Association between lipid lowering regimen intensity at discharge and long-term mortality in optimally-treated patients with acute myocardial infraction. The FAST-MI programme

Abstract Background Randomised trials evaluate the efficacy of individual medications, irrespective of overall patient management. We assessed the association between lipid-lowering therapy (LLT) intensity and long-term mortality in otherwise optimally-treated patients with acute myocardial infarction (AMI). Methods FAST-MI consists in one-month nationwide French surveys of patients admitted for a recent AMI, repeated every 5 years. We used the 2010 and 2015 data with 3-year follow-up. Background optimal therapy was defined as use of PCI, together with ESC guideline-recommended treatment with beta-blockers, ACEi/ARB, when indicated, and optimal antithrombotic medications including type of P2Y12-i; of 9,460 patients included, 4,042 were optimally-treated, with 478 (12%), 1120 (28%), and 2,444 (60%) respectively receiving conventional-dose statins (Gr 1), moderate-intensity statins (atorvastatin 40 mg or rosuvastatin 10 mg) (Gr2) or high-dose LLT (atorvastatin 80 mg, rosuvastatin ≥20 mg or statin-ezetimibe combination) (Gr3). Results Baseline characteristics markedly differed in the 3 groups (Table 1). Three-year Kaplan-Meier survival was 88.5%, 93.5% and 96.3% respectively for gr 1, 2 and 3, with Cox-adjusted HR of 0.75 (0.51–1.10), P=0.137, and 0.59 (0.41–0.86), P=0.006 for gr 2 and 3 compared with Gr1 (Figure). Conclusion In otherwise optimally-treated AMI patients, lipid-lowering regimen intensity at discharge was inversely associated with 3-year mortality. These results confirm that high-intensity lipid lowering therapy at discharge is likely beneficial even in patients receiving otherwise optimal therapy. Figure 1. 3-year survival Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD, AstraZeneca

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Do European patients with peripeheral arterial disease receive optimal lipid lowering therapy and achieve LDL-C goals? Results from the DA VINCI study

European Heart Journal ◽

10.1093/ehjci/ehaa946.3005 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

K.K Ray ◽

M Feudjo Tepie ◽

A.L Catapano ◽

P Giovas ◽

S Bray ◽

...

Keyword(s):

Da Vinci ◽

Arterial Disease ◽

Lipid Lowering ◽

Moderate Intensity ◽

Funding Source ◽

Lipid Lowering Therapy ◽

Private Company ◽

Cerebral Disease ◽

Study Visit ◽

Lowering Therapy

Abstract Background 2016 and 2019 EAS/ESC dyslipidemia guidelines recommend lipid lowering therapy (LLT) to reduce LDL-C in patients with peripheral arterial disease (PAD) with or without established cardiovascular (CV) disease, and recommend target LDL-C goals based on individual CV risk. Data regarding the implementation of these guidelines in clinical practice across Europe is currently lacking. Purpose Describe LLT and achievement of the target LDL-C goals recommended in EAS/ESC dyslipidemia guidelines in patients with PAD. Methods The cross-sectional Da Vinci study enrolled consenting adults who had received LLT in the 12 months prior to the study visit and had at least one LDL-C measurement in the 14 months prior to the study visit, seen in a primary or secondary care setting across 18 European countries. Patients with coronary, peripheral and cerebral disease were enrolled at a ratio of 1:2:2. FH patients with prior CV events were excluded. Data were collected from medical records at a single visit between Jun '17–Nov '18, including LLT and most recent LDL-C. Primary outcome was LDL-C goal attainment ≥28 days after starting most recent LLT (treatment-stabilised LLT). Results Of 5888 patients enrolled, 2794 met our definition of atherosclerotic cardiovascular disease (ASCVD). Of these ASCVD patients, 1036 (37%) had PAD. 31% (323/1036) of PAD patients were female and mean (SD) age was 69 (9.4) years. Concomitant CV risk factors included diabetes mellitus (473/1036 patients [46%]), hypertension (809/1036 [78%]) and smoking (794/1036 [77%]). 26% (271/1036) of patients with PAD also had coronary vascular disease and 12% (122/1036) also had cerebrovascular disease. At the visit date, approximately half (497/1036 [48%]) of all PAD patients were receiving moderate intensity statins and 41% (421/1036) were receiving high intensity statins. 818 (73%) of the PAD patients had a treatment-stabilised LDL-C measurement (median, 2.20 mmol/L), of whom 40% (326/818) achieved the 2016 EAS/ESC LDL-C goal of 1.8 mmol/L and only 19% (159/818) achieved the 2019 goal of 1.4mmol/L. Conclusions European patients with PAD are not treated as per EAS/ESC recommendations, with a large proportion receiving suboptimal LLT and fewer than half achieving target LDL-C levels. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen

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Abstract 13787: Efficacy of Lowering Low-density Lipoprotein Cholesterol in Elderly Subjects: A Systematic Review and Meta-analysis of Randomized Controlled Trials

Circulation ◽

10.1161/circ.142.suppl_3.13787 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Baris Gencer ◽

Nicholas A Marston ◽

KyungAh Im ◽

Peter S Sever ◽

Anthony C Keech ◽

...

