A real-world assessment of the distribution of lipid levels across increasing lipoprotein(a) levels in patients with established cardiovascular disease in the United States

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.F Fonseca ◽  
R Lahoz ◽  
P Ferber ◽  
A Laguna ◽  
D.T Amari ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
Total Cholesterol ◽  
Real World ◽  
Lipid Lowering ◽  
Funding Source ◽  
Lipid Levels ◽  
Lipoprotein A ◽  
The Mean ◽  
One Year

Abstract Background and purpose Measurements of lipid levels are frequently used to assess the risk of developing cardiovascular disease (CVD), including future myocardium infarction (MI) and ischemic stroke. Lipoprotein(a) [Lp(a)] has been established as an independent risk factor for developing CVD, however it is not widely measured. This real-world study assessed the distribution of lipid (Total Cholesterol [TC], low-density cholesterol [LDL-C], high-density cholesterol [HDL-C] and Triglycerides [TGs]) levels across different Lp(a) strata of patients with established CVD and at least one Lp(a) assessment. Methods This was a descriptive, non-interventional, retrospective cohort study of patients with established CVD and at least one Lp(a) assessment in the Optum® de-identified Electronic Health Record dataset (2007–2019). The index date was defined as the date of the first established CVD (MI, ischemic stroke or peripheral artery disease diagnosis) in the identification period (1/1/2008–30/6/2018) following one-year continuous enrollment. Patients were followed for up to one year, until death or transfer out of the dataset, whichever occurred first. Results 5,434 patients (55.5% males) with established CVD and at least one Lp(a) assessment having a mean (SD) age of 62.5 (12.6) years were evaluated. During the 12 months pre-index period, 49.9%, 46.1%, 48.1% and 49.8% of these patients had a measurement of TC, LDL-C, HDL-C and TGs, respectively. Overall, the mean (SD) TC, LDL-C, HDL-C and TGs levels were 182.1 (47.0) mg/dL [n=2,712], 102.6 (40.1) mg/dL [n=2,503], 52.7 (16.7) mg/dL [n=2,614], and 140.3 (108.8) mg/dL [n=2,707], respectively. More than half of these patients were treated with at least one lipid lowering drug (includes statins, ezetimibe, fibrates, niacin or PCSK9is) during the pre-index period. The mean (SD) levels of TC, LDL-C, HDL-C and TG in patients with Lp(a) <30 mg/dL, 30–50] mg/dL, 50–70 mg/dL, 70–90 mg/dL and ≥90 mg/dL are presented in Figure 1. Conclusions Overall, no trends in the levels of total cholesterol, LDL-C, HDL-C or triglycerides were observed across increasing levels of lipoprotein(a). These findings suggest the measurement of lipoprotein(a) is required to ensure a complete characterization of a patient lipid profile. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis Pharma AG

Survey of cardiovascular disease and risk factor management in patients with rheumatoid arthritis across 5 world regions: results from the SURF-RA

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A.N.N.E Semb ◽  
E Ikdahl ◽  
J Sexton ◽  
G Kitas ◽  
P Van Riel ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Risk Factors ◽  
Cardiovascular Disease ◽  
Lipid Lowering ◽  
Funding Source ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
East Europe ◽  
World Regions ◽  
The Mean

