will be analysed comprising demographics, institution profile, access to continuing medical education, clinical practice profile, attitude regarding use of statins, knowledge regarding proprotein convertase subtilisin/kexin type 9 inhibitors and attitudes regarding medical decisions about triglycerides. The present study will be the first part of a larger programme and aims to shed light on barriers between lipid-lowering drug therapy recommendations in the 2019 European Society of Cardiology guidelines and clinical practice in different countries.
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Affiliation(s)
- Ricardo Lopez Santi
- Division of Cardiology, Hospital Italiano de La Argentina La Plata, Buenos Aires, Argentina
| | - Felipe Martinez
- Instituto Médico DAMIC-Fundacion Rusculleda Cordoba, Argentina
| | - Adrian Baranchuk
- Department of Medicine, Queen's University, Kingston Ontario, Canada
| | | | - Daniel Piskorz
- Cardiovascular Institute of the Rosario British Sanatorium Santa Fe, Argentina
| | - Alberto Lorenzatti
- DAMIC-Rusculleda Foundation, National University of Córdoba Cordoba, Argentina
| | | | - Juan Carlos Kaski
- Molecular and Clinical Sciences Research Institute, St George's, University of London London, UK
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25
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Liver fibrosis scores and coronary atherosclerosis: novel findings in patients with stable coronary artery disease. Hepatol Int 2021; 15:413-423. [PMID: 33740211 DOI: 10.1007/s12072-021-10167-w] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/22/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND Although non-invasive liver fibrosis scores (LFSs) have already been considered as effective tools for estimating cardiovascular risk, their roles in predicting disease severity and cardiovascular event (CVEs) in patients with stable coronary artery disease (CAD) are not comprehensively evaluated. The aim of the present study was to investigate whether non-alcoholic fatty liver disease fibrosis score (NAFLD-FS) and fibrosis-4 (FIB-4) are associated with CVEs in a large cohort with long-term follow-up. METHODS A cohort of 5143 patients with angiography-proven stable CAD were consecutively enrolled and followed up for CVEs. The degree of coronary severity was assessed using the number of diseased vessels, Gensini, Syntax, and Jeopardy scores. The predictive values of NAFLD-FS and FIB-4 scores to coronary severity, coronary calcification (CAC), and CVEs were assessed, respectively. RESULTS During a median follow-up of 7 years, 435 CVEs were recorded. Both NAFLD-FS and FIB-4 were predictors for the presence of CAC. The degree of coronary stenosis was significantly higher in high NAFLD-FS categories while FIB-4 was only positively associated with the number of diseased vessels and Gensini score. In Kaplan-Meier analysis, the patients with intermediate and high NAFLD-FS and FIB-4 had higher risk of CVEs and cardiovascular mortality. In multivariate Cox regression analysis, NAFLD-FS and FIB-4 were independently associated with CVEs [hazard ratio (95% confidence interval): 1.150 (1.063-1.244), p < 0.001 and 1.128 (1.026-1.240), p = 0.012]. CONCLUSION The current data first indicated that both NAFLD-FS and FIB-4 scores were not only significantly related to coronary severity but also associated with CAC and CVEs. CLINICAL TRIALS REGISTRATION None.
