Adherence to high-intensity statin therapy after acute coronary syndrome and its impact on patient outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Sulzgruber ◽  
H Sinkovec ◽  
N Kazem ◽  
F Hofer ◽  
A Hammer ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
High Intensity ◽  
Lipid Lowering ◽  
Study Endpoint ◽  
Index Event ◽  
Coronary Syndrome ◽  
Observation Period

Abstract Background Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially lipid lowering therapy – via high-intensity statins (atorvastatin and rosuvastatin) – proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and stent thrombosis. However, profound epidemiological measures on adherence to statin intake after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to high-intensity statin therapy after ACS and its impact on patient outcome from an Austrian nationwide perspective. Methods Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to high-intensity statins was investigated according to handing in prescriptions for rosuvastatin and atorvastatin at local pharmacies. Patients were followed prospectively until the primary study endpoint (=mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to high-intensity statin therapy on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model. Results During the observation period a total of 23.240 patients (median age: 65 years [55–75]; male: 67.7% [n=15.728]) met the inclusion criteria. Individuals that died during the index event (n=366; 1.6%), presented with a re-ACS (n=569; 2.4%) or were lost during follow-up (n=158; 0.6%) were not included within the final analysis. Of alarming importance 66.4% (n=15.422) of all patients presenting with ACS did not take high-intensity statins as recommended by current guidelines. The highest rate of drug interruption/end of therapy was observed within the first month after the index event with more than 50% of all cases. During patient follow-up until 01/2018 a total of 3522 (15.2%) individuals died. Non-adherence to high-intensity statins had a strong an independent association with mortality with an adjusted hazard ratio of 1.16 (95% CI: 1.06–1.25; p<0.001) (see Figure 1). Conclusion The present nationwide investigation highlighted an overall low adherence to high-intensity statins after ACS, with the highest interruption/end of therapy rate within the first month after the index event. Since the intake of high-intensity statins after ACS was associated with a 14% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of drug-adherence and intensified patient follow-up should be promoted, in order to prevent fatal atherothrombotic events. Figure 1. Cumulative mortality Funding Acknowledgement Type of funding source: None

Adherence to dual anti-platelet therapy after acute coronary syndrome and its impact on patient outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Sulzgruber ◽  
H Sinkovec ◽  
N Kazem ◽  
F Hofer ◽  
A Hammer ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Acute Coronary Syndrome ◽  
Study Endpoint ◽  
Primary Study ◽  
Index Event ◽  
Coronary Syndrome ◽  
Anti Platelet Therapy ◽  
The Impact ◽  
Observation Period

Abstract Background Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially dual anti-platelet therapy (DAPT) – including aspirin plus a P2Y12 inhibitor – proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and stent thrombosis. However, profound epidemiological measures on adherence to DAPT intake after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to DAPT after ACS and its impact on patient outcome from an Austrian nationwide perspective. Methods Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to DAPT was investigated according to handing in prescriptions for aspirin and P2Y12 inhibitors at local pharmacies. Patients were followed prospectively until the primary study endpoint (=mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to DAPT on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model. Results During the observation period a total of 22.331 patients (median age: 65 years [55–75]; male: 69.7% [n=15.176]) met the inclusion criteria. Patients presenting with the indication for oral anticoagulation (n=2165; 9.7%), individuals that died during the index event (n=151; 0.7%), patients that presented with a re-ACS (n=396; 1.7%) or those who were lost during follow-up (n=96; 0.4%) were not included within the final analysis. Of alarming importance 70.7% (n=15.792) of all patients presenting with ACS did not take DAPT as recommended by current guidelines. The highest rate of drug interruption/end of therapy was observed within the first month after the index event with almost 50% of all cases. During patient follow-up until 14 months after the index event 513 individuals died. Non-adherence to DAPT proved a strong an independent association with mortality with an adjusted hazard ratio of 1.25 (95% CI: 1.09–1.41; p<0.001). (see Figure 1) Conclusion The present nationwide investigation highlighted an overall low adherence to DAPT after ACS, with the highest interruption/end of therapy rate within the first month after the index event. Since the intake of DAPT after ACS was associated with a 20% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of drug-adherence and intensified patient follow-up should be promoted, in order to prevent fatal atherothrombotic events. Figure 1. Cumulative Mortality Funding Acknowledgement Type of funding source: None

scholarly journals Cardiovascular events as a № 1 killer. Pharmacotherapy of coronary heart disease