Abstract Background Patients with rheumatoid arthritis (RA) are at high risk for cardiovascular disease (CVD). Purpose The aim of this survey was to evaluate updated information on CVD risk factors, comorbidities, RA disease characteristics, RA and CVD preventive medication in patient with RA. Methods The audit is termed SUrvey of cardiovascular disease Risk Factors in patients with Rheumatoid Arthritis (SURF-RA) and was performed in 53 centres/19 countries/5 world regions in 2014–2019. SURF-RA have been performed in patients with coronary heart disease, in primary care, and now in patients with stroke, SLE and antiphophlipid syndrome. The survey was approved by the Data Protection Officer (2017/7243) and a GDPR evaluation has been performed (10/10–2018). Results Among 14 503 patients with RA in West (n=8 493) and East (n=923) Europe, Latin (n=407) and North (n=4 030) America and Asia (n=650) the mean (SD) age was 59.9 (13.6) years, and 2/3 or more were female (table). RA disease duration was comparable across the world regions, ranging from 9.9 to 12.6 years. The prevalence of atherosclerotic CVD (ASCVD) was lowest in Latin America (2.5%) and highest in East Europe (21.4%), and this pattern was similar regarding familial premature CVD. The mean prevalence (% of each entity) of blood pressure above 140/90 mmHg was 5.3%, of low density lipoprotein cholesterol >2.5 mmol/L: 63.3%. Overall, 29% used antihypertensive medication, lowest in West Europe (17.4%) and highest in East Europe (57.0%), and 26.4% used lipid lowering agent(s), lowest in Asia (7.2%) and highest in North America (31.1%). Body mass index >30 kg/m2 was present in 26.6%, with the smallest waist circumference in Asia [mean (SD): 84.1 (13.6) cm] and highest in East Europe [92.5 (15.5) cm]. The proportion of current smokers was on average: 16.2%, lowest in Asia (7.8%) and highest in East Europe (28.5%). Conclusion The high prevalence of CVD risk factors and ASCVD in patients with RA across five world regions shows that there is still an unmet need for vigilance and improved implementation of preventive measures in this high CVD risk patient population. Funding Acknowledgement Type of funding source: Other. Main funding source(s): Lilly

Characteristics of patients with at least one lipoprotein(a) [Lp(a)] assessment and those with Lp(a) levels equal to or greater than 70 mg/dL: a real-world study in the US

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
A Laguna ◽  
R Lahoz ◽  
A.F Fonseca ◽  
D.T Amari ◽  
P Ferber ◽  
...  
Keyword(s):  
Total Cholesterol ◽  
Real World ◽  
Beta Blockers ◽  
Density Lipoprotein ◽  
The United States ◽  
Funding Source ◽  
Private Company ◽  
Lipoprotein A ◽  
Increased Risk ◽  
The Us

Abstract Background and purpose Elevated lipoprotein(a) [Lp(a)] has been associated with increased risk of cardiovascular disease (CVD). The objective of this real-world study was to characterize the patients in the United States (US) that have an Lp(a) assessment and those with Lp(a) levels ≥70 mg/dL. Methods This is a descriptive, non-interventional, retrospective cohort study of patients with at least one Lp(a) assessment and one-year continuous enrollment prior to index date (first Lp(a) assessment in the identification period i.e. 1/1/2008–30/6/2019) using the Optum® de-identified Electronic Health Record (EHR) dataset (2007–2019) in the US. Optum's longitudinal EHR repository include more than 700 Hospitals and 7000 Clinics; treating more than 95 million patients receiving care in the US. Results 26,997 patients (50.8% females) with ≥1 Lp(a) assessment having a mean (SD) age of 52.6 (14.1) years were evaluated. Patient distribution across Lp(a) levels ≥30, ≥50, ≥70, and ≥90 mg/dL were 32.4%, 20.2%, 12.3%, and 6.6%, respectively. Patients with Lp(a) ≥70 mg/dL (N=3,314) had a mean (SD) age of 54.7 (13.2) years and 55.2% were female. The overall population that gets tested for Lp(a) and the subgroup of patients with Lp(a) ≥70 mg/dL had prior myocardial infarction (4.8% and 6.2%), prior ischemic stroke (2.2% and 2.5%), peripheral artery disease (6.7% and 8.4%), dyslipidaemia (72.6% and 80.9%), hypertension (53.0% and 60.9%), diabetes mellitus (23.5% and 26.8%) and chronic ischemic heart disease (19.6% and 24.6%) at index. The use of baseline medications included statins (37.3% and 49.1%), ACEi/ARBs (28.2% and 34.0%) and beta-blockers (19.0% and 23.6%) for the overall population and those patients with Lp(a) ≥70 mg/dL, respectively. The mean (SD) low-density lipoprotein cholesterol, triglycerides and total cholesterol levels were 109.8 (39.8) mg/dL [n=7,371], 138.3 (119.3) mg/dL [n=8,179] and 190.5 (46.8) mg/dL [n=8,181], respectively for overall population and 114.8 (41.5) mg/dL [n=980], 129.6 (80.5) mg/dL [n=1,063] and 195.9 (47.6) mg/dL [n=1,056] for patients with Lp(a) ≥70 mg/dL. Conclusions Of patients with an Lp(a) assessment in the US, more than 10% had Lp(a) levels ≥70 mg/dL. These patients were frequently diagnosed with dyslipidaemia and when reported showed elevated LDL-C and total cholesterol values. Further analyses are required to better understand any differences in patient characteristics and treatment of patients across Lp(a) levels. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis Pharma AG

