Factors associated with compliance to lipid-lowering treatment in China

Comparative and Combined Effects of Epigallocatechin-3-gallate and Caffeine in Reducing Lipid Accumulation in Caenorhabditis elegans

Epigallocatechin-3-gallate (EGCG) and caffeine, two phytochemicals found in a wide range of natural dietary sources, have been reported to have protective effects against hyperlipidemia, a major risk factor for cardiovascular disease. However, their relative efficacy and synergy in lowering lipid level are unclear. This study intended to compare lipid-lowering activity of EGCG and caffeine and to elucidate their joint action using Caenorhabditis elegans (C. elegans) as a model organism. The worms were exposed to EGCG, caffeine or both agents, and lipid accumulation determined by levels of total lipids, triglycerides and cholesterol was monitored. A 3 × 3 factorial design combined with response surface methodology was used to characterize the nature of interactive effects. Total lipids, triglycerides and cholesterol in C. elegans were reduced by either EGCG or caffeine in a dose-dependent manner, with EGCG displaying a stronger lipid-lowering efficacy than caffeine. Overall, the EGCG/caffeine combination for lowering lipids was more effective than either substance alone. Factorial regression models revealed that the combination was antagonistic for total lipid reduction, perhaps due to a "ceiling" effect, and was synergistic for triglyceride-lowering and additive for cholesterol-lowering. Taken together, our work proposes the use of a combination of EGCG and caffeine as an alternative dietary intervention for the prevention of hyperlipidemia, and additionally highlights the suitability of C. elegans model for evaluating lipid-lowering capacity of natural products.

Barriers in utilizing lipid-lowering agents in non-institutionalized population in the U.S.: Application of a theoretical framework

Cardiovascular diseases are a major cause of death globally. Epidemiological evidence has linked elevated levels of blood cholesterol with the risk of coronary heart disease. However, lipid-lowering agents, despite their importance for primary prevention, are significantly underused in the United States. The objective of this study was to explore associations among socioeconomic factors and the use of antihyperlipidemic agents in 2018 in U.S. patients with hyperlipidemia by applying a theoretical framework. Data from the 2018 Medical Expenditure Panel Survey were used to identify the population of non-institutionalized U.S. civilians diagnosed with hyperlipidemia. This cross sectional study applied the Andersen Behavioral Model to identify patients' predisposing, enabling, and need factors. Approximately 43 million non-institutionalized adults were diagnosed with hyperlipidemia. With the exception of gender and race, predisposing factors indicated significant differences between patients who used antihyperlipidemic agents and those who did not. The relation between income level and use of antihyperlipidemic agents was significant: X2 (4, N = 3,781) = 7.09, p <.001. Hispanic patients were found to be less likely to receive treatment (OR: 0.62; 95% CI: 0.43-0.88), as observed using a logistic model, with controls for predisposing, enabling, and need factors. Patients without health insurance were less likely to use lipid-lowering agents (OR: 0.33; 95% CI: 0.14-0.77). The present study offers essential data for prioritizing interventions by health policy makers by identifying barriers in utilizing hyperlipidemia therapy. Non-adherence to treatment may lead to severe consequences and increase the frequency of fatal cardiac events in the near future.

Determinants of Non-Adherence to the Medications for Dyslipidemia: A Systematic Review

PURPOSE

Dyslipidemia is a major cardiovascular risk factor, and its control leads to less cardiovascular events. Many patients will need some medications to achieve ideal targets. Non-adherence to medications is a complex problem with high impact on their effectiveness. This study aims to identify the determinants of non-adherence to medications in patients with dyslipidemia.

PATIENTS AND METHODS

We conducted a systematic review. PubMed and Scopus databases were searched for original articles, published between 2000 and 2020, using the MeSH terms "Dyslipidemias" and "Medication Adherence".

RESULTS

From the initial 3502 identified articles, we selected 46 to include in the final qualitative synthesis. The determinants associated with non-adherence were lower age (≤50 years), female sex, African American ethnicity, smoking habits, being a new user of lipid-lowering medications, reporting or having concerns about lipid-lowering medication side effects and some comorbidities (chronic obstructive pulmonary disease, Alzheimer's disease/dementia, depression and diabetes). On the contrary, adherence is higher in older patients, alcohol drinking habits, taking β-blockers, having a higher number of comorbidities, having a history of cardiovascular events, cardiac interventions or revascularization procedures, having health insurance and having more provider follow-up visits.

CONCLUSION

There are important identifiable determinants of non-adherence in patients with dyslipidemia. These patients benefit from a specific approach to minimize the problem and maximize the potential benefit of the prescription.

Characteristics of patients with dyslipidemia treated in routine care setting in China

Objective: To describe characteristics of patients with dyslipidemia treated in routine care in China overall and stratified by diabetes and atherosclerotic cardiovascular disease (ASCVD). Methods: This study used data from a cross-sectional survey conducted in China in 2017 under the Dyslipidemia Disease Specific Programme (DSP). Each surveyed physician provided information including demographics, dyslipidemia diagnosis and treatment history, lab values on at least 8 patients currently treated for dyslipidemia with oversampling of patients with ASCVD or diabetes mellitus diagnosis at the time of survey. A related patient survey assessed treatment adherence and satisfaction. Results: This study included 195 physicians (40 endocrinologists, 75 internists, 80 cardiologists) who provided data on 1870 patients (852 with diabetes; 1018 patients without diabetes). Among patients with diabetes, 279 had ASCVD and 573 did not (non-ASCVD). In the diabetic population, patients with ASCVD were older (67.3 vs. 62.1 years), more often had caregiver support (34 vs. 14%), and had higher average LDL-C at diagnosis (172.4 vs. 167.4 mg/dL) compared to their non-ASCVD counterparts. Findings were similar for non-diabetic patients (ASCVD: 323 patients; non-ASCVD: 695) patients. In all four subgroups, 46-54% of patients reported low treatment adherence, and fewer than half expressed satisfaction with their cholesterol control, and 2-5% had LDL-C < 70 mg/dL at their most recent assessment. Conclusions: Among patients with dyslipidemia, those with ASCVD had higher LDL-C levels than patients without ASCVD, and many required caregiving. Low levels of treatment adherence, LDL-C control, and patient satisfaction suggest opportunities to improve care for Chinese patients with dyslipidemia.