2020 ◽  
pp. 317-319
Author(s):  
V.O. Shumakov
Keyword(s):  
Myocardial Infarction ◽  
Coronary Heart Disease ◽  
Acute Coronary Syndrome ◽  
Heart Disease ◽  
Statin Therapy ◽  
High Intensity ◽  
Lipid Lowering ◽  
Pcsk9 Inhibitors ◽  
Basic Therapy ◽  
Coronary Syndrome

Background. Computed tomography studies of ancient mummies have shown that the representatives of all ancient civilizations had atherosclerosis. It is now known that the severity of atherosclerosis depends on the content of non-high density lipoprotein cholesterol (nHDL-C) and age. A detailed analysis of global statistics on mortality from cardiovascular disease (CVD) found that the mortality of Ukrainian men and women is 14 and 23 times higher than the French counterparts. However, since the beginning of the 21st century, almost all European middle-income countries have reached a decline in mortality, probably due to the implementation of programs to combat hypertension and dyslipidemia. Objective. To describe modern pharmacotherapy of coro- nary heart disease. Materials and methods. Analysis of the literature on this topic. Results and discussion. A significant proportion of deaths are due to acute coronary heart disease. Long-term treat- ment of patients after myocardial infarction should include control of risk factors and lifestyle changes, antithrombotic therapy, use of b-blockers, angiotensin-converting enzyme inhibitors, mineralocorticoid receptor inhibitors, lipid-lowering therapy. Serial intravascular ultrasound studies have shown that high-intensity statin therapy has reduced the burden of atherosclerotic plaques in non-infarct-dependent arteries (from 67.5 to 58.5 %). In addition to slowing atherosclerosis, statins also increase plaque calcification and improve its stability. Medium-intensity statin therapy reduces low-density lipoprotein cholesterol (LDL-C) by 30 %, high-intensity statin therapy – by 50 %, high-intensity statin therapy in combination with ezetimibe – by 65 %, PCSK9 inhibitors – by 60 %, high-intensity statin and PCSK9 inhibitors – by 75 %, highintensity statin therapy in combination with PCSK9 inhibitors and ezetimibe – by 85 %. The FOURIER study confirmed the high efficacy of PCSK9 inhibitors in reducing LDL-C in high-risk patients. The hazard ratio for the composite endpoint (cardiovascular death, myocardial infarction, CVD hospitaliza- tion, need for revascularization) for evolocumab compared to placebo was 0.85 (p<0.0001). The ODYSSEY OUTCOMES study found similar results for alirocumab. In general, statin therapy with a decrease in LDL-C of more than 50 % and/or to a level <1.4 mmol/L is recommended for all patients with acute coro- nary syndrome without ST segment elevation. If maximal dose of statins does not allow to reach such results in 4-6 weeks, it is recommended to add ezetimibe. In the absence of effect on the background of treatment with this combination, it is necessary to add PCSK9 inhibitors. In the context of the COVID-19 pandemic, it is necessary to continue taking all cardiac drugs, including statins. There is evidence that statins help to reduce the severity of viral pneumonia and to decrease the mortality from acute respiratory viral infections. Statins have a number of pleiotropic effects: anti-inflammatory, immunomodulatory, antioxidant, and antithrombotic. All of them are favorable for coronavirus infection. In addition to statins, in coronary heart disease it is advisable to prescribe metabolic therapy. Tivorel (“Yuria-Pharm”) is indicated for coronary heart disease, acute myocardial infarction and after a heart attack. Already on the third day of treatment of acute coronary syn- drome, the effectiveness of basic therapy in combination with Tivorel (100 ml per day) exceeds the effectiveness of basic therapy only in reducing the incidence of anginal pain by 35 % and the use of opioid analgesics in case of pain by 38 % (Vakaliuk I.P., 2015). Foreign studies confirm that L-arginine reduces the symptoms of angina and improves the quality of life of patients, reduces blood pressure and pulmonary artery pressure in patients with pulmonary hypertension. Apart from that, L-carnitine helps to increase the ejection fraction and re- duce the area of myocardial infarction, eliminate arrhythmias, reduce cardiovascular mortality. Tivorel has a beneficial effect on left ventricular remodeling. After 10 days of basic therapy in combination with Tivorel, the end systolic volume of the left ventricle in post-infarction patients is reduced by 16 %, and in the group of basic therapy – by 3 %. 32-80 % of CVD patients have mental disorders that increase the risk of death. Lodixem (“Yuria-Pharm”) is a specialized cardioprotector with a daytime tranquilizer effect. The effectiveness of Lodixem in the combined therapy of stable angina, hypertension, heart failure, acute coronary syndrome has been proven. Conclusions. 1. Long-term therapy of patients after myo- cardial infarction should include control of risk factors and lifestyle changes, antithrombotic therapy, use of b-blockers, angiotensin-converting enzyme inhibitors, mineralocorticoid receptor inhibitors, and lipid-lowering therapy. 2. All patients with acute coronary syndrome without ST segment elevation are recommended statin therapy with a decrease in LDL-C by more than 50 % and/or to a level <1.4 mmol/L. 3. In the context of the COVID-19 pandemic, it is necessary to continue taking all cardiac drugs, including statins. 4. Tivorel reduces the incidence of anginal pain, the use of opioid analgesics for pain, and has a beneficial effect on left ventricular remodeling. 5. Lodixem (a specialized cardioprotector with the effect of a daytime tranquilizer) is effective in the treatment of stable angina, hypertension, heart failure, acute coronary syndrome.

