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Cosin-Sales J, Sidelnikov E, Villamayor S, Fernández M, Merino-Montero S, Zamora A. Identification of Secondary Prevention Patients Eligible for PCSK9 Inhibitors Therapy According to the Routine Clinical Practice in Spain. Adv Ther 2023; 40:2710-2724. [PMID: 36525203 PMCID: PMC10220136 DOI: 10.1007/s12325-022-02384-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2022] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Many patients at very high risk of cardiovascular (CV) events would benefit from lipid-lowering therapies (LLT) intensification to decrease their risk. This study aimed to identify the real-world secondary prevention patients potentially eligible for proprotein convertase subtilisin-kexin type 9 inhibitors (PCSK9i) in Spain. METHODS This retrospective cohort study included adult patients registered in the IQVIA Spanish Electronic Medical Records outpatient database (2014-2020), diagnosed with myocardial infarction (MI), unstable angina (UA), ischaemic stroke (IS), transient ischaemic attack (TIA) or peripheral artery disease (PAD) and with ≥ 1 low-density lipoprotein cholesterol (LDL-C) or total cholesterol measurements. Longitudinal data were collected from the initial diagnosis to the end of the study period or follow-up loss. RESULTS The study included 9516 patients, 63.9% male, mean (SD) age 67.7 (12.5) years and mean LDL-C 117.3 (38.8) mg/dL. MI, IS and PAD were the most severe events reported during the study period (28.5%, 18.7% and 29.3% of patients, respectively). At the time of last available LDL-C assessment (≥ 3 months post-event), 64.4% patients were on LLT. Of those, 45.4%, 46.9% and 7.7% were on high-, moderate- and low-intensity LLT. Overall, 9.6% patients achieved LDL-C < 55 mg/dL (24.2% LDL-C < 70 mg/dL). Furthermore, 17.9% patients receiving optimized oral LLT showed LDL-C > 100 mg/dL (LDL-C reimbursement threshold for PCSK9i in Spain). CONCLUSION Up to 82% of patients with atherosclerotic CV disease do not achieve LDL-C levels recommended by the 2019 ESC/EAS guidelines despite being on optimized oral LLT therapy. In 17.9% of these patients LDL-C levels exceed 100 mg/dL, being eligible for PCSK9i in Spain.
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Affiliation(s)
- Juan Cosin-Sales
- Servicio de Cardiología, Hospital Arnau de Vilanova, Carrer de Sant Clement, 12, 46015, Valencia, Spain.
- Departamento de Medicina, Facultad de Ciencias de la Salud, Universidad CEU-Cardenal Herrena, Moncada, Valencia, Spain.
| | | | | | | | | | - Alberto Zamora
- Unidad de Riesgo Vascular y Lípidos Corporació de Salut del Maresme i la Selva, Barcelona, Spain
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. Neurologia 2022; 37:136-150. [PMID: 33358061 DOI: 10.1016/j.nrl.2020.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Revised: 08/31/2020] [Accepted: 11/05/2020] [Indexed: 10/22/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels <20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, España; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, España
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, España
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, España
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, España
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), España
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, España
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, España
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, España
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, España
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Gil-Núñez A, Masjuan J, Montaner J, Castellanos M, Segura T, Cardona P, Tembl JI, Purroy F, Arenillas J, Palacio E. Proprotein convertase subtilisin/kexin type 9 inhibitors in secondary prevention of vascular events in patients with stroke: Consensus document and practice guidance. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:136-150. [PMID: 34906541 DOI: 10.1016/j.nrleng.2020.11.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 11/05/2020] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Patients with history of stroke or transient ischaemic attack present considerable risk of future vascular events. Reducing levels of low-density lipoprotein (LDL) cholesterol decreases the incidence of new vascular events, although in a substantial number of patients, the currently available lipid-lowering therapies fail to achieve the therapeutic goals recommended in clinical guidelines. The aim of this consensus statement is to provide updated information on the role of the proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors alirocumab and evolocumab in the secondary prevention of vascular events in patients with history of ischaemic stroke. METHODS A literature review was performed to identify the main evidence on the use of PCSK9 inhibitors in these patients and the recommended therapeutic targets of LDL cholesterol. The results were discussed in 2 consensus meetings that constituted the basis for the drafting of the document. CONCLUSIONS PCSK9 inhibitors are effective in reducing vascular risk in secondary prevention; evolocumab specifically has achieved this reduction in patients with history of ischaemic stroke. Moreover, both alirocumab and evolocumab present good safety profiles, even in patients achieving LDL cholesterol levels < 20 mg/dL, and no signs of cognitive impairment have been observed in patients treated with evolocumab who achieved very low levels of LDL cholesterol. In the light of this evidence, we provide practical recommendations about the use of PCSK9 inhibitors in secondary prevention of vascular events in patients with history of ischaemic stroke and follow-up of these patients.
