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Gitt AK, Horack M, Schneider S, Zeymer U, Zahn R. Management of the COVID-19 pandemic in Rhineland-Palatinate hospitals of all levels of care : Results of the COVID-19 Registry RLP. Herz 2023:10.1007/s00059-023-05187-1. [PMID: 37156927 PMCID: PMC10166456 DOI: 10.1007/s00059-023-05187-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/10/2023]
Abstract
The COVID-19 pandemic placed a significant burden on the German healthcare system. Based on the experience of severe disease progression of the SARS-CoV‑2 infection from neighboring European countries in the early 2020s, with ICU overload and high mortality rates, efforts were made in Germany to increase the capacity of available ICU beds. Subsequently, all documentation and reporting focused on the ICU capacities for COVID-19 patients. It was hypothesized that mainly a few large hospitals provided care for the majority of COVID-19 patients. The COVID-19 Registry RLP of Rhineland-Palatinate documented SARS-CoV‑2 inpatients from daily mandatory queries of all hospitals throughout the pandemic from April 2020 to March 2023, distinguishing between patients in ICUs and normal wards. In its 18th Corona Ordinance, the state government required all hospitals to participate in the care of SARS-CoV‑2 inpatients. We investigated the participation of hospitals at different levels of care in Rhineland-Palatinate in the management of the COVID-19 pandemic. Nine pandemic waves were documented during the pandemic and exemplary data on the respective pandemic peaks were evaluated. A distinction was made between the burden on hospitals at different levels of care: primary care hospitals, standard care hospitals, specialty hospitals, and maximal care hospitals. Analysis of the data showed that all hospital types participated equally in the care of SARS-CoV-2 patients. The requirement of the Ministry of Health of Rhineland-Palatinate to provide at least 20% of the available capacity was met by all levels of care and there were no disparities between hospitals of different levels of care in the management of the pandemic.Hospitals at all levels of care participated equally in the care of SARS-CoV‑2 inpatients and thus contributed significantly to the management of the pandemic in Rhineland-Palatinate.
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Affiliation(s)
- Anselm K Gitt
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen / Rhein, Ludwigshafen, Germany.
- Stiftung Institut für Herzinfarktforschung, Bremser Str. 79, 67063, Ludwigshafen, Germany.
| | - Martin Horack
- Institut für Herzinfarktforschung GmbH, Ludwigshafen, Germany
| | | | - Uwe Zeymer
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen / Rhein, Ludwigshafen, Germany
- Stiftung Institut für Herzinfarktforschung, Bremser Str. 79, 67063, Ludwigshafen, Germany
| | - Ralf Zahn
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen / Rhein, Ludwigshafen, Germany
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Gitt A, Horack M, Lautsch D, Zahn R, Ferrieres J. How many CCS- and ACS-patients might reach the newly recommended LDL-C-target <55mg/dl in clinical practice if guidelines were applied – an estimate from the DYSIS II study population. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.1445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
The 2019 ESC guidelines for the management of dyslipidemia even further lowered the LDL-C-target values for the very high-risk population from <70mg/dl to <55mg/dl. Population based studies already had shown that the previous target was difficult to reach. It is yet unclear how many patients in clinical practice might be treated to the new target.
Methods
The Dyslipidemia International Study (DYSIS II) prospectively collected data of patients with chronic coronary syndromes (CCS) and acute coronary syndromes (ACS) (all on statins) in 18 countries in Europe, the Middle East, South- and East Asia to document patient characteristics, medication and a current lipid profile from 2012 to 2014 under real life conditions in physicians' offices and hospitals. We took these real-life lipid profiles and data on the kind/dose of used statins to estimate how treatment escalation such as changing statin treatment to a high dose (atorvastatin ≥40mg / rosuvastatin≥20mg), adding ezetimibe and adding a PCSK9-inhibitor might help to bring LDL-C-levels to the recommended <55mg/dl target.
Results
A total of 7,865 patients were enrolled into DYSIS II, 6,794 had CCS and 1,071 ACS. Under the documented statin treatment in DYSIS only 12.7% of patients reached an LDL-C <55mg/dl. Putting all patients on high dose statins in combination with ezetimibe, 64.1% would reach the target. If PCSK9-inhibitors would be used in the remaining patients not at goal a total of 94.0% would match the goal.
Conclusion
Our analysis indicates that in real life practice the use available lipid-lowering medications would substantially increase the percentage of CCS- and ACS-patients reaching the newly recommended 2019 ESC guideline LDL-C-target of <55 mg/dl from less than 20% to more than 90% of the population.
Funding Acknowledgement
Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD
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Affiliation(s)
- A.K Gitt
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - M Horack
- Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - D Lautsch
- Merck & Co, Inc., Kenilworth, United States of America
| | - R Zahn
- Klinikum Ludwigshafen, Ludwigshafen, Germany
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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Ferrières J, Lautsch D, Bramlage P, Horack M, Baxter CA, Ambegaonkar B, Toth PP, Poh KK, De Ferrari GM, Gitt AK. Lipid-lowering treatment and low-density lipoprotein cholesterol target achievement in patients with type 2 diabetes and acute coronary syndrome. Arch Cardiovasc Dis 2020; 113:617-629. [PMID: 32873522 DOI: 10.1016/j.acvd.2020.05.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 04/11/2020] [Accepted: 05/06/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND Patients with type 2 diabetes mellitus characteristically display an atherogenic lipid profile with high triglyceride concentrations, low high-density lipoprotein cholesterol (HDL-C) concentrations and low-density lipoprotein cholesterol (LDL-C) concentrations not always elevated. It is unclear if patients with diabetes who present with an acute coronary syndrome (ACS) receive different or more-potent lipid-lowering therapy (LLT). AIMS To investigate lipid abnormalities in patients with and without type 2 diabetes hospitalised for an ACS, and use of LLT before admission and 4 months after the event. METHODS Patients were included in the observational DYSIS II study if they were hospitalised for an ACS and had a full lipid profile. RESULTS Of 3803 patients, diabetes was documented in 1344 (54.7%). Compared to patients without diabetes, those with diabetes had a lower mean LDL-C (101.2 vs. 112.0mg/dL; 2.6 vs. 2.9mmol/L; P<0.0001), with a greater proportion attaining concentrations<70mg/dL (1.8mmol/L) (23.9% vs. 16.0%; P<0.0001) and<55mg/dL (1.4mmol/L) (11.3% vs. 7.3%; P<0.0001), a higher mean triglyceride concentration (139.0 vs. 121.0mg/dL; 1.6 vs. 1.4mmol/L; P<0.0001) and a lower HDL-C concentration. LLT was more commonly given to patients with diabetes (77.5% vs. 58.8%; P<0.0001); there were no differences in types of therapy prescribed. Four months after hospitalisation, most patients from both groups were being treated with LLT (predominantly statin monotherapy). CONCLUSIONS Despite the different lipid profiles, the type of LLT prescribed did not vary depending on the presence or absence of type 2 diabetes. There was no difference in LLT in patients with and without diabetes at 4-month follow-up, except for fibrates, which were used in 2% of patients with and 1% of patients without diabetes. Statin monotherapy of intermediate potency was the predominant treatment in both groups.
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Affiliation(s)
- Jean Ferrières
- Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse University School of Medicine, INSERM UMR 1027, 31059 Toulouse, France.
| | - Dominik Lautsch
- Merck & Co., Inc., 07033 Kenilworth, NJ, United States of America
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, 49661 Cloppenburg, Germany
| | - Martin Horack
- Stiftung Institut für Herzinfarktforschung, 67063 Ludwigshafen am Rhein, Germany
| | | | | | - Peter P Toth
- CGH Medical Centre, Sterling, IL 61081; and Ciccarone Centre for the Prevention of Heart Disease, John-Hopkins University School of Medicine, 21287 Baltimore, MD, United States of America
| | - Kian-Keong Poh
- Department of Cardiology, National University Heart Centre, National University Health System, 119074 Singapore, Singapore; Yong-Loo-Lin School of Medicine, National University of Singapore, 117597 Singapore, Singapore
| | - Gaetano Maria De Ferrari
- Department of Molecular Medicine, University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology, IRCCS Fondazione Policlinico San Matteo, 27100 Pavia, Italy
| | - Anselm K Gitt
- Stiftung Institut für Herzinfarktforschung, 67063 Ludwigshafen am Rhein, Germany; Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen am Rhein, Germany
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Buddhari W, Uerojanaungkul P, Sriratanasathavorn C, Sukonthasarn A, Ambegaonkar B, Brudi P, Horack M, Lautsch D, Vyas A, Gitt AK. Low-Density Lipoprotein Cholesterol Target Attainment in Patients Surviving an Acute Coronary Syndrome in Thailand: Results From the Dyslipidaemia International Study (DYSIS) II. Heart Lung Circ 2020; 29:405-413. [DOI: 10.1016/j.hlc.2019.02.193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 01/22/2019] [Accepted: 02/19/2019] [Indexed: 11/30/2022]
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Hermans MP, Gevaert S, Descamps O, Missault L, Gillot B, De Keyzer D, Lautsch D, Brudi P, Ambegaonkar B, Vyas A, Horack M, Gitt A. Frequency and predictors of cholesterol target attainment in patients with stable coronary heart disease in Belgium: results from the Dyslipidemia International Study II (DYSIS II CHD). Acta Clin Belg 2019; 74:399-404. [PMID: 30355016 DOI: 10.1080/17843286.2018.1539203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Objectives: To document the frequency and predictors of low-density lipoprotein cholesterol (LDL-C) target value attainment among patients with coronary heart disease (CHD) in Belgium. Methods: The second Dyslipidemia International Study (DYSIS II) was an observational study of the prevalence of dyslipidemias and lipid target value attainment. Patients in this analysis were aged ≥ 18, had documented CHD, and had a full lipid profile. Use of lipid-lowering therapy (LLT), lipid profile, and LDL-C target value attainment (< 70 mg/dL) were assessed cross-sectionally at the enrollment visit. The distribution of LLTs was assessed among treated patients. Multivariate logistic regression was used to identify variables predictive of LDL-C target value attainment in treated patients. Results: We identified 409 patients with CHD in Belgium, 387 (94.6%) of whom were on LLT at the time of the lipid profile. Among treated patients, the rate of LDL-C target value attainment was 40.6%, and statin monotherapy was the most commonly used LLT (79.3%). Among users of statin monotherapy or combination therapy, simvastatin was the most commonly used treatment (41.6% of patients). Diabetes was associated with higher odds of LDL-C target value attainment (OR 2.29, 95% CI 1.33-3.93), and female gender was associated with lower odds (OR 0.48, 95% CI 0.24-0.97). Conclusion: Rates of LDL-C target value attainment are low in patients with CHD in Belgium. Intensifying statin therapy or combining it with non-statins is essential in Belgian patients for optimal LDL-C reduction.
