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Makhmudova U, Samadifar B, Maloku A, Haxhikadrija P, Geiling JA, Römer R, Lauer B, Möbius-Winkler S, Otto S, Schulze PC, Weingärtner O. Intensive lipid-lowering therapy for early achievement of guideline-recommended LDL-cholesterol levels in patients with ST-elevation myocardial infarction ("Jena auf Ziel"). Clin Res Cardiol 2023; 112:1212-1219. [PMID: 36602598 PMCID: PMC10449699 DOI: 10.1007/s00392-022-02147-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND AIMS Currently, less than 20% of patients at very high-risk achieve ESC/EAS dyslipidemia guideline-recommended LDL-C target levels in Europe. "Jena auf Ziel-JaZ" is a prospective cohort study in which early combination therapy with atorvastatin 80 mg and ezetimibe 10 mg was initiated on admission in patients with ST-elevation myocardial infarction (STEMI) and lipid-lowering therapy was escalated during follow-up with bempedoic acid and PCSK9 inhibitors to achieve recommended LDL-C targets in all patients. Moreover, we evaluated side-effects of lipid-lowering therapy. METHODS Patients admitted with STEMI at Jena University Hospital were started on atorvastatin 80 mg and ezetimibe 10 mg on admission. Patients were followed for EAS/ESC LDL-C target achievement during follow-up. RESULTS A total of 85 consecutive patients were enrolled in the study. On discharge, 32.9% achieved LDL-C targets on atorvastatin 80 mg and ezetimibe 10 mg. After 4-6 weeks, 80% of all patients on atorvastatin 80 mg and ezetimibe started at the index event were on ESC/EAS LDL-C targets. In 20%, combined lipid-lowering therapy was escalated with either bempedoic acid or PCSK9 inhibitors. All patients achieved LDL-C levels of or below 55 mg/dL during follow-up on triple lipid-lowering therapy. Combined lipid-lowering therapy was well-tolerated with rare side effects. CONCLUSIONS Early combination therapy with a high-intensity statin and ezetimibe and escalation of lipid-lowering therapy with either bempedoic acid or PCSK9 inhibitors gets potentially all patients with STEMI on recommended ESC/EAS LDL-C targets without significant side effects.
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Affiliation(s)
- Umidakhon Makhmudova
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Beasat Samadifar
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Aurel Maloku
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Pellumb Haxhikadrija
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Jens-Arndt Geiling
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Robert Römer
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Bernward Lauer
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Sven Möbius-Winkler
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Sylvia Otto
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - P Christian Schulze
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Oliver Weingärtner
- Division of Cardiology, Department of Internal Medicine I, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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Dooley DP, Callsen ME, Geiling JA. Triamterene nephrolithiasis. Mil Med 1989; 154:126-7. [PMID: 2496337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
A 59-year-old white male presented with a triamterene renal stone and pyelonephritis, requiring percutaneous lithotomy. A combination of hydrochlorothiazide and triamterene had been previously prescribed despite no history of hypokalemia. The indications for potassium replacement therapy and risks of triamterene nephrolithiasis are reviewed.
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