Outcomes of lipid control in secondary prevention of coronary artery disease in Finland: A 24-month follow-up after acute coronary syndrome

BACKGROUND AND AIMS

Ischemic heart diseases are the main cause of death worldwide, therefore secondary prevention and treatment of coronary artery disease (CAD) are highly significant for public health and mortality. The objective of this study is to evaluate LDL cholesterol (LDL-C) levels as outcomes of secondary prevention of CAD in Finland up to 24 months after being diagnosed with acute coronary syndrome (ACS). This retrospective analysis of patients with ACS was conducted in two areas of Finland that have a combined population of 400,000.

METHODS

The data used in the study covered all outpatient visits, inpatient episodes, prescriptions and LDL-C results for ACS patients during 2011-2015. To evaluate the outcome of the prevention, three separate measurements of patients' LDL-C levels were considered: baseline, first follow-up and final follow-up. The factors associated with reaching treatment goal were identified using logistic regression analysis.

RESULTS

32% of ACS patients achieved the treatment goal (LDL-C <1.8 mmol/l) at the end of the 24-month follow-up period, but 21% of patients fluctuated between being on and above target.

CONCLUSION

Two thirds of CAD patients with ACS and on statin therapy do not achieve LDL-C treatment target recommended by the guidelines. Since LDL-C levels fluctuate in the follow-up, a low level during the first 12 months after the acute event does not guarantee the maintenance of the results in the long term. Hence, LDL-C levels should be monitored at least on an yearly basis on follow-ups, and treatment adapted accordingly.

Localization of the alpha v subfamily of integrins and their putative ligands in synovial lining cell layer

OBJECTIVE

The lining cell layer of the synovium proliferates strongly in rheumatoid arthritis. It has been suggested that it has a central role in the destruction of cartilage. We have analyzed the structure of the extracellular matrix and the adhesion molecules of normal, osteoarthritic and rheumatoid lining cell layer.

METHODS

We localized the alpha v integrin subunit and its 4 putative partner beta subunits in synovial samples by using indirect immunofluorescence. The specimens were also analyzed by confocal microscopy. Indirect immunofluorescence was also used to analyze the ligands of alpha v integrins, namely fibronectin and vitronectin.

RESULTS

The alpha v integrin was abundant in the lining cell layer of normal and osteoarthritic synovia, whereas it was not expressed in the proliferating rheumatoid lining cell layers. A similar expression pattern was found for beta 5 subunit, suggesting that it is the major partner for alpha v. However, also some alpha v beta 1 and alpha v beta 3 heterodimers may be present. The confocal microscopy revealed the presence of both alpha v beta 5 positive and negative lining cells. The putative ligands for alpha v integrins, namely fibronectin and vitronectin were found in the lining cell layer of all the synovial specimens.

CONCLUSION

In spite of the proliferation of the lining cell layer in rheumatoid inflammation, the extracellular matrix stays very similar to that in normal and osteoarthritic synovium, whereas the pattern of the adhesion receptors is completely altered.