Progression of coronary atherosclerosis determined with EBCT in patients with significant CAD and lipid-lowering therapy: A three year follow-up

1999 ◽  
Vol 6 ◽  
pp. S147
Author(s):  
A. Knez ◽  
A. Becker ◽  
C. Thilo ◽  
C. Becker ◽  
R. Brüning ◽  
...  
Keyword(s):  
Coronary Atherosclerosis ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy

Non-statin lipid-lowering therapy in coronary atherosclerosis regression: a meta-analysis and meta-regression

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L.M Lobo ◽  
G Molinero ◽  
W Masson ◽  
D Siniawski ◽  
G Masson ◽  
...  
Keyword(s):  
Coronary Atherosclerosis ◽  
Meta Analysis ◽  
Lipid Lowering ◽  
Forest Plot ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Lowering Therapy ◽  
Meta Regression ◽  
Statin Drugs

Abstract Introduction Several studies have investigated the association between non-statin lipid-lowering therapy and regression of atherosclerosis. However, the studies were mostly small and their results were not always robust. Objectives (1) to define if a dual lipid-lowering therapy (statin ± non-statin drugs) is associated with coronary atherosclerosis regression, estimated by intravascular ultrasound (IVUS); (2) to assess the association between dual lipid-lowering-induced changes in LDL-C and non-HDL-C levels and atherosclerosis regression. Methods We performed a meta-analysis including trials of non-statin lipid-lowering therapy, reporting C-LDL, non-HDL-C and total atheroma volume (TAV) with a minimum of 6 months of follow-up. The primary endpoint was defined as the change in TAV measured from baseline to follow-up, comparing groups of subjects on statins alone versus combination of statin and non-statin drugs. The random-effects model and meta-regression were performed. Results Eight eligible trials of non-statin lipid-lowering drugs (1759 patients) were included. Overall, the dual lipid-lowering therapy was associated with a significant reduction in TAV [−3.5 mm3 (95% CI: −4.5 to −2.6)]; I2=11%]. In the analysis stratified according to the lipid-lowering drug class (ezetimibe or PCSK9 inhibitors), the findings were similar. In a meta-regression, a 10% decrease in LDL-C or non-HDL-C levels, was associated, respectively, with 0.92 mm3 and 1.05 mm3 regressions in TAV. Conclusion Our data suggest the addition of ezetimibe or PCSK9 inhibitors to statin therapy results in significantly increased regression of TAV. When the LDL-C and non-HDL-C levels reached were lower, the observed effect was also greater. Forest Plot by Drugs Group Funding Acknowledgement Type of funding source: None

scholarly journals Association Between Dietary Intake and Lipid-lowering Therapy: Prospective Analysis Using a Quantile Regression Approach (OR22-03-19)

2019 ◽  
Vol 3 (Supplement_1) ◽  
Author(s):  
Adelle Gadowski ◽  
Natalie Nanayakkara ◽  
Stephane Heritier ◽  
Dianna Magliano ◽  
Jonathan Shaw ◽  
...  
Keyword(s):  
Dietary Intake ◽  
Quantile Regression ◽  
Daily Intake ◽  
Lipid Lowering ◽  
Current Evidence ◽  
Lipid Lowering Therapy ◽  
Food Groups ◽  
Dietary Behaviours ◽  
Lowering Therapy

Abstract Objectives Lipid-lowering therapy (LLT) is ideally accompanied by dietary guidance for cardiovascular risk reduction, however current evidence suggests sub optimal dietary behaviours in those on pharmacological interventions. This study examines associations between daily intake of major food groups (vegetable, fruit, cereal, protein and dairy) and LLT use in Australian adults. Methods Data were analysed from 5895 participants of the Australian Diabetes, Obesity and Lifestyle Study (AusDiab) aged ≥ 25 years. Medical history and dietary intake was obtained at baseline (1999–00) and follow up (2004–05). LLT use was categorised as: LLT users, commenced LLT, ceased LLT, and non-users. The association between dietary intake and LLT use was examined using quantile regression, at the 25th, 50th and 75th quantile of dietary intake. Analysis was adjusted for known risk factors. Results A total of 446 participants remained on LLT from baseline to follow up; 565 participants commenced LLT; 71 participants ceased LLT and 4813 were non-users. Less than 1% of the cohort met recommended intakes of all food groups at baseline and follow up, with no difference by LLT status. Median daily dietary intake at follow up among LLT users was 2.2 serves of vegetables, 1.4 serves of fruit, 2.8 serves of cereal, 2.0 serves of protein and 1.4 serves of dairy. Dietary intake was similar across all LLT groups. LLT use was not significantly associated with dietary intake at the 25th, 50th and 75th quantile. Conclusions Adjusted quantile regression analysis showed no differences in median daily intake of key food groups in LLT users, compared to non-users. The dietary behaviours observed suggest that all adults, regardless of their medication regimen, need additional education on improving their dietary intake. These findings emphasise the importance of addressing adherence to dietary guidelines, for people with chronic disease, with special focus on people requiring LLT. Funding Sources Nil Supporting Tables, Images and/or Graphs

