P824The clinical impact of polyunsaturated fatty acid on clinical outcomes in acute coronary syndrome with dyslipidemia: HIJ-PROPER sub-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
M Nakawaza ◽  
H Arashi ◽  
H Nomura ◽  
E Kawada-Watanabe ◽  
M Ogiso ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Arachidonic Acid ◽  
Eicosapentaenoic Acid ◽  
Clinical Outcomes ◽  
Primary Endpoint ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Coronary Syndrome ◽  
Lowering Therapy

Abstract Background Polyunsaturated fatty acids, especially omega-3 and -6 series, are key essential nutrients that play an important role in humans to maintain cell membranes and function. A recent randomized trial reported that adding eicosapentaenoic acid (EPA) to statins was beneficial to cardiovascular disease patients who had a residual risk factor. Further, several studies have reported that the low baseline value for EPA to arachidonic acid (AA) ratio is related to worse clinical outcome and plaque vulnerability in coronary artery disease patients. However, effects of baseline EPA/AA ratio on clinical outcomes in ACS patients have not been thoroughly evaluated. Objectives This study aimed to examine the impact of baseline eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio on clinical outcomes of acute coronary syndrome (ACS) patients and how lipid-lowering therapy affects serum EPA/AA levels in these patients. Methods This is a sub-analysis of HIJ-PROPER assessing the effect of aggressive low-density lipoprotein cholesterol (LDL-C)-lowering treatment with pitavastatin+ezetimibe in 1,734 ACS patients with dyslipidemia. Patients were divided into two groups based on EPA/AA level on admission (cut-off: 0.34 μg/mL; median of baseline EPA/AA level) and clinical outcomes were examined. Results Percent reduction of LDL-C from baseline to follow-up and mean LDL-C level during follow-up were similar regardless of baseline EPA/AA ratio. In the low EPA/AA group, the Kaplan–Meier estimate for the primary endpoint at 3 years was 27.2% in the pitavastatin+ezetimibe group, compared with 36.6% in the pitavastatin-monotherapy group [hazard ratio (HR), 0.69; 95% confidence interval (CI), 0.52–0.93; P=0.015). However, in the high EPA/AA group, there was no significant reduction in the primary endpoint by pitavastatin+ezetimibe therapy (HR, 0.92; 95% CI, 0.70–1.20; P=0.52). Conclusions Aggressive lipid-lowering therapy with ezetimibe had a positive effect on clinical outcomes in the low EPA/AA group of ACS patients with dyslipidemia, but not in the high EPA/AA group. This effect was independent of LDL-C reduction and suggests that EPA/AA measurement on admission in ACS patients contributes to a “personalized” lipid-lowering approach.

Lower levels of high-density lipoprotein cholesterol are associated with increased cardiovascular events in patients with acute coronary syndrome receiving contemporary lipid-lowering therapy

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Nakazawa ◽  
H Arashi ◽  
Y Inagaki ◽  
H Otsuki ◽  
J Yamaguchi ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Primary Endpoint ◽  
Cardiovascular Events ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Group 3 ◽  
Group 1