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26
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Obońska K, Kasprzak M, Tymosiak K, Fabiszak T, Krintus M, Kubica J. Low dose of ROSuvastatin in combination with EZEtimibe effectively and permanently reduce low density lipoprotein cholesterol concentration independently of timing of administration (ROSEZE): A randomized, crossover study - preliminary results. Cardiol J 2020; 28:58-66. [PMID: 33200812 PMCID: PMC8105047 DOI: 10.5603/cj.a2020.0166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 11/09/2020] [Accepted: 10/13/2020] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In an attempt to improve low density lipoprotein-cholesterol (LDL-C) level control in patients ineffectively treated with statins, we evaluated the effectiveness of a fixed-dose combination (FDC) of 10 mg rosuvastatin and ezetimibe and its relation to the timing of drug administration. METHODS A randomized, open label, single center, crossover study involving 83 patients with coronary artery disease and hypercholesterolemia with baseline LDL-C ≥ 70 mg/dL. In arm I the FDC drug was administered in the morning for 6 weeks, then in the evening for the following 6 weeks and vice versa in arm II. The primary endpoint was the change in LDL-C after 6 and 12 weeks. RESULTS The median LDL-C concentration at baseline, after 6 and 12 weeks respectively was: 98.10 mg/dL (Q1;Q3: 85.10;116.80), 63.14 mg/dL (50.70;77.10) and 59.40 mg/dL (49.00;73.30); p < 0.001. LDL-C levels were similar regardless of the timing of drug administration (morning 62.50 mg/dL [50.70;76.00] vs. evening 59.70 mg/dL [48.20;73.80]; p = 0.259], in both time points: 6 week: 63.15 mg/dL (50.75;80.65) vs. 63.40 mg/dL (50.60;74.00), p = 0.775; and 12 week: 62.00 mg/dL (50.20;74.40) vs. 59.05 mg/dL (47.65;66.05), p = 0.362. The absolute change in LDL-C concentration for the morning vs. evening drug administration was - 6 week: -34.6 mg/dL (-56.55; -19.85) (-34.87%) vs. -31.10 mg/dL (-44.20; -16.00) (-35.87%) (p not significant); 12. week: -34.20 mg/dL (-47.8; -19.0) (-37.12%) vs. -37.20 mg/dL (-65.55; -23.85) (-40.06%) (p not significant). The therapy was safe and well tolerated. CONCLUSIONS Fixed-dose combination of rosuvastatin and ezetimibe significantly and permanently decreases LDL-C regardless of the timing of drug administration.
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Affiliation(s)
- Karolina Obońska
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland.
| | - Michał Kasprzak
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland
| | - Kamila Tymosiak
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland
| | - Tomasz Fabiszak
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland
| | - Magdalena Krintus
- Department of Laboratory Medicine, Nicolaus Copernicus University, Collegium Medicum, 9 Sklodowskiej-Curie Street, 85-094 Bydgoszcz, Poland
| | - Jacek Kubica
- Department of Cardiology and Internal Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Poland
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Saely CH, Sternbauer S, Vonbank A, Heinzle C, Zanolin-Purin D, Larcher B, Mader A, Leiherer A, Muendlein A, Drexel H. Type 2 diabetes mellitus is a strong predictor of LDL cholesterol target achievement in patients with peripheral artery disease. J Diabetes Complications 2020; 34:107692. [PMID: 32878717 DOI: 10.1016/j.jdiacomp.2020.107692] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 07/21/2020] [Accepted: 07/21/2020] [Indexed: 01/05/2023]
Abstract
BACKGROUND AND AIMS Patients with peripheral artery disease (PAD) are at a very high risk of cardiovascular events and strongly benefit from lowering LDL cholesterol (LDL-C); updated European Society of Cardiology guidelines recommend an LDL-C target of at least <55 mg/dl for these patients. Whether the presence of type 2 diabetes (T2DM) affects LDL-C target achievement in PAD patients is unknown and is addressed in the present study. METHODS We investigated an unselected consecutive series of 319 patients with sonographically proven PAD, of whom 136 (42.6%) had T2DM. RESULTS The LDL-C target of <55 mg/dl was met by 8.1% of T2DM patients and by 2.2% of non-diabetic patients (p = 0.014); LDL-C was <70 mg/dl in 22.8% of patients with T2DM and in 9.8% of non-diabetic patients (p = 0.002). Logistic regression analysis showed that the presence of T2DM was an independent and strong predictor of LDL-C target achievement after multivariate adjustment including age, gender, potency adjusted statin use, BMI, smoking, hypertension and other lipid-modifying therapy for the <55 mg/dl target (OR 3.58 [1.08-11.90]; p = 0.038) as well as for the <70 mg/dl target (OR 2.78 [1.40-5.35]; p = 0.003). CONCLUSION We conclude that T2DM is a strong and independent predictor of LDL-C target achievement among PAD patients; however, also among PAD patients with T2DM only a minority meets the current target of <55 mg/dl and most patients do not even have an LDL-C < 70 mg/dl.
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Affiliation(s)
- Christoph H Saely
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Simon Sternbauer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Alexander Vonbank
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Christine Heinzle
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
| | - Daniela Zanolin-Purin
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Barbara Larcher
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Arthur Mader
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Andreas Leiherer
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Axel Muendlein
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Drexel University College of Medicine, Philadelphia, PA, USA.