P641Patient characteristics and treatment patterns in patients on lipid-lowering therapies following an acute coronary syndrome in France

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
E Bruckert ◽  
G Desamericq ◽  
A Khachatryan ◽  
P Ngo ◽  
G Gusto ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
High Intensity ◽  
Density Lipoprotein ◽  
Treatment Patterns ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Treatment Intensity ◽  
Coronary Syndrome ◽  
Low Intensity

Abstract Background introduction Many patients, especially those at very high cardiovascular (CV) risk, do not reach low-density lipoprotein cholesterol (LDL-C) targets for at least 2 reasons: they may not receive a sufficiently intensive regimen, and/or they may not adhere to their medication. Purpose Describe demographic, clinical characteristics and treatment intensity and adherence in patients on lipid lowering therapies (LLT) following an Acute Coronary Syndrome (ACS) in France. Methods Retrospective cohort study on the PGRx (the Pharmacoepidemiologic General Research eXtension program)-ACS dataset in France, with data collected retrospective and prospectively via physicians, prescription records and patient interviews. Patients were accrued prospectively and/or retrospectively by centres from the PGRx Cardiology and General Practitioners networks. We included adult patients (≥18 years) suffering an ACS between 2013 and 2016 who received LLT at or within 92 days of their ACS hospital discharge. Follow-up was censored at time of new CV event, death, lost to follow-up or interview date (mean duration 12.4 months). Outcomes of interest included LLT intensity (high, moderate and low intensity statins with or without ezetimibe) and adherence measured as proportion of days covered (PDC). Results 2695 eligible patients were included (77% men); mean age (SD) 63.1 (12.8), 18% had diabetes mellitus, mean (SD) LDL-C 112.1 (46.4) mg/dl. Treatment with LLT at discharge is summarised in table below. Age and baseline LDL-C were drivers of treatment intensity with higher proportion of patients on high intensity statins in younger patients and in those with higher baseline LDL-C. Overall 70% of patients were adherent (PDC≥80%). Patients on moderate intensity were more adherent (76%) than those on low (63%) or high intensity statins (67%). Treatment patterns with LLT after an ACS LLT following ACS N (%) PDC at 1 year, Mean (SD) Adherent, N (%) Not Adherent, N (%) Ezetimibe 34 (1.3%) 82.8% (31.3%) 26 (76.5%) 8 (23.5%) Low intensity statins 64 (2.4%) 74.8% (33.8%) 40 (62.5%) 24 (37.5%) Moderate intensity statins 993 (37.1%) 82.0% (30.9%) 751 (75.6%) 242 (24.4%) High intensity statins 1515 (56.6%) 74.6% (36.2%) 1007 (66.5%) 508 (33.5%) Statin + ezetimibe 59 (2.2%) 75.9% (34.7%) 40 (67.8%) 19 (32.2%) Overall 2695 (100%) 77.6% (34.3%) 1871 (69.9%) 807 (30.1%) Conclusion(s) Our data show a substantial proportion of patients in France are not treated with high intensity statins after an ACS despite guidelines recommendation. Adherence to LLT is acceptable in patients after an ACS although it appears to worsen when high intense statins are used Acknowledgement/Funding Study has been funded by Amgen GmbH

