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

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

P3598Cardiac Cycle - The effect of exercise on cardiac troponin release

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
L Marshall ◽  
K Lee ◽  
F E Strachan ◽  
T Fujisawa ◽  
S Stewart ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Physical Exercise ◽  
High Intensity ◽  
Cardiac Troponin ◽  
High Sensitivity ◽  
High Intensity Exercise ◽  
Moderate Intensity ◽  
Study Visit ◽  
Coronary Syndrome ◽  
Low Intensity

Abstract Introduction International guidelines recommend the use of low concentrations of high-sensitivity cardiac troponin to risk stratify patients with suspected acute coronary syndrome, however, troponin concentration may also rise due to physical exercise. Interpreting cardiac troponin concentration in this context is challenging because the magnitude and duration of troponin elevation following physical exercise is uncertain. Purpose To determine the effect of intensity and duration of physical exercise on cardiac troponin concentration. Methods We invited 10 physically active healthy volunteers (7 male and 3 female; mean age: 34±7) to attend 3 study visits, during which they underwent exercise on a stationary bicycle at prespecified intensities and durations. The first visit involved low intensity cycling (50–60% of the participant's lactate threshold [LT]) for 60 minutes. During the second visit, participants cycled at high intensity (80–90% LT) for 60 minutes and during the third study visit, participants cycled at moderate intensity (60–70% LT) for 4 hours. High-sensitivity cardiac troponin I (hs-cTnI) concentration was measured at the start of exercise and every hour up to 6 hours during each study visit and subsequently at 1, 2 and 7 days after each exercise visit. Results Study participants had a median hs-cTnI concentration of 1.8 ng/L (interquartile range [IQR] 0.8–5.7 ng/L) at baseline. Cardiac troponin concentration was elevated following moderate- and high-intensity exercise (P=0.006 and P<0.001, respectively) but not following low-intensity exercise (P=0.137). Troponin concentrations were significantly higher following the shorter duration of high-intensity exercise (peak hs-cTnI concentration = 13 ng/L [IQR 6.5–27.1 ng/L]) compared to the longer duration moderate-intensity exercise (peak hs-cTnI concentration = 6.9 ng/L [2.9–7.9 ng/L]; P-value <0.001). Following both moderate- and high-intensity exercise, cardiac troponin concentration returned to baseline within 48 hours (Figure 1). Troponin concentrations ng/L / time Conclusions Our study suggests that elevation in cardiac troponin concentration is associated with the intensity rather than duration of physical exercise, and that exercise-induced troponin elevations resolve within 48 hours. These findings have important implications for the interpretation of cardiac troponin in the risk stratification and diagnosis of patients who present with symptoms suggestive of acute coronary syndrome following physical exercise. Acknowledgement/Funding British Heart Foundation

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.

P944Comparing therapeutic gap in lipid-lowering management between high-risk cardiovascular patients after acute coronary syndrome, stroke and critical limb ischemia

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
B P Y Yan ◽  
C K Y Chan ◽  
W H S Lai ◽  
O T L To
Keyword(s):  
Acute Coronary Syndrome ◽  
Critical Limb Ischemia ◽  
Goal Attainment ◽  
Density Lipoprotein ◽  
Limb Ischemia ◽  
Lipid Lowering ◽  
Stroke Patients ◽  
High Potency ◽  
Coronary Syndrome ◽  
Risk Patients

Abstract Background Guidelines recommend intensive low-density-lipoprotein cholesterol (LDL-C) lowering in high cardiovascular (CV) risk patients with acute coronary syndrome (ACS), stroke and critical limb ischemia (CLI). Purpose We evaluated LDL-C goal attainment and lipid-lowering treatment (LLT) in a Chinese population with ACS, stroke and CLI patients. Methods We retrospectively evaluated consecutive high CV risk patients discharged between 2013 and 2017 from 3 hospitals in Hong Kong. Lipid profile and LLT were compared among 3 patient groups: ACS, Stroke and CLI. Results Of 10,168 high-CV risk patients (mean age 70.6±13.7 years; 62.4% male), 64.0% were ACS, 33.6% stroke and 2.5% CLI. Between baseline and 12-month, mean LDL-C reduced from 2.7±1.1 to 2.0±0.8 mmol/L in ACS patients, 2.7±1.0 to 2.0±0.7 mmol/L in stroke patients and 2.5±1.0 to 2.2±0.9 mmol/L in CLI patients (p<0.01). Proportion of CLI patients (29.9%) who achieved target LDL-C <1.8mmol/L at month 12 was significantly lower than stroke (45.6%) and ACS (48.2%) patients (p<0.01). The mean residual distance to target LDL-C was greatest in CLI (0.8±0.8 mmol/L) compared to stroke (0.6±0.6 mmol/L) and ACS (0.7±0.7 mmol/L) patients (p<0.01). Use of statin therapy on discharge was highest in ACS (88.4%) compared to stroke (78.3%) and CLI (52.6%) patients (p<0.01). But use of high-potency statin (rosuvastatin ≥20mg, atorvastatin ≥40mg or simvastatin ≥80mg) on discharge was very low in stroke (3.0%) and CLI (2.0%) compared to ACS (21.4%, p<0.01) patients. At 12 months 28.8% ACS, 34.3% stroke and 51.4% CLI patients were on no LLT (p<0.01) and the use of high-potency statin did not change significantly (3.0% in stroke, p=0.99; and 1.2% in CLI, p=0.48). Despite the poor achievement in LDL-C target in CLI patients, the proportion of CLI patients switching to high-potency statin (0.8%) was significantly lower than stroke (1.3%) and ACS (5.2%) patients (p<0.01). Conclusion This study demonstrated significant therapeutic gaps in lipid-lowering management in high CV risk patients. In particular, CLI patients were less aggressively treated with LLT and hence larger proportion of patient not achieving LDL-C target compared to ACS and stroke patients.

scholarly journals Lipid Goal Attainment and Prescription Behavior in Asian Patients with Acute Coronary Syndromes: Experience from a Tertiary Hospital

2013 ◽  
Vol 7 ◽  
pp. CMC.S11488 ◽  
Author(s):  
Calvin W Chin ◽  
F Gao ◽  
TT Le ◽  
RS Tan
Keyword(s):  
Goal Attainment ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Dose Titration ◽  
Lipid Lowering Therapy ◽  
Coronary Syndrome ◽  
Asian Patients ◽  
Statin Dose ◽  
Prescription Behavior

Lipid goal attainment studies in Asian patients with acute coronary syndrome (ACS) are limited. The objectives of this study were to determine low-density lipoprotein cholesterol (LDL-C) goal attainment rate at 4 months, and to examine prescription behavior influencing lipid goal attainment in Asian patients with ACS. A retrospective analysis of 267 patients with ACS was performed. The mean follow-up duration was 41.2 ± 10.7 months. LDL-C goal attainment rate was highest at 4 months (36.7%) but declined progressively throughout follow-up. More than 85% of patients were discharged with equipotent statin dose of 2 (equivalent to simvastatin 20 mg) or less. In patients who did not attain LDL-C goals, the statin dose remained low throughout follow-up because of a lack in responsive dose titration. Aggressive lipid-lowering therapy should be initiated early to improve goal attainment in these high-risk patients.

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.

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