P651Prevalence of hypertriglyceridemia in statin treated high risk patients who might benefit from treatment with icosapent ethyl for secondary prevention in clinical practice - Results of DYSIS

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A K Gitt ◽  
M Horack ◽  
D Lautsch ◽  
J Ferrieres
Keyword(s):  
Clinical Practice ◽  
Ldl Cholesterol ◽  
Cardiovascular Death ◽  
Additional Treatment ◽  
High Cardiovascular Risk ◽  
Icosapent Ethyl ◽  
Mixed Dyslipidemia ◽  
Risk Patients ◽  
Ischemic Events ◽  
Very High

Abstract Background Patients with elevated triglyceride (TG) levels are at increased risk for ischemic events. In the recently published REDUCE-IT-Study among patients with elevated triglyceride levels who were receiving statin therapy, the risk of major ischemic events, including cardiovascular death, was significantly lower with 2 g of icosapent ethyl twice daily than with placebo. Little is known about how many patients in clinical practice might benefit from this additional treatment. Methods The cross sectional, observational Dyslipidemia International Study (DYSIS) examined lipid goal attainment among statin-treated very high cardiovascular risk patients (defined as per 2011 EAS/ESC guidelines, including patients suffering from coronary heart disease, diabetes, chronic kidney disease or peripheral atherosclerotic disease) in Canada, Europe, Middle East countries and China. Data were collected under real life conditions in physicians' offices and hospital outpatient wards between 2008–2012. We examined the prevalence of mixed dyslipidemia with TG >135 mg/dl in high statin treated high risk patients in clinical practice. Results Of a total of 44,593 patients on very high cardiovascular risk, all on chronic statin treatment, 21,312 (47.8%) had mixed dyslipidemia with TG values >135mg/dl. Patients with elevated TG also had higher levels of total and LDL-cholesterol. The overall use of additional fibrates on top of statins was low (4.0%), but more frequent in patients with TG >135 mg/dl. CVD patients with TG>135 mg/dl Pts with TG >135 mg/dl Pts with TG ≤135 mg/dl p-value OR (95% CI) n=21,312 (47.8%) n=23,281 (52.2%) Age (years) 65.4±10.1, 68.1±10.2 <0.0001 Females 42.2% 38.6% <0.0001 1.16 (1.12–1.21) Sedentary lifestyle 43.0% 37.6% <0.0001 1.25 (1.20–1.30) Risk factors/CV-disease   Hypertension 79.0% 74.9% <0.0001 1.26 (1.21–1.32)   Diabetes mellitus 56.3% 45.3% <0.0001 1.55 (1.50–1.61)   Ischemic heart disease 50.6% 54.4% <0.0001 0.86 (0.83–0.89)   Cerebrovascular disease 16.1% 17.7% <0.0001 0.90 (0.85–0.94)   Peripheral artery disease 8.1% 6.9% <0.0001 1.18 (1.10–1.27) Lipid lowering therapy   Rosuvastatin 11.3% 11.8% 0.13 0.95 (0.90–1.01)   Atorvastatin 38.2% 40.9% <0.0001 0.89 (0.86–0.93)   Simvastatin 41.9% 38.9% <0.0001 1.13 (1.09–1.18)   Other statins 8.6% 8.4% 0.12 0.96 (0.88–1.05)   Fibrates 5.5% 1.5% <0.0001 3.86 (3.40–4.37) Lipid Profile   Total Cholesterol (mg/dl) 185.6 159.0 <0.0001   LDL-Cholesterol (mg/dl) 102.1 88.9 <0.0001   Triglyderides (mg/dl) 189.5 95.7 <0.0001 Conclusion Almost half of consecutive patients with cardiovascular disease treated with statins for secondary prevention in clinical practice suffer from TG levels >135 mg/dl and might benefit from additional treatment with icosapent ethyl with further reduction in subsequent major ischemic events, including cardiovascular death. Acknowledgement/Funding MSD

scholarly journals Real-World Effectiveness of Therapy With Rosuvastatin Combined With Fenofibric Acid in a Sample of Colombian Patients With Mixed Dyslipidemia

2020 ◽  
Vol 11 ◽  
pp. 215013272097773
Author(s):  
Manuel E. Machado-Duque ◽  
Andrés Gaviria-Mendoza ◽  
Jorge E. Machado-Alba
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Lipid Profile ◽  
Ldl Cholesterol ◽  
Clinical Laboratory ◽  
Lower Probability ◽  
Fenofibric Acid ◽  
High Cardiovascular Risk ◽  
Mixed Dyslipidemia ◽  
Very High