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Froylan D MS, Esteban JG, Carlos PR, Aida X MU, Ma Rocío MA, Horacio OA, Juan G JR. Prevalence of poor lipid control in patients with premature coronary artery disease. Nutr Metab Cardiovasc Dis 2020; 30:1697-1705. [PMID: 32571615 DOI: 10.1016/j.numecd.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Lipid goals have become more stringent in high risk patients. However, no studies have analyzed lipid control defined as the composite achievement of goals in low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (Non-HDL-C) and apolipoproteinB-100 (ApoB-100), in patients with premature coronary artery disease (CAD). We aimed to analyze lipid control rates, and the associated factors with its poor achievement in patients with premature CAD. METHODS AND RESULTS The study included 1196 patients with CAD diagnosed before 55 and 65 years old in men and women, respectively. The American Heart Association/American College of Cardiology (non-strict) and the American Association of Clinical Endocrinologists (strict) criteria were used to analyze lipid control rates. Sociodemographic, dietary-healthy and clinical characteristics of the patients were collected. Participants were 54 ± 8 years old, 19.7% were women, and median CAD evolution was 2.4 years. Non-strict and strict lipid control was achieved in 23.0% and 8.9% of the patients, respectively. Moreover, 46.5% and 62.8% of the patients did not achieve any lipid goal using both criteria. Sociodemographic data were not different among patients who achieved or not lipid control. Treatment adherence<85%, prescription of low- and moderate-intensity statins, and obesity were consistently associated with poor lipid control. CONCLUSIONS Lipid control is suboptimal in patients with premature CAD. Low lipid-lowering treatment adherence, low prescription of high-intensity statins, and obesity were independently associated with poor lipid control. Novel preventive programs and more aggressive pharmacological intervention should be implemented in order to reduce the burden of premature CAD.
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Affiliation(s)
- Martínez-Sánchez Froylan D
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Jorge-Galarza Esteban
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Posadas-Romero Carlos
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Medina-Urrutia Aida X
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Martínez-Alvarado Ma Rocío
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Osorio-Alonso Horacio
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico.
| | - Juárez-Rojas Juan G
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
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Wang Y, Wei C, Song Q, Liu J, Cheng Y, Li Y, Wu B, Liu M. Reduction in the Ratio of Low-density Lipoprotein Cholesterol to Highdensity Lipoprotein Cholesterol is Associated with Increased Risks of Hemorrhagic Transformation in Patients with Acute Ischemic Stroke. Curr Neurovasc Res 2020; 16:266-272. [PMID: 31258087 DOI: 10.2174/1567202616666190619151914] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 05/21/2019] [Accepted: 05/22/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND PURPOSE Hemorrhagic transformation (HT) is a potentially serious complication in patients with acute ischemic stroke (AIS). Whether the ratio of low-density lipoprotein cholesterol to high-density lipoprotein cholesterol (LDL-C/HDL-C) is associated with HT remains unclear. METHODS Ischemic stroke patients within 7 days of stroke onset from January 2016 to November 2017 were included in this study. Lipid profiles were measured within 24h after admission. HT was determined by a second computed tomography or magnetic resonance imaging within 7 days after admission. Univariate and multivariate logistic regression analysis was used to assess the association between LDL-C/HDL-C and HT. RESULTS We enrolled 1239 patients with AIS (788 males; mean age, 64 ± 15 years), of whom 129 (10.4%) developed HT. LDL-C/HDL-C was significantly lower on admission in patients with HT than those without HT (2.00 ± 0.89 vs. 2.25 ± 1.02, P=0.009). The unadjusted odds ratio (OR) of low LDL-C/HDL-C for HT was 2.07 (95% confidence interval [CI] 1.42-3.01, P<0.001). After adjustment for possible confounders, lower LDL-C/HDL-C (≤1.52) was significantly associated with HT (OR 1.53, 95% CI: 1.02-2.31, P=0.046). Similar results were observed between lower LDL-C (≤ 4 mmol/L) and HT (OR 4.17, 95% CI: 1.25-13.90, P=0.02). However, no significant association was found between HT and high HDL-C, low triglycerides or low total cholesterol. CONCLUSION Lower LDL-C/HDL-C and LDL-C were significantly associated with increased risk of HT after AIS. Further investigations are warranted to confirm these findings and then optimize lipid management in stroke patients with lower LDL/HDL-C or LDL-C.