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Affiliation(s)
- A Gil-Núñez
- Sección Neurología Vascular-Centro de Ictus, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain.
| | - J Masjuan
- Servicio de Neurología, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - J Montaner
- Servicio de Neurología, Hospital Virgen Macarena, Sevilla, Spain
| | - M Castellanos
- Servicio de Neurología, Complejo Hospitalario Universitario A Coruña, Instituto de Investigación Biomédica A Coruña, La Coruña, Spain
| | - T Segura
- Servicio de Neurología, Hospital Universitario de Albacete, Albacete, Spain
| | - P Cardona
- Servicio de Neurología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat (Barcelona), Spain
| | - J I Tembl
- Servicio de Neurología, Hospital La Fe, Valencia, Spain
| | - F Purroy
- Servicio de Neurología, Hospital Arnau de Vilanova, Lérida, Spain
| | - J Arenillas
- Servicio de Neurología, Hospital de Valladolid, Valladolid, Spain
| | - E Palacio
- Servicio de Neurología, Hospital Marqués de Valdecilla, Santander, Spain
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Ferreira-González I, Sánchez-Recalde Á, Abu-Assi E, Arias MÁ, Gallego P. Despedida del equipo editorial de Revista Española de Cardiología 2015-2021. Rev Esp Cardiol 2021. [DOI: 10.1016/j.recesp.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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McCormick D, Bhatt DL, Bays HE, Taub PR, Caldwell KA, Guerin CK, Steinhoff J, Ahmad Z, Singh R, Moreo K, Carter J, Heggen CL, Sapir T. A regional analysis of payer and provider views on cholesterol management: PCSK9 inhibitors as an illustrative alignment model. J Manag Care Spec Pharm 2020; 26:1517-1528. [PMID: 33251993 PMCID: PMC10391214 DOI: 10.18553/jmcp.2020.26.12.1517] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND: Multiple barriers exist for appropriate use of the proprotein convertase subtilisin/kexin type 9 enzyme inhibitors (PCSK9i) in patients with atherosclerotic cardiovascular disease (ASCVD) or familial hypercholesterolemia (FH) with inadequately controlled hypercholesterolemia despite standard therapies. Among these barriers, high payer rejection rates and inadequate prior authorization (PA) documentation by providers hinder optimal use of PCSK9i. OBJECTIVES: To (a) identify and discuss provider and payer discordances on barriers to authorization and use of PCSK9i based on clinical and real-world evidence and (b) align understanding and application of clinical, cost, safety, and efficacy data of PCSK9i. METHODS: Local groups of 3 payers and 3 providers met in 6 separate locations across the United States through a collaborative project of AMCP and PRIME Education. Responses to selected pre- and postmeeting survey questions measured changes in attitudes and beliefs regarding treatment barriers, lipid thresholds for considering PCSK9i therapy, and tactics for improving PA processes. Statistical analysis of inter- and intragroup changes in attitudes were performed by Cox proportional hazards test and Fisher's exact test for < 5 variables. RESULTS: The majority of providers and payers (67%-78%) agreed that high patient copayments and inadequate PA documentation were significant barriers to PCSK9i usage. However, payers and providers differed on beliefs that current evidence does not support PCSK9i cost-effectiveness (6% providers, 56% payers; P = 0.003) and that PA presents excessive administrative burden (72% providers, 44% payers; P = 0.09) Average increases pre- to postmeeting were noted in provider beliefs that properly documented PA forms expedite access to PCSK9i (22%-50% increase) and current authorization criteria accurately distinguish patients who benefit most from PCSK9i (6%-22%). Payers decreased in their belief that current authorization criteria accurately distinguish benefiting patients (72%-50%). Providers and payers increased in their belief that PCSK9i are cost-effective (44%-61% and 28%-50%, respectively) and were more willing to consider PCSK9i at the low-density lipoprotein cholesterol threshold