How many CCS- and ACS-patients might reach the newly recommended LDL-C-target <55mg/dl in clinical practice if guidelines were applied – an estimate from the DYSIS II study population

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.K Gitt ◽  
M Horack ◽  
D Lautsch ◽  
R Zahn ◽  
J Ferrieres
Keyword(s):  
Clinical Practice ◽  
Real Life ◽  
Statin Treatment ◽  
Lipid Lowering ◽  
High Risk Population ◽  
High Dose ◽  
Funding Source ◽  
Pcsk9 Inhibitors ◽  
Target Values ◽  
Coronary Syndromes

Abstract Background The 2019 ESC guidelines for the management of dyslipidemia even further lowered the LDL-C-target values for the very high-risk population from &lt;70mg/dl to &lt;55mg/dl. Population based studies already had shown that the previous target was difficult to reach. It is yet unclear how many patients in clinical practice might be treated to the new target. Methods The Dyslipidemia International Study (DYSIS II) prospectively collected data of patients with chronic coronary syndromes (CCS) and acute coronary syndromes (ACS) (all on statins) in 18 countries in Europe, the Middle East, South- and East Asia to document patient characteristics, medication and a current lipid profile from 2012 to 2014 under real life conditions in physicians' offices and hospitals. We took these real-life lipid profiles and data on the kind/dose of used statins to estimate how treatment escalation such as changing statin treatment to a high dose (atorvastatin ≥40mg / rosuvastatin≥20mg), adding ezetimibe and adding a PCSK9-inhibitor might help to bring LDL-C-levels to the recommended &lt;55mg/dl target. Results A total of 7,865 patients were enrolled into DYSIS II, 6,794 had CCS and 1,071 ACS. Under the documented statin treatment in DYSIS only 12.7% of patients reached an LDL-C &lt;55mg/dl. Putting all patients on high dose statins in combination with ezetimibe, 64.1% would reach the target. If PCSK9-inhibitors would be used in the remaining patients not at goal a total of 94.0% would match the goal. Conclusion Our analysis indicates that in real life practice the use available lipid-lowering medications would substantially increase the percentage of CCS- and ACS-patients reaching the newly recommended 2019 ESC guideline LDL-C-target of &lt;55 mg/dl from less than 20% to more than 90% of the population. Funding Acknowledgement Type of funding source: Private grant(s) and/or Sponsorship. Main funding source(s): MSD

scholarly journals Intensification of lipid-lowering therapy in patients with severe lipid metabolism disorders in specialized lipid control centers. Possibilities of using evolocumab

2020 ◽  
Vol 4 (7) ◽  
pp. 437-444
Author(s):  
O.L. Barbarash ◽  
◽  
V.V. Kashtalap ◽  
N.V. Fedorova ◽  
D.Yu. Sedykh ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
Current Data ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Control Center ◽  
Lowering Therapy ◽  
Lipid Metabolism Disorders ◽  
Target Values ◽  
Lipid Control

The article presents current data on the prevalence of dyslipidemia worldwide and in the Russian Federation as the main cardiovascular risk factor of developing diseases associated with atherosclerosis. The article identifies the problems of low-level detection of dyslipidemia in the population and insufficient efficacy of lipid-lowering therapy to achieve the lipid profile target values depending on the established risk. It also presents the possibilities of modern lipid-lowering therapy with the use of innovative drugs — PCSK9 inhibitors and the use of evolocumab in accordance with evidence-based medicine. Adding that, the article shows the experience of two lipid control centers (in Kemerovo and Surgut) with the postulation of the need to expand the lipid control center chain to improve methods for providing medical care to patients with severe forms of dyslipidemia. The possibilities of intensifying lipid-lowering therapy in real clinical practice are outlined on the example of patients undergoing treatment in the lipid control center of Kemerovo. Evolocumab has been shown to be highly effective: reduction of atherogenic cholesterol fractions by 67% from the baseline and high safety of such therapy.KEYWORDS: lipid metabolism disorders, statins, lipid-lowering therapy, familial hypercholesterolemia, PCSK9 inhibitors, evolocumab.FOR CITATION: Barbarash O.L., Kashtalap V.V., Fedorova N.V. et al. Intensification of lipid-lowering therapy in patients with severe lipid metabolism disorders in specialized lipid control centers. Possibilities of using evolocumab. Russian Medical Inquiry. 2020;4(7):437–444. DOI: 10.32364/2587-6821-2020-4-7-437-444.

