scholarly journals Impact of comprehensive management on clinical outcomes in hypertensive patients with coronary artery disease: HIJ-CREATE sub-study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
H Ogawa ◽  
H Sekiguchi ◽  
K Jujo ◽  
E Kawada-Watanabe ◽  
H Arashi ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Primary Outcome ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Hypertensive Patients ◽  
Mean Values ◽  
Comprehensive Management ◽  
The Mean ◽  
Artery Disease

Abstract Background There are limited data on the effects of blood pressure (BP) control and lipid lowering in secondary prevention of coronary artery disease (CAD) patients. We report a secondary analysis of the effects of BP control and lipid management in participants of the HIJ-CREATE, a prospective randomized trial. Methods HIJ-CREATE was a multicenter, prospective, randomized, controlled trial that compared the effects of candesartan-based therapy with those of non-ARB-based standard therapy on major adverse cardiac events (MACE; a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other cardiovascular events requiring hospitalization) in 2,049 hypertensive patients with angiographically documented CAD. In both groups, titration of antihypertensive agents was performed to reach the target BP of <130/85 mmHg. The primary endpoint was the time to first MACE. Incidence of endpoint events in addition to biochemistry tests and office BP was determined during the scheduled 6, 12, 24, 36, 48, and 60-month visits. Achieved systolic BP and LDL-Cholesterol (LDL-C) level were defined as the mean values of these measurements in patients who did not develop MACEs and as the mean values of them prior to MACEs in those who developed MACEs during follow-up. Results During a median follow-up of 4.2 years (follow-up rate of 99.6%), the primary outcome occurred in 304 patients (30.3%). Among HIJ-CREATE participants, 905 (44.2%) were prescribed statins on enrollment. Kaplan–Meier curves for the primary outcome revealed that there was no relationship between statin therapy and MACEs in hypertensive patients with CAD. The original HIJ-CREATE population was divided into 9 groups based on equal tertiles based on mean achieved BP and LDL-C during follow-up. For the analysis of subgroups, estimates of relative risk and the associated 95% CIs were generated with a Cox proportional-hazards model (Figure 1). The relation between LDL cholesterol level and hazard ratios for MACEs was nonlinear, with a significant increase of MACEs only in the patients with inadequate controlled LDL-C level even in the patients with tightly controlled BP. Conclusions The results of the post-hoc analysis of the HIJ-CREATE suggest that clinicians should pay careful attention to conduct comprehensive management of lipid lowering even in the contemporary BP lowering for the secondary prevention in hypertensive patients with CAD. Figure 1 Funding Acknowledgement Type of funding source: None

Abstract 18995: Statins in Familial Hypercholesterolemia - Effects on Coronary Artery Disease and All-cause Mortality

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Joost Besseling ◽  
Gerard K Hovingh ◽  
John J Kastelein ◽  
Barbara A Hutten
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Familial Hypercholesterolemia ◽  
Lipid Lowering ◽  
Premature Coronary Artery Disease ◽  
Lipid Lowering Therapy ◽  
Time Varying ◽  
All Cause Mortality ◽  
Artery Disease

Introduction: Heterozygous familial hypercholesterolemia (heFH) is characterized by high levels of low-density lipoprotein cholesterol (LDL-C) and increased risk for premature coronary artery disease (CAD) and death. Reduction of CAD and mortality by statins has not been properly quantified in heFH. The aim of the current study is to determine the effect of statins on CAD and mortality in heFH. Methods: All adult heFH patients identified by the Dutch FH screening program between 1994 and 2014 and registered in the PHARMO Database Network were eligible. Of these patients we obtained hospital, pharmacy (in- and outpatient), and mortality records in the period between 1995 and 2015. The effect of statins (time-varying) on CAD and all-cause mortality was determined using a Cox proportional hazard model, while correcting for the use of other lipid-lowering therapy, thrombocyte aggregation inhibitors, antihypertensive and antidiabetic medication (all time-varying). Furthermore, we used inverse probability for treatment weighting (IPTW) to account for differences between statin-treated and untreated patients regarding history of CAD before follow-up, age at start of follow-up and age of screening, as well as body mass index, LDL-C and triglycerides. Results: Of the 25,479 identified heFH patients, 11,021 gave informed consent to obtain their medical records, of whom 2,447 could be retrieved. We excluded 766 patients younger than 18. The remaining 1,681 heFH patients comprised our study population and these had very similar characteristics as compared to the 23,798 excluded FH patients, e.g. mean (SD) LDL-C levels were 214 (74) vs. 203 (77) mg/dL. Among 1,151 statin users, there were 133 CAD events and 15 deaths during 10,115 statin treated person-years, compared to 17 CAD events and 9 deaths during 4,965 person-years in 530 never statin users (combined rate: 14.6 vs. 5.2, respectively, p<0.001). After applying IPTW to account for indication bias and correcting for use of other medications, the hazard ratio of statin use for CAD and all-cause mortality was 0.61 (0.40 - 0.93). Conclusions: In heFH patients, statins lower the risk for CAD and mortality by 39%.

scholarly journals Do athletes play by different rules? Obstructive coronary artery disease in asymptomatic competitive Masters athletes: a case series