of > 70 mg/dL for patients with ASCVD (78%-83% and 44%-67%, respectively) or FH (22%-39% and 22%-33%). Payers were more agreeable to less stringent PA requirements for patients with FH (33%-72%, P = 0.019) and need for standardized PA requirements (50%-83%, P = 0.034); these considerations remained high (89%) among providers after the meeting. Most participants supported educational programs for patient treatment adherence (83%) and physician/staff PA processes (83%-94%). CONCLUSIONS: Provider and payer representatives in 6 distinct geographic locations provided recommendations to improve quality of care in patients eligible for PCSK9i. Participants also provided tactical recommendations for streamlining PA documentation processes and improving awareness of PCSK9i cost-effectiveness and clinical efficacy. The majority of participants supported development of universal, standardized patient eligibility criteria and PA forms. DISCLOSURES: The study reported in this article was part of a continuing education program funded by an independent educational grant awarded by Sanofi US and Regeneron Pharmaceuticals to PRIME Education. The grantor had no role in the study design, execution, analysis, or reporting. AMCP received grant funding from PRIME to assist in the study, as well as in writing the manuscript. McCormick, Bhatt, Bays, Taub, Caldwell, Guerin, Steinhoff, and Ahmad received an honorarium from PRIME for serving as faculty for the continuing education program. McCormick, Bhatt, Bays, Taub, Caldwell, Guerin, Steinhoff, and Ahmad were involved as participants in the study. Bhatt discloses the following relationships: Advisory board: Cardax, CellProthera, Cereno Scientific, Elsevier Practice Update Cardiology, Level Ex, Medscape Cardiology, PhaseBio, PLx Pharma, Regado Biosciences; Board of directors: Boston VA Research Institute, Society of Cardiovascular Patient Care, TobeSoft; Chair: American Heart Association Quality Oversight Committee; Data monitoring committees: Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute, for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial, funded by Edwards), Contego Medical (Chair, PERFORMANCE 2), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial, funded by Daiichi Sankyo), Population Health Research Institute; Honoraria: American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee funded by Boehringer Ingelheim; AEGIS-II executive committee funded by CSL Behring), Belvoir Publications (Editor in Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor in Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), K2P (Co-Chair, interdisciplinary curriculum), Level Ex, Medtelligence/ReachMD (CME steering committees), MJH Life Sciences, Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today's Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), WebMD (CME steering committees); Other: Clinical Cardiology (Deputy Editor), NCDR-ACTION Registry Steering Committee (Chair), VA CART Research and Publications Committee (Chair); Research funding: Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lexicon, Lilly, Medtronic, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi Aventis, Synaptic, The Medicines Company; Royalties: Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald's Heart Disease); Site co-investigator: Biotronik, Boston Scientific, CSI, St. Jude Medical (now Abbott), Svelte; Trustee: American College of Cardiology; Unfunded research: FlowCo, Merck, Novo Nordisk, Takeda. Bays' research site has received research grants from 89Bio, Acasti, Akcea, Allergan, Alon Medtech/Epitomee, Amarin, Amgen, AstraZeneca, Axsome, Boehringer Ingelheim, Civi, Eli Lilly, Esperion, Evidera, Gan and Lee, Home Access, Janssen, Johnson and Johnson, Lexicon, Matinas, Merck, Metavant, Novartis, Novo Nordisk, Pfizer, Regeneron, Sanofi, Selecta, TIMI, and Urovant. Bays has served as a consultant/advisor for 89Bio, Amarin, Esperion, Matinas, and Gelesis, and speaker for Esperion. McCormick, Caldwell, Guerin, Ahmad, Singh, Moreo, Carter, Heggen, and Sapir have nothing to disclose.