scholarly journals A real-world assessment of treatment patterns in patients with atherosclerotic cardiovascular disease with hypercholesterolemia: a retrospective database analysis in Germany

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
I Gouni-Berthold ◽  
D Seshagiri ◽  
R Studer ◽  
S Klebs ◽  
A Achouba ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Real World ◽  
Treatment Patterns ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Pcsk9 Inhibitors ◽  
Private Company ◽  
General Physician ◽  
Statin Monotherapy ◽  
The Mean

Abstract Background The European Society of Cardiology (ESC) guidelines suggest that greater absolute reduction in low-density lipoprotein cholesterol (LDL-C) leads to greater cardiovascular risk reduction. Several lipid-lowering treatments (LLTs) are available in Germany; however, the research on treatment patterns and LDL-C outcomes among patients (pts) receiving LLTs in real-world setting is limited. Purpose To characterize the pts characteristics, treatment patterns and LDL-C outcomes of pts with atherosclerotic cardiovascular disease (ASCVD) with hypercholesterolemia (ASCVD-H) in Germany. Methods This is a descriptive, non-interventional, retrospective cohort study of ASCVD-H pts identified from general physician (GP) practices available in the electronic medical record (EMR) database Disease Analyzer (January 1992-June 2020) in Germany. ASCVD-H pts were included if they had a recorded diagnosis, were prescribed LLTs or had LDL-C levels of ≥55 mg/dL anytime within 6 months before and 3 months after the index date (ID), as per the data recorded by the participating physician. The first encounter of ASCVD after hypercholesterolemia during the identification period (1/07/2015–30/06/2019) was considered as the ID. Persistence was measured as the duration (in days) with allowed gap of 60 days and adherence as proportion of days covered (PDC) within 12 and 24 months after ID. Results We included 147,905 pts with ASCVD-H (57.2% male; mean age: 70.6 yrs; ≥75 yrs-old: 43.3%; mean BMI: 29.0 kg/m2). Coronary artery disease was the most common index diagnosis (73.2%), followed by cerebrovascular disease (31.7%) and peripheral vascular disease (21.5%). Hypertension (83.5%) and diabetes (27.6%) were the most common comorbidities among these pts. At ID, statin monotherapy (58.6%) was the most commonly prescribed LLT, with simvastatin being the most common drug (36.4%). The use of PCSK9 inhibitors, ezetimibe and fibrates was very limited (<1%; Table 1). Of note, LDL-C measurements (6 months prior and 3 months post index) were available for 50.7% of pts. In pts with uncontrolled LDL-C (≥55 mg/dL), 47.9% were receiving statin monotherapy (28.6% were on simvastatin), whereas there was no LLT prescribed in 48.0% of pts. The mean (SD) persistence and adherence to statins monotherapy within 24 months follow-up was 522 (260) days and 0.721 (0.345), respectively, with 60% of pts being adherent (PDC ≥0.80) to statins monotherapy. Conclusions Pts with ASCVD-H in Germany treated by GPs are elderly pts with multiple cardiovascular comorbidities. LDL-C was measured in nearly half of the pts, and almost all had LDL-C ≥55 mg/dL at ID. Findings indicate low prescription of LLTs in GP setting, particularly non-statin LLTs. The mean adherence (PDC) to statin monotherapy was 72% within the 24-month after ID. Data suggest the need for newer therapies with potential to control LDL-C levels. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novartis Pharma AG, Basel, Switzerland.

