IMPROVE-IT clinical implications. Should the “high-intensity cholesterol-lowering therapy” strategy replace the “high-intensity statin therapy”?

Introduction: In the US, LDL-C levels and treatment patterns of patients with familial hypercholesterolemia (FH) – a group prioritized for statin therapy in the 2013 ACC/AHA cholesterol guidelines – remain poorly described. In 2013 the FH Foundation launched the CAscade SCreening for Awareness and DEtection (CASCADE) of FH Registry, the only active US FH patient registry addressing this knowledge gap. Methods: We conducted a 2-year (2013-2015) cross-sectional analysis among 1,295 adults with heterozygous FH enrolled in the CASCADE FH Registry from 10 US lipid clinics. Results: Mean (SD) age at enrollment was 54 (16) years; mean age at FH diagnosis was 45 (19) years; 59% were female; and 80% were white. Mean pretreatment and post-treatment LDL-C levels were 256 (66) and 156 (71) mg/dl, respectively. At enrollment, 43% of patients were taking high-intensity statin therapy; 25% were not taking a statin; and 45% received >1 LDL-lowering therapy. Among FH patients on LDL-lowering therapy, 25% achieved an LDL-C <100 mg/dl, and 41% achieved a ≥50% LDL-C reduction (Table). Factors associated with a ≥50% LDL-C reduction included high-intensity statin use (adjusted OR 2.24, 95% CI 1.47-3.42) and use of >1 LDL-lowering therapy (1.94, 1.29-2.93) (Figure). Atherosclerotic cardiovascular disease (ASCVD) was present in 37%, of whom 44% achieved a ≥50% LDL-C reduction and 9% achieved an LDL-C <70 mg/dl. Conclusions: Despite the high prevalence of ASCVD, several care gaps exist for FH patients enrolled in the CASCADE US registry: lack of early diagnosis, insufficient use of high-intensity statin therapy, and failure to achieve adequate LDL-C reductions.

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Effect of intensive statin therapy on regression of carotid intima-media thickness in patients with subclinical carotid atherosclerosis (a prospective, randomized trial: PEACE (Pitavastatin Evaluation of Atherosclerosis Regression by Intensive Cholesterol-lowering Therapy) study)

European Journal of Preventive Cardiology ◽

10.1177/2047487312451539 ◽

2012 ◽

Vol 20 (6) ◽

pp. 1069-1079 ◽

Cited By ~ 14

Author(s):

Koji Ikeda ◽

Tomosaburo Takahashi ◽

Hiroyuki Yamada ◽

Kiyoaki Matsui ◽

Takahisa Sawada ◽

...

Keyword(s):

Randomized Trial ◽

Statin Therapy ◽

Carotid Atherosclerosis ◽

Intima Media Thickness ◽

Carotid Intima Media Thickness ◽

Prospective Randomized Trial ◽

Cholesterol Lowering ◽

Media Thickness ◽

Lowering Therapy ◽

Intensive Statin Therapy

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Combined lipid-lowering therapy from standpoint of modern guidelines for management of dyslipidaemias

Medical alphabet ◽

10.33667/2078-5631-2021-17-13-19 ◽

2021 ◽

pp. 13-19

Author(s):

O. D. Ostroumova ◽

A. I. Kochetkov ◽

A. I. Listratov

Keyword(s):