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Affiliation(s)
- Yanan Wang
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Chenchen Wei
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Quhong Song
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Junfeng Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Yajun Cheng
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Yisong Li
- Department of Laboratory Medicine, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Bo Wu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
| | - Ming Liu
- Department of Neurology, Center of Cerebrovascular Diseases, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu, 610041, Sichuan Province, China
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The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice. J Clin Med 2020; 9:jcm9072140. [PMID: 32645925 PMCID: PMC7408902 DOI: 10.3390/jcm9072140] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 07/01/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
The aim of this study was to assess the impact of the 2019 published European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline on cardiovascular (CV) risk management compared with its predecessor from 2016 in a cohort in general practice. We performed a cross-sectional retrospective study with data from electronic medical records. The study cohort included 103,351 patients with known CV risk. We assessed changes in CV risk classification and low-density lipoprotein cholesterol (LDL-C) target values, the impact on LDL-C achievement rates, and the current lipid-lowering treatments. Under the 2019 ESC guideline, CV risk categories changed in 27.5% of patients, LDL-C target levels decreased in 71.4% of patients, and LDL-C target achievement rate dropped from 31.1% to 16.5%. Among non-achievers according to the 2019 guideline, 52.2% lacked lipid-lowering drugs entirely, and 41.5% had conventional drugs at a submaximal intensity. Of patients in the high-risk and very high-risk categories, at least 5% failed to achieve the LDL-C target level despite treatment at maximal intensity with conventional lipid-lowering drugs, making them eligible for PCSK-9 inhibitors. In conclusion, the 2019 ESC/EAS guideline lowered LDL-C target values for the majority of patients in general practice and halved LDL-C target achievement rates. There is still a large undeveloped potential to lower CV risk by introducing conventional lipid-lowering drugs, particularly in patients at high or very high CV risk. A substantial proportion of the patients can only achieve their LDL-C targets using PCSK-9 inhibitors, which would currently require an at least 10-fold increase in prescribing of these drugs.
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Barter PJ, Yamashita S, Laufs U, Ruiz AJ, Sy R, Fang MDG, Folco E, Libby P, Matsuzawa Y, Santos RD. Gaps in beliefs and practice in dyslipidaemia management in Japan, Germany, Colombia and the Philippines: insights from a web-based physician survey. Lipids Health Dis 2020; 19:131. [PMID: 32522192 PMCID: PMC7285462 DOI: 10.1186/s12944-020-01265-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Accepted: 04/22/2020] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Implementing evidence-based management of dyslipidaemia is a challenge worldwide. OBJECTIVES To understand physician beliefs and behaviour and identify uncertainties in dyslipidaemia management across four world regions. METHODS Web-based survey of 1758 physicians in Japan, Germany, Colombia and the Philippines who were selected randomly from existing databases. Key inclusion criteria were 1) for cardiologists and diabetes/endocrinology specialists: ≥50 dyslipidaemia patients examined in the last month; 2) for specialists in neurology/neurosurgery/stroke medicine: ≥50 dyslipidaemia patients and ≥ 20 patients with a history of ischaemic stroke examined in the last month; and 3) for specialists in nephrology and general medicine: based at centres with ≥20 beds and ≥ 50 dyslipidaemia patients examined in the last month. The self-report survey covered dyslipidaemia management, target low-density lipoprotein cholesterol (LDL-C) levels in different patient groups, and statin safety. All physicians gave voluntary consent and all data were anonymised. Analysis was solely descriptive. RESULTS The survey highlighted key areas of uncertainty in dyslipidaemia management in the four countries. These related to LDL-C targets in different patient groups, the safety of low LDL-C levels, the safety of statins, especially for effects on cognitive, renal and hepatic function and for haemorrhagic stroke risk, and lipid management strategies in patients with chronic kidney disease, including those with concomitant hypertriglyceridaemia. CONCLUSIONS This survey of physicians in Japan, Germany, Colombia and the Philippines has identified key gaps in knowledge about dyslipidaemia management. These relate to the safety of low LDL-C levels, the safety of statins, and lipid management of chronic kidney disease. The findings from this survey highlight the need for further education to improve the implementation of guideline recommendations for dyslipidaemia management.