Baseline characteristics and clinical features of patients with heart failure with reduced ejection fraction: a European real-world, non-interventional registry study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
U Zeymer ◽  
L.H Lund ◽  
V Barrios ◽  
C Fonseca ◽  
A.L Clark ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Real World ◽  
Nyha Class ◽  
Funding Source ◽  
Class Iii ◽  
Reduced Ejection Fraction ◽  
Cardioverter Defibrillator ◽  
Real World Setting ◽  
The Mean

Abstract Background Heart failure (HF) is a major medical and economic burden that is often managed in office based practices. Recently, the angiotensin receptor neprilysin inhibitor (ARNI) sacubitril/valsartan (S/V) was introduced as novel therapeutic option into European guidelines for the management of HF. The ARIADNE registry aims to provide information on how outpatients with HF with reduced ejection fraction (HFrEF) are managed in Europe, in light of this novel treatment option. Methods ARIADNE was a prospective registry of patients with HFrEF treated by office-based cardiologists (OBC) or selected primary care physicians (recognized as HF specialists; PCP) in a real world setting. HFrEF patients were included prospectively, independently of whether treatment had been changed recently or not. 9069 patients were recruited from 687 centres in 17 European countries. Results The mean age of all patients was 68.1 years (S/V: 67.3 years, Non-S/V: 68.9 years). The majority of patients were in NYHA class II (61.3%), or NYHA class III (37.1%) overall, while more patients in the S/V group showed NYHA class III (S/V: 42.8%, Non-S/V: 30.9%). Mean LVEF was slightly lower in the S/V group than in the Non-S/V group (S/V: 32.7%, Non-S/V: 35.4%, overall 34.0%). The most frequently observed signs of HF were dyspnoea upon effort, followed by fatigue, palpitations on exertion at baseline. More patients tend to have more severe symptoms in the S/V groups (e.g. for dyspnoea on effort, Non-S/V: moderate 40.8%, severe 8.6%; S/V: moderate 46.4%, severe 14.1%). 44.0% of patients from the S/V group and 39.3% of non-S/V patients reported at least one hospitalization within 12 months prior to baseline, of which 73.3% in S/V and 69.9% in non-S/V patients were due to HF., At baseline, 44.7% of the patients used a CV device, of which most were implantable cardioverter defibrillator (ICD: Non-S/V 54.2%, S/V: 52.8%), implantable cardioverter defibrillator (CRT-ICD:Non-S/V 21.9%, S/V: 27.0%), and pacemaker (Non-S/V: 13.4%, S/V: 10.5%). The mean KCCQ overall summary score was 62.6 in the S/V group and 69.5 in the Non-S/V group at baseline. 83.9% of patients were treated with ARB or ACEi in Non-S/V group, (ACEi 57.3%, ARB 26.9%). The most frequently taken drug combinations in either group were ACEi/ ARB or S/V with β -blockers (Non-S/V 69.3%, S/V 67.3%). 40.2% in the Non-S/V group and 42.9% in S/V groups used a combination of ACEi/ARB or S/V, β-blocker and MRA. Conclusions The ARIADNE prospective registry provides insights and reflects variations in HF treatment practices in outpatients in Europe and the way S/V was introduced by OBCs and specialized PCPs in a real-world setting. In the observed population, S/V is more often prescribed to slightly younger patients with slightly lower LVEF, there was a greater observed percentage of S/V patients NYHA class III, with lower quality of life measurements and with more severe symptoms and recent hospitalizations for heart failure. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Novartis Pharma AG