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Affiliation(s)
- Michel P. Hermans
- Endocrinology and Nutrition, Cliniques Universitaires Saint-Luc, Bruxelles, Belgium
| | | | - Olivier Descamps
- Department of Internal Medicine, Centre Hospitalier Jolimont, La Louvière, Belgium and Department of Cardiology, UCL Cliniques Universitaires Saint-Luc, Brussels, Belgium
| | - Luc Missault
- Department of Cardiology, AZ St Jan Brugge, Brugge, Belgium
| | | | | | | | | | | | - Ami Vyas
- Department of Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | - Martin Horack
- Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Anselm Gitt
- Herzzentrum Ludwigshafen, Germany and Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
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Gitt AK, Horack M, Lautsch D, Ferrieres J. P651Prevalence of hypertriglyceridemia in statin treated high risk patients who might benefit from treatment with icosapent ethyl for secondary prevention in clinical practice - Results of DYSIS. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Background
Patients with elevated triglyceride (TG) levels are at increased risk for ischemic events. In the recently published REDUCE-IT-Study among patients with elevated triglyceride levels who were receiving statin therapy, the risk of major ischemic events, including cardiovascular death, was significantly lower with 2 g of icosapent ethyl twice daily than with placebo. Little is known about how many patients in clinical practice might benefit from this additional treatment.
Methods
The cross sectional, observational Dyslipidemia International Study (DYSIS) examined lipid goal attainment among statin-treated very high cardiovascular risk patients (defined as per 2011 EAS/ESC guidelines, including patients suffering from coronary heart disease, diabetes, chronic kidney disease or peripheral atherosclerotic disease) in Canada, Europe, Middle East countries and China. Data were collected under real life conditions in physicians' offices and hospital outpatient wards between 2008–2012. We examined the prevalence of mixed dyslipidemia with TG >135 mg/dl in high statin treated high risk patients in clinical practice.
Results
Of a total of 44,593 patients on very high cardiovascular risk, all on chronic statin treatment, 21,312 (47.8%) had mixed dyslipidemia with TG values >135mg/dl. Patients with elevated TG also had higher levels of total and LDL-cholesterol. The overall use of additional fibrates on top of statins was low (4.0%), but more frequent in patients with TG >135 mg/dl.
CVD patients with TG>135 mg/dl Pts with TG >135 mg/dl Pts with TG ≤135 mg/dl p-value OR (95% CI) n=21,312 (47.8%) n=23,281 (52.2%) Age (years) 65.4±10.1, 68.1±10.2 <0.0001 Females 42.2% 38.6% <0.0001 1.16 (1.12–1.21) Sedentary lifestyle 43.0% 37.6% <0.0001 1.25 (1.20–1.30) Risk factors/CV-disease Hypertension 79.0% 74.9% <0.0001 1.26 (1.21–1.32) Diabetes mellitus 56.3% 45.3% <0.0001 1.55 (1.50–1.61) Ischemic heart disease 50.6% 54.4% <0.0001 0.86 (0.83–0.89) Cerebrovascular disease 16.1% 17.7% <0.0001 0.90 (0.85–0.94) Peripheral artery disease 8.1% 6.9% <0.0001 1.18 (1.10–1.27) Lipid lowering therapy Rosuvastatin 11.3% 11.8% 0.13 0.95 (0.90–1.01) Atorvastatin 38.2% 40.9% <0.0001 0.89 (0.86–0.93) Simvastatin 41.9% 38.9% <0.0001 1.13 (1.09–1.18) Other statins 8.6% 8.4% 0.12 0.96 (0.88–1.05) Fibrates 5.5% 1.5% <0.0001 3.86 (3.40–4.37) Lipid Profile Total Cholesterol (mg/dl) 185.6 159.0 <0.0001 LDL-Cholesterol (mg/dl) 102.1 88.9 <0.0001 Triglyderides (mg/dl) 189.5 95.7 <0.0001
Conclusion
Almost half of consecutive patients with cardiovascular disease treated with statins for secondary prevention in clinical practice suffer from TG levels >135 mg/dl and might benefit from additional treatment with icosapent ethyl with further reduction in subsequent major ischemic events, including cardiovascular death.
Acknowledgement/Funding
MSD
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Affiliation(s)
- A K Gitt
- Klinikum Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - M Horack
- Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - D Lautsch
- Merck & Co, Inc., Kenilworth, United States of America
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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Al Mahmeed W, Bakir S, Beshyah SA, Morcos B, Wajih S, Horack M, Lautsch D, Ambegaonkar B, Brudi P, Baxter CA, Vyas A, Gitt AK. Prevalence of Lipid Abnormalities and Cholesterol Target Value Attainment in Patients with Stable and Acute Coronary Heart Disease in the United Arab Emirates. Heart Views 2019; 20:37-46. [PMID: 31462957 PMCID: PMC6686608 DOI: 10.4103/heartviews.heartviews_32_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background Careful management of lipid abnormalities in patients with coronary heart disease (CHD) or an acute coronary syndrome (ACS) can reduce the risk of recurrent cardiovascular events. The extent of hyperlipidemia in these very high-risk patients in the United Arab Emirates (UAE), along with the treatment strategies employed, is not clear. Methods The Dyslipidemia International Study II was a multinational observational analysis carried out from 2012 to 2014. Patients were enrolled if they had either stable CHD or an ACS. Patient characteristics, lipid levels, and use of lipid-lowering therapy (LLT) were recorded at enrollment. For the ACS patients, the LLT used during the 4 months' follow-up period was documented, as were any cardiovascular events. Results A total of 416 patients were recruited from two centers in the UAE, 216 with stable CHD and 200 hospitalized with an ACS. Comorbidities and cardiovascular risk factors were extremely common. A low-density lipoprotein cholesterol level of <70 mg/dl, recommended for patients at very high cardiovascular risk, was attained by 39.3% of the LLT-treated CHD patients and 33.3% of the LLT-treated ACS patients at enrollment. The mean atorvastatin-equivalent daily statin dose was 29 ± 15 mg for the CHD patients, with 13.7% additionally using ezetimibe. For the ACS patients, the daily dosage was 23 ± 13 mg at admission, rising to 39 ± 12 mg by the end of the 4-month follow-up. The use of nonstatin agents was extremely low in this group. Conclusions Despite LLT being widely used, hyperlipidemia was found to be prevalent in ACS and CHD patients in the UAE. Treatment strategies need to be significantly improved to reduce the rate of cardiovascular events in these very high-risk patients.
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Affiliation(s)
- Wael Al Mahmeed
- Cleveland Clinic, Heart and Vascular Institute, Sheikh Khalifa Medical City, Abu Dhabi, Dubai, UAE.,Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Sherif Bakir
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | - Salem A Beshyah
- Department of Cardiology, Sheikh Khalifa Medical City, Abu Dhabi, UAE
| | | | | | - Martin Horack
- Foundation Institute for Myocardial Infarction Research, Ludwigshafen, Germany
| | | | | | | | | | - Ami Vyas
- Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Kingston, RI, USA
| | - Anselm K Gitt
- Foundation Institute for Myocardial Infarction Research, Ludwigshafen, Germany.,Medical Department B, Hospital Ludwigshafen, Ludwigshafen, Germany
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Lee SH, Song WH, Jeong MH, Hur SH, Jeon DW, Jeung W, Gitt AK, Horack M, Vyas A, Lautsch D, Ambegaonkar B, Brudi P, Jang Y. Dyslipidemia and Rate of Under-Target Low-Density Lipoprotein-Cholesterol in Patients with Coronary Artery Disease in Korea. J Lipid Atheroscler 2019; 8:242-251. [PMID: 32821714 PMCID: PMC7379120 DOI: 10.12997/jla.2019.8.2.242] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 07/18/2019] [Accepted: 08/06/2019] [Indexed: 12/17/2022] Open
Abstract
Objective The aim of this study was to evaluate under target rates of low-density lipoprotein-cholesterol (LDL-C) in Korean patients with stable coronary artery disease (CAD) or an acute coronary syndrome (ACS) in real world practice. Methods Dyslipidemia International Study II was an international observational study of patients with stable CAD or an ACS. Lipid profiles and use of lipid-lowering therapy (LLT) were documented at enrollment, and for the ACS cohort, 4 months follow-up was recommended. Rates of under target LDL-C as per European guidelines, were evaluated, and multivariate regression was performed to identify predictive factors of patients presenting under the target. Results A total of 808 patients were enrolled in Korea, 500 with stable CAD and 308 with ACS. Of these, 90.6% and 52.6% were being treated with LLT, respectively. In the stable CAD group, 40.0% were under target LDL-C, while in ACS group, the rate was 23.7%. A higher statin dose was independently associated with under target LDL-C in both groups (OR, 1.03; p=0.046 [stable CAD] and OR, 1.05; p=0.01 [ACS]). The mean statin dosage (atorvastatin equivalent) was 17 mg/day. In the 79 ACS patients who underwent the follow-up examination, the LDL-C under target rate rose to 59.5%. Conclusion Only a minority of patients with stable CAD or ACS were under their target LDL-C level at enrollment. The statin dose was not sufficient in the majority of patients. These results indicate a considerable LLT gap in Korean patients with established CAD.
