Clinical outcomes in managed-care patients with coronary heart disease treated aggressively in lipid-lowering disease management clinics

A total of 47 patients suffering from heterozygous hyperlipidemia were treated with LDL-apheresis (24 patients, aged 49.5±11.5 years), diet and/or lipid-lowering drugs or with diet and lipid-lowering drugs only (23 patients, aged 48.0±11.9 years). After treatment periods of 44.4±14.3 (apheresis group) and 33.5±15.9 (drug group) months, respectively, the ensuing results revealed significant differences (p<0.0001): total cholesterol decreased from 10.4 to 5.5 vs 9.9 to 8.7 mmol/l, LDL from 7.4 to 3.9 vs 6.6 to 5.2 mmol/l, triglycerides from 5.8 to 3.7 vs 4.8 to 4.1 mmol/l and the LDL/HDL-ratio decreased from 7.1 to 3.4 vs 6.7 to 5.8. In the apheresis group one patient died from myocardial infarction vs one non-fatal myocardial infarction and the manifestation of coronary heart disease in three cases in the drug group. There were no severe side-effects in either group. All patients in the apheresis group experienced an increased clinical performance. On the other hand physological well-being of these patients was lower than that of the drug group (scores 42.3±8.9 vs 50.2±9.9, p<0.002). The present trial suggests that a continuing reduction in serum lipid concentrations may lower in a dose dependent manner the risk of development and progression of coronary heart disease. With respect to clinical and laboratory results, LDL-apheresis seems safe and appears to be the most effective therapy.

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Gut microbiota: a potential target for traditional Chinese medicine intervention in coronary heart disease

Chinese Medicine ◽

10.1186/s13020-021-00516-0 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Tian-Yi Cheng ◽

Jia-Xin Li ◽

Jing-Yi Chen ◽

Pei-Ying Chen ◽

Lin-Rui Ma ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Chinese Medicine ◽

Traditional Chinese Medicine ◽

Gut Microbiota ◽

Short Chain Fatty Acids ◽

Lipid Lowering ◽

China National Knowledge Infrastructure ◽

Antiplatelet Aggregation ◽

Single Target

AbstractCoronary heart disease (CHD) is a common ischaemic heart disease whose pathological mechanism has not been fully elucidated. Single target drugs, such as antiplatelet aggregation, coronary artery dilation and lipid-lowering medicines, can relieve some symptoms clinically but cannot effectively prevent and treat CHD. Accumulating evidence has revealed that alterations in GM composition, diversity, and richness are associated with the risk of CHD. The metabolites of the gut microbiota (GM), including trimethylamine N-oxide (TMAO), short-chain fatty acids (SCFAs) and bile acids (BAs), affect human physiology by activating numerous signalling pathways. Due to the advantage of multiple components and multiple targets, traditional Chinese medicine (TCM) can intervene in CHD by regulating the composition of the GM, reducing TMAO, increasing SCFAs and other CHD interventions. We have searched PubMed, Web of science, Google Scholar Science Direct, and China National Knowledge Infrastructure (CNKI), with the use of the keywords “gut microbiota, gut flora, traditional Chinese medicine, herbal medicine, coronary heart disease”. This review investigated the relationship between GM and CHD, as well as the intervention of TCM in CHD and GM, and aims to provide valuable insights for the treatments of CHD by TCM.

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Lipid-Lowering Strategies for the Prevention of Coronary Heart Disease: Authors' Reply

Clinical Science ◽

10.1042/cs0920431a ◽

1997 ◽

Vol 92 (4) ◽

pp. 431-432

Author(s):

I. U. Haq ◽

L. E. Ramsay ◽

D. M. Pickin ◽

W. W. Yeo ◽

P. R. Jackson ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Lipid Lowering

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Abstract 4985: Are All Patients Considered “Low Risk” for Coronary Heart Disease Really Low Risk? An Analysis from the Atherosclerosis Risk in Communities (ARIC) Study

Circulation ◽

10.1161/circ.118.suppl_18.s_1125-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Vijay Nambi ◽

Lloyd Chambless ◽

Aaron R Folsom ◽

Yijuan Hu ◽

Tom Mosley ◽

...

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Risk Group ◽

Low Risk ◽

Lipid Lowering ◽

Chd Risk ◽

The Absolute ◽

Event Rates ◽

Aric Study

Low risk for coronary heart disease (CHD) is defined by ATP III as a 10 year risk of <10%. There have been suggestions, however, that a 10 year CHD risk of 5–10% be considered as intermediate risk. The addition of carotid intima media thickness (CIMT) has been shown to improve CHD risk prediction when added to traditional risk factors (TRF) (age, gender, high density lipoprotein cholesterol, total cholesterol, diabetes, hypertension and cigarette smoking) in the ARIC study. We investigated the absolute event rates with and without the addition of CIMT to TRF in the ARIC study and determined the impact in the 0–10% risk group. Participants in the ARIC study (n=13145) without baseline CHD or stroke and with CIMT measurements available were included for this analysis. Using Cox proportional hazards models the participants were classified into various risk categories using TRF and further classified by sex specific CIMT (categorized as <25 th , 25 th to 75 th and >75 th percentile). The absolute event rates were then described in each group (table ). Over a mean follow up of 13.8 years, 1601 (12.2%) individuals had incident CHD events. Approximately 31% of these incident CHD events were in the 5–10% risk group which made up 28% of the study while only 16% of the incident CHD events occurred in the 0–5% risk group which made up 47% of the study population. The 5–10% group had event rates (13.7%) greater than the study average (12.2%), especially in those with thicker CIMT (>75 th percentile, event rate 17%), and greater event rates than those in the 0–5% risk group (4.1%) (table ). Given the notably higher observed CHD risk in the 5–10% group (especially in those with thicker CIMT) relative to the 0–5% group, the availability of safe, low cost lipid lowering medications and low risk tests such as ultrasound that may improve risk stratification, it may be time to evaluate the low risk group more carefully for cardiovascular preventive therapies. Table. Incident CHD in the various risk groups over a mean follow up of 13.8 years in the ARIC study

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