Abstract P102: Variability In Lipid Levels And Risk For Cardiovascular Disease: An Electronic Health Record-based Population Cohort Study

Circulation ◽  
2021 ◽  
Vol 143 (Suppl_1) ◽  
Author(s):  
Sheila M Manemann ◽  
Suzette J Bielinski ◽  
Ethan D Moser ◽  
Jennifer L St. Sauver ◽  
Paul Y Takahashi ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Electronic Health Record ◽  
Total Cholesterol ◽  
Index Date ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Health Record ◽  
Lipid Levels ◽  
Population Cohort ◽  
Increased Risk

Background: Larger within-patient variability of lipid levels has been associated with an increased risk of cardiovascular disease (CVD). However, measures of lipid variability are not currently used clinically. We investigated the feasibility of calculating lipid variability within a large electronic health record (EHR)-based population cohort and assessed associations with incident CVD. Methods: We identified all individuals ≥40 years of age who resided in Olmsted County, MN on 1/1/2006 (index date) without prior CVD. CVD was defined as myocardial infarction, coronary artery bypass graft surgery, percutaneous coronary intervention or stroke. Patients with ≥3 measurements of total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and/or triglycerides during the 5 years before the index date were retained in the analyses. Lipid variability was calculated using variability independent of the mean (VIM). Patients were followed through 9/30/2017 for incident CVD (including CVD death). Cox regression was used to investigate the association between quintiles of lipid VIMs and incident CVD. Results: We identified 18,642 individuals (mean age 60; 55% female) who were free of CVD at baseline and VIM calculated for at least one lipid measurement. After adjustment, those in the highest VIM quintiles of total cholesterol had a 25% increased risk of CVD (Q5 vs. Q1 HR: 1.25, 95% CI: 1.08-1.45; Table). We observed similar results for LDL-C (Q5 vs. Q1 HR: 1.20, 95% CI: 1.04-1.39) and HDL-C (Q5 vs. Q1 HR: 1.25, 95% CI: 1.09-1.43). There was no association between triglyceride variability quintiles and CVD risk. Conclusion: In a large EHR-based population cohort, high variability in total cholesterol, HDL-C and LDL-C was associated with an increased risk of CVD, independently of traditional risk factors, suggesting it may be a target for intervention. Lipid variability can be calculated in the EHR environment but more research is needed to determine its clinical utility.

scholarly journals The Effect of Urtica Dioica Extract on Blood Lipids Profile in Patients with Type 2 Diabetes: A Randomized Double-blinded Clinical Trial

2021 ◽  
Author(s):  
Roya Khajeh Mehrizi ◽  
Hassan Mozaffari-Khosravi ◽  
Parisa Aboee
Keyword(s):  
Type 2 Diabetes ◽  
Cardiovascular Disease ◽  
Clinical Trial ◽  
Total Cholesterol ◽  
Density Lipoprotein ◽  
Urtica Dioica ◽  
Significant Difference ◽  
The Mean ◽  
Double Blinded

Background: Diabetes is an endocrine disorder that is strongly associated with cardiovascular disease. The use of alternative therapy has recently increased and medicinal plants are one of the alternative therapies for diabetic patients. This study aimed to evaluate the protective effect of Urtica dioica (Nettle) on lipid profile in patients with type 2 diabetes (T2D). Method: This parallel randomized double-blinded clinical trial was conducted on 60 men and women with T2D for an 8-week period. The participants were randomly assigned to received 100mg/kg/day extract of Urtica Dioica (UG) and the placebo group (PG). Blood triglyceride (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDLc) and high density lipoprotein cholesterol (HDLc) were measured at baseline and end of the study. The data were analyzed using SPSS 16.0 and P < 0.05 was considered significant. Results: The mean difference of total cholesterol showed no significant difference in the UG compared to the PG which were -10.56±40.5 and -19.5± 35.9 (P = 0.14), respectively. The study also showed no significant difference between TG and LDLc in the UG compared to the PG (-39.8±171.5 vs. -23.37±72.3 (P = 0.68) and -3.16±33.4 vs. -11.2±35.6 (P = 0.15), respectively). The mean difference of HDLc in the UG and PG were -2.68±8.11 and 2.62±10.6 (P = 0.05), respectively, indicating a significant increase in the UG compared to the PG. Conclusion: The results demonstrated that consumption of 100mg/kg/day extract of UD for 8 weeks by increasing HDL concentration can decrease the risk of cardiovascular disease in patients with T2D.