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Affiliation(s)
- Sang-Hak Lee
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Woo-Hyuk Song
- Cardiovascular Division, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Myung Ho Jeong
- Department of Cardiovascular Medicine, Chonnam National University Hospital, Gwangju, Korea
| | - Seung-Ho Hur
- Department of Cardiology, Keimyung University Hospital, Daegu, Korea
| | - Dong Woon Jeon
- Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
| | | | - Anselm K Gitt
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.,Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
| | - Martin Horack
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Ami Vyas
- Department of Epidemiology, School of Public Health, Rutgers University, Piscataway, NJ, USA
| | | | | | | | - Yangsoo Jang
- Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Liberopoulos E, Rallidis L, Spanoudi F, Xixi E, Gitt A, Horack M, Ashton V, Brudi P, Lautsch D, Ambegaonkar B, Elisaf M. Attainment of cholesterol target values in Greece: results from the Dyslipidemia International Study II. Arch Med Sci 2019; 15:821-831. [PMID: 31360176 PMCID: PMC6657251 DOI: 10.5114/aoms.2018.73961] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 10/20/2017] [Indexed: 12/15/2022] Open
Abstract
INTRODUCTION Current European guidelines recommend treatment with lipid-lowering therapy (LLT) to a low-density lipoprotein cholesterol (LDL-C) target of < 70 mg/dl for patients at very high risk. LDL-C target attainment and use of LLTs in these patients in Greece is not known. MATERIAL AND METHODS The Dyslipidemia International Study (DYSIS) II was a multicenter observational study. The coronary heart disease (CHD) cohort was divided into two groups based on treatment status (on LLT for ≥ 3 months or not on LLT). The acute coronary syndrome (ACS) cohort was evaluated at the time of admission and again 120 ±15 days after admission. RESULTS In the CHD cohort (n = 499), 457 (91.6%) patients were on LLT. The LDL-C target value was attained by 26.5% of LLT users. Statin monotherapy was used by 77.5% of treated patients, with a mean ± SD atorvastatin dose equivalent of 24 ±16 mg/day. In the ACS cohort (n = 200), 159 (79.5%) patients were on LLT at admission. Mean ± SD LDL-C levels were 108 ±40 mg/dl at admission and 86 ±25 mg/dl at follow-up. LDL-C target value attainment rates were 16.2% at admission and 25.0% at follow-up. At admission, statin monotherapy was used by 86.8% of treated patients. The mean ± SD atorvastatin dose equivalent increased from 20 ±14 mg/day at admission to 29 ±15 mg/day at follow-up. The statin dose was associated with higher odds of LDL-C target value attainment (OR = 1.05, 95% CI: 1.02-1.08). CONCLUSIONS The LDL-C target attainment by very high risk patients in Greece is suboptimal. Increasing the statin dose or combining it with non-statins may improve target value attainment.
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Affiliation(s)
- Evangelos Liberopoulos
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
| | - Loukianos Rallidis
- Second Department of Cardiology, Attikon Hospital, Medical School, University of Athens, Athens, Greece
| | - Filio Spanoudi
- Merck Sharp & Dohme Pharmaceutical, Industrial and Commercial S.A, Athens, Greece
| | - Elena Xixi
- Merck Sharp & Dohme Pharmaceutical, Industrial and Commercial S.A, Athens, Greece
| | - Anselm Gitt
- Stiftung Institut fur Herzinfarktforschung, Germany
| | | | | | | | | | | | - Moses Elisaf
- Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece
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De Ferrari GM, Perna GP, Nicosia A, Guasti L, Casu G, Cuccia C, Picco F, Strazzella C, Totaro R, Cercone S, Canullo L, Horack M, Lautsch D, Gitt AK, Di Biase M. Available oral lipid-lowering agents could bring most high-risk patients to target: an estimate based on the Dyslipidemia International Study II-Italy. J Cardiovasc Med (Hagerstown) 2019; 19:485-490. [PMID: 29917002 DOI: 10.2459/jcm.0000000000000680] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The analysis evaluated the contemporary percentage of patients with established coronary heart disease (CHD) reaching the European guidelines recommended LDL-cholesterol (LDL-C) levels of less than 70 mg/dl and the threshold required for proprotein convertase subtlisin/kexin type 9 reimbursement in Italy (100 mg/dl). It also assessed how these percentages would change in case of diffuse use of ezetimibe. METHODS The Dyslipidemia International Study II enrolled CHD patients aged at least 18 either on lipid-lowering therapy (LLT) for at least 3 months or not on LLT at the time of the lipid profile. Distribution of LLTs and LDL-C target attainment were assessed. Multivariate logistic regression evaluated predictors of LDL-C target attainment. A 24% LDL-C lowering was modeled in patients not taking ezetimibe to assess its potential effects. RESULTS Among 676 Italian CHD patients enrolled, LDL-C concentrations were lower among the 631 patients (93.3%) who were on LLT (82 versus 118 mg/dl; P < 0.001). The LDL-C target was attained by 35.4% of patients. Statin dose (median atorvastatin dose 40 mg/day) was the sole significant predictor of LDL-C target attainment. The simple addition of ezetimibe in the model reduced the percentage of patients more than 70 and 100 mg/dl from 64.6 to 37.9% and from 25.1 to 11.8%, respectively. CONCLUSION Despite treatment in more than 90%, only one-third of Italian stable CHD patients attained the recommended LDL-C target. Statin dose was the sole predictor of the target achievement. The addition of ezetimibe would almost double patients at target and halve the potential candidates for reimbursement of more expensive agents such as proprotein convertase subtlisin/kexin type 9 inhibitors.
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Affiliation(s)
- Gaetano M De Ferrari
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo.,Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia
| | - Gian P Perna
- Azienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Ancona
| | | | - Luigina Guasti
- Centro di Ricerca delle Dislipidemie, Università dell'Insubria, Varese
| | | | | | | | - Caterina Strazzella
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo.,Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia
| | - Rossana Totaro
- Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo.,Dipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia
| | | | | | - Martin Horack
- Herzzentrum Ludwigshafen, Medizinische Klinik B.,Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - Anselm K Gitt
- Herzzentrum Ludwigshafen, Medizinische Klinik B.,Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | - Matteo Di Biase
- Azienda Ospedaliera Universitaria Ospedali Riuniti di Foggia, Foggia, Italy
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11
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Gitt AK, De Ferrari G, Lautsch D, Horack M, Baxter C, Brudi P, Ferrières J. CONSEQUENT USE OF AVAILABLE ORAL LIPID LOWERING AGENTS WOULD BRING THE MAJORITY OF HIGH-RISK PATIENTS WITH CHD TO RECOMMENDED TARGETS: AN ESTIMATE BASED ON THE DYSIS II STUDY POPULATION. J Am Coll Cardiol 2019. [DOI: 10.1016/s0735-1097(19)30891-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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12
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Poh KK, Chin CT, Tong KL, Tan JKB, Lim JS, Yu W, Horack M, Vyas A, Lautsch D, Ambegaonkar B, Brudi P, Gitt AK. Cholesterol goal achievement and lipid-lowering therapy in patients with stable or acute coronary heart disease in Singapore: results from the Dyslipidemia International Study II. Singapore Med J 2019; 60:454-462. [PMID: 30773600 DOI: 10.11622/smedj.2019021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Dyslipidaemia is a major risk factor for coronary heart disease (CHD). There is a lack of data on the extent of lipid abnormalities and lipid-lowering therapy (LLT) in Singapore. METHODS The Dyslipidemia International Study (DYSIS) II was a multinational observational study of patients with stable CHD and hospitalised patients with an acute coronary syndrome (ACS). A full lipid profile and use of LLT were documented at baseline, and for the ACS cohort, at four months post-hospitalisation. RESULTS 325 patients were recruited from four sites in Singapore; 199 had stable CHD and 126 were hospitalised with an ACS. At baseline, 96.5% of the CHD cohort and 66.4% of the ACS cohort were being treated with LLT. In both cohorts, low-density lipoprotein cholesterol (LDL-C) levels were lower for the treated than the non-treated patients; accordingly, a higher proportion of patients met the LDL-C goal of < 70 mg/dL (CHD: 28.1% vs. 0%, p = 0.10; ACS: 20.2% vs. 0%, p < 0.01). By the four-month follow-up, a higher proportion of the ACS patients that were originally not treated with LLT had met the LDL-C goal (from 0% to 54.5%), correlating with the increased use of medication. However, there was negligible improvement in the patients who were treated prior to the ACS. CONCLUSION Dyslipidaemia is a significant concern in Singapore, with few patients with stable or acute CHD meeting the recommended European Society of Cardiology/European Atherosclerosis Society goal. LLT was widely used but not optimised, indicating considerable scope for improved management of these very-high-risk patients.
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Affiliation(s)
- Kian-Keong Poh
- Department of Cardiology, National University Heart Centre Singapore, National University Health System, Singapore.,Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Chee Tang Chin
- Department of Cardiology, National Heart Centre Singapore, Singapore.,Duke-NUS Medical School, Singapore
| | - Khim Leng Tong
- Department of Cardiology, Changi General Hospital, Singapore
| | | | - Jee Seong Lim
- Merck Sharp & Dohme (Malaysia) Sdn Bhd, Petaling Jaya, Selangor, Malaysia
| | - Weixuan Yu
- MSD Pharma (Singapore) Pte Ltd, Singapore
| | - Martin Horack
- Herzzentrum Ludwigshafen, Cardiology, Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Ami Vyas
- University of Rhode Island, College of Pharmacy, Department of Pharmacy Practice, Kingston, RI, USA
| | | | | | | | - Anselm K Gitt
- Herzzentrum Ludwigshafen, Cardiology, Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.,Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
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13
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Ferrières J, Lautsch D, Gitt AK, De Ferrari G, Toplak H, Elisaf M, Drexel H, Horack M, Baxter C, Ambegaonkar B, Brudi P, Toth PP. Body mass index impacts the choice of lipid-lowering treatment with no correlation to blood cholesterol - Findings from 52 916 patients in the Dyslipidemia International Study (DYSIS). Diabetes Obes Metab 2018; 20:2670-2674. [PMID: 29888459 PMCID: PMC6220851 DOI: 10.1111/dom.13415] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Revised: 06/04/2018] [Accepted: 06/08/2018] [Indexed: 11/28/2022]
Abstract
A high body mass index (BMI) is associated with increased cardiovascular risk. We sought to identify whether BMI influences the choice of lipid-lowering treatment in a large, real-world cohort of 52 916 patients treated with statins. The Dyslipidemia International Study (DYSIS) is a cross-sectional, observational, multicentre study in statin-treated patients ≥45 years of age from 30 countries; 1.1% were underweight (BMI < 18.5 kg/m2 ), 33.1% had normal weight (BMI 18.5-24.9 kg/m2 ), 41.5% were overweight (BMI 25-29.9 kg/m2 ), 17.1% had class I obesity (BMI 30.0-34.9 kg/m2 ), 5.0% had class II obesity (BMI 35-39.9 kg/m2 ), and 2.1% had class III obesity (≥40 kg/m2 ). BMI correlated with high-density lipoprotein cholesterol (HDL-C) and triglycerides (Spearman's ρ: -0.147 and 0.170, respectively; P < 0.0001 for both); however, there was no correlation with low-density lipoprotein cholesterol (LDL-C; ρ: 0.003; P = 0.51). Statin intensity increased with increasing BMI (ρ: 0.13; P < 0.001), an association that held after adjustment for comorbidities (OR: 2.4; 95% CI: 2.0-3.0) on BMI ≥ 30 kg/m2 for atorvastatin equivalent ≥40 mg/d.