Abstract 2015: Effect of Early Intensive Statin Therapy on Regression of Coronary Atherosclerosis in Patients with Acute Coronary Syndrome: The Multi-Center Randomized Trial Evaluated by Volumetric Intravascular Ultrasound Comparing Pitavastatin versus Atorvastatin (JAPAN-ACS study)

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Takeshi Kimura ◽  
Takafumi Hiro ◽  
Takeshi Morimoto ◽  
Katsumi Miyauchi ◽  
Yoshihisa Nakagawa ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
Intravascular Ultrasound ◽  
Percentage Change ◽  
Lipid Lowering ◽  
Plaque Volume ◽  
Atorvastatin Group ◽  
Coronary Syndrome ◽  
Intensive Statin Therapy

A prior single center study reported that early lipid-lowering therapy with atorvastatin 20 mg/day in patients (pts) with acute coronary syndrome (ACS) significantly reduced coronary plaque volume (PV) of the non-culprit site by intravascular ultrasound (IVUS) evaluation. Effect of statins other than atorvastatin on PV has not been evaluated yet in the setting of ACS. A prospective, randomized open-label parallel group study with blinded endpoint evaluation was perfomed at 33 centers in Japan. Pts with ACS undergoing IVUS-guided percutaneous coronary intervention (PCI) were randomly assigned to receive either 4 mg/day of pitavastatin or 20 mg/day of atorvastatin within 72 hours after PCI. The primary endpoint was the percentage change in non-culprit coronary PV by IVUS from baseline to 8 –12 months follow-up. The study was powered to evaluate non-inferiority of pitavastatin to atorvastatin. Between November 2005 and October 2006, 307 pts (pitavastatin group 153 pts and atorvastatin group 154 pts) were enrolled; 252 pts (82%) had IVUS image qualified for evaluation both at baseline and at follow-up. Low-density lipoprotein cholesterol (LDL-C) decreased from 130.9±33.3mg/dL at baseline to 81.1±23.4mg/dL at 8 –12 months follow-up (p= 0.001) in the pitavastatin group and from 133.8±31.4mg/dL to 84.1±27.4mg/dL (p= 0.001) in the atorvastatin group. PV decreased from 49.8±28.8mm 3 to 41.6±25.0mm 3 (p= 0.001) in the pitavastatin group and from 63.9±33.9mm 3 to 53.3±31.7mm 3 (p= 0.001) in the atorvastatin group. Mean percentage change in PV was −16.9±13.9% and −18.1±14.2% (p=0.5) in the pitavastatin and atorvastatin group, respectively. Upper limit of the 95% confidence interval of the mean difference in percentage change in PV between the two groups (1.11% (−2.27 to 4.48)) did not exceed the pre-defined non-inferiority margin of 5%. There was no significant correlation between percent change in plaque volume and LDL-C at baseline or at follow-up. Early intensive statin therapy with 4mg/day of pitavastatin or 20mg/day of atorvastatin in Japanese patients with ACS resulted in remarkable regression of coronary PV. The effect of pitavastatin 4mg/day on coronary PV was similar to that of atorvastatin 20mg/day.

scholarly journals Adherence to cardiac rehabilitation after acute coronary syndrome and its impact on patient outcome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
P Sulzgruber ◽  
H Sinkovec ◽  
N Kazem ◽  
F Hofer ◽  
A Hammer ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Acute Coronary Syndrome ◽  
Health Insurance ◽  
Cardiac Rehabilitation ◽  
Study Endpoint ◽  
Primary Study ◽  
Inverse Association ◽  
Coronary Syndrome ◽  
The Impact ◽  
Observation Period