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Affiliation(s)
- Philip J Barter
- School of Medical Sciences, University of New South Wales, Sydney, Australia
| | - Shizuya Yamashita
- Rinku General Medical Center and Osaka University Graduate School of Medicine, Osaka, Japan
| | | | | | - Rody Sy
- College of Medicine, University of the Philippines-Manila, Manila, the Philippines
| | - Mark David G Fang
- Cardinal Santos Medical Center, San Juan City, MetroManila, the Philippines
| | - Emanuela Folco
- International Atherosclerosis Society, Viale Piave 35, Milan, Italy
| | - Peter Libby
- Brigham and Women's Hospital, Harvard Medical School, Boston, USA
| | | | - Raul D Santos
- Hospital Israelita Albert Einstein, São Paulo, Brazil. .,Heart Institute -InCor, University of São Paulo Medical School Hospital, Av Dr Enéas C. Aguiar 44, Sao Paulo, SP, CEP-05403-900, Brazil.
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Abstract
Atherosclerotic cardiovascular disease (ASCVD) is the main cause of morbidity and mortality in the US. ASCVD is caused by elevated levels of ApoB lipoproteins, which over many years penetrate the arterial subendothelial space leading to plaque growth and eventually rupture causing clinical symptoms. ApoB lipoprotein levels are approximated in clinical practice by LDL-C measurement. LDL-C lowering agents (statins, ezetimibe and PCSK9 inhibitors) reduce cardiovascular risk in primary and secondary prevention proportionally to LDL-C reduction (23% per 1 mmol/L of LDL). However, for a variety of reasons, many patients do not achieve their recommended LDL-C levels using currently available therapies. This has prompted the development of new LDL-C lowering drugs in the hope to reduce cardiovascular risk, such as bempedoic acid, inclisiran, gemcabene and evinacumab. Drugs targeting other lipids (triglycerides, HDL-C, lipoprotein (a)), intravascular inflammation or acting by other mechanisms also have a role in atherosclerosis prevention, however, they will not be covered in this review.
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Affiliation(s)
- Cezary Wójcik
- Center for Preventive Cardiology, Oregon Health and Sciences University, Portland, OR
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Urbonas G, Vencevičienė L, Valius L, Krivickienė I, Petrauskas L, Lazarenkienė G, Karpavičienė J, Briedė G, Žučenkienė E, Vencevičius K. Primary Prevention of Cardiovascular Risk in Lithuania-Results from EUROASPIRE V Survey. MEDICINA (KAUNAS, LITHUANIA) 2020; 56:E134. [PMID: 32197516 PMCID: PMC7143447 DOI: 10.3390/medicina56030134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/09/2020] [Accepted: 03/13/2020] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Cardiovascular disease (CVD) prevention guidelines define targets for lifestyle and risk factors for patients at high risk of developing CVD. We assessed the control of these factors, as well as CVD risk perception in patients enrolled into the primary care arm of the European Action on Secondary and Primary Prevention by Intervention to Reduce Events (EUROASPIRE V) survey in Lithuania. Materials and Methods: Data were collected as the part of the EUROASPIRE V survey, a multicenter, prospective, cross-sectional observational study. Adults without a documented CVD who had been prescribed antihypertensive medicines and/or lipid-lowering medicines and/or treatment for diabetes (diet and/oral antidiabetic medicines and/or insulin) were eligible for the survey. Data were collected through the review of medical records, patients' interview, physical examination and laboratory tests. Results: A total of 201 patients were enrolled. Very few patients reached targets for low-density lipoprotein cholesterol (LDL-C) (4.5%), waist circumference (17.4%) and body mass index (15.4%). Only 31% of very high CVD risk patients and 52% of high-risk patients used statins. Blood pressure target was achieved by 115 (57.2%) patients. Only 21.7% of patients at very high actual CVD risk and 27% patients at high risk correctly estimated their risk. Of patients at moderate actual CVD risk, 37.5% patients accurately self-assessed the risk. About 60%-80% of patients reported efforts to reduce the intake of sugar, salt or alcohol; more than 70% of patients were current nonsmokers. Only a third of patients reported weight reduction efforts (33.3%) or regular physical activity (27.4%). Conclusions: The control of cardiovascular risk factors in a selected group of primary prevention patients was unsatisfactory, especially in terms of LDL-C level and body weight parameters. Many patients did not accurately perceive their own risk of developing CVD.