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.

PCSK9 inhibitors: The breakthrough lipid-lowering treatment at real-life setting. A 2-year regional lipid clinic experience

2020 ◽  
Vol 315 ◽  
pp. e257-e258
Author(s):  
G. Anastasiou ◽  
G. Liamis ◽  
H. Milionis ◽  
M. Elisaf ◽  
E. Christopoulou ◽  
...  
Keyword(s):  
Real Life ◽  
Lipid Lowering ◽  
Pcsk9 Inhibitors ◽  
Lipid Clinic ◽  
Real Life Setting ◽  
Clinic Experience

PCSK9 inhibitors: The breakthrough lipid-lowering treatment at real-life setting. A 3-year regional lipid clinic experience

2021 ◽  
Vol 331 ◽  
pp. e134
Author(s):  
G. Anastasiou ◽  
G. Liamis ◽  
H. Milionis ◽  
M. Elisaf ◽  
E. Christopoulou ◽  
...  
Keyword(s):  
Real Life ◽  
Lipid Lowering ◽  
Pcsk9 Inhibitors ◽  
Lipid Clinic ◽  
Real Life Setting ◽  
Clinic Experience

2183Intravenous administration of IV-STATIN CARDIOSHIELD during myocardial infarction renders higher cardioprotection than oral atorvastatin given shortly after reperfusion: a translational CMR study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L G Mendieta Badimon ◽  
S Ben-Aicha ◽  
L Casani ◽  
M Gutierrez ◽  
F Carreras ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Statin Treatment ◽  
Cardiovascular Complications ◽  
Lipid Lowering ◽  
Placebo Control ◽  
High Dose ◽  
Myocardial Salvage ◽  
Intravenous Bolus ◽  
Cardiac Damage ◽  
Cardioprotective Effects

Abstract Background Statins are known to exert rapid cardioprotective effects irrespective of their lipid-lowering properties. Several trials have suggested that high-dose statin treatment may reduce cardiovascular complications in patients undergoing invasive management. However, the ideal timing and administration regime is not clear. Purpose We compared the cardioprotective effects derived from IV-STATIN CARDIOSHIELD® administered intravenously during myocardial infarction (MI) with those attained by oral atorvastatin administration shortly after reperfusion. This study was conducted in a preclinical pig model of MI by serial CMR imaging. Methods Diet-induced hypercholesterolemic pigs (N=21; cholesterol: 387±74mg/dL) were subjected to 90 minutes of complete coronary occlusion (closed-chest model of MI), then reperfusion was established and animals were kept for 42 days. Within this experimental design animals were distributed in 3 groups (G) (7animals/arm): G1) animals received an intravenous bolus (0.3mg/kg) of IV-STATIN during MI; G2) animals received an intravenous bolus of the vehicle during MI (placebo-control); and G3) animals were administered atorvastatin p.o. initiated within the first 2h post-MI (Atorva-post-MI). G1 and G3 animals remained on atorvastatin p.o. for the following 42 days whereas G2 controls received placebo-pills. We assessed cardiac damage and global and regional functional parameters by CMR at day3 and day42 post-MI. Myocardial samples were processed for molecular studies on cardiac remodeling-related parameters (collagen and AMPK). Results CMR analysis at day-3 revealed that G1 pigs showed a marked reduction in infarct size as compared to both G3 and G2 animals (19.1±2.8% LV vs. 29.0±1.8% and 29.3%±3.2%, respectively; p<0.05) with a resultant 50% increase in myocardial salvage (p<0.05 vs. both). At day-42 both G1 and G3 animals showed a significant decrease in the size of the scar vs. G2 animals; however, G1 animals showed a further 24% scar reduction as compared to G3 (14.4±1.1% vs. 18.8±1.0% LV; p<0.05). Functional analyses revealed higher LVESV in G1 animals as compared to G2 (p<0.05) and less wall motion abnormalities in the jeopardized myocardium (p<0.05) vs. both groups at day42 post-MI. Collagen expression and AMPK activation were found to be significantly enhanced in the scar of G1 (p<0.05 vs. both groups). No changes were detected in lipids levels or liver and renal parameters throughout the study in any pig group. Conclusions Intravenous IV-STATIN CARDIOSHIELD® treatment during MI limited cardiac damage and improved cardiac function and remodeling to a larger extent than when atorvastatin was administered orally shortly after reperfusion. Our results support this novel regime of intravenous administration of IV-STATIN CARDIOSHIELD® as a routine procedure during MI. Further investigation of the potential benefits of this new therapeutic approach in STEMI patients is warranted.