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Affiliation(s)
- Jean Ferrières
- Department of CardiologyToulouse Rangueil University HospitalToulouseFrance
- Department of Epidemiology and Public HealthUMR INSERM 1027, Toulouse University School of MedicineToulouseFrance
| | | | - Anselm K. Gitt
- Herzzentrum LudwigshafenLudwigshafenGermany
- Stiftung Institut für HerzinfarktforschungLudwigshafenGermany
| | - Gaetano De Ferrari
- Department of CardiologyIRCCS Fondazione Policlinico San Matteo, and University of PaviaPaviaItaly
| | - Hermann Toplak
- Lipid Clinic, Department of MedicineMedical University of GrazGrazAustria
| | - Moses Elisaf
- School of MedicineUniversity of IoanninaIoanninaGreece
| | - Heinz Drexel
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT)FeldkirchAustria
- Department of Medicine and CardiologyPrivate University of the Principality of LiechtensteinTriesenLiechtenstein
- Department of Medicine Division of CardiologyDrexel University College of MedicinePhiladelphiaPennsylvania
| | - Martin Horack
- Stiftung Institut für HerzinfarktforschungLudwigshafenGermany
| | | | | | | | - Peter P. Toth
- CGH Medical CenterSterlingIllinois
- Ciccarone Center for the Prevention of Heart DiseaseJohns Hopkins University School of MedicineBaltimoreMaryland
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14
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Ferrières J, Lautsch D, Ambegaonkar BM, De Ferrari GM, Vyas A, Baxter CA, Bash LD, Velkovski-Rouyer M, Horack M, Almahmeed W, Chiang FT, Poh KK, Elisaf M, Brudi P, Gitt AK. Use of guideline-recommended management in established coronary heart disease in the observational DYSIS II study. Int J Cardiol 2018; 270:21-27. [DOI: 10.1016/j.ijcard.2018.06.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2018] [Revised: 05/02/2018] [Accepted: 06/04/2018] [Indexed: 10/14/2022]
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15
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Ferrieres J, De Ferrari GM, Hermans MP, Elisaf M, Toth PP, Horack M, Brudi P, Lautsch D, Bash LD, Baxter CA, Ashton V, Ambegaonkar B, Gitt AK. Predictors of LDL-cholesterol target value attainment differ in acute and chronic coronary heart disease patients: Results from DYSIS II Europe. Eur J Prev Cardiol 2018; 25:1966-1976. [DOI: 10.1177/2047487318806359] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Background Patients with coronary heart disease (CHD) and survivors of acute coronary syndrome (ACS) are at very high risk for adverse cardiovascular events. Lowering low-density lipoprotein cholesterol (LDL-C) can reduce the risk, with effective lipid-lowering therapy (LLT) readily available; however, dyslipidemia remains prevalent throughout Europe. Design The observational Dyslipidemia International Study II (DYSIS II) aimed to identify unmet treatment needs in adult ACS and CHD patients. Data for the seven participating European countries are presented herein. Methods The study was carried out from December 2012 to November 2014. Use of LLT and attainment of European-guideline-recommended LDL-C targets were assessed. For ACS patients, changes in lipid levels and LLT were evaluated 4 months post-hospitalization. Results Of the 4344 patients enrolled, 2946 were attending a physician visit for the assessment of stable CHD, while 1398 had been hospitalized for an ACS event. In both patient sets, mean LDL-C levels were high (89.5 and 112.5 mg/dl, respectively) and <70 mg/dl target attainment extremely poor. The mean daily statin dosage (normalized to atorvastatin potency) was 27 ± 20 mg for CHD and 22 ± 17 mg for ACS patients. Treatment was intensified slightly for ACS subjects after hospitalization, with the dosage reaching 35 ± 24 mg/day. LDL-C target attainment was higher by the end of the 4-month follow up (30.9% and 41.5% for patients on LLT and without LLT at baseline, respectively; p < 0.05). Conclusion Elevated blood cholesterol levels are highly prevalent across Europe, with low numbers of coronary patients reaching their recommended LDL-C target. While use of LLT is widespread, there is significant scope for intensifying treatment.
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Affiliation(s)
- Jean Ferrieres
- Department of Cardiology, Toulouse Rangueil University Hospital, Toulouse, France; Department of Epidemiology and INSERM UMR 1027, Toulouse University School of Medicine, Toulouse, France
| | - Gaetano Maria De Ferrari
- Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Michel P. Hermans
- Division of Endocrinology & Nutrition, Cliniques Universitaires St-Luc and Institut de Recherche Expérimentale et Clinique (IREC), Université Catholique de Louvain, Brussels, Belgium
| | - Moses Elisaf
- Department of Internal Medicine, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Peter P. Toth
- CGH Medical Center, Sterling, Illinois, and Ciccarone Center for the Prevention of heart Disease, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Martin Horack
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | | | | | | | | | - Anselm K. Gitt
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
- Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
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16
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Poh KK, Ambegaonkar B, Baxter CA, Brudi P, Buddhari W, Chiang FT, Horack M, Jang Y, Johnson B, Lautsch D, Sawhney J, Vyas A, Yan BP, Gitt AK. Low-density lipoprotein cholesterol target attainment in patients with stable or acute coronary heart disease in the Asia-Pacific region: results from the Dyslipidemia International Study II. Eur J Prev Cardiol 2018; 25:1950-1963. [PMID: 30198749 DOI: 10.1177/2047487318798927] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND As mortality due to cardiovascular disease increases throughout the world, accurate data on risk factors such as hyperlipidemia are required. This is lacking in the Asia-Pacific region. DESIGN The observational Dyslipidemia International Study (DYSIS) II was established to quantify the extent of hyperlipidemia in adults with acute and stable coronary heart disease globally. METHODS Patients with stable coronary heart disease or hospitalised with an acute coronary syndrome were enrolled across nine Asia-Pacific countries from July 2013 to October 2014. Lipid-lowering therapy and low-density lipoprotein cholesterol target attainment (<70 mg/dL) were assessed. The acute coronary syndrome cohort was followed up 4 months post-discharge. RESULTS Of the 4592 patients enrolled, 2794 had stable coronary heart disease and 1798 were admitted with an acute coronary syndrome. In the coronary heart disease cohort, the mean low-density lipoprotein cholesterol level was 86.9 mg/dL, with 91.7% using lipid-lowering therapy and 31% achieving low-density lipoprotein cholesterol of less than 70 mg/dL. In the acute coronary syndrome cohort at admission, the corresponding values were 103.2 mg/dL, 63.4% and 23.0%, respectively. Target attainment was significantly higher in lipid-lowering therapy-treated than non-treated patients in each cohort (32.6% vs. 12.9% and 31.1% vs. 9.0%, respectively). Mean atorvastatin-equivalent dosages were low (20 ± 15 and 22 ± 18 mg/day, respectively), with little use of non-statin adjuvants (13.0% and 6.8%, respectively). Low-density lipoprotein cholesterol target attainment had improved by follow-up for the acute coronary syndrome patients, but remained low (41.7%). CONCLUSIONS Many patients in Asia at very high risk of recurrent cardiovascular events had a low-density lipoprotein cholesterol level above the recommended target. Although lipid-lowering therapy was common, it was not used to its full potential.
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Affiliation(s)
- Kian-Keong Poh
- 1 Department of Cardiology, National University Heart Centre, Singapore.,2 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | | | | | - Wacin Buddhari
- 5 Division of Cardiovascular Medicine, Chulalongkorn University, Thailand
| | - Fu-Tien Chiang
- 6 Department of Internal Medicine, National Taiwan University Hospital, Taiwan
| | - Martin Horack
- 7 Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Yangsoo Jang
- 8 Division of Cardiology, Yonsei University College of Medicine, Korea
| | - Brett Johnson
- 9 Merck Sharp & Dohme (Australia) Pty Ltd., Australia
| | | | - Jps Sawhney
- 10 Department of Cardiology, Sri Ganga Ram Hospital, Rajinder Nagar, India
| | - Ami Vyas
- 11 Department of Epidemiology, Rutgers University, USA.,12 Department of Pharmacy Practice, University of Rhode Island, USA
| | - Bryan P Yan
- 13 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong
| | - Anselm K Gitt
- 7 Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.,14 Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Germany
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17
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Gitt AK, Rieber J, Hambrecht R, Brachmann J, Graf K, Horack M, Karmann B, Vyas A, Lautsch D, Ambegaonkar B, Brudi P. Do acute coronary events affect lipid management and cholesterol goal attainment in Germany? : Results from the Dyslipidemia International study II. Wien Klin Wochenschr 2018; 130:707-715. [PMID: 30178071 PMCID: PMC6290720 DOI: 10.1007/s00508-018-1375-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 07/23/2018] [Indexed: 02/04/2023]
Abstract
Objective To document utilization of lipid-lowering therapy, attainment of low-density lipoprotein cholesterol target values, and cardiovascular outcomes in patients hospitalized for acute coronary syndrome in Germany. Methods The Dyslipidemia International Study II was a multicenter, observational study of the prevalence of dyslipidemia and lipid target value attainment in patients surviving any acute coronary syndrome event. Among patients on lipid-lowering therapy for ≥3 months, use of lipid-lowering therapy and lipid profiles were assessed at admission and again at 120 ± 15 days after admission (the follow-up time point). Multivariate logistic regression was used to identify variables predictive of low-density lipoprotein cholesterol target value attainment in patients using lipid-lowering therapy. Results A total of 461 patients hospitalized for acute coronary syndrome were identified, 270 (58.6%) of whom were on lipid-lowering therapy at admission. Among patients on lipid-lowering therapy, 90.7% and 85.9% were receiving statin monotherapy at admission and follow-up, respectively. Mean (SD) low-density lipoprotein cholesterol levels in patients on lipid-lowering therapy were 101 (40) mg/dl and 95 (30) mg/dl at admission and follow-up, respectively. In patients with data at both admission and follow-up (n = 61), low-density lipoprotein cholesterol target value attainment rates were the same (19.7%) at both time points. Smoking was associated with a 77% lower likelihood of attaining the low-density lipoprotein cholesterol target value. Conclusion Hospitalization for an acute event does not greatly alter lipid management in acute coronary syndrome patients in Germany. Both lipid-lowering therapy doses and rates of low-density lipoprotein cholesterol target value attainment remained essentially the same several months after the event.