Prescription of statins at discharge and 1-year risk of major clinical outcomes among acute coronary syndromes patients with extremely low LDL-cholesterol in clinical pathways for acute coronary syndromes studies

OBJECTIVE

The aim of this study was to investigate statin description on discharge and the benefit on the long-term outcomes in acute coronary syndromes (ACS) patients with very low baseline LDL-cholesterol (LDL-c).

METHODS

This is a post-hoc analysis of 3374 ACS patients who were discharged alive and had baseline LDL-c levels below 70 mg/dL (1.8 mmol/L). The propensity score of using statin was estimated with a multivariable Logistic model including patient's demography, social economic status, cardiovascular risk factors, subtype of the diagnosis, and treatments received during hospitalization and current LDL-c level. The risk of major adverse cardiovascular events (MACEs) was compared between patients received and not-received statin with Cox-regression models adjusting for the propensity score plus other factors. A sensitivity analysis was done in propensity score matched patients.

RESULTS

Compared with nonstatin group, the incidence of MACE at 12 months after discharge was lower in the statin group (11.1% vs 5.8%; P < 0.001). The propensity score plus other factors-adjusted hazard ratios for MACEs was significant (0.58; 95% CI: 0.39, 0.87). The effect showed a significant dose-response relationship (P for trend = 0.02). The results in analyses with propensity-score matched participants were in consistent with above findings. Analyses on total mortality in 12 months showed similar results.

CONCLUSIONS

Among ACS survivors with a very low baseline LDL-c, low to moderate intensity statin therapy was associated significantly with lower risk of MACEs and total mortality at 12 months. The results suggested that ACS survivors should take statin regardless of the baseline of LDL-c.

Drug Brand Response and Its Impact on Compliance and Efficacy in Depression Patients

Introduction: Patient's response to drug brand is a comprehensive physiological and psychological effect which might impact the compliance and efficacy of drugs. Whether the therapeutic outcome altered on patients with brand response after they experience drug switch is not clear.

Methods: 459 outpatients with mild-to-moderate depression were divided into the imported (joint venture) drug group and the domestic drug group according to their current drug application. Two groups of patients were assessed by drug brand preference questionnaire and medication compliance questionnaire. Patients with brand preference in imported (joint venture) drugs group received rational use of limited medical resource and pharmacoeconomics education, and then switched with domestic drug for 8 weeks. Safety and efficacy were evaluated both before and after the drug switch.

Results: Overall, there were 27% of patients in imported drug group and 35% of patients in domestic drug group have brand response, respectively. About 2/3 patients in both groups showed low or no brand response. The compliance was similar in both groups with no significant difference (6.04 ± 2.08 vs. 4.74 ± 2.13, respectively, P > 0.05). The efficacy of imported drug group was significantly better than of the domestic drug group. Correlation analysis showed that in imported (joint venture) drugs group, medication compliance was closely related with brand response, but negatively correlated with age and duration. In domestic drugs group, medication compliance was independent of brand response, but closely related with education, age, and duration. After drug switch with domestic drug on patients with brand response, patients continued to maintain good antidepressant effect, and no severe adverse reaction occurred.

Conclusion: The results suggested that domestic drugs switch might be feasible for patients using imported drugs with brand response, while providing patients with rational use of drug education and psychological support. The medical staff should focus on medication education to help patients make better use of limited medical resources.

The relationship between apolipoprotein CIII gene polymorphism and serum lipid levels in Han Chinese males

Background

Although apolipoprotein (apo) CIII gene polymorphisms have proved to be related to the increased serum lipid level in foreign studies, the results have not always been consistent among diverse populations. In addition, the research focuses on the impact of the apoCIII on the serum lipid levels of Han Chinese subjects which was not conducted before.

Objective

To explore the relationship between the apoCIII gene C3175G and T3206G polymorphisms and serum lipid levels as well as other risk factors for hyperlipidaemia, in Han Chinese males.

Method

A total of 337 healthy male participants undergoing physical examinations were randomly selected from two hospitals in Chongqing, China. Through DNA sequencing, apoCIII gene C3175G and T3206G polymorphisms were identified and their relationships with serum lipid levels were further analysed.

Results

Carriers of apoCIII³¹⁷⁵ GG genotypes have higher levels of TG than other genotypes (P < 0.05). After the stratified selection of triacylglycerol (TG), G gene loci of apoCIIIT3206G are associated with decreasing the content of total cholesterol (TC) and low density lipoprotein-cholesterol (LDL-C) in relatively high TG group while the G gene loci of apoCIIIC3175G have an inverse effect. The outcome of TG unconditional logistic regression shows that the G gene loci of apoCIIIT3206G polymorphism are also beneficial for decreasing TG.

Conclusion

The detection of TG in apoCIII³¹⁷⁵ GG genotype carriers is an efficient predictor of hypertriglyceridaemia in Han Chinese males. The G gene loci of apoCIII³²⁰⁶ may be beneficial for decreasing serum lipid level.

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Our research has tried its best to avoid all possible factors associated with lipids.

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The method has been adopted in new DNA sequencing.

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No previous similar research has worked on it, and we filled the gap.

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The outcome is accurate and exciting.