Abstract 406: Achievement of Treatment Target in Korean Patients With Familial Hypercholesterolemia

2016 ◽  
Vol 36 (suppl_1) ◽  
Author(s):  
Chan Joo Lee ◽  
Jaewon Oh ◽  
Jung Sun Kim ◽  
Sang-Hak Lee
Keyword(s):  
Total Cholesterol ◽  
Familial Hypercholesterolemia ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Treatment Target ◽  
Evaluation Point ◽  
The Mean ◽  
Artery Disease ◽  
Primary Evaluation

Background: In many cases of familial hypercholesterolemia (FH), there remains difficulty in achievement of treatment target. However, despite growing attention to FH, data on the treatment and its results in these patients are very limited. Methods: From nine sites in Korea, 122 consecutive unrelated men and women who were diagnosed with heterozygous FH by Simon Broome criteria were initially enrolled. Atorvastatin 20 mg or similar-potency drugs were prescribed and the dose was escalated every 2 months (for the first 6 months) or 6 months (thereafter) if needed. Forty one subjects were dropped and 81 subjects who underwent regular laboratory check-up were finally analyzed. The primary evaluation points were achievement rates of low-density lipoprotein cholesterol (LDL-C) <70 mg/dL, LDL-C<100 mg/dL, and LDL-C down to 50% of baseline levels at 12 month. The secondary evaluation point was % change of LDL-C at 12 month. Results: Patients’ mean age was 53 years and 59.3% were males. 21.0% were definite type FH and 28.4% had coronary artery disease (CAD). The mean total cholesterol and LDL-C were 319 mg/dL and 232 mg/dL, respectively. At 12 month, 7.4% received atorvastatin 10mg or similar, 21.0% received atorvastatin 20mg or similar, 16.0% received atorvastatin 40mg or similar, 4.9% received atorvastatin 80mg or similar, and 49.4% received atorvastatin (mean 57 mg) or similar plus ezetimibe 10mg. The mean follow-up total cholesterol and LDL-C were 201 mg/dL and 124 mg/dL, respectively. The mean % change of LDL-C was -45.6%. The achievement rates of LDL-C<70 mg/dL, <100 mg/dL, and LDL-C down to 50% of baseline were 1%, 21%, and 44%, respectively. The achievement rates were not significantly different between the patients without or with CAD (1.8%, 26.3%, 47.4% vs. 0%, 8.7%, 34.8%, respectively, all p values > 0.05). Conclusions: The achievement rate of treatment target in FH was low in Korea even after maximum tolerable dose of lipid lowering drugs. Improvement of awareness on this issue and more aggressive treatment are needed for this population.

Abstract P183: Lipid Control in Veterans Following Percutaneous Intervention

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Sloane A McGraw ◽  
Chris Healy ◽  
Burhan Mohamedali ◽  
Anupama Shivaraju ◽  
Adhir Shroff
Keyword(s):  
Total Cholesterol ◽  
Therapeutic Option ◽  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Management ◽  
Beneficial Effects ◽  
The Mean ◽  
Lipid Control ◽  
Statin Use