5130Association between degree of LDL-cholesterol decrease after a myocardial infarction and mortality - a nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Schubert ◽  
B Lindahl ◽  
H Melhus ◽  
H Renlund ◽  
M Leosdottir ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lower Risk ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Index Event ◽  
Risk Of Death ◽  
Lowering Therapy ◽  
Statin Use

Abstract Background In clinical trials, patients with myocardial infarction (MI) and elevated LDL-cholesterol (LDL-C) benefit the most from lipid lowering therapy, and more intensive LDL-C lowering therapy is associated with better prognosis. Purpose To investigate the association between degree of LDL-C lowering and prognosis in MI patients from a large real-world setting. Methods Patients admitted with an MI between 2006 and 2016 and registered in the Swedish MI-registry (SWEDEHEART) were followed until 2018. The difference in LDL-C between the MI hospitalization and a 6–10 week follow-up was measured. In multivariable Cox regression analysis adjusting for clinical risk factors (eg. age, diabetes, prior cardiovascular disease), the association between LDL-C change, mortality and recurrent MI was assessed using restricted cubic splines. Further, the patients were stratified according to quartile decrease in LDL-C from MI hospitalization to the follow-up. Results A total of 44,148 patients (median age: 64) had an LDL-C measured during the MI hospitalization and at follow-up. Of these, 9,905 (22.4%) had ongoing statin treatment prior to admission. The median LDL-C at the MI hospitalization was 2.96 (interquartile range 2.23, 3.74) mmol/L and the median decrease in LDL-C was 1.17 (0.37, 1.86) mmol/L. During a median follow-up of 3.9 years, 3,342 patients died and 3,210 had an MI. Patients with the highest quartile of LDL-C decrease (1.86 mmol/L) from index event to follow-up, had a lower risk of mortality, hazard ratio (HR) 0.59 (95% confidence interval [CI] 0.44–0.80) compared to those with the lowest quartile of LDL-C decrease (0.37 mmol/L) (figure). For MI, the corresponding HR was 0.83 (95% CI 0.68–1.02). Ongoing statin-use prior to admission did not alter the effect of LDL-C decrease and outcome in the analysis. Conclusions In this large nationwide cohort of MI patients, a gradually lower risk of death was observed in patients with larger decrease in LDL-C from index event to follow-up, regardless of statin use prior to admission. The same trend was observed for recurrent MI, although not reaching statistical significance. This confirms previous findings that efforts should be made to lower LDL-C after MI.

Effect of lipid-lowering therapy with atorvastatin on atherosclerotic aortic plaques: a 2-year follow-up by noninvasive MRI

2009 ◽  
Vol 16 (2) ◽  
pp. 222-228 ◽  
Author(s):  
Atsushi Yonemura ◽  
Yukihiko Momiyama ◽  
Zahi A. Fayad ◽  
Makoto Ayaori ◽  
Reiko Ohmori ◽  
...  
Keyword(s):  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Aortic Plaques

scholarly journals Is Treatment Inertia Unique to Publicly Funded Healthcare? Insights from the Guidelines Oriented Approach to Lipid lowering (GOAL) Canada Program

2021 ◽  
Vol 4 (7) ◽  
pp. 01-06
Author(s):  
Anatoly Langer
Keyword(s):  
Private Insurance ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Multivariable Model ◽  
Public Insurance ◽  
Similar Treatment ◽  
Lowering Therapy ◽  
Oriented Approach