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

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Danchin ◽  
J Ferrieres ◽  
E Puymirat ◽  
G Cayla ◽  
Y Cottin ◽  
...  
Keyword(s):  
Lipid Lowering ◽  
Moderate Intensity ◽  
High Dose ◽  
Funding Source ◽  
Lipid Lowering Therapy ◽  
Optimal Therapy ◽  
Lowering Therapy ◽  
Myocardial Infraction ◽  
Long Term Mortality

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

scholarly journals Cardiovascular outcomes trials with non-statin lipid-lowering drugs in diabetes

2018 ◽  
Vol 18 (3) ◽  
pp. 101-105
Author(s):  
Fariha Naeem ◽  
Gerard McKay ◽  
Miles Fisher
Keyword(s):  
Statin Therapy ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
High Dose ◽  
Large Trial ◽  
Pcsk9 Inhibitors ◽  
Vascular Events ◽  
Lipid Lowering Drugs ◽  
Cardiovascular Morbidity And Mortality

Statin therapy is proven to reduce cardiovascular morbidity and mortality in people with diabetes, and high-dose statins are recommended for people with established atherosclerotic vascular disease. In two dedicated studies in people with diabetes, fibrates did not significantly reduce cardiovascular events and were associated with serious side effects. A similar lack of benefit was seen in two large studies of niacin. Ezetimibe, when added to statins, may further reduce LDL cholesterol and non-fatal vascular events. The PCSK9 inhibitors are a new class of subcutaneous lipid- lowering drugs which cause profound reductions in LDL cholesterol when added to statins. Evolocumab reduced non-fatal cardiovascular events when added to background statin therapy in a larger group of subjects and the benefits were confirmed in a diabetes subgroup. In another large trial alirocumab reduced major adverse cardiovascular events and total mortality. The clinical use of ezetimibe and PCSK9 inhibitors is currently limited by cost.

Abstract 18396: Low Rate of LDL-Goal-Attainment in 57,855 High-Risk-Patients in Europe, Canada, South-Africa, Middle East and China - Results of DYSIS

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Anselm K Gitt ◽  
Dominik Lautsch ◽  
Martin Horack ◽  
Baishali Ambegaonkar ◽  
Jean Ferrieres ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Secondary Prevention ◽  
Goal Attainment ◽  
Ldl Cholesterol ◽  
Statin Treatment ◽  
Lipid Lowering ◽  
High Risk Patients ◽  
Risk Patients ◽  
Very High

Background: Statin treatment is routinely used for secondary prevention world-wide. Little is known about the prevalence of persistent lipid abnormalities under chronic statin treatment for secondary prevention and possible differences in LDL-Cholesterol (LDL-C) goal attainment in clinical practice between countries in different parts of the world. Methods: Between 2008 and 2012, consecutive statin-treated outpatients were enrolled in 26 countries worldwide, (DYSIS = Dyslipidemia International Study; list of countries in table) to assess LDL-C goal attainment for secondary prevention. European Society of Cardiology recommendations were used to classify patient risk, and to define LDL-cholesterol treatment goals. Data were collected under real life conditions in physicians’ offices and hospital outpatient wards. Results: Serum lipid values of 57,885 consecutive statin-treated outpatients were studied in the context of their cardiovascular risk factors, and the potency and composition of their lipid-lowering treatment. In the very-high risk patients only 21.7% did reach the currently recommended LDL-Chol target <70mg/dl with large differences between the countries varying from 9.2% to 44.3%. In the high-risk population the LDL-Chol target <100mg/dl was achieved in 38.0% oft he patients, varying between 16.6% and 66.7% between countries Conclusion: Despite chronic statin treatment, only 21.7% of the very-high-risk patients reached the current recommended LDL-Chol target <70mg/dl in this large multinational cross-sectional trial, highlighting the persistent large gap between guideline recommendations and clinical practice. Further treatment escalations are necessary to reduce the risk of subsequent cardiovascular events.

