scholarly journals Organizational and patient-level predictors for reaching key risk factor targets in cardiac rehabilitation after myocardial infarction – the perfect-CR study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H Ogmundsdottir Michelsen ◽  
P Henriksson ◽  
J Wallert ◽  
M Back ◽  
I Sjolin ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Risk Factor ◽  
Cardiac Rehabilitation ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Smoking Abstinence ◽  
Organizational Variables ◽  
Patient Level ◽  
One Year

Abstract Background The benefits of specific cardiac rehabilitation (CR) programme components on patient outcomes after myocardial infarction (MI) remain unclear, as does their relative predictive strength compared to patient-level predictors. Purpose To identify CR organizational and patient-level predictors for reaching risk factor targets at one-year post-MI. Methods This was an observational survey- and registry-based study. Data on CR organization at all 78 CR centres in Sweden was collected in 2016 and merged with individual patient data from nationwide registries (n=7549, median age 64 years, 24% females). Cross-validation resampled orthogonal partial least squares discriminant analysis identified predictors for reaching treatment targets for low-density lipoprotein-cholesterol (LDL-C<1.8 mmol/L), blood pressure (BP<140/90 mmHg) and smoking abstinence (yes/no). Predictors with Variables of Importance for the Projection (VIP) value >0.8 and 95% confidence intervals (CI) excluding zero, were considered meaningful. Results Of the 71 analysed organizational variables, 36 were identified as meaningful predictors for reaching LDL-C and 35 for BP targets (Figure 1). The strongest predictors (VIP [95% CI]) for LDL-C and BP were: offering psychosocial management at initial CR assessment 2.09 [1.70–2.49]; 2.34 [1.90–2.78], having a CR team psychologist 1.59 [1.28–1.91]; 2.00 [1.46–2.55], having extended CR centre opening hours 2.17 [1.95–2.40]; 1.51 [1.03–2.00], staff reporting satisfaction with CR centre facilities 1.55 [1.07–2.04]; 1.96 [1.64–2.28], having a medical director 1.71 [1.45–1.97]; 1.47 [1.07–1.87], nurses using protocols for antihypertensive and/or lipid lowering medication adjustment 1.58 [1.35–1.81]; 1.56 [1.03–2.08], having operational team meetings 1.36 [1.08–1.64]; 1.34 [0.99–1.70], and using audit data for quality improvement 1.00 [0.79–1.20]; 1.27 [0.99–1.56]. Offering pre-exercise-based CR (exCR) assessment and different modes of exCR were predictors for reaching both targets. The strongest patient-level predictor of reaching LDL-C target was low baseline LDL-C 3.90 [3.25–4.56], and for BP it was having no history of hypertension 2.93 [2.74–3.12]. Second, participation in exCR was the strongest predictor for both outcomes 1.60 [0.83–2.37]; 1.50 [1.15–1.86]. For smoking abstinence, 5 organizational variables were identified as meaningful predictors, the strongest being prescription of varenicline by the centre physicians 1.98 [0.13–3.84] (Figure 2). The strongest patient-level predictors were exCR participation 2.51 [2.24–2.79] and socioeconomic status variables e.g., income 1.67 [1.28–2.06], living with partner 1.47 [0.84–2.09] and education 0.80 [0.48–1.12]. Conclusion The study identified multiple CR organizational and patient-level predictors for reaching key risk factor targets one-year post-MI. The results might contribute to defining the optimal composition of comprehensive CR programmes. FUNDunding Acknowledgement Type of funding sources: Public grant(s) – National budget only. Main funding source(s): 1) The Swedish Research Council for Health, Working Life and Welfare (FORTE)2) The Swedish Heart and Lung Foundation (Hjärt Lung Fonden)

scholarly journals Evaluation of two highly effective lipid-lowering therapies in subjects with acute myocardial infarction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aline Klassen ◽  
Andrea Tedesco Faccio ◽  
Carolina Raissa Costa Picossi ◽  
Priscilla Bento Matos Cruz Derogis ◽  
Carlos Eduardo dos Santos Ferreira ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Low Density Lipoprotein Cholesterol ◽  
Residual Cardiovascular Risk ◽  
St Segment Elevation ◽  
Lipidomic Analysis ◽  
St Segment ◽  
Highly Effective