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Affiliation(s)
- Anselm K Gitt
- Herzzentrum Ludwigshafen, Ludwigshafen, Germany. .,Stiftung IHF-Institut für Herzinfarktforschung Ludwigshafen, Bremser Str. 79, 67117, Ludwigshafen, Germany.
| | | | | | | | | | - Martin Horack
- Stiftung IHF-Institut für Herzinfarktforschung Ludwigshafen, Bremser Str. 79, 67117, Ludwigshafen, Germany
| | | | - Ami Vyas
- School of Public Health, Department of Epidemiology, Rutgers University, Piscataway, NJ, USA.,College of Pharmacy, Department of Pharmacy Practice, University of Rhode Island, Kingston, RI, USA
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18
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Sobhy M, El Etriby A, El Nashar A, Wajih S, Horack M, Brudi P, Lautsch D, Ambegaonkar B, Vyas A, Gitt AK. Prevalence of lipid abnormalities and cholesterol target value attainment in Egyptian patients presenting with an acute coronary syndrome. Egypt Heart J 2018; 70:129-134. [PMID: 30190636 PMCID: PMC6123296 DOI: 10.1016/j.ehj.2018.05.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 05/07/2018] [Indexed: 01/19/2023] Open
Abstract
Background Effective management of hyperlipidemia is of utmost importance for prevention of recurring cardiovascular events after an acute coronary syndrome (ACS). Indeed, guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL for such patients. The Dyslipidemia International Study II (DYSIS II) - Egypt was initiated in order to quantify the prevalence and extent of hyperlipidemia in patients presenting with an ACS in Egypt. Methods In this prospective, observational study, we documented patients presenting with an ACS at either of two participating centers in Egypt between November 2013 and September 2014. Individuals were included if they were over 18 years of age, had a full lipid profile available (recorded within 24 h of admission), and had either been taking lipid-lowering therapy (LLT) for ≥3 months at time of enrollment or had not taken LLT. Data regarding lipid levels and LLT were recorded on admission to hospital and at follow-up 4 months later. Results Of the 199 patients hospitalized for an ACS that were enrolled, 147 were on LLT at admission. Mean LDL-C at admission was 127.1 mg/dL, and was not significantly different between users and non-users of LLT. Only 4.0% of patients had an LDL-C level of <70 mg/dL, with the median distance to this target being 61.0 mg/dL. For the patients with LDL-C information available at both admission and follow-up, LDL-C target attainment rose from 2.8% to 5.6%. Most of the LLT-treated patients received statin monotherapy (98.6% at admission and 97.3% at follow-up), with the mean daily statin dose (normalized to atorvastatin) increasing from admission (30 mg/day) to follow-up (42 mg/day). Conclusions DYSIS II revealed alarming LDL-C goal attainment, with none of the patients with follow-up information available reaching the target of LDL-C <70 mg/dL, either at hospital admission or 4 months after their ACS event. Improvements in guideline adherence are urgently needed for reducing the burden of cardiovascular disease in Egypt. Strategies include the effective use of statins at high doses, or combination with other agents recommended by guidelines.
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Affiliation(s)
- Mohamed Sobhy
- Faculty of Medicine, Alexandria University, Egypt
- Corresponding author at: Faculty of Medicine, Alexandria University, Alexandria, Egypt.
| | | | | | - Sameh Wajih
- Merck Sharp & Dohme, Medical Affairs EEMEA, United Arab Emirates
| | - Martin Horack
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | | | - Ami Vyas
- Rutgers University, School of Public Health, Department of Epidemiology, Piscataway, NJ, USA
| | - Anselm K. Gitt
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
- Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
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19
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Gitt AK, Lautsch D, Lautsch D, Horack M, Horack M, Baxter CA, Baxter CA, De Ferrari G, De Ferrari G, Ferrieres J, Ferrieres J. P5383Risk for major adverse cardiovascular events estimated by the TIMI Risk Score for Secondary Prevention TRS2P in patients with coronary artery disease did not impact lipid lowering treatment in clinica. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p5383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A K Gitt
- Herzzentrum Ludwigshafen, Cardiology and Stiftung Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | | | - M Horack
- Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - M Horack
- Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - C A Baxter
- Merck & Co., Inc., Kenilworth, United States of America
| | - C A Baxter
- Merck & Co., Inc., Kenilworth, United States of America
| | | | | | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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20
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Gitt AK, Lautsch D, Horack M, Baxter CA, Ferrieres J, De Ferrari G. P781Better LDL-cholesterol-target attainment in patients with ACS and type 2 diabetes - results of DYSIS II ACS. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy564.p781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A K Gitt
- Herzzentrum Ludwigshafen, Cardiology and Stiftung Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - M Horack
- Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - C A Baxter
- Merck & Co., Inc., Kenilworth, United States of America
| | - J Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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21
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Al Sifri S, Al Shammeri O, Al Jaser S, Alkhenizan A, Bin Shafi Shafiurrehman A, Morcos B, Wajih S, Elnahal I, Horack M, Brudi P, Lautsch D, Ambegaonkar B, Vyas A, Baxter CA, Gitt AK. Prevalence of lipid abnormalities and cholesterol target value attainment in patients with stable coronary heart disease or an acute coronary syndrome in Saudi Arabia. Saudi Med J 2018; 39:697-704. [PMID: 29968891 PMCID: PMC6146262 DOI: 10.15537/smj.2018.7.22146] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Objectives: To provide an overview of the extent of hyperlipidemia in very high-risk patients, and how lipid-lowering therapy (LLT) is used in a real-world setting. Methods: In this multicenter observational study, data were collected from LLT-treated patients with stable CHD or an ACS in Saudi Arabia between 2013 and 2014. Individuals were included if they were >18 years and had a full lipid profile available, recorded either prior to the baseline physician visit (CHD patients) or within 24-hours of admission to hospital (ACS patients). Results: A total of 737 patients were included in the study, 597 with stable CHD and 140 with ACS. Few patients in either group had an LDL-C level of <70 mg/dl, which is advocated for very high-risk patients (24.3% and 11.4%, respectively). The median distances to this value were 19.0 mg/dl (CHD) and 25.0 mg/dl (ACS). Low doses of statins were being utilized (31 and 24 mg/day for CHD and ACS, respectively), with only minimal intensification for the ACS patients after hospital admission (41 mg/day at follow-up). Conclusions: Achievement of recommended LDL-C levels was poor for patients with stable CHD or an ACS. Statin intensity was low, indicating huge scope for intensifying the treatment of these very high-risk patients.
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Affiliation(s)
- Saud Al Sifri
- Al Hada Armed Forces Hospital, Al Hada Taif, Kingdom of Saudi Arabia. E-mail.
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Bonaca MP, De Ferrari GM, Atar D, Bash LD, Lautsch D, Bohula EA, Horack M, Brudi P, Ferrieres J, Gitt AK. How does the TRS 2°P score relate to real-world patients? Eur Heart J Cardiovasc Pharmacother 2018; 4:72-74. [PMID: 29554293 PMCID: PMC5939887 DOI: 10.1093/ehjcvp/pvy004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Marc P Bonaca
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Gaetano M De Ferrari
- Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Dan Atar
- Oslo University Hospital, Department of Cardiology B, and Institute of Clinical Sciences, University of Oslo, Norway
| | | | | | - Erin A Bohula
- TIMI Study Group, Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA, USA
| | - Martin Horack
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - Jean Ferrieres
- Department of Cardiology, Toulouse Rangueil Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Anselm K Gitt
- Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
- Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Germany
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Ferrieres J, Lautsch D, Velkovski-Rouyer M, Ambegaonkar B, De Ferrari G, Vyas A, Baxter C, Horack M, Bash L, Al Mahmeed W, Chiang F, Keong Poh K, Brudi P, Gitt A. Use of guideline-recommended treatments in 10,661 patients with coronary heart disease: Observational multinational DYSIS II study. Archives of Cardiovascular Diseases Supplements 2018. [DOI: 10.1016/j.acvdsp.2017.11.173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Gitt AK, Lautsch D, Ferrières J, De Ferrari GM, Vyas A, Baxter CA, Bash LD, Ashton V, Horack M, Almahmeed W, Chiang FT, Poh KK, Brudi P, Ambegaonkar B. Contemporary data on treatment practices for low-density lipoprotein cholesterol in 3867 patients who had suffered an acute coronary syndrome across the world. Data Brief 2017; 16:369-375. [PMID: 29234694 PMCID: PMC5723270 DOI: 10.1016/j.dib.2017.11.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2017] [Revised: 11/07/2017] [Accepted: 11/08/2017] [Indexed: 10/25/2022] Open
Abstract
DYSIS II ACS was a longitudinal, observational study in 3867 patients from 18 countries. They were being hospitalized after suffering an acute coronary syndrome. Evaluations were performed at the time of admission and again 120±15 days following the date of admission (the follow-up time point). 2521 patients were on active lipid lowering treatment (LLT) at admission. Mean atorvastatin dose was 22 mg per day and 2.7% received ezetimibe in combination with a statin. At discharge from hospital, 3767 patients received LLT expressed as a mean atorvastatin dose of 36 mg per day with 4.8% receiving ezetimibe on top of a statin. After 120 days, intensity in lipid lowering treatment was reduced to 32 mg per day with 4.9% of the patients receiving ezetimibe and a statin. Of note, during this 4-month follow up period, only 32% of all patients received laboratory lipid testing. 37% attained the low density lipoprotein cholesterol (LDL-C) target value of <70 mg/dl after 120 days. There are differences in the therapy administered as well as in the switch strategies when comparing the data from the respective countries studied. Conclusions Only one in three patients achieved the LDL-C target value following only marginal improvements in atorvastatin dose or combination therapy after an ACS event.