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Affiliation(s)
| | - Deepak L Bhatt
- Brigham and Women’s Hospital Heart and Vascular Center and Harvard Medical School, Boston, MA
| | - Harold E Bays
- Louisville Metabolic and Atherosclerosis Research Center, Louisville, KY
| | - Pam R Taub
- Division of Cardiovascular Medicine, University of California San Diego School of Medicine
| | | | - Chris K Guerin
- Tri-City Medical Center and University of California San Diego School of Medicine
| | - Jeff Steinhoff
- Largo Medical Center, Largo, FL; HCA Healthcare/USF Morsani College of Medicine, Tampa, FL; and Nova Southeastern University, Davie, FL
| | - Zahid Ahmad
- Division of Nutrition and Metabolic Disease, UT Southwestern Medical Center, Dallas, TX
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Barrios V, Escobar C, Arrarte V, García E, Fernández MR, Rincón LM, Roldán C. First national registry on the effectiveness and safety of evolocumab in clinical practice in patients attended in cardiology in Spain. The RETOSS-CARDIO study. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE ARTERIOSCLEROSIS 2020; 32:231-241. [PMID: 32605806 DOI: 10.1016/j.arteri.2020.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2019] [Revised: 05/07/2020] [Accepted: 05/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE To present the first registry used to analyse the clinical profile of patients treated with evolocumab in Spain, including the effectiveness on the lipid profile and safety in the «real world» setting. METHODS Multicentre, retrospective, and observational study of patients starting treatment with evolocumab from February 2016 to May 2017 in clinical practice in Spanish cardiology units. RESULTS A total of 186 patients (mean age 60.3 ± 9.8 years were included, 35.5% with familial hypercholesterolaemia, and 94.1% with a previous cardiovascular event) from 31 cardiology units. Baseline lipid profile: Total cholesterol 219.4 ± 52.2 mg/dL, LDL-cholesterol 144.0 ± 49.0mg/dL, HDL-cholesterol 47.7 ± 13.0mg/dL, and triglycerides 151.0 ± 76.2mg/dL. At the time of initiating evolocumab, 53.8% of patients were taking statins (50% had partial or total intolerance to statins), and 51.1% ezetimibe. In all cases, the dose of evolocumab used was 140 mg, mainly every 2 weeks (97.3%). Evolocumab compliance was high (92.3%). Treatment with evolocumab was interrupted in 6 patients (3.2%), with only 1 (0.5%) due to a probable side effect. Evolocumab significantly reduced total cholesterol (30.9% at week 2, and 39.3% at week 12; P<.001), LDL cholesterol (44.4% and 57.6%, respectively; P<.001), and triglycerides (14.8% and 5.2%, respectively; P<001), with no significant changes in HDL-cholesterol (6.7% and 2.0%; P=.14). CONCLUSIONS In clinical practice, evolocumab is associated with reductions in LDL cholesterol, with nearly 60% after 12 weeks of treatment, and with low rates of interruptions due to side effects and high medication compliance. These results are consistent with those reported in randomised clinical trials.