AbstractFor cardiovascular disease prevention, statins alone or combined with ezetimibe have been recommended to achieve low-density lipoprotein cholesterol targets, but their effects on other lipids are less reported. This study was designed to examine lipid changes in subjects with ST-segment elevation myocardial infarction (STEMI) after two highly effective lipid-lowering therapies. Twenty patients with STEMI were randomized to be treated with rosuvastatin 20 mg QD or simvastatin 40 mg combined with ezetimibe 10 mg QD for 30 days. Fasting blood samples were collected on the first day (D1) and after 30 days (D30). Lipidomic analysis was performed using the Lipidyzer platform. Similar classic lipid profile was obtained in both groups of lipid-lowering therapies. However, differences with the lipidomic analysis were observed between D30 and D1 for most of the analyzed classes. Differences were noted with lipid-lowering therapies for lipids such as FA, LPC, PC, PE, CE, Cer, and SM, notably in patients treated with rosuvastatin. Correlation studies between classic lipid profiles and lipidomic results showed different information. These findings seem relevant, due to the involvement of these lipid classes in crucial mechanisms of atherosclerosis, and may account for residual cardiovascular risk.Randomized clinical trial: ClinicalTrials.gov, NCT02428374, registered on 28/09/2014.

Abstract P127: Racial Disparities in Risk Factor Control in Older Adults with Diabetes: The Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽  
2015 ◽  
Vol 131 (suppl_1) ◽  
Author(s):  
Christina Parrinello ◽  
Ina Rastegar ◽  
Job G Godino ◽  
Michael D Miedema ◽  
Kunihiro Matsushita ◽  
...  
Keyword(s):  
Risk Factors ◽  
Older Adults ◽  
Risk Factor ◽  
Racial Disparities ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Tight Control ◽  
Risk Factor Control ◽  
Atherosclerosis Risk In Communities

Background: Racial disparities in risk factor control have been documented in middle-aged adults, but much less is known about older adults with diabetes. Our findings will inform clinical guidelines on appropriate risk factor control in older adults with diabetes. Methods: In 2011-13, 6,538 ARIC participants attended visit 5, and 4,988 provided data on all key covariates used in these analyses. Of these, 31% had diagnosed diabetes (N=1,561, 72% white, mean age=75 years) and were included in this study. Tight control of risk factors was defined according to American Diabetes Association guidelines: hemoglobin A1c <7%; low-density lipoprotein cholesterol <100 mg/dL; systolic blood pressure (BP) <140 mmHg and diastolic BP <80 mmHg. We evaluated risk factor control overall and by race. We used logistic regression and predictive margins to assess independent associations of race with tight risk factor control. Results: Among older adults with diabetes, 64% used glucose-lowering medication, 70% lipid-lowering medication and 82% BP-lowering medication. Only 5% of participants did not take medication for any of these risk factors. Tight control was observed in 72% for glucose, 64% for lipids and 70% for BP. Only 34% had tight control of all three. A higher proportion of whites than blacks consistently achieved tight control ( Figure ). In multivariable analyses of persons with diabetes who were treated for risk factors, racial disparities in tight control of lipids and BP remained significant: adjusted prevalence ratios and 95% CIs (white vs black) were 1.04 (0.91, 1.17) for glucose, 1.21 (1.08-1.34) for lipids, 1.15 (1.03-1.26) for BP, and 1.33 (0.95, 1.70) for tight control of all three risk factors. Conclusions: Our results highlight racial disparities in risk factor control in older adults with diabetes that were not explained by demographic or clinical characteristics. Further studies are needed to elucidate the determinants of disparities in risk factor control and strategies to address these.

Abstract TMP16: Morphologic Evolution and Remodelling of Intracranial Atherosclerosis Under Intensive Risk Factor Control

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Thomas Leung ◽  
Yannie Soo ◽  
Vincent Ip ◽  
Ka Sing Wong ◽  
Simon Yu
Keyword(s):  
Risk Factor ◽  
Medical Therapy ◽  
Plaque Rupture ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Risk Factor Control ◽  
Luminal Narrowing ◽  
Atherosclerotic Stenosis ◽  
Before And After ◽  
One Year