Background: Management of lipids is vital in patients with underlying coronary artery disease (CAD). According to the American College of Cardiology (ACC) guidelines, all patients with CAD should have low density lipoproteins (LDL) goals to be less than 100 mg/dl with the therapeutic option of treatment to less than 70 mg/dl. This can be achieved using multiple lipid lowering agents, however statin use is encouraged in CAD patients due to its multiple beneficial effects. Methods: We conducted a retrospective cohort study focusing on lipid management and statin use in 857 veterans undergoing percutaneous coronary intervention (PCI) between September 2004 and December 2009 at the Jesse Brown Veterans Hospital in Chicago, IL. Values were collected both pre-intervention as well as at six month follow up. Results: Both pre and post PCI, focus was maintained on the total cholesterol as well as the LDL levels. The mean total cholesterol prior to intervention was 166mg/dl and decreased to150mg/dl at six month follow up. The LDL mean pre-PCI was 98mg/dl and at six months the mean LDL decreased to 86mg/dl. With regards to ACC guidelines, the percent at goal for LDL less than 100mg/dl increased from 59% pre-PCI to 74% post-PCI Furthermore, treatment to less than 70mg/dl increased from 22 to 32% at six months. Lastly, the use of statins increased from 72 to 89%. Conclusions: There were in improvements in both total cholesterol and LDL values at six months post-PCI. There were also improvements in the percentage of patients who met the ACC recommended goal of LDL cholesterol less than 100mg/dl and the suggested goal of 70mg/dl. At six months, there was also an increase in usage of statin therapy.

482Direct oral anticoagulant rivaroxaban in very old and frail patients: A one-year prospective follow-up of a large-scale cohort (SAFIR-AC)

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
O Hanon ◽  
J Vidal ◽  
E Chaussade ◽  
J P David ◽  
N Boulloche ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Major Bleeding ◽  
Large Scale ◽  
Bleeding Risk ◽  
Geriatric Population ◽  
Very Old ◽  
The Mean ◽  
One Year ◽  
The One

Abstract Background/Introduction Age is one of the strongest predictors/risk factors for ischemic stroke in subjects with atrial fibrillation (AF). Direct oral anticoagulants (DOACs) have been shown to be effective in the prevention of this condition; however, clinical evidence on bleeding risk with this therapeutic strategy in very old and frail geriatric patients is poor. Purpose To assess bleeding risk in French geriatric patients aged ≥80 years and diagnosed with AF newly treated with rivaroxaban. Methods Subjects, presenting to one of 33 geriatric centers, with non-valvular AF and recent initiation of a treatment with rivaroxaban were enrolled in the study and followed-up every 3 months for 12 months. Clinical and routine laboratory data and evaluation scores, such as HAS-BLED, HEMORR2HAGES, ATRIA, and CHA2DS2-VASc, as well as comprehensive geriatric evaluation were reported. Major bleeding, as defined in ROCKET AF study, was reported at each visit, and this primary outcome was adjudicated by an independent committee. Results of this cohort were compared with findings from a similar cohort treated with vitamin K antagonists (VKAs) from the same centers (n=924). Results A total of 1045 subjects were enrolled in the study of whom 995 (95%) had a one-year follow-up (analyzed population). The mean (standard deviation (SD)) age was 86.0 (4.3) years, with the majority of patients being female (61%), 23% aged 90 years or older, and 48% having an estimated glomerular filtration rate (eGFR) <50 mL/min. The main comorbidities were hypertension in 77% of subjects, malnutrition 49%, anemia 43%, dementia 39%, heart failure 36%, and falls 27%. The mean (SD) score for CHA2DS2-VASc was 4.8 (1.4), HAS-BLED 2.4 (0.9), Mini-Mental State Examination (MMSE) 21.5 (6.9), Activities of Daily Living (ADL) 4.4 (1.9), and Charlson Comorbidity Index 6.7 (2.0). The one-year rate of major bleeding events was 6.4% of which 0.8% were fatal and 1.1% intracranial hemorrhages (ICH), whereas the one-year rate of ischemic stroke was 1.4% and all-cause mortality 17.9%. Computed with VKA cohort findings and adjusted for age, gender, eGFR and Charlson score, this would result in a hazard ratio of 0.54 (95% confidence interval [CI], 0.38 to 0.78) for major bleeding, 0.36 (0.17 to 0.76) for ICH, 0.62 (0.29 to 1.33) for ischemic stroke, and 0.82 (0.65 to 1.02) for all-cause mortality, in favor of rivaroxaban. Conclusions This is the first large-scale prospective study in geriatric population in AF subjects treated with DOAC (rivaroxaban) Major bleeding risk appeared higher in very old than younger population, however major bleeding and ICH rates were significantly lower with rivaroxaban than with VKAs when used in the same geriatric population. This study indicates that Rivaroxaban can be used in very old and frail patients for the treatment of non-valvular AF. Acknowledgement/Funding Unrestricted grant from Bayer