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Affiliation(s)
- Vivencio Barrios
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España.
| | - Carlos Escobar
- Servicio de Cardiología, Hospital Universitario La Paz, Madrid, España
| | - Vicente Arrarte
- Servicio de Cardiología, Hospital General Universitario, Alicante, España
| | - Eusebio García
- Servicio de Cardiología, Hospital Universitario Puerta de Hierro, Madrid, España
| | | | - Luis Miguel Rincón
- Servicio de Cardiología, Hospital Universitario Ramón y Cajal, Universidad de Alcalá, Madrid, España
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Comentarios a la guía ESC/EAS 2019 sobre el tratamiento de las dislipemias. Rev Esp Cardiol (Engl Ed) 2020. [DOI: 10.1016/j.recesp.2019.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Ferreira-González I, Sánchez-Recalde Á, Abu-Assi E, Arias MÁ, Gallego P, Del Río I. Revista Española de Cardiología: annual report 2019. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:410-417. [PMID: 32291243 DOI: 10.1016/j.rec.2020.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
| | | | | | | | | | - Iria Del Río
- Editorial Director, Revista Española de Cardiología
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Pérez de Isla L, Masana L, Argüeso R, Campuzano R, Egocheaga I, Escobar C, Fácila L, Mata López P, Rossi M, Rus Mansilla C, Alarcón Duque JA, Arrarte V, Barón G, Barrios V, Carro A, Castro A, Cosin-Sales J, Fernández Olmo R, Gámez Martínez J, Huelmos A, Sandín M, Saltijeral A, Valle A, Arribas F, Berga Congost G, Bueno H, Evangelista A, Ferreira-González I, Jiménez Navarro M, Marín F, Pérez de Isla L, Sambola A, Vázquez R, Viana-Tejedor A, Ibáñez B, Alfonso F. Comments on the 2019 ESC/EAS guidelines for the management of dyslipidemias. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2020; 73:348-353. [PMID: 32205101 DOI: 10.1016/j.rec.2019.11.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/13/2019] [Indexed: 06/10/2023]
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Bruckert E, Parhofer KG, Gonzalez-Juanatey JR, Nordestgaard B, Arca M, Giovas P, Ray K. Proportion of High-Risk/Very High-Risk Patients in Europe with Low-Density Lipoprotein Cholesterol at Target According to European Guidelines: A Systematic Review. Adv Ther 2020; 37:1724-1736. [PMID: 32200537 PMCID: PMC7467492 DOI: 10.1007/s12325-020-01285-2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Assess achievement of low-density lipoprotein cholesterol (LDL-C) targets in European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines. DESIGN Systematic literature review. DATA SOURCES Medline, EMBASE, Cumulated Index to Nursing and Allied Health Literature. ELIGIBILITY CRITERIA Observational studies reporting LDL-C levels/target attainment, measured between 1 August 2006 to 31 August 2017, in European adults with established cardiovascular disease (CVD), diabetes with target organ damage, familial hypercholesterolaemia (FH) or 10-year risk of fatal CVD ≥ 5% (assessed by Systematic Coronary Risk Evaluation [SCORE]). DATA EXTRACTION AND SYNTHESIS Two reviewers independently extracted relevant studies and assessed study quality using the Risk of Bias for Non-Randomised Studies-Interventions (ROBINS-I) tool. Primary outcome was the proportion of patients achieving LDL-C targets in the 2011/2016 ESC/EAS guidelines. Where available, patient characteristics were presented as means weighted by sample size. The proportions of patients achieving LDL-C targets in the 5 years before and after publication of the 2011 guidelines were compared using a chi-square test. RESULTS Across 81 eligible studies (303,534 patients), achievement of LDL-C < 1.8 mmol/L was poor among patients with established CVD (16%; range 9-56%) and at very high risk of CVD (SCORE ≥ 10% [18%; 14-25%]). In individuals with FH, SCORE 5-10%, or diabetes and target organ damage, LDL-C < 2.5 mmol/L was achieved by 15% (9-22%), 46% (21-55%) and 13% (6-34%), respectively. Comparing the 5 years before/after publication of the 2011 guidelines, target achievement increased significantly over time but remained suboptimal (LDL-C < 1.8, 22% versus 15%; LDL-C < 2.5, 68% versus 61%; both p < 0.001; established CVD group only). CONCLUSIONS These data show suboptimal LDL-C control among European patients at high risk of CVD. Those at greatest overall risk (clinically established CVD or at least a 10% 10-year risk of fatal CVD) had the lowest achievement of 2011/2016 EAS/ESC LDL-C targets. With lower LDL-C targets advocated in 2019 ESC/EAS guidelines, this unmet need will increase. PROTOCOL REGISTRATION PROSPERO registration number; CRD77844.