Background Ischemic heart disease is the leading cause of death in the world and is associated with dyslipidemia, high blood pressure, diabetes mellitus, and other factors. Objective To determine the clinical effectiveness on the lipid profile of the rosuvastatin + fenofibric acid combination in Colombian patients with high cardiovascular risk and mixed dyslipidemia. Methods Longitudinal observational study in a random sample of patients with a diagnosis of mixed dyslipidemia and moderate, high, or very high cardiovascular risk who were treated with rosuvastatin + fenofibric acid. Anthropometric, clinical, laboratory, comorbidity, and pharmacological variables were identified. Effectiveness on the lipid profile was determined. Results A total of 386 patients were analyzed. They had a mean age of 60.8 ± 11.4 years, 53.1% were female, and 75.6% had high/very high cardiovascular risk. The initial evaluation showed a mean LDL cholesterol of 138.4 ± 67.1 mg/dL and triglycerides of 679.7 ± 573.6 mg/dL. At the end of follow-up, mean LDL cholesterol was 87.5 ± 41.2 mg/dL (reduced by 43.3%; P < .001), and triglycerides were 243.5 ± 170.5 mg/dL (reduced by 64.2%; P < .001). Only 35.4% (n = 73) of patients with very high risk reached the goal of metabolic control, compared to 61.6% (n = 53) with high risk and 55.4% (n = 46) with moderate risk. Belonging to the very high-risk group was associated with a lower probability of achieving the control goal (OR: 0.32; 95%CI: 0.192-0.539). Conclusion The combination of rosuvastatin + fenofibric acid is an effective option in patients with mixed dyslipidemia and high cardiovascular risk, providing a therapeutic alternative for those conditions that require it.

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

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

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

The Role of n-3 Fatty Acids in Cardiovascular Disease: Back to the Future

Angiology ◽  
2019 ◽  
Vol 71 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Pablo Perez-Martinez ◽  
Niki Katsiki ◽  
Dimitri P Mikhailidis
Keyword(s):  
Cardiovascular Disease ◽  
Fatty Acids ◽  
Cardiovascular Death ◽  
Icosapent Ethyl ◽  
Randomized Controlled ◽  
Risk Patients ◽  
Lifestyle Measures ◽  
Current Therapies ◽  
Ischemic Events

Cardiovascular disease (CVD) remains the major cause of death and disability worldwide, and residual risk after implementing all current therapies is still high. In this context, the latest (2016) European Cardiology Society/European Atherosclerosis Society guidelines recommend that triglyceride (TG)-lowering drugs should be used in high-risk patients with TGs levels >2.3 mmol/L (200 mg/dL), after lifestyle measures fail to lower them. After several neutral CVD outcome trials with n-3 fatty acids, the Reduction of Cardiovascular Events with EPA–Intervention Trial met its primary end point, that is, among patients with elevated TGs levels despite the use of statins, the risk of ischemic events, including cardiovascular death, was significantly lower in those who received 4 g of icosapent ethyl daily. In this review, we comment on the findings of previous and recently published randomized controlled CVD outcome trials assessing n-3 fatty acids supplementation. Both efficacy and safety, as well as future perspectives, are discussed.

scholarly journals Features and main problems of treating patients with high and very high cardiovascular risk with statins in real clinical practice (according to the data of the “PRIORITET” research)

2018 ◽  
Vol 17 (6) ◽  
pp. 52-60 ◽  
Author(s):  
S. Yu. Martsevich ◽  
Yu. V. Lukina ◽  
N. P. Kutishenko ◽  
N. A. Dmitrieva ◽  
T. A. Gomova ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Cardiovascular Risk ◽  
Statin Therapy ◽  
Working Group ◽  
Target Level ◽  
High Cardiovascular Risk ◽  
Lipid Pattern ◽  
Very High ◽  
Real Clinical Practice ◽  
Group 1