Introduction: In SAMMPRIS, the benefit of aggressive medical therapy over stenting persisted throughout the extended follow-up. It is uncertain how modern medical management could diminish stroke relapses. Method: In a prospective academic-initiated study, we recruited 40 patients (mean age 63.4±9.0 years) with acute strokes attributed to high-grade (≥70%) intracranial atherosclerotic stenosis for 3D-rotational angiograms before and after intensive medical therapy for 12 months. Treatment targets included low-density lipoprotein <70 mg/dl; HbA1c <6.5%; and systolic blood pressure <140 mmHg. We analyzed the morphologic and geometric evolution of the symptomatic plaques. Results: Overall, the risk factor control reached the pre-specified intensity. Plaque thickness, and hence luminal narrowing, significantly diminished at one year (from 1.50±0.48 to 1.24±0.42mm; p<0.001). The site of maximal stenosis shifted significantly towards mid-portion of the plaque (p<0.001), leading to a diminished upstream angulation. The ulcers noted at baseline (n=3) had all healed by one year. There was no significant change in terms of plaque length or lesion eccentricity. Conclusion: Intracranial plaques might regress and positively remodel under intensive risk factor control. These morphologic changes might stabilise the plaques, alleviate unfavourable hemodynamics across the steno-occlusion, and hence reduce the risk of plaque rupture or platelet aggregation.

P829The impact of APOC3 and APOE gene polymorphisms on response to statin therapy in acute myocardial infarction

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Teterina ◽  
A Geraskin ◽  
P Potapov ◽  
L Babaeva ◽  
A Pisaryuk ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Statin Therapy ◽  
Gene Polymorphisms ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Genetic Studies ◽  
Apoc3 Gene ◽  
Pronounced Reduction

Abstract Background and aim Many genetic studies have been reported about the association between APOE, APOC3 gene polymorphisms and response to statin therapy in myocardial infarction, but results remain controversial. The aim of this study was to investigate the association between SNP rs7412 (APOE), rs2854117 (APOC3), rs2854116 (APOC3) and lipid-lowering effect of atorvastatin and rosuvastatin in patients with myocardial infarction. Methods Polymorphism of genes APOE (rs7412), APOC3 (rs2854117 and rs2854116) was determened. Lipid profile was determined on admission and after 1 year of treatment. Results 78 patients with myocardial infarction treated with maximal tolerated dose of atorvastatin or rosuvastatin were included. More pronounced reduction of lipid levels was associated with of T allele of rs7412 (APOE), p<0,05. ANOVA demonstrated greater low-density lipoprotein and total cholesterol decrease in patients with combination of genes CT/TT (rs7412, APOE) and CC (rs2854117, APOC3) genotypes, CT/TT (rs7412, APOE) and CT (rs2854116, APOC3) genotypes. Conclusion The genetic variants of APOC3 and APOE are useful markers and can be use to predict response to lipid-lowering therapy with statin in myocardial infarction.

scholarly journals Application of the 2019 ESC/EAS dyslipidaemia guidelines to nationwide data of patients with a recent myocardial infarction: a simulation study

2020 ◽  
Vol 41 (40) ◽  
pp. 3900-3909 ◽  
Author(s):  
Ali Allahyari ◽  
Tomas Jernberg ◽  
Emil Hagström ◽  
Margrét Leosdottir ◽  
Pia Lundman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Intensity ◽  
Low Density Lipoprotein ◽  
Monte Carlo Model ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Recent Myocardial Infarction ◽  
Lowering Therapy

Abstract Aims To estimate the proportion of patients with a recent myocardial infarction (MI) who would be eligible for additional lipid-lowering therapy according to the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidaemias, and to simulate the effects of expanded lipid-lowering therapy on attainment of the low-density lipoprotein cholesterol (LDL-C) target as recommended by the guidelines. Methods and results Using the nationwide SWEDEHEART register, we included 25 466 patients who had attended a follow-up visit 6–10 weeks after an MI event, 2013–17. While most patients (86.6%) were receiving high-intensity statins, 82.9% of the patients would be eligible for expanded lipid-lowering therapy, as they had not attained the target of an LDL-C level of &lt;1.4 mmol and a ≥50% LDL-C level reduction. When maximized use of high-intensity statins followed by add-on therapy with ezetimibe was simulated using a Monte Carlo model, the LDL-C target was reached in 19.9% using high-intensity statin monotherapy and in another 28.5% with high-intensity statins and ezetimibe, while 50.7% would still be eligible for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. When use of alirocumab or evolocumab was simulated in those who were eligible for PCSK9 inhibitors, around 90% of all patients attained the LDL-C target. Conclusion  Our study suggests that, even with maximized use of high-intensity statins and ezetimibe, around half of patients with MI would be eligible for treatment with PCSK9 inhibitors according to the 2019 ESC/EAS guidelines. Considering the current cost of PCSK9 inhibitors, the financial implications of the new guidelines may be substantial.

scholarly journals Non-HDL Cholesterol Versus LDL Cholesterol as a CVD Risk Factor in Diabetic Subjects