Abstract Background Secondary prevention after acute coronary syndrome (ACS) mirrors a key position in the reduction of morbidity and mortality in this highly vulnerable patient population. Especially cardiac rehabilitation proved to be one of the most beneficial therapeutic approaches for the reduction of re-events and overall modification of cardiovascular risk factors. However, profound epidemiological measures on adherence to a recommended cardiac rehabilitation after ACS remain scare, but seem of major importance in terms of preventing fatal cardiac adverse events. Therefore, we aimed to investigate adherence to cardiac rehabilitation after ACS and its impact on patient outcome from an Austrian nationwide perspective. Methods Within this population-based national observation all patients presenting with ACS between 04/2011 and 8/2015 in Austria were enrolled. Patient characteristics and co-morbidities were assessed via the Austrian national health insurance system and elucidated according to ICD10 definitions. Adherence to recommended cardiac rehabilitation was investigated according to health insurance documentation. Patients were followed prospectively until the primary study endpoint (= mortality) was reached. Cox Regression hazard analysis was used to investigate the impact of non-adherence to cardiac rehabilitation on patient outcome and was adjusted for a comprehensive subset of confounders within the multivariate model. Results During the observation period a total of 16.518 patients (median age: 64 years [54–74]; male: 68.4% [n=11.306]) met the inclusion criteria. Of alarming importance 86.6% (n=14.305) of all patients presenting with ACS did not perform any cardiac rehabilitation as recommended by current guidelines. During patient follow-up until 01/2018 a total of 1774 (10.7%) individuals died. Adherence to recommended cardiac rehabilitation had a strong an independent inverse association with mortality with an adjusted hazard ratio of 0.73 (95% CI: 0.54–0.98; p=0.036) (see Figure 1). Conclusion The present nationwide investigation highlighted an overall low adherence to recommended cardiac rehabilitation after ACS. Since cardiac rehabilitation after ACS was associated with a 27% risk reduction for fatal cardiovascular events during the observation period, awareness in terms of cardiac rehabilitation and associated intensified risk factor modification should be promoted, in order to prevent fatal atherothrombotic events. Figure 1. Cumulative mortality Funding Acknowledgement Type of funding source: None

scholarly journals Lipid Lowering Treatment and Follow Up in Recent Post Acute Coronary Syndrome Patients: Real-World Evidence from the Multicenter Observational Prospective - Post Acute Coronary Syndrome Italian Study (PACSI)

2020 ◽  
Vol 19 ◽  
Author(s):  
Pompilio Faggiano ◽  
Giuseppe Patti ◽  
Stefania Cercone ◽  
Laura Canullo ◽  
Roberta Rossini ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Recurrent Events ◽  
Real Life ◽  
Lipid Lowering ◽  
Pharmacological Intervention ◽  
Adherence Rate ◽  
Prospective Clinical Study ◽  
Target Attainment ◽  
Coronary Syndrome

PURPOSE: Patients suffering from an acute coronary syndrome are at very high risk for recurrent events. Early targeted pharmacological intervention primarily aimed at controlling plasma LDL-cholesterol (LDL-C) levels can result in the reduction of recurrent cardiovascular events. This study aimed to evaluate real-life evidence from the Italian setting to document current practice of secondary prevention in patients after acute coronary syndrome (ACS), specifically assessing: (i) the rate of LDL-C target (<70 mg/dl) achievement after 6-10 weeks from index event and at later follow-up, (ii) the distance from LDL-C target during follow up, (iii) adherence rate and visit attendance. METHODS Multicenter observational prospective clinical study ACS patients, evaluating target attainment rate at 6 weeks (V0) and 18 months (V2). RESULTS Approximately 97.4% patients enrolled (N=524) received statin-based therapy, and 3.6% received ezetimibe at discharge; mean LDL-C values decreased from 113.0±44.7 mg/dL at discharge to 71.3±26.5 mg/dl at V0. Among patients with known LDL-C for main time-points, 51.7% achieved target LDL-C at V0, 45.8% at V2. Among patients not reaching the target, the mean distance from target was 23.5±20.7 mg/dL. Attainment of target LDL-C was similar in patients receiving intensive or low-moderate statin-based treatment (approximately 50%). LDL-C target attainment was associated with lower LDL-C value at discharge and smoking status. Adherence to statin treatment was high (96.2%) throughout, similarly to medical appointment attendance at V2 (84.7%). CONCLUSION Despite most ACS patients receiving intensive statin-based regimens, only approximately half achieved LDL-C target, suggesting the need for further optimizing drug selection, combination and dosage. 