Abstract Background This study aimed to elucidate whether high-density lipoprotein cholesterol (HDL-C) at 3-month follow-up for patients receiving contemporary lipid-lowering therapy after acute coronary syndrome (ACS) could predict cardiac events. Methods The HIJ-PROPER study was a multicenter, prospective, randomized trial comparing intensive lipid-lowering therapy (pitavastatin + ezetimibe) and conventional lipid-lowering therapy (pitavastatin monotherapy) after ACS. For the present analysis, the entire cohort was divided into three groups according to HDL-C levels at 3-month follow-up (Group 1, HDL-C ≤43 mg/dL; Group 2, 43–53.6 mg/dL; Group 3; HDL-C ≥53.6 mg/dL). Baseline characteristics and the incidence of the primary endpoint (a composite of all-cause death, non-fatal myocardial infarction, non-fatal stroke, unstable angina pectoris, or ischemia-driven revascularization) were compared among the three groups. Results The primary endpoint was reported in 34.8%, 30.1%, and 24.6% of patients in Groups 1, 2, and 3, respectively. The incidence of the primary endpoint was significantly higher in Group 1 than in Group 3 (hazard ratio [HR], 1.5; 95% confidence interval [CI], 1.19–1.9; p=0.001). Irrespective of the treatment regimen, Group 1 had a significantly higher rate of the primary endpoint than Group 3 (pitavastatin + ezetimibe therapy: HR, 1.6; 95% CI, 1.12–2.22; p=0.01 and pitavastatin monotherapy: HR, 1.4; 95% CI, 1.05–1.98; p=0.02). These trends remained even after adjustment for baseline characteristics and lipid profiles. Conclusions Lower levels of HDL-C at 3-month follow-up are associated with higher incidence of the cardiovascular events in patients with acute coronary syndrome receiving contemporary lipid-lowering therapy. HDL-C levels and Cardiovascular events Funding Acknowledgement Type of funding source: None

The Effects of Lipid-Lowering Therapy on Serum Eicosapentaenoic Acid to Arachidonic Acid Ratio: An HIJ-PROPER Sub-Analysis

2020 ◽  
Vol 25 (6) ◽  
pp. 548-555
Author(s):  
Hiroyuki Arashi ◽  
Junichi Yamaguchi ◽  
Erisa Kawada-Watanabe ◽  
Hisao Otsuki ◽  
Haruki Sekiguchi ◽  
...  
Keyword(s):  
Arachidonic Acid ◽  
Eicosapentaenoic Acid ◽  
Therapy Group ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Acid Ratio

Background: Controversy remains regarding the influence of lipid-lowering therapy on the eicosapentaenoic acid/arachidonic acid ratio. Objective: This study aimed to clarify the effects of lipid-lowering therapy on the eicosapentaenoic acid/arachidonic acid ratio in patients with acute coronary syndrome (ACS). Methods: This was a post hoc sub-analysis of the Heart Institute of Japan-PRoper level of lipid-lowering with pitavastatin and ezetimibe in ACS study. We compared the eicosapentaenoic acid/arachidonic acid ratio changes from baseline to the 3-month follow-up after contemporary lipid-lowering therapy with pitavastatin + ezetimibe therapy and pitavastatin mono-therapy. Results: Among patients with ACS and dyslipidemia, the eicosapentaenoic acid/arachidonic acid increased significantly in the pitavastatin mono-therapy group (0.40 ± 0.26 to 0.46 ± 0.34, P < .0001) but did not increase in the pitavastatin + ezetimibe group (0.37 ± 0.22 to 0.38 ± 0.27, P = .18). When the analysis was limited to patients who received 2 mg/day of pitavastatin during the follow-up period, these trends in changes of the eicosapentaenoic acid/arachidonic acid ratio remained unchanged. Multivariate analysis showed that ezetimibe use ( P = .005; β = 0.09), ST-elevation myocardial infarction ( P = .04; β = −0.01), and baseline low-density lipoprotein cholesterol (LDL-C) level ( P = .0003; β = 0.12) were independent predictors of the percentage change in the eicosapentaenoic acid/arachidonic acid ratio. These trends were similar even when the analysis was limited to patients who did not take statins at enrollment. Conclusion: Standard lipid-lowering therapy with pitavastatin mono-therapy improved the eicosapentaenoic acid/arachidonic acid ratio for patients with ACS. Intensive lipid-lowering therapy with pitavastatin + ezetimibe did not improve the eicosapentaenoic acid/arachidonic acid ratio, although LDL-C decreased significantly. Inhibition of the improvement in the eicosapentaenoic acid/arachidonic acid ratio by adding ezetimibe may affect cardiovascular disease prognosis.