2014 ◽  
Vol 31 (4) ◽  
pp. 199-203
Author(s):  
M Saiedullah ◽  
S Begum ◽  
S Hayat ◽  
SM Kamahuddin ◽  
MR Rahman ◽  
...  
Keyword(s):  
Risk Factor ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Upward Trend ◽  
Cvd Risk ◽  
Cross Sectional

Objective: Serum low density lipoprotein (LDL) cholesterol is considered as the primary target of lipid lowering therapy and non-high density lipoprotein (HDL) cholesterol is the recommended second target. Recent studies claimed that non-HDL cholesterol is a better predictor of cardiovascular diseases (CVD) than LDL cholesterol. In this study we aimed to compare non-HDL cholesterol and LDL cholesterol as a CVD risk factor in confirmed diabetic subjects. Materials and methods: In this cross-sectional observational study, 1042 confirmed diabetic subjects selected randomly were included. HbA1cResults: In the total subjects, 767 (74%) subjects had LDL cholesterol > 100 mg/dL and 822 (79%) subjects had non- HDL cholesterol > 130 mg/dL. HbA1c values were different (p<0.02) in five groups and showed upward trend (p<0.01). All the lipid parameters studied were significantly different in five groups (p<0.0001) and TC, TG and non-HDL cholesterol showed upward trend (p<0.0001), but HDL cholesterol and LDL cholesterol showed downward trend (p<0.0001). Odds ratio (OR) of likelihood of risk individuals regarding non-HDL cholesterol compared to LDL cholesterol were 0.50 (p<0.001), 1.32 (p>0.05), 2.96 (p<0.001), 6.49 (p<0.001) and 9.37 (p<0.001) for TG concentrations of up to 150 mg/dL, 151-200 mg/dL, 201-250 mg/dL, 251-300 mg/dL and 301-400 mg/dL respectively with relative risk of 0.60, 1.24, 2.43, 4.83, 5.10. Conclusion: LDL cholesterol is a better tool for the detection of high-risk individuals than non-HDL cholesterol at TG concentration up to 150 mg/dL, whereas non-HDL cholesterol is better than LDL cholesterol at TG concentration above 200 mg/dL as a CVD risk factor. DOI: http://dx.doi.org/10.3329/jbcps.v31i4.21004 J Bangladesh Coll Phys Surg 2013; 31: 199-203

scholarly journals Improvement of low-density lipoprotein cholesterol target achievement rates through cardiac rehabilitation for patients after ST elevation myocardial infarction or non-ST elevation myocardial infarction in Germany: Results of the PATIENT CARE registry

2018 ◽  
Vol 26 (3) ◽  
pp. 249-258 ◽  
Author(s):  
Bernhard Schwaab ◽  
Uwe Zeymer ◽  
Christina Jannowitz ◽  
David Pittrow ◽  
Anselm Gitt
Keyword(s):  
Myocardial Infarction ◽  
Cardiac Rehabilitation ◽  
Patient Care ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
St Elevation Myocardial Infarction ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
St Elevation

Aims The PATIENT CARE registry aimed to document clinical characteristics of patients during cardiac rehabilitation after myocardial infarction, including the current pharmacological treatment, risk factor modification and achievement of treatment targets for low-density lipoprotein cholesterol (LDL-C). Methods Multicentre, prospective non-interventional study at 20 cardiac rehabilitation in-patient centres across Germany. Results A total of 1408 patients post myocardial infarction were analysed. Patients’ mean age was 62 ± 11 years and 27.0% were women. ST elevation myocardial infarction ( n = 657; 48.7%), and non-ST elevation myocardial infarction ( n = 617; 45.8%) were equally balanced causes for hospitalization, while previous coronary artery bypass grafting was reported in n = 134 patients (9.9%). On average, cardiac rehabilitation began 19 ± 10 days after the index event and lasted for 22 ± 4 days. At discharge, 96.7% of patients received statins, 13.0% another lipid-lowering medication in addition to a statin, 98.5% antithrombotic drugs and 22.3% antidiabetic medication. The rate of patients with LDL-C on target according to the European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines 2011 (<70 mg/dl (1.8 mmol/l) or at least 50% reduction of baseline value) was increased from 21.4% at admission to cardiac rehabilitation to 41.9% at discharge after cardiac rehabilitation. Most patients (95.2%) completed the cardiac rehabilitation and 88% returned to their former work at full time. Conclusion During cardiac rehabilitation, the modifiable cardiovascular risk factors, in particular the LDL-C, were substantially improved in patients after myocardial infarction. The great majority were able to return to work. However, less than 50% reached the LDL-C guideline targets during short-term cardiac rehabilitation.

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