P647An audit of possible familial hypercholesterolaemia in general practice

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Gallagher ◽  
M McGuckin ◽  
D Behan ◽  
P Harrington
Keyword(s):  
Cardiovascular Disease ◽  
General Practice ◽  
Familial Hypercholesterolaemia ◽  
Lipid Lowering ◽  
Inclusion Criteria ◽  
Clinical Notes ◽  
Structured Care ◽  
Premature Cardiovascular Disease ◽  
History Of ◽  
The Mean

Abstract Background Familial hypercholesterolaemia (FH) is an autosomal dominant condition associated with elevated total cholesterol and low-density lipoprotein (LDL). It confers an increased risk of premature cardiovascular disease and associated mortality. It is estimated that the majority of patients with FH in Ireland are undiagnosed and structured care programmes are not available. Purpose To undertake an audit of those patients in a general practice with possible FH Methods A retrospective audit was carried out on the patients attending a GP practice. Inclusion criteria for the study were as follows: LDL level >4.9mmol/L Triglyceride level (<2mmol/L) Data was collected from the patients' clinical notes and patients were interviewed to acquire additional details not available in the clinical notes where possible. A Dutch Lipid Clinic Network Score (DLCNS) was calculated for each patient. Results Of 5,438 patients with a LDL recorded 284 patients fulfilled the inclusion criteria. 52.4% were female. Mean age 60 years old (range: 19–95 years). The highest LDL level recorded for these patients ranged from 5.0 - 8.6 mmol/L, with a mean value of 5.4 mmol/L. The mean most recent LDL level was 3.6mmol/L (range: 1.0–6.3 mmol/L). 42 patients (14.8%) had a family history of premature coronary and/or vascular disease in line with DLCNS criteria. 9 patients (3.2%) had a personal history of premature cardiovascular disease. The DLCNS was calculated for each patient based on the information available. 225 patients (79.2%) had a score of 3, 36 patients (12.7%) had a score of 4, 12 patients (4.2%) had a score of 5 and 6 patients (2.1%) had a score of 6. This equates to 273 patients (96.1%) with a possible diagnosis of FH, and 6 patients (2.1%) with a probable diagnosis of FH. The mean most recent systolic blood pressure reading for these patients was 128mmHg, and diastolic 76mmHg. 51 patients (18%) were current smokers, 83 (29.2%) were ex-smokers, and 111 (39%) had never smoked. Smoking status was unknown for 38 patients (13.4). 128 patients (45%) were on lipid-lowering treatment at the time of this audit. 60 (21.1%) were on high intensity treatment, 68 (23.9%) were on medium intensity treatment and none were on low intensity treatment. 24.3% of patients were at target LDL. There were 5 patients (1.8%) currently receiving ezetimibe and 1 (0.4%) on fenofibrate. Conclusion A significant number of patients had a LDL >5mmol/l in this audit. Only 45% were on lipid lowering treatment and 24.3% were at a target LDL. This highlights the needs for structured programmes for screening and management of FH in primary care. Acknowledgement/Funding Funded by an unrestricted grant from Amgen

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