Complex lipid-lowering treatment options in patients with a history of acute coronary syndrome

2011 ◽  
Vol 152 (8) ◽  
pp. 296-302 ◽  
Author(s):  
Győző Dani ◽  
László Márk ◽  
András Katona
Keyword(s):  
Acute Coronary Syndrome ◽  
Serum Lipid ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
Coronary Syndrome ◽  
Target Values ◽  
History Of ◽  
Lipid Parameters

Authors aimed to assess how target values in serum lipid concentrations (LDL- and HDL-cholesterol, triglyceride) can be achieved in patients with a history of acute coronary syndrome during follow up in an outpatient cardiology clinic. Methods: 201 patients with a history of acute coronary syndrome were included and were followed up between January 1 and May 31, 2007.Authors analyzed serum lipid parameters of the patients and the lipid-lowering medications at the time of the first meeting and during follow up lasting two years. Results: During the enrollment visit only 26.4% of the patients had serum LDL cholesterol at target level, whereas high triglycerides and low HDL cholesterol levels were observed in 40.3% and 33.3% of the patients, respectively. Only 22 patients (10.9%) achieved the target levels in all three lipid parameters. Of the 201 patients, 179 patients participated in the follow up, and data obtained from these patients were analyzed. There was a positive trend toward better lipid parameters; 42.5% of the patients reached the desired LDL-cholesterol target value and 17.3% of the patients had HDL-cholesterol and triglycerides target values. Conclusions: These findings are consistent with those published in the literature. Beside the currently used therapeutic options for achieving optimal LDL-cholesterol, efforts should be made to reduce the so-called “residual cardiovascular risk” with the use of a widespread application of combination therapy. Orv. Hetil., 2011, 152, 296–302.

scholarly journals Effects of Fatty Acid Therapy in Addition to Strong Statin on Coronary Plaques in Acute Coronary Syndrome: An Optical Coherence Tomography Study

2020 ◽  
Vol 9 (16) ◽  
Author(s):  
Yoko Kita ◽  
Makoto Watanabe ◽  
Daisuke Kamon ◽  
Tomoya Ueda ◽  
Tsunenari Soeda ◽  
...  
Keyword(s):  
Optical Coherence Tomography ◽  
Acute Coronary Syndrome ◽  
Fatty Acid ◽  
Statin Therapy ◽  
Control Group ◽  
Optical Coherence ◽  
Acid Therapy ◽  
Coronary Syndrome ◽  
Percent Change

BACKGROUND Vascular healing response associated with adjunctive n‐3 polyunsaturated fatty acid therapy therapy in patients receiving strong statin therapy remains unclear. The aim of this study was to evaluate the effect of polyunsaturated fatty acid therapy with eicosapentaenoic acid (EPA) or docosahexaenoic acid (DHA) in addition to strong statin therapy on coronary atherosclerotic plaques using optical coherence tomography. METHODS AND RESULTS This prospective multicenter randomized controlled trial included 130 patients with acute coronary syndrome treated with strong statins. They were assigned to either statin only (control group, n=42), statin+high‐dose EPA (1800 mg/day) (EPA group, n=40), statin+EPA (930 mg/day)+DHA (750 mg/day) (EPA+DHA group, n=48). Optical coherence tomography was performed at baseline and at the 8‐month follow‐up. The target for optical coherence tomography analysis was a nonculprit lesion with a lipid plaque. Between baseline and the 8‐month follow‐up, fibrous cap thickness (FCT) significantly increased in all 3 groups. There were no significant differences in the percent change for minimum FCT between the EPA or EPA+DHA group and the control group. In patients with FCT <120 µm (median value), the percent change for minimum FCT was significantly higher in the EPA or EPA+DHA group compared with the control group. CONCLUSIONS EPA or EPA+DHA therapy in addition to strong statin therapy did not significantly increase FCT in nonculprit plaques compared with strong statin therapy alone, but significantly increased FCT in patients with thinner FCT. Registration URL: https://www.umin.ac.jp/ctr/ ; Unique identifier: UMIN 000012825.