Aim. To determine the features and main problems of statin therapy, as well as assess the possibility of achieving the target level of lipid pattern in patients with high and very high cardiovascular risk (CVR) in real clinical practice.Material and methods. The design of the “PRIORITET” observational program is an open observational study. Patients with high and very high CVR were divided into 3 groups in accordance with the initial data: (1) not taking statins, (2) taking statins, but not reaching the target low-density lipoprotein cholesterol (LDL-C) level, (3) taking statins with the achievement of the target LDL-C level, which is justified in replacing the statin inside the class — adverse effects (AE), high price, etc. Within 12 weeks 3 visits of patients to hospitals were carried out: baseline visit (B0), visit 1 month after the study initiation (B1) and visit 3 months after the study initiation (B3). The choice of atorvastatin or rosuvastatin was assessed by the doctors.Results. Groups 1, 2 and 3 included 112, 170 and 16 people, respectively. At B0, 145 (48,7%) patients were prescribed atorvastatin, and 153 (51,3%) — rosuvastatin. Three people dropped out of the study to B3, 295 patients completed the program. Lipid pattern of 285 patients were analyzed: 121 (41%) people (101 with very high CVR and 20 with high CVR) achieved the target LDL-C level, the remaining 164 (59%) patients (CVR — 156 and 8, respectively) — no. The most pronounced dynamics of LDL=C level was revealed in group 1, the differences between group 1 and groups 2 and 3 are highly statistically significant (p<0,0001). There were no differences in the frequency of reaching the target LDL-C level between patients taking atorvastatin or rosuvastatin. The target level of LDL-C (p=0,003) in the treatment of rosuvastatin in patients with high CVR was reached significantly more often than in patients with very high CVR. Also 3 non-serious AEs were reported. On average, in 9% of cases, reaching the target level of LDL-С during visits B1 and B3 was wrong interpreted by the attending physicians.Conclusion. The main problems of statin therapy in real clinical practice are the wrong interpretation of reaching the target level of LDL-C, inertness of doctors in titrating of statins doses and achieving the target level of lipid pattern. It may be the cause of reduced efficiency and deterioration of lipid-lowering therapy results in patients with high and very high CVR. The results of the “PRIORITET” study demonstrated the possibility of improving the practice of statins use and its accordance with clinical guidelines.Skibitsky V. V. on behalf of the working group of the “PRIORITET” researchWorking Group of the “PRIORITET” study: Voronina V. P. (Moscow), Zelenova T. I. (Moscow), Sladkova T.A. (Moscow), Alekseeva A. I. (Tula), Barabanova T. Yu. (Tula), Zotova A. S. (Tula), Kolomeitseva T. M. (Tula), Prikhod’ko T. N. (Tula), Pazelt E. A. (Nizhny Novgorod), Khramushev N. Yu. (Nizhny Novgorod), Skibitsky A. V. (Krasnodar), Alekseeva V. V. (Saratov), Lazareva E. V. (Saratov).

scholarly journals Possibilities of combination lipid-lowering therapy in a patient with very high cardiovascular risk (сlinical case)

2021 ◽  
Vol 23 (1) ◽  
pp. 70-73
Author(s):  
Daria Yu. Sedykh ◽  
◽  
Natalia V. Fedorova ◽  
Vasily V. Kashtalap ◽  
◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Clinical Practice ◽  
Cardiovascular Risk ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
High Cardiovascular Risk ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Lipid Metabolism Disorders ◽  
Very High

The article demonstrates the possibility of prescribing an effective and safe lipid-lowering combination of the most tolerated doses of statins in combination with ezetimibe, using the example of a patient with severe lipid metabolism disorders in the post-infarction period. It has been shown that in real clinical practice, patients with acute coronary syndrome and persisting high LDL values are quite common, despite of the prescription of statins. These patients need closer follow-up and wider use of combined lipid-lowering therapy by adding ezetimibe to maximally tolerated doses of statins. Current clinical guidelines allow this to be done when patients fail to achieve target LDL values (>1.4 mmol/L) with statins monotherapy. This approach is effective and safe, which is illustrated by this hereditary clinical case. In routine clinical practice mandatory lipids control is required 4–6 weeks after patient’s discharge from the hospital for acute coronary syndrome. If the target lipids values were not achieved with the maximum dosage of statins, a mandatory using the combination therapy with ezetimibe is required. Keywords: myocardial infarction, dyslipidemia, improved prognosis, statins, ezetimibe For citation: Sedykh DYu, Fedorova NV, Kashtalap VV. Possibilities of combination lipid-lowering therapy in a patient with very high cardiovascular risk (сlinical case). Consilium Medicum. 2021; 23 (1): 70–73. DOI: 10.26442/20751753.2021.1.200604

Quality Of Life Improvement In High And Very High Cardiovascular Risk Patients Treated With Pcsk9 Inhibitors

2019 ◽  
Vol 287 ◽  
pp. e199
Author(s):  
A. Cesaro ◽  
F. Gragnano ◽  
F. Fimiani ◽  
E. Moscarella ◽  
I. Pariggiano ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Cardiovascular Risk ◽  
High Cardiovascular Risk ◽  
Pcsk9 Inhibitors ◽  
Risk Patients ◽  
Life Improvement ◽  
Very High

3040Plaque burden, but not the severity of carotid stenosis, predicts adverse cardiovascular events in patients at high and very high cardiovascular risk

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
V Genkel ◽  
A Salashenko ◽  
I Shaposhnik
Keyword(s):  
Cardiovascular Risk ◽  
Carotid Stenosis ◽  
Carotid Plaque ◽  
Cardiovascular Events ◽  
Carotid Arteries ◽  
Cardiovascular Death ◽  
Carotid Ultrasound ◽  
High Cardiovascular Risk ◽  
Very High ◽  
Fatal Myocardial Infarction