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Affiliation(s)
- Eric Bruckert
- Endocrinologie Métabolisme et Prévention Cardiovasculaire, Institut E3M et IHU Cardiométabolique (ICAN), Hôpital Pitié Salpêtrière, Paris, France.
| | - Klaus Georg Parhofer
- Medizinische Klinik IV-Grosshadern, Klinikum der Universität München, Marchioninistr. 15, 81377, Munich, Germany
| | | | - Børge Nordestgaard
- Department of Clinical Biochemistry, Faculty of Health and Medical Sciences, Herlev and Gentofte Hospital, Copenhagen University Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Marcello Arca
- Department of Internal Medicine and Medical Specialties, UOS Atherosclerosis Center, La Sapienza University of Rome, Rome, Italy
| | | | - Kausik Ray
- Department of Public Health and Primary Care, Imperial Centre for Cardiovascular Disease Prevention, Imperial College London, London, UK
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Ferreira-González I, Sánchez-Recalde Á, Abu-Assi E, Arias MÁ, Gallego P, del Río I. Revista Española de Cardiología: anuario de 2019. Rev Esp Cardiol 2020. [DOI: 10.1016/j.recesp.2020.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Pintó X, Sarasa I. Nuevas perspectivas en el tratamiento de la hipercolesterolemia desde la disponibilidad de los inhibidores de la proteína PCSK9. HIPERTENSION Y RIESGO VASCULAR 2019; 36:213-220. [DOI: 10.1016/j.hipert.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Revised: 05/07/2019] [Accepted: 05/25/2019] [Indexed: 10/26/2022]
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Incidence of Cardiovascular Disease in Patients with Familial Hypercholesterolemia Phenotype: Analysis of 5 Years Follow-Up of Real-World Data from More than 1.5 Million Patients. J Clin Med 2019; 8:jcm8071080. [PMID: 31340450 PMCID: PMC6678686 DOI: 10.3390/jcm8071080] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/10/2019] [Accepted: 07/19/2019] [Indexed: 12/18/2022] Open
Abstract
In the statin era, the incidence of atherosclerotic cardiovascular diseases (ASCVD) in patients with familial hypercholesterolemia (FH) has not been updated. We aimed to determine the incidence of ASCVD in patients with FH-phenotype (FH-P) and to compare it with that of normal low-density lipoprotein cholesterol (LDL-C) patients. We performed a retrospective cohort study using the Database of the Catalan primary care system, including ≥18-year-old patients with an LDL-C measurement. From 1,589,264 patients available before 2009, 12,823 fulfilled FH-P criteria and 514,176 patients were normolipidemic (LDL-C < 115 mg/dL). In primary prevention, patients with FH-P had incidences of ASCVD and coronary heart disease (CHD) of 14.9/1000 and 5.8/1000 person-years, respectively, compared to 7.1/1000 and 2.1/1000 person-years in the normolipidemic group. FH-P showed hazard ratio (HR) of 7.1 and 16.7 for ASCVD and CHD, respectively, in patients younger than 35 years. In secondary prevention, patients with FH-P had incidences of ASCVD and CHD of 89.7/1000 and 34.5/1000 person-years, respectively, compared to 90.9/1000 and 28.2/1000 person-years in the normolipidemic group (HR in patients younger than 35 years: 2.4 and 6.0). In the statin era, FH-P remains associated with high cardiovascular risk, compared with the normolipidemic population. This excess of risk is markedly high in young individuals.