scholarly journals PCSK9 inhibitors for in-hospital treatment of patients with acute coronary syndrome and severe lipid metabolism disorders

2020 ◽  
Vol 25 (8) ◽  
pp. 4010
Author(s):  
O. L. Barbarash ◽  
N. V. Fedorova ◽  
D. Yu. Sedykh ◽  
O. V. Gruzdeva ◽  
O. N. Khryachkova ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
Lipid Lowering ◽  
High Density Lipoproteins ◽  
Hospital Treatment ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitor ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Baseline Values

Aim. To assess the efficacy and safety of PCSK9 inhibitor alirocumab as part of a combination lipid-lowering therapy in patients with acute coronary syndrome (ACS).Material and methods. This prospective, open-label, single-center activetreatment study included 13 patients hospitalized due to ACS. The main inclusion criterion was nonachievement of target low-density lipoprotein cholesterol (LDL-C) values (<1,4 mmol/L) with high-intensity statin therapy prior to ACS. During the first 30 days after ACS, all patients received therapy with atorvastatin 40-80 mg/day or rosuvastatin 20-40 mg/day in combination with alirocumab 150 mg/ml (Praluent) administered by subcutaneous injection. Lipid and biochemical profiles were monitored. The first injection of the PCSK9 inhibitor was performed on days 3-5 of hospitalization, the second — after 2 weeks.Results. On admission, the median LDL-C was 4,3 [3,5;5,3] mmol/L. A day after administration, there was a decrease in LDL-C by 41,9% (median 2,5 [1,8;3,2] mmol/L; p=0,001) without a negative effect on high-density lipoproteins (HDL-C) (median 1,2 [0,8;1,4] mmol/L; p=0,270). Before the next injection, LDL-C decreased by another 8% (median 2,3 [1,1;4,1] mmol/L). A day after the second injection, a decrease in LDL-C from the baseline values was 69,8% (median 1,3 [0,7;1,5] mmol/L; p=0,010). Strengthening lipid-lowering therapy with a PCSK9 inhibitor within 30 days after ACS did not lead to clinical and biochemical deterioration.Conclusion. The use of subcutaneous 150-mg injections of alirocumab 2 times a week 30 days after ACS in patients who did not reach target LDL-C values with statin therapy, leads to a 69% decrease in LDL-C from baseline values and is safe.

scholarly journals The Role of PCSK9 Inhibitors in the Improvement of Outcomes in Patients after Acute Coronary Syndrome: Results of ODYSSEY OUTCOMES Trial

2019 ◽  
Vol 14 (6) ◽  
pp. 922-934 ◽  
Author(s):  
Yu. A. Karpov
Keyword(s):  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
High Intensity ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Pcsk9 Inhibitors ◽  
Coronary Syndrome

The aim of this review was to present the recently published results of ODYSSEY OUTCOMES trial and discuss the clinical perspective of these data. Patients with acute coronary syndrome are at very high risk of recurrent ischemic cardiovascular complications, especially during the first year after the event. The use of high-intensity statin therapy in this group of patients does not always lead to the achievement of target levels of atherogenic lipoproteins. PCSK9 inhibitors, administered in addition to statins, can provide additional reduction of low-density lipoprotein cholesterol, which leads to further improvements of outcomes in patients with atherosclerotic cardiovascular disease. According to the latest results from ODYSSEY OUTCOMES trial, among patients with recent acute coronary syndrome, who were receiving high-intensity statin therapy, the risk of recurrent ischemic cardiovascular events was lower among those who were treated with alirocumab then among those who received placebo. The treatment with alirocumab in patients with recent acute coronary syndrome was associated with reduction in death from any causes. The absolute risk reduction with alirocumab was the most prominent in the subpopulation of patients with low-density lipoprotein cholesterol ≥2,6 mmol/l at baseline. These results have implication for clinical practice and may play an important role for the improvement of outcomes in patients at highest cardiovascular risk after acute cardiovascular syndrome.

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