Background: We compared the use of lipid lowering therapy, low density-lipoprotein cholesterol (LDL-C) levels, and proportion achieving guideline-recommended LDL-C levels in patients with private vs. public insurance coverage for their lipid lowering treatment. Materials and Methods: Guidelines Oriented Approach to Lipid lowering (GOAL) Canada enrolled 2009 patients with cardiovascular disease (CVD) or heterozygous familial hypercholesterolemia (FH) and an LDL-C above the guideline-recommended target of <2.0 mmol/L despite maximally tolerated statin therapy. During two follow-up visits physicians received online reminders of treatment recommendations. Results: Of 2009 patients enrolled (median age 63 years, 42% female), there were 1284 (64%) patients with private and 725 (36%) with public insurance for lipid lowering therapy. Patients with private insurance were younger and less likely to have a history of heart failure or to be on bile acid sequestrants. There was no difference between the groups in their lipid levels or lipid lowering therapy at baseline. During the follow up, there was no difference in the use of ezetimibe; however, the use of PCSK9i was more frequent in patients with private insurance (31.7 % vs. 21%, p<0.0001), the mean LDL-C level was slightly lower (2.11±1.17 vs. 2.31±1.17 mmol/L, p = 0.001), and the proportion of patients achieving the guideline-recommended LDL-C level was greater (54% vs. 45.5%, p = 0.001). After adjustment for other factors in a multivariable model, private insurance was not a significant predictor of achieving the guideline-recommended LDL-C level in a multivariable model. Conclusion: While PCSK9i use was higher in patients with private insurance, the majority of patients with either private or public insurance experienced similar treatment inertia. The cost of non-generic medications does not appear to be the dominant reason for the continued care gap in lipid lowering of high-risk patients.

The current LDL-C target <1.4mmol/l of the ESC is achieved in less than 16% of patients with Coronary Heart Disease despite effective lipid-lowering therapy: data from the LLT-R registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Noack ◽  
B Schwaab ◽  
H Voeller ◽  
K Eckrich ◽  
M Guha ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Lipid Lowering ◽  
Funding Source ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Lowering Therapy ◽  
Rehabilitation Clinic

Abstract Background In the current guideline of the ESC, in patients with very high cardiovascular risk such as coronary heart disease (CHD) a treatment target for LDL-C &lt;1.4mmol/l and/or a halving of the initial value are defined. It is unclear whether these treatment targets are achievable with standard therapy including statins and/or ezetemibe. Methods The primary objective of this prospective, multi-centre register study was the question of the guidance-based adaptation and adherence to lipid-lowering therapy during and after a cardiac rehabilitation in 1,100 patients with CHD up to 12 months after discharge from the six rehabilitation clinics involved. Patients were included from 2016 to 2018. Results The median age of the 1,100 patients was 63.4±10.4 years, the mean BMI was 28.5±4.7kg/m2, and 24.1% of patients were female. 12.2% were active smokers, 91.6% reported dyslipoproteinemia, 33.9% suffered from diabetes mellitus and 86.5% from hypertension. The majority of patients were included with the main indications NSTEMI (31.6%), STEMI (29.6%) and after CABG surgery (26.4%). The proportion of patients treated with statins was more than 94% when admitted and discharged from the rehabilitation clinic, as well as in 3- and 12-months follow-ups. Approximately 9% of patients were treated with ezetemibe at baseline. On discharge from the rehabilitation clinic 23% of patients were treated with ezetemibe, which remains stable at 3 and 12 months. PCSK9 inhibitors were used in 0.1–0.3% of patients at all times. The adjustment of LLT during three week cardiac rehabilitation resulted in median LDL-C values of 2.27mmol/l (1.80/2.84) at baseline, 1.97mmol/l (1.57/2.47) on discharge (p&lt;0.001 compared to baseline), 1.94mmol/l (1.57/2.49) after three months and 1.94mmol/l (1.53/2.40) after 12 months. The proportion of patients with LDL-C &lt;1.4mmol/l was 9% at baseline, 15.7% on discharge (p&lt;0.001 compared to baseline), 15.6% at three-month follow-up and 15.1% at 12-month follow-up (Figure 1). Discussion In the context of cardiac rehabilitation, an effective adjustment of LLT is carried out, which resulted in a significant reduction of LDL-C. However, despite a high percentage of patients on statins and ezetemibe, the proportion of patients in the new target range &lt;1.4mmol/l was only achievable in a small percentage and the question arises whether these treatment targets can be achieved without additional administration of PCSK9 inhibitors in majority of patients with CHD. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This study was supported by an unrestricted grant from Sanofi-Aventis Germany.

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