Abstract Introduction According to the current guidelines the visualization of atherosclerotic plaques in the carotid arteries is the only option that carotid ultrasound provides for the assessment of cardiovascular risk (CVR). The direction devoted to the development and implementation of markers based on the quantification of atheroma, is promising. Purpose The aim of the study was to evaluate the prognostic value of various markers of carotid atherosclerosis (plaque, carotid total plaque area (cTPA) and carotid stenosis) in patients at high and very high CVR. Methods The study included patients aged 40–75 years at high and very high CVR. All patients underwent carotid duplex ultrasound. The presence of carotid plaque was assessed according to Mannheim consensus. The percentage of stenosis was measured planimetrically in the B-mode by the diameter in the cross section of the vessel. cTPA was estimated in the longitudinal position, which allows to achieve the best visualization of plaque, the area of plaque was measured in the manual trace mode. These measurements were performed for each rendered plaque, followed by the calculation of the total value. The combined endpoint was cardiovascular death, non-fatal myocardial infarction or unstable angina (which required hospitalization), non-fatal stroke, and coronary revascularization. Results The study included 100 patients at high and very high risk. The duration of the follow-up period was 24.4 (14.1–34.3) months. The events constituting the combined endpoint occurred in 34 (34%) patients: cardiovascular death was recorded in 7 (7%) patients; non-fatal myocardial infarction or stroke in 3 (3%) patients; unstable angina, which required hospitalization in 24 (24%) patients, while emergency coronary angiography was performed in 8 (8%) patients, coronary artery stenting was performed in 3 (3%) cases. The presence of carotid plaque in accordance with Cox regression after adjusting for factors such as sex, age, smoking, hypertension, BMI, eGFR, LDL-c and HbA1c, RR of adverse cardiovascular events was 10.5 (95% CI 1.27–86.5; p=0.008; see Figure 1). The optimal cut-off values of cTPA and carotid stenosis were determined by ROC-analysis. An increase in cTPA ≥69 mm2 corrected for sex, age, smoking, hypertension, BMI, eGFR, LDL-c, HbA1c, and the presence of carotid plaque was associated with an increase in the RR of adverse cardiovascular events by 5.86 times (95% CI 2.09–16.4; p=0.001; see Figure 1). Also, there were no statistically significant associations between carotid arteries stenosis and adverse cardiovascular events (RR 1.29; 95% CI 0.61–2.76; p=0.504). Kaplan–Meier curves for cTPA, stenosis Conclusion In patients at high and very high cardiovascular risk among carotid ultrasound parameters the presence of carotid plaque and cTPA, but not the degree of stenosis, had an independent predictive value regarding the development of adverse cardiovascular events.

Abstract 14997: Icosapent Ethyl Reduces Ischemic Events in Patients With Prior Coronary Artery Bypass Grafting: REDUCE-IT CABG

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Subodh Verma ◽  
Deepak L Bhatt ◽  
Philippe G Steg ◽  
Michael Miller ◽  
Eliot A Brinton ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery ◽  
Coronary Artery Bypass Grafting ◽  
Artery Bypass ◽  
Composite Endpoint ◽  
Cardiovascular Death ◽  
Bypass Grafting ◽  
Icosapent Ethyl ◽  
History Of ◽  
Ischemic Events

Background: Patients with a prior history of coronary artery bypass grafting (CABG) are at high risk for future ischemic events despite statin therapy. Methods: REDUCE-IT, a multicenter, double-blind, placebo-controlled trial, randomized statin-treated patients with elevated triglycerides (135-499 mg/dL), controlled LDL (41-100 mg/dL), and either established cardiovascular disease or diabetes plus other risk factors to receive icosapent ethyl 4g daily or placebo. In the overall trial, the primary composite endpoint (cardiovascular death, myocardial infarction, stroke, coronary revascularization, hospitalization for unstable angina) and the key secondary composite endpoint (cardiovascular death, myocardial infarction, stroke) were significantly reduced. Here we examine the subgroup of patients with a history of CABG. Results: A total of 8,179 randomized patients were followed for 4.9 years (median), 1837 (22.5%) of whom had a prior CABG, with a median of 5.1 years (0.7 months to 33.3 years) from CABG to randomization (in the 1263 patients who had the date of CABG recorded). The rate of the primary endpoint was reduced by 24% [22.0% with icosapent ethyl versus 28.2% with placebo (hazard ratio [HR]=0.76; 95% confidence interval [CI], 0.63-0.92; p=0.004; number needed to treat [NNT]=16)]. The rate of the key secondary endpoint was reduced by 31%: [14.7% with icosapent ethyl versus 20.7% with placebo (HR=0.69; 95% CI, 0.56-0.87; p=0.001; NNT=17)]. Conclusions: In statin-treated patients with a history of prior CABG, the addition of icosapent ethyl significantly reduced ischemic events, with both large relative and absolute risk reductions.

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