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Affiliation(s)
- Anselm K Gitt
- Herzzentrum Ludwigshafen, Germany.,Institut für Herzinfarktforschung Ludwigshafen, Germany
| | | | - Jean Ferrières
- Rangueil Hospital, Toulouse University School of Medicine, Toulouse, France
| | - Gaetano M De Ferrari
- Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy
| | - Ami Vyas
- Rutgers University, School of Public Health, Piscataway, NJ, USA
| | | | | | | | - Martin Horack
- Institut für Herzinfarktforschung Ludwigshafen, Germany
| | - Wael Almahmeed
- Sheikh Khalifa Medical City, Abu Dhabi, UAE.,Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, UAE
| | - Fu-Tien Chiang
- National Taiwan University Hospital, Taipei, Taiwan and Fu-Jen Catholic University Hospital, Taipei, Taiwan
| | - Kian Keong Poh
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Department of Cardiology, National University Heart Center Singapore, National University Health System, Singapore
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Gitt AK, Lautsch D, Ferrières J, De Ferrari GM, Vyas A, Baxter CA, Bash LD, Ashton V, Horack M, Almahmeed W, Chiang FT, Poh KK, Brudi P, Ambegaonkar B. Cholesterol target value attainment and lipid-lowering therapy in patients with stable or acute coronary heart disease: Results from the Dyslipidemia International Study II. Atherosclerosis 2017; 266:158-166. [DOI: 10.1016/j.atherosclerosis.2017.08.013] [Citation(s) in RCA: 77] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Revised: 07/21/2017] [Accepted: 08/18/2017] [Indexed: 11/29/2022]
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Gitt A, Lautsch D, Horack M, Brudi P, Poh K, De Ferrari G, Ferrieres J. P629Undertreatment of female patients in lipid-lowering for secondary prevention in Europe, Canada, South Africa, Middle East and China: results of the Dyslipidemia International Study (DYSIS). Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p629] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- A.K. Gitt
- Herzzentrum Ludwigshafen, Cardiology and Stiftung Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - M. Horack
- Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - P.H. Brudi
- Merck & Co, Inc., Kenilworth, United States of America
| | - K.K. Poh
- National University of Singapore, Singapore, Singapore
| | | | - J. Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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Gitt A, Lautsch D, Horack M, Brudi P, Poh K, De Ferrari G, Ferrieres J. P173Low LDL-cholesterol goal attainment 4 months after ACS due to lack of adjustment in lipid lowering treatment: Results from DYSIS II. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx501.p173] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- A.K. Gitt
- Herzzentrum Ludwigshafen, Cardiology and Stiftung Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany
| | | | - M. Horack
- Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen am Rhein, Germany
| | - P.H. Brudi
- Merck & Co, Inc., Kenilworth, United States of America
| | - K.K. Poh
- National University of Singapore, Singapore, Singapore
| | | | - J. Ferrieres
- Toulouse Rangueil University Hospital (CHU), Toulouse, France
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Gitt AK, Lautsch D, Horack M, Brudi P, Liu L, Ferrari GD, Poh KK, Ferrières J. LOW LDL-CHOLESTEROL TARGET VALUE ATTAINMENT AT THE TIME OF ACUTE CORONARY SYNDROME (ACS) AND EVEN 4 MONTHS AFTER THE ACUTE EVENT DUE TO LACK OF ADJUSTMENT IN LIPID LOWERING TREATMENT: RESULTS FROM THE DYSLIPIDEMIA INTERNATIONAL STUDY II ACS. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35090-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Gitt AK, Lautsch D, Horack M, Brudi P, Liu L, Ferrières J. IMPROVEMENT OF LDL-CHOLESTEROL GOAL ATTAINMENT IN HIGH-RISK PATIENTS IN EUROPE AND MIDDLE EAST BETWEEN 2008-09 AND 2013-14: RESULTS OF DYSIS AND DYSIS II CHD. J Am Coll Cardiol 2017. [DOI: 10.1016/s0735-1097(17)35091-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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30
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Ferrières J, Rouyer MV, Lautsch D, Ambegaonkar BM, Horack M, Brudi P, Gitt AK. Improvement in achievement of lipid targets in France: Comparison of data from coronary patients in the DYSIS and DYSIS II studies. Int J Cardiol 2016; 222:793-794. [DOI: 10.1016/j.ijcard.2016.08.084] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Accepted: 08/04/2016] [Indexed: 10/21/2022]
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Gitt AK, Lautsch D, Ferrieres J, Kastelein J, Drexel H, Horack M, Brudi P, Vanneste B, Bramlage P, Chazelle F, Sazonov V, Ambegaonkar B. Contemporary data on low-density lipoprotein cholesterol target value attainment and distance to target in a cohort of 57,885 statin-treated patients by country and region across the world. Data Brief 2016; 9:616-620. [PMID: 27766290 PMCID: PMC5066206 DOI: 10.1016/j.dib.2016.09.037] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Revised: 09/15/2016] [Accepted: 09/22/2016] [Indexed: 11/18/2022] Open
Abstract
Data presented here refer to 57,885 patients on lipid-lowering statin therapy from the Dyslipidaemia International Study (DYSIS) registry. Subjects were divided into 3 discrete subsets: those at very high-risk, high-risk, and non-high-risk for cardiovascular events, with assigned low density lipoprotein cholesterol (LDL-C) targets of 70 mg/dl, 100 mg/dl and 115 mg/dl, respectively. Overall, the highest proportion of patients meeting their LDL-C target was seen in the UAE and Kuwait (49.5%), while the lowest was seen in Germany (14.3%). The smallest median distance to target was documented in Canada (18.8 mg/dl), and the largest in the Baltics (42.1 mg/dl). Interpretation and discussion of this data can be found in the manuscript entitled “Low-density lipoprotein cholesterol in a global cohort of 57,885 statin-treated patients” (Gitt et al., 2016) [1].
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Affiliation(s)
- Anselm K. Gitt
- Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
- Corresponding author.
| | | | - Jean Ferrieres
- Toulouse University School of Medicine, Toulouse, France
| | - John Kastelein
- Department of Vascular Medicine, Academic Medical Center/University of Amsterdam, Amsterdam, The Netherlands
| | - Heinz Drexel
- Department of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria
- Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria
- Private University of the Principality of Liechtenstein, Triesen, Liechtenstein
- Drexel University College of Medicine, Philadelphia, PA, USA
| | - Martin Horack
- Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | | | | | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Mahlow, Germany
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Catapano AL, Lautsch D, Tokgözoglu L, Ferrieres J, Horack M, Farnier M, Toth PP, Brudi P, Tomassini JE, Ambegaonkar B, Gitt AK. Prevalence of potential familial hypercholesterolemia (FH) in 54,811 statin-treated patients in clinical practice. Atherosclerosis 2016; 252:1-8. [DOI: 10.1016/j.atherosclerosis.2016.07.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Revised: 06/20/2016] [Accepted: 07/07/2016] [Indexed: 10/21/2022]
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Lautsch D, Ferrieres J, Ambegaonkar B, Horack M, Brudi P, Gitt A. Does Body Mass Index Correlate To Lipoproteins And Triglycerides? Findings From DYSIS In 52.916 Statin Treated Patients. J Clin Lipidol 2016. [DOI: 10.1016/j.jacl.2016.03.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gitt AK, Lautsch D, Ambegaonkar B, Horack M, Brudi P, Ferrières J. STILL HIGH PREVALENCE OF PERSISTENT LIPID ABNORMALITIES AMONG CORONARY PATIENTS DESPITE CHRONIC STATIN THERAPY IN 2014: RESULTS OF DYSIS II ACS AND CHD. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)32041-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gitt AK, Lautsch D, Ambegaonkar B, Horack M, Ferrières J. PERSISTENT HIGH DISTANCE TO RECOMMENDED LDL-CHOLESTEROL-TARGETS DESPITE CHRONIC STATIN TREATMENT: RESULTS OF DYSIS. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31935-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Gitt AK, Lautsch D, Ambegaonkar B, Horack M, Ferrières J. ESTIMATED PREVALENCE OF POSSIBLE AND PROBABLE FAMILIAL HYPERCHOLESTEROLEMIA IN 35,451 STATIN-TREATED PATIENTS IN EUROPE, CANADA, THE MIDDLE EAST, AND SOUTH AFRICA. J Am Coll Cardiol 2016. [DOI: 10.1016/s0735-1097(16)31934-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ferrières J, TokgözoğLu L, Lautsch D, Horack M, Ambegaonkar B, Brudi P, Gitt AK. 0033: Unexpected high prevalence of possible and probable familial hyper-cholesterolemia in clinical practice – the DYSIS study. Archives of Cardiovascular Diseases Supplements 2016. [DOI: 10.1016/s1878-6480(16)30270-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Gitt A, Ashton V, Horack M, Jannowitz C, Brudi P, Lautsch D, Ambegaonkar B. Low LDL-C target achievement among treated acs patients in germany: the dyslipidemia international study (dysis) iiacs results. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pitsavos C, Alexopoulos D, Goudevenos J, Xixi E, Gitt A, Horack M, Ashton V, Brudi P, Lautsch D, Ambegaonkar B. Prevalence of lipid abnormalities among treated ACS patients in Greece: The Dyslipidemia International Study (DYSIS) II ACS results. Atherosclerosis 2015. [DOI: 10.1016/j.atherosclerosis.2015.04.452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Al Mahmeed W, Yusufali AH, Bakir S, Gitt A, Horack M, Ashton V, Brudi P, Wajih S, Ambegaonkar B. APSC2015-1329 LDL-C Target Achievement Remains Low Among Treated Very High Cardiovascular Risk Patients: The Dyslipidemia International Study (DYSIS) II UAE Results. Glob Heart 2015. [DOI: 10.1016/j.gheart.2015.03.096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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Gitt AK, Ambegaonkar B, Brudi P, Horack M, Lautsch D. LOW LDL-CHOLESTEROL TARGET ACHIEVEMENT IN STATIN-TREATED PATIENTS IN CLINICAL PRACTICE IN CHINA AND EUROPE: RESULTS OF THE DYSLIPIDEMIA INTERNATIONAL STUDY (DYSIS). J Am Coll Cardiol 2015. [DOI: 10.1016/s0735-1097(15)61482-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ledwoch J, Franke J, Gerckens U, Kuck KH, Linke A, Nickenig G, Krülls-Münch J, Vöhringer M, Hambrecht R, Erbel R, Richardt G, Horack M, Zahn R, Senges J, Sievert H. Incidence and predictors of permanent pacemaker implantation following transcatheter aortic valve implantation: analysis from the German transcatheter aortic valve interventions registry. Catheter Cardiovasc Interv 2013; 82:E569-77. [PMID: 23475694 DOI: 10.1002/ccd.24915] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2012] [Revised: 02/19/2013] [Accepted: 03/03/2013] [Indexed: 11/08/2022]
Abstract
OBJECTIVES To determine predictors of permanent pacemaker (PPM) implantation up to 30 days after transcatheter aortic valve implantation (TAVI) in a prospective multicenter registry. BACKGROUND Conduction disorders requiring PPM implantation are one of the most common complications seen after TAVI. Knowledge about possible predictors may help to decrease the rate of PPM implantations. METHODS In total, 1347 consecutive patients who underwent TAVI in 22 centers were prospectively enrolled in the German transcatheter aortic valve interventions registry. Both Medtronic CoreValve™ and Edwards Sapien™ valves were implanted. Patients with preprocedurally implanted PPM or implantable cardioverter defibrillator were excluded from the analysis (n = 199). Regression analysis of baseline and procedure characteristics of the remaining 1,147 patients was performed. RESULTS Procedural success was achieved in 97.4% of the cases. The rate for PPM after TAVI was 33.7%. The absence of prior valve surgery, the use of Medtronic CoreValve™ prosthesis and the presence of a porcelain aorta were identified as independent predictors for PPM after TAVI. Mortality at 30 days did not differ between patients with or without PPM necessity (6.0% vs. 8.1%, respectively; HR 0.72; CI (0.45-1.16); P = 0.17). CONCLUSIONS PPM is a common postprocedure requirement after TAVI. The absence of prior valve surgery, the implantation of Medtronic CoreValve™ prosthesis, and the presence of a porcelain aorta were independently associated with PPM after TAVI.