Abstract 1520: Are Contemporary Patients Hospitalized with Acute Coronary Syndrome Being Discharged on Intensive Lipid Lowering Therapy?: An Analysis Of 22, 807 Hospitalizations In GWTG-CAD

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Prakash C Deedwania ◽  
Gregg C Fonarow ◽  
Christopher P Cannon ◽  
David Dai
Keyword(s):  
Acute Coronary Syndrome ◽  
Intensive Therapy ◽  
Female Gender ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
The Usa ◽  
And Gender ◽  
Get With The Guidelines

Background: Based on the documented benefits of intensive lipid lowering therapy (LLT) with statins in patients with acute coronary syndrome (ACS) guidelines recommend intensive LLT in ACS patients. However, little information is available regarding application of these guidelines in hospitalized ACS patients. Methods: The Get With The Guidelines database was analyzed for all ACS hospitalizations from 07/2005 to 04/2007 at 329 hospitals across the USA of which 277 sites reported the dose of LLT. Intensive LLT was defined as that expected to provide a >50% reduction in LDL: atorvastatin 40/80 mg, rosuvastatin 20/40 mg, simvastatin 80 mg, and any statin combined with ezetimibe. All other LLTs were considered less intensive therapy. Results: Of 60,453 ACS hospitalizations, 84.4% eligible were discharged on LLT. LLT dosing was available in 22,807 (37.7%). Of these patients only 8400 (36.8%) of ACS patients were treated at time of discharge with intensive LLT, whereas 63.2% were discharged on less intensive LLT. Comparison of demographic characteristic and clinical features revealed that older age and female gender were associated with use of less intensive LLT whereas patients undergoing PCI with a stent and history of smoking were more likely to receive intensive LLT. Admission LDL level was modestly predictive of more intensive LLT. Conclusions: In this large cohort of contemporary ACS patients, close to two-thirds of eligible patients were not discharged on intensive LLT. Age and gender appear to be significant contributors to less intensive LLT. These findings emphasize the ongoing need for implementation of current guidelines for intensive LLT in ACS patients.

FEATURES OF THE LIPID SPECTRUM IN PATIENTS WITH ACUTE CORONARY SYNDROME IN THE LONG-TERM PERIOD AFTER CORONARY ARTERY BYPASS GRAFTING

2021 ◽  
pp. 8-12
Author(s):  
М.А. НУРЖАНОВА ◽  
А.Е. ТЕМУРОВА ◽  
Ж.Ш. БАБАК ◽  
Г.Б. БЕКТІБАЙ ◽  
Ш.Б. БАТЫР ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Coronary Artery ◽  
Artery Bypass ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Bypass Grafting ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Lipid Spectrum

В данной статье представлены особенности липидного спектра у пациентов с острым коронарным синдромом в отдаленном периоде после операции коронарного шунтирования (КШ), в сравнении групп с Инфарктом миокарда (ИМ) и Нестабильной стенокардии (НС), а также результаты приверженности к гиполипидемической терапии с особенностями достижения целевых уровней липидного спектра. Полученные результаты представляют, что по липидному спектру группы идентичны между собой и отличаются от нормы, пациенты с низкой приверженности к гиполипидемической терапии и не достигают целевых уровень по холестерин липопротеинов низкой плотности (ХС-ЛПНП) рекомендованным Европейского кардиологического общества (ESC, ЕОК) от 2019г. This article presents the features of the lipid spectrum in patients with acute coronary syndrome in the long-term period after coronary artery bypass grafting (CABG) surgery, in comparison with the groups with myocardial infarction and Unstable angina pectoris, as well as the results of adherence to lipid-lowering therapy with particularities of achieving target levels of the lipid spectrum. The results obtained represent that in terms of the lipid spectrum the groups are identical and differ from the norm, patients with low adherence to lipid-lowering therapy and do not reach the target levels for low-density lipoprotein cholesterol (LDL-C) recommended by the European Society of Cardiology (ESC) from 2019.

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 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

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