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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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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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Allahyari A, Jernberg T, Lautsch D, Lundman P, Hagstrom E, Schubert J, Boggs R, Salomonsson S, Ueda P. P828Low-density lipoprotein cholesterol lowering therapy and target level attainment after a recent myocardial infarction - nationwide cohort study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0427] [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: 11/14/2022] Open
Abstract
Abstract
Background
Lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk of cardiovascular disease after a myocardial infarction (MI). The European Society of Cardiology (ESC) guidelines recommend lipid lowering therapy to reach LDL-C treatment targets after an MI.
Purpose
To assess LDL-C target level attainment according to the ESC guidelines among patients with a recent MI in Sweden.
Methods
We used data from nationwide registers in Sweden and included patients aged 18–74 years admitted to a hospital with MI (1 January 2013–1 October 2016). Among patients who were alive and had LDL-C data available, we assessed LDL-C target achievement at 6–10 weeks (n=21,505) and 12–14 months (n=17,957) after the MI by category of lipid lowering therapy (no statin; low/moderate-intensity statins; high-intensity statins; any statin plus ezetimibe). The target was defined as an LDL-C of <1.8 mmol/L and a ≥50% reduction from the baseline if LDL-C was 1.8–3.5 mmol/L and the patient was not already receiving statins.
Results
Most patients were treated with high-intensity statin monotherapy (84.2% and 72.0%) or any statin with ezetimibe (2.1% and 10.4%) at 6–10 weeks and 12–14 months after the MI, respectively. In total, 37.7% (6–10 weeks) and 38.3% (12–14 months) had attained their LDL-C target. The proportion of patients attaining their LDL-C target at 6–10 weeks was 12% (no statin), 30% (low/moderate-intensity statins), 39% (high-intensity statins), and 49% (any statin plus ezetimibe). The corresponding numbers at 12–14 months were 16% (no statin), 29% (low/moderate-intensity statins), 39% (high-intensity statins), and 58% (any statin plus ezetimibe). A total of 11.8% at 6–10 weeks and 12.3% at 12–14 months reached an LDL-C level of <1.8 mmol/L, but did not reach their LDL-C target level due to the ≥50% reduction criteria. (Figure 1)
Figure 1
Conclusions
In this large population-based study using nationwide data, more than half of patients with a recent MI did not achieve the ESC guidelines LDL-C target levels, despite a large proportion with high-intensity statin therapy. In patients treated with statins and ezetimibe, four out of ten did not reach the ESC LDL-C target level. Our findings indicate that there may be a need for additional LDL-C lowering therapy if the target level is to be attained in all patients.
Acknowledgement/Funding
This project was supported by funding from Merck Sharp & Dohme.
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Affiliation(s)
- A Allahyari
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - T Jernberg
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - D Lautsch
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | - P Lundman
- Karolinska Institute, Department of Clinical Sciences, Danderyd Hospital, Stockholm, Sweden
| | - E Hagstrom
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - J Schubert
- Uppsala University, Department of Medical Sciences, Cardiology, Uppsala, Sweden
| | - R Boggs
- Merck & Co., Inc., Kenilworth, New Jersey, United States of America
| | | | - P Ueda
- Karolinska Institute, Division of Clinical Epidemiology, Department of Medicine, Solna, Stockholm, Sweden
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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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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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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 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 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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