Abstract 10426: One Year Impact of the 2013 Cholesterol Guidelines on Patterns of Lipid Lowering Treatment

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Josephine N Tran ◽  
Tzu Chun Kao ◽  
Toros Caglar ◽  
Karen M Stockl ◽  
Heidi C Lew ◽  
...  
Keyword(s):  
Statin Therapy ◽  
High Intensity ◽  
Arterial Disease ◽  
Statin Treatment ◽  
Lipid Lowering ◽  
High Dose ◽  
Atherosclerotic Cardiovascular Disease ◽  
Patients With Diabetes ◽  
Cholesterol Guidelines ◽  
One Year

Background: In 2013, national organizations issued new cholesterol guidelines to emphasize evidence-based treatment with moderate- to high-dose statins for patients at high risk for atherosclerotic cardiovascular disease (ASCVD), which includes coronary heart disease, stroke, and peripheral arterial disease. Whether these new guidelines have influenced patterns of treatment one year after their dissemination is unknown. Methods: Using pharmacy and medical claims from a large U.S. health insurance organization, we identified 610,535 adult patients with ASCVD (n=301,440) or diabetes mellitus (n=309,095) and examined statin treatment rates before and one year after the new cholesterol guidelines. Among patients receiving statins post-guidelines, we also evaluated whether patients were treated with guideline-recommended intensity of statin therapy. A standardized difference (SD) of at least 10% was required to declare the effect size meaningful. Results: Overall, there was no change in statin treatment rates for patients with ASCVD (48.0% before guidelines vs. 47.3% after, SD [1.4]) or diabetes (50% vs. 51.5% after, SD [2.4]). Statin initiation rates among patients not on statins pre-guidelines were 10.1% in patients with ASCVD and 14.3% in patients with diabetes, and these gains were offset by 13.0% and 12.2% statin discontinuation rates among ASCVD and diabetes patients, respectively. Among patients taking statins one year post-guidelines, 80% of patients with ASCVD and < 75 years of age were not on guideline-recommended high-intensity statin therapy, whereas >75% of patients with ASCVD and >75 years of age or patients with diabetes were on moderate- or high-intensity statin treatment. Conclusion: One year after dissemination of the new 2013 cholesterol guidelines, overall treatment rates with statins among patients with ASCVD and diabetes have not changed appreciably, and many patients remain either untreated or under-treated. Character Count: 1683

scholarly journals Lipidek és az agyérbetegség – Új lehetőségek az LDL-koleszterin-szint csökkentésére

2016 ◽  
Vol 157 (52) ◽  
pp. 2059-2065 ◽  
Author(s):  
Emese Lovadi ◽  
Péter Csécsei ◽  
Csenge Lovig ◽  
Zsófia Karádi ◽  
László Szapáry
Keyword(s):  
Adverse Effects ◽  
Statin Therapy ◽  
Ldl Cholesterol ◽  
Statin Treatment ◽  
Cerebrovascular Diseases ◽  
High Dose ◽  
Cholesterol Levels ◽  
Cerebrovascular Events ◽  
Incidence And Mortality ◽  
Target Values

Abstract: Stroke is the third most common cause of death worldwide following myocardial infaction and malignancies, furthermore, its functional outcome is the worst of all conditions. Cholesterol, especially LDL-cholesterol plays a key role in the formation of atherosclerotic plaques. It has been verified recently that escalating incidence and mortality of cerebrovascular diseases are proportional to increased levels of LDL-cholesterol. Statin therapy undeniably reduces the risk of stroke, however other methods for decreasing lipid levels have not been proved significantly effective. Preventive effect of high-dose statin treatment is without doubt, although administration of such high dosage might require special precautions for patients with prior intracerebral hemorrhage and it also risks development of incident diabetes. The recently published IMPROVE-IT study is the first to prove that the addition of ezetimibe as a non-statin type drug, to statin treatment contributes to further reduction of LDL-cholesterol. The combination treatment results in additional decrease in the incidence and mortality of cerebrovascular events, without any expansion in the number or adverse effects. These results confirm the importance of any further reduction of LDL-cholesterol levels. Achieving target values with statin-ezetimibe combination allows administration of low to moderate dose of statin, which decreases risks of adverse effects related to high-dose statin therapy. Orv. Hetil., 2016, 157(52), 2059–2065.

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