Statin Therapy ◽

Safety Profile ◽

High Intensity ◽

Residual Risk ◽

Lipid Lowering ◽

High Density Lipoproteins ◽

Lipid Lowering Therapy ◽

Lowering Therapy ◽

Increased Risk ◽

Wide Range

Coronary artery disease (CAD) remains the leading cause of death, and its prevalence is projected to increase in the near future. Dyslipidemia is one of the most important risk factors for CAD, and special attention is currently being paid to improving approaches to its correction. In the new revision of the Russian Guidelines for the Management of Patients with dyslipidemia (2020), priorities are given to high-intensity statin therapy: new more strict target levels of low-density lipoprotein cholesterol (LDL–C) are introduced. Experts also emphasize the important role of the cholesterol fraction of non-high-density lipoproteins (non-HDL–C), primarily triglycerides, and introduce their target levels. The concept of residual risk, which remains despite effective statin therapy and achievement of the target level of LDL–C, is closely related to non-HDL–C. Here, hypertriglyceridemia is of crucial importance, contributing to an increased risk of coronary heart disease and cardiovascular mortality. Therefore, combined lipid-lowering therapy in the form of a combination of high-intensity statin and fenofibrate is an effective approach to significantly improve the prognosis and reduce the residual risk. According to research data, rosuvastatin provides a reduction in LDL–C by ≥ 50 %, has a wide range of pleiotropic effects in combination with an optimal safety profile. Fenofibrate allows you to effectively reduce the level of triglycerides and implements additional protective effects on the cardiovascular system. The logical continuation of the principle of combined lipid-lowering therapy was the appearance of a fixed combination (FC) of rosuvastatin and fenofibrate, which already has its own evidence base of studies indicating a complex and complementary effect on the disturbed blood lipid spectrum, a good safety profile of therapy, and the form of ‘single-pill’ significantly increases patients adherence to treatment. It can be expected that the widespread use of rosuvastatin and fenofibrate in clinical practice will effectively reduce the residual cardiovascular risk and thus provide an improved prognosis for patients.

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A Cholesterol Lowering Therapy of Non-invasive Focused High-intensity Ultrasound Mediated Perirenal Fat Modification

Case Medical Research ◽

10.31525/ct1-nct04223557 ◽

2020 ◽

Author(s):

Keyword(s):

High Intensity ◽

High Intensity Ultrasound ◽

Cholesterol Lowering ◽

Non Invasive ◽

Lowering Therapy ◽

Perirenal Fat

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Effectiveness of lipid-lowering therapy in outpatients with coronary artery disease living in a large industrial center of Eastern Siberia

CARDIOVASCULAR THERAPY AND PREVENTION ◽

10.15829/1728-8800-2021-3135 ◽

2022 ◽

Vol 20 (8) ◽

pp. 3135

Author(s):

N. G. Gogolashvili ◽

R. A. Yaskevich

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Statin Therapy ◽

High Intensity ◽

Lipid Lowering ◽

Moderate Intensity ◽

Lipid Lowering Therapy ◽

Target Level ◽

Lowering Therapy ◽

Artery Disease

Aim. To study the prescription rate of lipid-lowering therapy and achieving the target low-density lipoprotein cholesterol (LDL-C) values in outpatients with coronary artery disease (CAD) living in Krasnoyarsk.Material and methods. The study included all patients with CAD hospitalized in the cardiology department of the clinic of the Research Institute of Medical Problems of the North (Krasnoyarsk) in 2018-2019. The analysis included data from 1671 patients (men, 770; women, 901). During hospitalization, an in-depth survey of patients was carried out on the subject of prescribing and taking lipid-lowering drugs. On admission, lipid profile was assessed in all patients.Results. At the time of admission, only 51,4% of patients received lipidlowering therapy. The majority received statin monotherapy (99,2%). Only 0,8% of patients received combination therapy (statin+ezetimibe). The most frequently prescribed statin in the study was atorvastatin — 74,6%. Rosuvastatin was received by 17,1% of patients. In most cases, the doses of atorvastatin and rosuvastatin corresponded to the moderate-intensity statin therapy regimen. The frequently prescribed dose of atorvastatin was 20 mg/day — 54,4%, rosuvastatin — 10 mg/day — 68,7%. The target level of LDL-C <1,8 mmol/L was reached by 16,3%, <1,5 mmol/L — by 9,0%, <1,4 mmol/L — only 6,5% of patients. Most often, the target LDL-C levels were achieved by patients receiving high-intensity statin (HIS) therapy. The target level of LDL-C <1,8 mmol/L was reached by 37,5%, <1,5 mmol/L — 23,9%, LDL cholesterol <1,4 mmol/L — 20,7% of patients, receiving HIS.Conclusion. In patients with CAD living in Krasnoyarsk, the most commonly prescribed statins were atorvastatin and rosuvastatin, but only 32% of patients received HIS. Combination lipid-lowering therapy has been used extremely rarely. Among the surveyed patients, the current target level of LDL-C for patients with CAD (<1,4 mmol/L) was achieved only in 6,5% of patients. In the group of patients receiving high-intensity statin therapy, this target level was achieved in 20,7% of patients, which indicates the need for strict adherence to current clinical guidelines.