Keyword(s):

Statin Therapy ◽

Coronary Revascularization ◽

The Elderly ◽

Lipid Lowering ◽

Elderly Subjects ◽

Lipid Lowering Therapy ◽

Vascular Events ◽

Randomized Controlled ◽

Lowering Therapy ◽

Myocardial Infraction

Introduction: The clinical benefit from LDL-C lowering therapy in the elderly remains debated. Aim: To synthesize the efficacy of lowering LDL-C in patients aged ≥75 years in the light of most recently published data. Methods: Medline database was searched for the most recent evidence (2015-2020). The key inclusion criterion was a randomized controlled cardiovascular outcome trial testing an LDL-C lowering therapy with data available in patients aged ≥75 years at randomization. For efficacy, we meta-analyzed the risk ratio (RR) of major vascular events (a composite of cardiovascular (CV) death, myocardial infarction, stroke or coronary revascularization) per 1-mmol/L reduction in LDL-C. Results: Among 244,090 patients from 29 trials, 21,492 (8.8%) were elderly; 11,750 from statin trials, 6209 from ezetimibe trials, and 3533 from PCSK9 inhibitor trials. Median follow-up ranged from 2.2-6.0 years. LDL-C lowering therapy significantly reduced major vascular events (n=3519) in the elderly by 26% per 1-mmol/L LDL-C reduction (RR 0.74 [0.61-0.89], P=0.002), which was at least as good as the magnitude of effect seen in the non-elderly patients (RR 0.85 [0.78-0.92]; P interaction =0.24). Amongst the elderly, the RR was similar for statin (0.81 [0.70-0.94]) and non-statin therapy (0.67 [0.47-0.95]; P interaction =0.60). The benefit of LDL-C lowering in the elderly was observed for each component of the composite, including CV death (RR 0.85 [0.73-0.996], P=0.045), myocardial infraction (RR 0.80 [0.70-0.92], P=0.001), stroke (RR 0.71 [0.58-0.87], P=0.001) and coronary revascularization (RR 0.78 [0.63-0.96], P=0.017). Conclusion: In patients 75 years and older, lipid-lowering therapy is as effective in reducing CV events as it is in younger adults. These results should strengthen guideline recommendations for the use of lipid-lowering therapies, including non-statin therapy, in the elderly.

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FEATURES OF THE LIPID SPECTRUM IN PATIENTS WITH ACUTE CORONARY SYNDROME IN THE LONG-TERM PERIOD AFTER CORONARY ARTERY BYPASS GRAFTING

Farmaciâ Kazahstana ◽

10.53511/pharmkaz.2021.45.26.002 ◽

2021 ◽

pp. 8-12

Author(s):

М.А. НУРЖАНОВА ◽

А.Е. ТЕМУРОВА ◽

Ж.Ш. БАБАК ◽

Г.Б. БЕКТІБАЙ ◽

Ш.Б. БАТЫР ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Coronary Artery ◽

Artery Bypass ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Bypass Grafting ◽

Coronary Syndrome ◽

Lowering Therapy ◽

Lipid Spectrum

В данной статье представлены особенности липидного спектра у пациентов с острым коронарным синдромом в отдаленном периоде после операции коронарного шунтирования (КШ), в сравнении групп с Инфарктом миокарда (ИМ) и Нестабильной стенокардии (НС), а также результаты приверженности к гиполипидемической терапии с особенностями достижения целевых уровней липидного спектра. Полученные результаты представляют, что по липидному спектру группы идентичны между собой и отличаются от нормы, пациенты с низкой приверженности к гиполипидемической терапии и не достигают целевых уровень по холестерин липопротеинов низкой плотности (ХС-ЛПНП) рекомендованным Европейского кардиологического общества (ESC, ЕОК) от 2019г. This article presents the features of the lipid spectrum in patients with acute coronary syndrome in the long-term period after coronary artery bypass grafting (CABG) surgery, in comparison with the groups with myocardial infarction and Unstable angina pectoris, as well as the results of adherence to lipid-lowering therapy with particularities of achieving target levels of the lipid spectrum. The results obtained represent that in terms of the lipid spectrum the groups are identical and differ from the norm, patients with low adherence to lipid-lowering therapy and do not reach the target levels for low-density lipoprotein cholesterol (LDL-C) recommended by the European Society of Cardiology (ESC) from 2019.