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Lauten A, Zahn R, Horack M, Sievert H, Linke A, Ferrari M, Harnath A, Grube E, Gerckens U, Kuck KH, Sack S, Senges J, Figulla HR. Transcatheter aortic valve implantation in patients with low-flow, low-gradient aortic stenosis. JACC Cardiovasc Interv 2012; 5:552-559. [PMID: 22625194 DOI: 10.1016/j.jcin.2012.04.001] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2011] [Revised: 03/13/2012] [Accepted: 04/04/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVES The purpose of this study was to evaluate the efficacy and outcome of transcatheter aortic valve implantation (TAVI) in patients with low-flow, low-gradient aortic stenosis (LG-AS). BACKGROUND Patients with LG-AS have a poor prognosis with medical treatment and a high risk for surgical aortic valve replacement. METHODS Between January 2009 and June 2010, a total of 1,302 patients underwent TAVI for severe AS and were prospectively included in the multicenter German TAVI registry. RESULTS LG-AS was present in 149 patients (11.4%; mean age: 80.2 ± 6.3 years). In this subgroup, the EuroSCORE was significantly higher (26.8 ± 16.6 vs. 20.0 ± 13.3; p < 0.0001) compared with patients with high-gradient AS (HG-AS). The procedural success rate (LG-AS: 95.3% vs. HG-AS: 97.5%; p = 0.13) and the rate of TAVI-associated complications were comparable in both groups (new pacemaker: 27.0% vs. 28.1%; p = 0.76; cerebrovascular events: 3.4% vs. 3.1%, p = 0.83). However, post-operative low-output syndrome occurred more frequently in the LG-AS-group (LG-AS: 14.9% vs. HG-AS: 5.7%, p < 0.0001), and mortality at 30 days and 1 year was significantly higher in this subgroup (LG-AS: 12.8% and 36.9% vs. HG-AS: 7.4% and 18.1%; p < 0.001 and p < 0.0001, respectively). Post-operative New York Heart Association functional class improved, and self-assessed quality of life increased significantly, demonstrating a substantial benefit in the LG-AS group at 30 days and 1 year after TAVI. CONCLUSIONS In high-risk patients with LG-AS, TAVI is associated with a significantly higher mortality at 30 days and at 1 year. However, long-term survivors benefit from TAVI with functional improvement and a significantly increased quality of life. Therefore, in view of the poor prognosis with medical treatment, TAVI should be considered an option in high-risk patients with LG-AS.
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Affiliation(s)
- Alexander Lauten
- Department of Internal Medicine I, University Heart Center Jena, Jena, Germany.
| | - Ralf Zahn
- Department of Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany
| | - Martin Horack
- Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - Horst Sievert
- CardioVascular Center Frankfurt, Sankt Katharinen, Frankfurt, Germany
| | - Axel Linke
- Department of Cardiology, Herzzentrum Leipzig, Leipzig, Germany
| | - Markus Ferrari
- Department of Internal Medicine I, University Heart Center Jena, Jena, Germany
| | - Axel Harnath
- Department of Cardiology, Sana-Herzzentrum Cottbus, Cottbus, Germany
| | - Eberhard Grube
- Medizinische Klinik II, Universitaetsklinikum Bonn, Bonn, Germany
| | - Ulrich Gerckens
- Department of Cardiology, Gemeinschaftskrankenhaus Bonn, Bonn, Germany
| | - Karl-Heinz Kuck
- Department of Cardiology, Asklepios Klinik St. Georg, Hanseatic Heart Center Hamburg, Hamburg, Germany
| | - Stefan Sack
- Department of Cardiology, Klinikum Muenchen Schwabing, Munich, Germany
| | - Jochen Senges
- Institut fuer Herzinfarktforschung, Ludwigshafen, Germany
| | - Hans R Figulla
- Department of Internal Medicine I, University Heart Center Jena, Jena, Germany
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Biermann J, Horack M, Kahlert P, Konorza T, Plicht B, Wasem J, Zahn R, Senges J, Erbel R, Neumann T. The impact of transcatheter aortic valve implantation on quality of life. Results from the German transcatheter aortic valve interventions registry. Gesundheitswesen 2012. [DOI: 10.1055/s-0032-1321995] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Abdel-Wahab M, Zahn R, Horack M, Gerckens U, Schuler G, Sievert H, Naber C, Voehringer M, Schäfer U, Senges J, Richardt G. Transcatheter aortic valve implantation in patients with and without concomitant coronary artery disease: comparison of characteristics and early outcome in the German multicenter TAVI registry. Clin Res Cardiol 2012; 101:973-81. [PMID: 22772776 DOI: 10.1007/s00392-012-0486-5] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2012] [Accepted: 06/08/2012] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the prevalence and impact of concomitant coronary artery disease (CAD) on short-term outcome after transcatheter aortic valve implantation (TAVI). BACKGROUND The prevalence of CAD in patients undergoing surgical aortic valve replacement is estimated at 30-50 % and its presence increases procedural risk. The prevalence and impact of CAD on outcome after TAVI are not well defined. METHODS We analyzed 1,382 patients enrolled in the German TAVI registry; the majority (81 %) received the Medtronic CoreValve. The presence of coronary lesions with ≥50 % stenosis on pre-TAVI angiography defined the existence of concomitant CAD. RESULTS 859 patients (62.2 %) had concomitant CAD, of which 534 (62.3 %) had multi-vessel and 83 (9.7 %) left main disease. Patients with CAD were younger (81.5 ± 6.1 vs. 82.1 ± 6.3 years, p < 0.05), more commonly males (49.4 vs. 30.0 %, p < 0.0001) and diabetics (36.9 vs. 31.2 %, p < 0.05), and had a worse Canadian Cardiovascular Society angina class at baseline compared to patients with no CAD. During TAVI patients with CAD more often required additional coronary intervention and had longer procedures, but procedural success rates were similar (97.1 vs. 97.7 %). Crude in-hospital mortality was higher in patients with CAD (10.0 vs. 5.5 %, OR 1.90, 95 % CI 1.23-2.93), but this was not significant after adjustment for confounders (adjusted OR 1.41, 95 % CI 0.85-2.33). Both groups had significant improvement in 30-day symptoms and quality of life. CONCLUSION The prevalence of CAD in contemporary TAVI patients is high. Its presence characterizes a high-risk population and is associated with increased crude short-term mortality, largely explained by co-morbidities, but does not limit functional improvement after TAVI.
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Affiliation(s)
- Mohamed Abdel-Wahab
- Heart Center, Segeberger Kliniken GmbH, Academic Teaching Hospital of the Universities of Kiel and Hamburg, Am Kurpark 1, 23795, Bad Segeberg, Germany.
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Sinning JM, Horack M, Grube E, Gerckens U, Erbel R, Eggebrecht H, Zahn R, Linke A, Sievert H, Figulla HR, Kuck KH, Hauptmann KE, Hoffmann E, Hambrecht R, Richardt G, Sack S, Senges J, Nickenig G, Werner N. The impact of peripheral arterial disease on early outcome after transcatheter aortic valve implantation: results from the German Transcatheter Aortic Valve Interventions Registry. Am Heart J 2012; 164:102-10.e1. [PMID: 22795289 DOI: 10.1016/j.ahj.2012.04.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2011] [Accepted: 04/12/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND A significant proportion of patients undergoing transcatheter aortic valve implantation (TAVI) have concomitant peripheral arterial disease (PAD), which plays a crucial role in the preinterventional selection process of determining an optimal vascular access site. The aim of our study was to determine the impact of PAD on clinical outcome after TAVI in a real-world setting. METHODS A total of 1,315 patients (mean logistic European System for Cardiac Operative Risk Evaluation 20.6% ± 13.7%) underwent TAVI in 27 centers and were included in the prospective German TAVI Registry. RESULTS Of the 1,315 patients with TAVI, 330 (25.1%) had PAD. These patients had a higher logistic European System for Cardiac Operative Risk Evaluation score (27.7% ± 16.0% vs 18.3% ± 12.0%, P < .0001), mainly attributed to more frequent and severe comorbidities. Compared with patients without PAD, patients with PAD had a higher rate of vascular complications (28.5% vs 20.7%, P < .01), dialysis-dependent renal failure (11.2% vs 5.4%, P < .001), myocardial infarction (1.2% vs 0.3%, P < .05), and, subsequently, 30-day mortality (12.7% vs 6.9%, P < .001). Choosing a surgical approach, for example, transapical access, did not reduce the periprocedural risk associated with PAD; in-hospital mortality was 15.7% for surgical and 10.5% for percutaneous patients with TAVI having PAD (P < .001). In a multivariate regression analysis, PAD was an independent predictor of 30-day mortality (hazard ratio 1.8, 95% CI 1.2-2.7, P = .004) after TAVI. CONCLUSIONS In this real-world TAVI Registry, PAD was an independent predictor of mortality in patients with percutaneous and surgical TAVI, including vascular complications. Assessment of PAD should play a crucial role in the preinterventional selection process, regardless of the access strategy.