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Faculty Opinions recommendation of Effect of very high-intensity statin therapy on regression of coronary atherosclerosis: the ASTEROID trial.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.11488.468969 ◽

2006 ◽

Author(s):

Anders Olsson

Keyword(s):

Statin Therapy ◽

High Intensity ◽

Coronary Atherosclerosis ◽

Very High

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Cholesterol Lowering Therapy: Treat to Target or Reduce the Global Risk? The Unresolved Problem of Residual Risk

Current Pharmaceutical Design ◽

10.2174/1381612822666160822143753 ◽

2016 ◽

Vol 22 (37) ◽

pp. 5676-5686 ◽

Cited By ~ 3

Author(s):

Giulia Bruzzone ◽

Giorgia Corbelli ◽

Paola Belci ◽

Annalaura Cremonini ◽

Aldo Pende ◽

...

Keyword(s):

Residual Risk ◽

Treat To Target ◽

Global Risk ◽

Cholesterol Lowering ◽

Unresolved Problem ◽

Lowering Therapy

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Effects of High Intensity Statin Therapy in the Treatment of Diabetic Dyslipidemia in Patients with Coronary Artery Disease

Current Pharmaceutical Design ◽

10.2174/1381612824666171227215708 ◽

2018 ◽

Vol 24 (4) ◽

pp. 427-441 ◽

Cited By ~ 2

Author(s):

Marija Vavlukis ◽

Sasko Kedev

Keyword(s):

Statin Therapy ◽

High Intensity ◽

Statistical Significance ◽

Incident Diabetes ◽

Moderate Intensity ◽

Protective Effects ◽

Pcsk9 Inhibitors ◽

Diabetic Dyslipidemia ◽

Patients With Diabetes

Background: Diabetic dyslipidemia has specifics that differ from dyslipidemia in patients without diabetes, which contributes to accelerated atherosclerosis equally as dysglycemia. The aim of this study was to deduce the interdependence of diabetic dyslipidemia and cardiovascular diseases (CVD), therapeutic strategies and the risk of diabetes development with statin therapy. Method: We conducted a literature review of English articles through PubMed, PubMed Central and Cochrane, on the role of diabetic dyslipidemia in atherosclerosis, the antilipemic treatment with statins, and the role of statin therapy in newly developed diabetes, by using key words: atherosclerosis, diabetes mellitus, diabetic dyslipidemia, CVD, statins, nicotinic acid, fibrates, PCSK9 inhibitors. Results: hyperglycemia and dyslipidemia cannot be treated separately in patients with diabetes. It seems that dyslipidemia plays one of the key roles in the development of atherosclerosis. High levels of TG, decreased levels of HDL-C and increased levels of small dense LDL- C particles in the systemic circulation are the most specific attributes of diabetic dyslipidemia, all of which originate from an inflated flux of free fatty acids occurring due to the preceding resistance to insulin, and exacerbated by elevated levels of inflammatory adipokines. Statins are a fundamental treatment for diabetic dyslipidemia, both for dyslipidemia and for CVD prevention. The use of statin treatment with high intensity is endorsed for all diabetes-and-CVD patients, while a moderate - intensity treatment can be applied to patients with diabetes, having additional risk factors for CVD. Statins alone are thought to possess a small, although of statistical significance, risk of incident diabetes, outweighed by their benefits. Conclusion: As important as hyperglycemia and glycoregulation are in CVD development in patients with diabetes, diabetic dyslipidemia plays an even more important role. Statins remain the cornerstone of antilipemic treatment in diabetic dyslipidemia, and their protective effects in CVD progression overcome the risk of statin- associated incident diabetes.

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