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Zamora A, Masana L, Plana N, Ramos R. Estimación del porcentaje de pacientes con enfermedad coronaria estable candidatos a recibir inhibidores de PCSK9. Respuesta. Rev Esp Cardiol 2019. [DOI: 10.1016/j.recesp.2018.12.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Zamora A, Masana L, Plana N, Ramos R. Estimated Percentage of Patients With Stable Coronary Heart Disease Candidates for PCSK9 Inhibitors. Response. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2019; 72:519-520. [PMID: 30930255 DOI: 10.1016/j.rec.2018.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/19/2018] [Indexed: 06/09/2023]
Affiliation(s)
- Alberto Zamora
- Laboratorio de Medicina Traslacional, Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain; Xarxa d'Unitats de Lípids de Catalunya (XULA), Girona, Spain; Unidad de Lípidos, Hospital de Blanes, Blanes, Girona, Spain
| | - Luis Masana
- Xarxa d'Unitats de Lípids de Catalunya (XULA), Girona, Spain; Unitat de Medicina Vascular i Metabolisme (UVASMET), Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Reus, Tarragona, Spain
| | - Nuria Plana
- Xarxa d'Unitats de Lípids de Catalunya (XULA), Girona, Spain; Unitat de Medicina Vascular i Metabolisme (UVASMET), Hospital Universitari Sant Joan de Reus, Institut d'Investigació Sanitària Pere Virgili (IISPV), Universitat Rovira i Virgili, Centro de Investigación Biomédica en Red de Diabetes y Enfermedades Metabólicas Asociadas (CIBERDEM), Reus, Tarragona, Spain
| | - Rafel Ramos
- Grup Investigació en Salut Cardiovascular de Girona (ISV-Girona), Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Girona, Spain; Institut d'Investigació Biomédica de Girona (IdIBGi), Institut Catalá de la Salut (ICS), Girona, Spain; Departamento de Ciencias Médicas, Facultad de Medicina, Universidad de Girona, Girona, Spain.
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Ascaso JF, Civeira F, Guijarro C, López Miranda J, Masana L, Mostaza JM, Pedro-Botet J, Pintó X, Valdivielso P. Indications of PCSK9 inhibitors in clinical practice. Recommendations of the Spanish Sociey of Arteriosclerosis (SEA), 2019. CLINICA E INVESTIGACION EN ARTERIOSCLEROSIS 2019; 31:128-139. [PMID: 31130361 DOI: 10.1016/j.arteri.2019.04.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Accepted: 04/11/2019] [Indexed: 02/06/2023]
Abstract
A group of experts convened by the Spanish Society of Arteriosclerosis (SEA) has been in charge of updating the SEA document on the indications of PCSK9 inhibitors (PCSK9i) in clinical practice that was published in 2016. This update is justified by the fact that the data from clinical trials carried out on a large scale with PCSK9i have shown that in addition to their high potency to lower atherogenic cholesterol, they reduce the risk of atherosclerotic cardiovascular disease, both in patients with stable disease, and with recent disease, and with a high degree of security. This update provides the recommendations and level of evidence for the prescription of iPCSK9 in patients with homozygous and heterozygous familial hypercholesterolemia, with atherosclerotic cardiovascular disease, and in primary prevention in patients with very high cardiovascular risk. These recommendations have been established taking into account the concentration of LDL-C, the clinical situation of the patient, the additional risk factors and the cost-effectiveness of their use.