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Gitt A, Jannowitz C, Karoff M, Karmann B, Horack M, Völler H. Treatment patterns and risk factor control in patients with and without metabolic syndrome in cardiac rehabilitation. Vasc Health Risk Manag 2012; 8:265-74. [PMID: 22566748 PMCID: PMC3346265 DOI: 10.2147/vhrm.s28949] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Aim Metabolic syndrome (MetS) is a clustering of factors that are associated with increased cardiovascular risk. We aimed to investigate the proportion of patients with MetS in patients undergoing cardiac rehabilitation (CR), and to describe differences between patients with MetS compared to those without MetS with regard to (1) patient characteristics including demographics, risk factors, and comorbidities, (2) risk factor management including drug treatment, and (3) control status of risk factors at entry to CR and discharge from CR. Methods Post-hoc analysis of data from 27,904 inpatients (Transparency Registry to Objectify Guideline-Oriented Risk Factor Management registry) that underwent a CR period of about 3 weeks were analyzed descriptively in total and compared by their MetS status. Results In the total cohort, mean age was 64.3 years, (71.7% male), with no major differences between groups. Patients had been referred after a ST elevation of myocardial infarction event in 41.1% of cases, non-ST elevation of myocardial infarction in 21.8%, or angina pectoris in 16.7%. They had received a percutaneous coronary intervention in 55.1% and bypass surgery (coronary artery bypass graft) in 39.5%. Patients with MetS (n = 15,819) compared to those without MetS (n = 12,085) were less frequently males, and in terms of cardiac interventions, more often received coronary artery bypass surgery. Overall, statin use increased from 79.9% at entry to 95.0% at discharge (MetS: 79.7% to 95.2%). Patients with MetS compared to those without MetS received angiotensin converting enzyme inhibitors, angiotensin receptor blockers, oral antidiabetics, and insulin at entry and discharge more frequently, and less frequently clopidogrel and aspirin/clopidogrel combinations. Mean blood pressure was within the normal range at discharge, and did not differ substantially between groups (124/73 versus 120/72 mmHg). Overall, between entry and discharge, levels of total cholesterol, low density lipoprotein cholesterol, and triglycerides were substantially lowered, in particular in MetS patients. Thus, control rates of lipid parameters improved substantially, with the exception of high density lipoprotein cholesterol. Low density lipoprotein cholesterol rates <100 mg/dL increased from 38.7% at entry to 73.8% at discharge (MetS: from 39.4% to 74.6%) and triglycerides control rates (<150 mg/dL) from 58.1% to 70.4% (MetS: 43.7% to 62.2%). Physical fitness on exercise testing improved substantially in both groups. Conclusion Patients with and without MetS benefited substantially from the participation in CR, as their lipid profile, blood pressure, and physical fitness improved. Treatment effects were similar in the two groups.
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Affiliation(s)
- Anselm Gitt
- Institut für Herzinfarktforschung an der Universität Heidelberg, Ludwigshafen, Germany
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Staubach S, Franke J, Gerckens U, Schuler G, Zahn R, Eggebrecht H, Hambrecht R, Sack S, Richardt G, Horack M, Senges J, Steinberg DH, Ledwoch J, Fichtlscherer S, Doss M, Wunderlich N, Sievert H. Impact of aortic valve calcification on the outcome of transcatheter aortic valve implantation: Results from the prospective multicenter German TAVI registry. Catheter Cardiovasc Interv 2012; 81:348-55. [DOI: 10.1002/ccd.24332] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 01/03/2012] [Indexed: 11/06/2022]
Affiliation(s)
- Stephan Staubach
- CardioVascular Center Frankfurt; Sankt Katharinen und Universitätsklinikum Frankfurt; Frankfurt; Germany
| | - Jennifer Franke
- CardioVascular Center Frankfurt; Sankt Katharinen und Universitätsklinikum Frankfurt; Frankfurt; Germany
| | - Ulrich Gerckens
- Klinik für Kardiologie und Angiologie; Helios Klinikum Siegburg; Siegburg; Germany
| | - Gerhard Schuler
- Herzzentrum Leipzig; Klinik für Kardiologie; Leipzig; Germany
| | - Ralf Zahn
- Herzzentrum; Kardiologie; Ludwigshafen; Städtisches Klinikum; Germany
| | - Holger Eggebrecht
- Universitätsklinikum Essen; Westdeutsches Herzzentrum Essen; Klinik für Kardiologie; Essen; Germany
| | - Rainer Hambrecht
- Klinik für Kardiologie und Angiologie; Herzzentrum Bremen; Bremen; Germany
| | - Stefan Sack
- Klinik für Kardiologie; Pneumologie und Internistische Intensivmedizin; Städtisches Klinikum München; München; Germany
| | | | - Martin Horack
- Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg; Ludwigshafen; Germany
| | - Jochen Senges
- Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg; Ludwigshafen; Germany
| | - Daniel H. Steinberg
- CardioVascular Center Frankfurt; Sankt Katharinen und Universitätsklinikum Frankfurt; Frankfurt; Germany
| | - Jakob Ledwoch
- CardioVascular Center Frankfurt; Sankt Katharinen und Universitätsklinikum Frankfurt; Frankfurt; Germany
| | - Stephan Fichtlscherer
- CardioVascular Center Frankfurt; Sankt Katharinen und Universitätsklinikum Frankfurt; Frankfurt; Germany
| | - Mirko Doss
- CardioVascular Center Frankfurt; Sankt Katharinen und Universitätsklinikum Frankfurt; Frankfurt; Germany
| | - Nina Wunderlich
- CardioVascular Center Frankfurt; Sankt Katharinen und Universitätsklinikum Frankfurt; Frankfurt; Germany
| | - Horst Sievert
- CardioVascular Center Frankfurt; Sankt Katharinen und Universitätsklinikum Frankfurt; Frankfurt; Germany
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Bestehorn K, Jannowitz C, Horack M, Karmann B, Halle M, Völler H. Current state of cardiac rehabilitation in Germany: patient characteristics, risk factor management and control status, by education level. Vasc Health Risk Manag 2011; 7:639-47. [PMID: 22140313 PMCID: PMC3225345 DOI: 10.2147/vhrm.s22971] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background After the acute hospital stay, most cardiac patients in Germany are transferred for a 3–4-week period of inpatient cardiac rehabilitation. We aim to describe patient characteristics and risk factor management of cardiac rehabilitation patients with a focus on drug treatment and control status, differentiated by education level (low level, elementary school; intermediate level, secondary modern school; high level, grammar school/university). Methods Data covering a time period between 2003 and 2008 from 68,191 hospitalized patients in cardiac rehabilitation from a large-scale registry (Transparency Registry to Objectify Guideline- Oriented Risk Factor Management) were analyzed descriptively. Further, a multivariate model was applied to assess factors associated with good control of risk factors. Results In the total cohort, patients with a manifestation of coronary artery disease (mean age 63.7 years, males 71.7%) were referred to cardiac rehabilitation after having received percutaneous coronary intervention (51.6%) or coronary bypass surgery (39.5%). Statin therapy increased from 76.3% at entry to 88.9% at discharge, and low density lipoprotein cholesterol < 100 mg/dL rates increased from 31.1% to 69.6%. Mean fasting blood glucose decreased from 108 mg/dL to 104 mg/dL, and mean exercise capacity increased from 78 W to 95 W. Age and gender did not differ by education. In contrast with patients having high education, those with low education had more diabetes, hypertension, and peripheral arterial disease, had lower exercise capacity, and received less treatment with statins and guideline-orientated therapy in general. In the multivariate model, good control was significantly more likely in men (odds ratio 1.38; 95% confidence interval 1.30–1.46), less likely in patients of higher age (0.99; 0.99–0.99), with diabetes (0.90; 0.85–0.95), or peripheral arterial disease (0.88; 0.82–0.95). Compared with a low level education, a mid level education was associated with poor control (0.94; 0.89–0.99), while high education did not have a significant effect (1.08; 0.99–1.17). Conclusion Patients with different levels of education treated in cardiac rehabilitation did not differ relevantly in terms of demographics, but did differ in some clinical aspects. With respect to the ultimate goal of cardiac rehabilitation, ie, optimal control of risk factors, education level does not play an important role.
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Affiliation(s)
- Kurt Bestehorn
- Institute for Clinical Pharmacology, Technical University, Dresden, Germany.
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Ino H, Sprenger C, Breithardt G, Haeusler KG, Meinertz T, Ravens U, Steinbeck G, Tebbe U, Oeff M, Pisters R, Nieuwlaat R, Prins MH, Le Heuzey JY, Maggioni AP, Camm AJ, Crijns HJGM, Torp-Pedersen C, Crijns HJ, Page RL, Connolly SJ, Hohnloser SH, Sehra R, Krummen D, Briggs C, Rappel WJ, Narayan S, Simon HU, Horack M, Senges J, Hoffmann E, Willems S, Spitzer S, Kuck KH, Brachmann J, Revishvili A, Matsonashvili G, Labartkava E, Dzhordzhikiya T, Serguladze S, Shmul A, Kvasha B, Lima CEB, Martinelli M, Alkmim-Teixeira R, Nishioka SAD, Siqueira S, Jesus LD, Wajngarten M, Costa R, Ferrero P, De Filippo P, Ferrari P, Brambilla R, Cantu F, Pachon J, Pachon M E, J Lobo T, Pachon JC, Pachon MZ, Santillana P T, Jatene AD, Sinha AM, Senges J, Kuck KH, Andresen D, Hoffmann E, Schumacher B, Tebbenjohanns J, Brachmann J, Castrejon Castrejon S, Perez-Silva A, Doiny D, Estrada A, Ortega M, Lopez-Sendon JL, Merino JL, Jais P, Sacher F, Derval N, Jadidi A, Maury P, Nault I, Hocini M, Haissaguerre M, Pokushalov E, Romanov A, Artemenko S, Shabanov V, Turov A. Flash Presentations I. Europace 2011. [DOI: 10.1093/europace/eur227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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