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Affiliation(s)
- Gediminas Urbonas
- Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania; (L.V.); (I.K.); (L.P.); (G.L.); (J.K.)
| | - Lina Vencevičienė
- Institute of Clinical Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (L.V.); (G.B.); (E.Ž.); (K.V.)
| | - Leonas Valius
- Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania; (L.V.); (I.K.); (L.P.); (G.L.); (J.K.)
| | - Ieva Krivickienė
- Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania; (L.V.); (I.K.); (L.P.); (G.L.); (J.K.)
| | - Linas Petrauskas
- Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania; (L.V.); (I.K.); (L.P.); (G.L.); (J.K.)
| | - Gintarė Lazarenkienė
- Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania; (L.V.); (I.K.); (L.P.); (G.L.); (J.K.)
| | - Justina Karpavičienė
- Department of Family Medicine, Medical Academy, Lithuanian University of Health Sciences, 50161 Kaunas, Lithuania; (L.V.); (I.K.); (L.P.); (G.L.); (J.K.)
| | - Gabrielė Briedė
- Institute of Clinical Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (L.V.); (G.B.); (E.Ž.); (K.V.)
| | - Emilė Žučenkienė
- Institute of Clinical Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (L.V.); (G.B.); (E.Ž.); (K.V.)
| | - Karolis Vencevičius
- Institute of Clinical Medicine, Clinic of Internal Diseases, Family Medicine and Oncology, Faculty of Medicine, Vilnius University, 01513 Vilnius, Lithuania; (L.V.); (G.B.); (E.Ž.); (K.V.)
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Wang X, He Y, Wang T, Li C, Ma Z, Zhang H, Ma H, Zhao H. Lipid-Lowering Therapy and Low-Density Lipoprotein Cholesterol (LDL-C) Goal Achievement in High-Cardiovascular-Risk Patients in Fuzhou, China. J Cardiovasc Pharmacol Ther 2020; 25:307-315. [PMID: 31918567 DOI: 10.1177/1074248419899298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aims to analyze the treatment patterns and goal attainment of low-density lipoprotein cholesterol (LDL-C) among patients with atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus (DM) in the real-world setting in Fuzhou, China. METHODS Patients aged ≥20 years with a valid LDL-C measurement (index date) in 2016 were selected from National Healthcare Big Data in Fuzhou, China. Patients were stratified into mutually exclusive cardiovascular risk categories: ASCVD (including recent acute coronary syndrome [ACS], chronic coronary heart disease [CHD], stroke, and peripheral arterial disease [PAD]), and DM alone (without ASCVD). Lipid-modifying medication and LDL-C attainment at the index date were assessed. RESULTS A total of 21 989 patients met the inclusion criteria, including 17 320 (78.8%) with ASCVD and 4669 (21.2%) with DM alone; 47.7% of patients received current statin therapy in the overall cohort (53.5% in ASCVD, 26.5% for DM); 20.5% ASCVD population achieved LDL-C target with the highest in patients with recent ACS (33.8%), followed by chronic CHD (21.2%), PAD (20.9%), and ischemic stroke (17.3%); 49.0% of patients with DM achieved LDL-C target. Higher LDL-C attainment was observed in high-intensity statin and a combination of statin and nonstatin groups. Atorvastatin was the most commonly used statin with the highest LDL-C attainment, followed by rosuvastatin. CONCLUSION Compared with previous studies in China, our study found a relatively low statin use and LDL-C target attainment, but higher than similar studies in Europe. Guidelines should be well complied and more prescription of high-intensity statin or statin and nonstatin combination should be advocated.
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Affiliation(s)
- Xing Wang
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Public Health School, Fudan University, Shanghai, China.,Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Yan He
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Tao Wang
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Chunming Li
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Zihui Ma
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Heng Zhang
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Handong Ma
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China.,Department of Computer Science, Shanghai Jiao Tong University, Shanghai, China
| | - Hongxin Zhao
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
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