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Affiliation(s)
| | - Fernando Civeira
- Hospital Universitario Miguel Servet, IIS Aragón, CIBERCV, Universidad de Zaragoza, Zaragoza, España
| | - Carlos Guijarro
- Hospital Universitario Fundación Alcorcón, Universidad Rey Juan Carlos, Alcorcón, Madrid, España
| | - José López Miranda
- Hospital Universitario Reina Sofía, IMIBIC, Universidad de Córdoba, CIBEROBN, Córdoba, España
| | - Luis Masana
- Hospital Universitario de Reus, Universidad Rovira y Virgili, IISPV, CIBERDEM, Reus, Tarragona, España
| | | | - Juan Pedro-Botet
- Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, España
| | - Xavier Pintó
- Hospital Universitario de Bellvitge-Idibell, Universidad de Barcelona, CIBEROBN, Hospitalet de Llobregat, Barcelona, España.
| | - Pedro Valdivielso
- Hospital Universitario Virgen de la Victoria, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Málaga, España
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Cordero A, Fácila L, Galve E, González Juanatey JR. Estimated Percentage of Patients With Stable Coronary Heart Disease Candidates for PCSK9 Inhibitors. ACTA ACUST UNITED AC 2019; 72:518-519. [PMID: 30981589 DOI: 10.1016/j.rec.2018.11.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 11/29/2018] [Indexed: 11/25/2022]
Affiliation(s)
- Alberto Cordero
- Departamento de Cardiología, Hospital Universitario de San Juan, San Juan de Alicante, Alicante, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain.
| | - Lorenzo Fácila
- Departamento de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
| | - Enrique Galve
- Departamento de Cardiología, Hospital Vall d'Hebron, Barcelona, Spain
| | - José Ramón González Juanatey
- Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Madrid, Spain; Departamento de Cardiología, Complejo Hospital Universitario de Santiago, Santiago de Compostela, A Coruña, Spain
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Elamin AFM, Grafton-Clarke C, Wen Chen K, Obafemi T, Luvai A, Katira R, Davis G. Potential use of PCSK9 inhibitors as a secondary preventative measure for cardiovascular disease following acute coronary syndrome: a UK real-world study. Postgrad Med J 2019; 95:61-66. [DOI: 10.1136/postgradmedj-2018-136171] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 12/26/2018] [Accepted: 01/03/2019] [Indexed: 01/03/2023]
Abstract
BackgroundProprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors are a major development in the prevention of cardiovascular disease (CVD) and is one of the most significant discoveries since the development of statin therapy. Administration of two human monoclonal antibodies to PCSK9 (alirocumab and evolocumab) can significantly reduce low-density lipoprotein cholesterol (LDL-c) concentrations, thus improving lipid management. Accordingly, guidelines on the specific indications for alirocumab and evolocumab usage have been released. This multicentre study aimed to estimate the proportion of patients treated for an acute myocardial infarction (MI) who could be considered for PCSK9 inhibitors under the current National Institute for Health and Care Excellence (NICE) lipid targets criteria.MethodsThe records of 596 patients in two large hospitals in Liverpool, UK were analysed. Information was collected on lipid profiles during and after admission, lipid-lowering therapy and previous CVD.ResultsAt least 2.2% of patients were eligible for PCSK9 inhibitors post-MI under the current NICE guidance. Additionally, 29% of patients failed to achieve LDL-c concentrations <2.0 mmol/L despite maximum statin therapy and failed to meet eligibility for PCSK9 inhibitors as per the NICE criteria. This cohort represents a group of patients ‘in limbo’, in which statin therapy alone is not sufficient to reduce LDL-c.ConclusionsPCSK9 inhibitors are expensive and so their use must be highly selective. At present, in a real-world setting with ezetimibe underprescribing, ~2% of patients are eligible and a further 30% are deprived of benefit and improved outcomes by lack of optimisation and/or potential use of PCSK9 inhibitors.
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Lekuona I. PCSK9 Inhibitors: From Innovation to Sustainable Clinical Application. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2018; 71:996-998. [PMID: 30150140 DOI: 10.1016/j.rec.2018.06.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Accepted: 06/06/2018] [Indexed: 06/08/2023]
Affiliation(s)
- Iñaki Lekuona
- Servicio Cardiología, Hospital Galdakao-Usansolo OSI Barrualde, Galdácano, Vizcaya, Spain.
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