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Statin Induced Dysuria- A Case Report

Indian Journal of Cardiovascular Disease in Women WINCARS ◽

10.1055/s-0038-1656392 ◽

2016 ◽

Vol 01 (02) ◽

pp. 028-030

Author(s):

Radhika Soanker ◽

Arun Jyothi ◽

Sita ram

Keyword(s):

Ldl Cholesterol ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Primary Target ◽

Short Term ◽

Statin Group ◽

Lowering Therapy ◽

Hypolipidemic Drugs ◽

Prevention Of Cardiovascular Disease

AbstractStatins are a class of hypolipidemic drugs, that are primarily used for the treatment of dyslipidemia and the prevention of cardiovascular disease. ATP III guidelines, 2002, recommends that LDL cholesterol be the primary target of therapy, and lipid lowering therapy may be initiated based on evaluation of short term and long term cardiovascular risk(1). We are report a case of dysuria follow statin group of drugs, which is not enlisted in the side effect of these drugs. In the present case after re-challenge with similar group of drug patient again developed the symptoms. Underlying hyperlipidemia was effectively controlled with Fenofibrates.

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Lipid-Lowering Therapy and Long-Term Survival in Heart Transplantation

The American Journal of Cardiology ◽

10.1016/s0002-9149(97)00524-9 ◽

1997 ◽

Vol 80 (6) ◽

pp. 802-805 ◽

Cited By ~ 20

Author(s):

Dwight D. Stapleton ◽

Mandeep R. Mehra ◽

Debi Dumas ◽

Frank W. Smart ◽

Richard V. Milani ◽

...

Keyword(s):

Heart Transplantation ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Term Survival ◽

Long Term Survival ◽

Lowering Therapy

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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

European Heart Journal ◽

10.1093/ehjci/ehaa946.2998 ◽

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 <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<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 <1.4mmol/l was 9% at baseline, 15.7% on discharge (p<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 <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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P820The prevalence and management of familial hypercholesterolemia in patients with acute coronary syndrome in Poland: results of the TERCET Registry

European Heart Journal ◽

10.1093/eurheartj/ehz747.0419 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

K Dyrbus ◽

M Gasior ◽

P Desperak ◽

T Osadnik ◽

M Banach

Keyword(s):

Familial Hypercholesterolemia ◽

Lipid Lowering ◽

High Risk Population ◽

Lipid Lowering Therapy ◽

Long Term Outcomes ◽

Coronary Syndrome ◽

Lowering Therapy ◽

Number Of Patients ◽

Stable Cad

Abstract Background Prevalence of familial hypercholesterolemia (FH) is high among patients with CAD. However, data on FH among ACS patients are still scarce. Therefore, we aimed to assess the prevalence, lipid-lowering therapy and short- and long-term outcomes in FH patients with ACS. Methods We finally included 19,781 consecutive patients from the Hyperlipidaemia Therapy in the tERtiary Cardiological cEnTer (TERCET) Registry for years 2006–2018, including 7,319 patients with ACS: 3,085 with STEMI, 2,256 with NSTEMI, and 1,978 due to unstable angina (UA) (stable CAD group [n=12,462] was treated as a reference). FH diagnosis was based on Dutch Lipid Clinic Network (DLCN) score. Results The overall occurrence of probable/definite FH and possible FH were 1.2% and 13.7% respectively. In ACS patients 1.6% had probable/definite FH and 17.0% possible FH. The highest occurrence of FH was observed in STEMI subgroup, where 20.6% of the patients had ≥3 points according to the DLCN criteria. In patients with definite/probable FH, 98.1% were administered statins at discharge (including 57.5% prescribed intensive statin therapy in comparison to only 23.7% in non-FH patients). Patients with definite/probable FH had higher in-hospital and 30-day mortality than patients without FH (3.5% vs 1.2%, p=0.0046 and 4.4% vs 1.7%, p=0.024, respectively). However, no significant differences in investigated outcomes were observed between the FH groups in the 12-month and 36-month follow-up. The number of patients with FH Conclusion The prevalence of FH (definite/probable/possible) in the Polish very high-risk population is even 14.9% and is significantly higher in patients with ACS than in patients with stable CAD. High intensive lipid lowering therapy, including the combination therapy allows improving long-term outcomes in patients with FH.

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