2020 ◽  
Vol 4 (3) ◽  
pp. 1-5
Author(s):  
James McKinney ◽  
Nathaniel Moulson ◽  
Barbara N Morrison ◽  
Jobanjit S Phulka ◽  
Phillip Yeung ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Angiography ◽  
Exercise Stress ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Masters Athletes ◽  
The Mean ◽  
Artery Disease

Abstract Background Both the age and number of endurance Masters athletes is increasing; this coincides with increasing cardiovascular risk. The vast majority of sports-related sudden cardiac deaths (SCDs) occur among athletes &gt;35 years of age. Coronary artery disease (CAD) is the most common cause of SCD amongst Masters athletes. Case summary In our prospective screening trial, six asymptomatic Masters athletes with ischaemia on electrocardiogram exercise stress testing had their coronary anatomy defined either by cardiac computed tomography or coronary angiography. Three patients underwent coronary angiography, with fractional flow reserve (FFR) testing performed when indicated. Subsequent percutaneous revascularization was performed in one patient after a shared-decision making process involving the patient and the referring cardiologist. All six athletes identified with obstructive CAD were male. The mean age and Framingham risk score was 61.8 years (±9.5) and 22.7% (±6.1), respectively. The mean metabolic equivalent of task achieved was 14.4 (±3.8). All athletes were treated with optimal medical therapy as clinically indicated. No cardiac events occured in 4.3 years of follow-up. Discussion Guidelines recommend revascularization of Masters athletes to alleviate the ischaemic substrate despite a paucity of evidence that revascularization will translate into a reduction in myocardial infarct or sudden cardiac arrest/death. Herein, although a limited study population, we demonstrate a lack of clinical events after 4.3 years of follow-up whether or not revascularization was performed. A prospective multicentre registry for asymptomatic Masters athletes with documented obstructive CAD is needed to help establish the role of revascularization in this population.

Abstract 3330: Effect of Achieved Low-density Lipoprotein Cholesterol Level by Atorvastatin on Stabilization of Coronary Plaques - Results from TWINS study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Katsuki Okada ◽  
Yasunori Ueda ◽  
Satoshi Saito ◽  
Atsushi Hirayama ◽  
Kazuhisa Kodama
Keyword(s):  
Cholesterol Level ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Coronary Plaque ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Yellow Plaque ◽  
The Mean

Background We have previously reported the stabilization and regression of coronary plaque by atorvastatin using both angioscopy and IVUS. However, it has not been clarified if plaque stabilization is achieved through the reduction of cholesterol level or the direct effect of statin. Then, we analyzed the effect of achieved low-density lipoprotein (LDL) cholesterol level on the stabilization of coronary plaque. Methods Twenty-nine patients with hypercholesterolemia and coronary heart disease were studied. They received lipid-lowering therapy with atorvastatin (10 –20 mg/day) for 80 weeks and were divided into 2 groups by the achieved LDL cholesterol level at 80-week follow up (low LDL group: LDL cholesterol < median value, and high LDL group: LDL cholesterol ≥ median value). Angioscopic examination was performed before and after 80 weeks treatment with atorvastatin. Angioscopic findings of coronary yellow plaque characteristics were divided into six grades (grade 0 to 5) to evaluate vulnerability of plaques; and the mean grade of each patient was evaluated. Results In all 29 patients, LDL cholesterol level was reduced (146.2 to 87.9 mg/dl; p<0.001) and the mean yellow plaque grade was decreased (1.4 to 1.2; p=0.002) at 80-week follow up. LDL cholesterol level was reduced both in low LDL group (140.3 to 75.9 mg/dl; p<0.001) and in high LDL group (151.7 to 99.1 mg/dl; p<0.001). Angioscopic examination showed significant improvement of the grade in low LDL group (1.4 to 1.1; p=0.012) at 80-week follow up, but no significant difference in high LDL group (1.4 to 1.3; p=0.11). Conclusions Lipid-lowering therapy with atorvastatin stabilized coronary plaques, and this effect was larger in the patients LDL cholesterol was reduced more.

LDL-cholesterol and HDL-cholesterol concentrations decrease during the day

2002 ◽  
Vol 39 (3) ◽  
pp. 241-249 ◽  
Author(s):  
Takashi Miida ◽  
Yuichi Nakamura ◽  
Toru Mezaki ◽  
Osamu Hanyu ◽  
Seitaro Maruyama ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Coronary Arteries ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Normal Coronary Arteries ◽  
The Mean ◽  
Baseline Levels ◽  
Artery Disease ◽  
Homogeneous Assays

Background Homogenous assays for LDL-cholesterol (LDL-C) and HDL-cholesterol (HDL-C) are highly accurate, with little interference from triglyceride. Using these methods, we measured postprandial LDL-C and HDL-C. Earlier studies suggested a postprandial decrease in LDL-C. Methods To elucidate whether LDL-C and HDL-C decrease significantly during the day, we determined daily profiles of LDL-C and HDL-C using homogeneous assays in subjects with normal coronary arteries (N; n = 10), and subjects with coronary artery disease (CAD; n = 23). Results In both groups, LDL-C and HDL-C were significantly lower from after breakfast until midnight than they were before breakfast. The next morning, they returned to baseline levels. The mean reduction in LDL-C was 0·09--0·13 mmol/L in N and 0·05--0·20 mmol/L in CAD, while that in HDL-C was 0·02--0·06 mmol/L in N and 0·00--0·05 mmol/L in CAD. Conclusion LDL-C and HDL-C decrease significantly over the course of the day.

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