Abstract P320: Gender Disparities in Low Density Lipoprotein (LDL) Control for Secondary Prevention Among Patients with Coronary Heart Disease (CHD): Does Having a Caregiver Matter?

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Gmerice Hammond ◽  
Heidi Mochari-Greenberger ◽  
Ming Liao ◽  
Lori Mosca
Keyword(s):  
Secondary Prevention ◽  
Gender Gap ◽  
Medical Center ◽  
Academic Medical Center ◽  
Density Lipoprotein ◽  
Gender Disparities ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Multivariable Adjustment ◽  
Statin Use

Background: Despite the proven benefits of lipid lowering therapy for the prevention of recurrent CHD, research has consistently shown that women are less likely than men to be at established LDL targets. The reasons for the gender gap remain elusive. The purpose of this study was to test the hypothesis that having a caregiver is independently associated with adherence to Adult Treatment Panel (ATP) III LDL goals for secondary prevention, and to determine if the association varies by gender. Methods: We studied 2190 consecutive patients admitted to the cardiac service of an academic medical center as part of the NHLBI sponsored Family Cardiac Caregiver Investigation To Evaluate Outcomes (FIT-O) Study (93% participation rate). Patients with CHD or equivalent, and a documented LDL within 12 months of admission were included in this analysis (58% white, 66% male, mean age 67 yrs). Caregiver status was assessed by a standardized interviewer-assisted questionnaire and was classified as either paid (nurse/home aide) or informal (family member/friend). Lipid levels and statin use were obtained from a hospital-based informatics system and medical chart review. ATP III targets were classified as target (LDL<100 mg/dL) and aggressive target (LDL<70 mg/dL). The associations between caregiving and LDL were assessed using chi square statistics, overall and stratified by gender. Multivariable regression was used to adjust for confounders (age, marital status, race, gender, health insurance, statin use, comorbidities). Results: Males with CHD were more likely than females with CHD to be at target LDL <100 [79% (1149/1446) vs 69% (515/744) respectively; p=0.0001], and at LDL<70 [48% (688/1446) vs 36% (271/744); p<0.0001]. The prevalence of caregiving overall was 40% (N= 879/2190; 13% paid; 27% informal only), and did not differ by gender. Having an informal caregiver was significantly associated with LDL<70 (OR=1.35; 95%CI=1.07-1.70), and this remained significant after multivariable adjustment for confounders (OR=1.25; 95% CI=1.00-1.56). The association between caregiving and LDL<100 did not reach significance (OR=1.20; 95% CI=0.95-1.51). In stratified analysis, men with an informal caregiver were more likely than men without a caregiver to have an LDL<70 (OR=1.35; 95%CI=1.07-1.70); this remained significant after multivariable adjustment for confounders, including statin use (OR=1.37; 95%CI=1.04-1.80). The relation between caregiving and LDL control was not significant among women. Conclusion: Men with CHD were more likely to be at ATP III targets LDL <70 and <100 mg/dL than women with CHD. Having an informal caregiver was a significant predictor of being at aggressive target LDL <70mg/dL among men but not among women, even after adjustment for confounders. The potential role of caregiving as a novel contributor to gender disparities in LDL control deserves further study.

scholarly journals Utilization and adherence to guideline-recommended lipid-lowering therapy at an academic medical center

2017 ◽  
Vol 37 (4) ◽  
pp. 276-281 ◽  
Author(s):  
Khalid A. Alburikan ◽  
Rayah M. Asiri ◽  
Abduallah M. Alhammad ◽  
Amer A. Abuelizz ◽  
Ghada A. Bawazeer ◽  
...  
Keyword(s):  
Medical Center ◽  
Academic Medical Center ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Academic Medical

scholarly journals Improved Triglycerides and Insulin Sensitivity with 3 Months of Acipimox in Human Immunodeficiency Virus-infected Patients with Hypertriglyceridemia

2006 ◽  
Vol 91 (11) ◽  
pp. 4438-4444 ◽  
Author(s):  
Colleen Hadigan ◽  
James Liebau ◽  
Martin Torriani ◽  
Rebecca Andersen ◽  
Steven Grinspoon
Keyword(s):  
Insulin Sensitivity ◽  
Medical Center ◽  
Controlled Trial ◽  
Academic Medical Center ◽  
Fat Distribution ◽  
Lipid Lowering ◽  
Secondary Outcome ◽  
Outcome Variable ◽  
Lipid Lowering Therapy ◽  
Men And Women

Abstract Context: Metabolic abnormalities such as hypertriglyceridemia remain a challenge for optimizing long-term health in HIV-infected patients. Objective: Elevation of free fatty acids (FFAs) may contribute to hyperlipidemia and insulin resistance in HIV. We evaluated the efficacy and safety of chronic inhibition of lipolysis in HIV-infected men and women with hypertrigyceridemia. We hypothesized that acipimox would lead to significant reductions in triglycerides and improved insulin sensitivity, compared with placebo. Design: A 3-month, randomized, double-blind, controlled trial of acipimox (250 mg thrice daily) vs. placebo was conducted in 23 HIV-infected men and women with hypertriglyceridemia (&gt;150 mg/dl), abnormal fat distribution, and no current lipid-lowering therapy. The primary outcome variable was triglyceride concentration, and insulin sensitivity measured by hyperinsulinemic euglycemic clamp was a secondary outcome. Setting: The study was conducted at an academic medical center. Results: Acipimox resulted in significant reductions in FFAs [mean change −0.38 (0.06) vs. 0.08 (0.06) mEq/liter with placebo, −68 vs. +17% change from mean baseline, P &lt; 0.0001], decreased rates of lipolysis (P &lt; 0.0001), and a median triglyceride decrease from 238 mg/dl at baseline to 190 mg/dl, compared with an increase from 290 to 348 mg/dl in the placebo group (P = 0.01). Acipimox improved insulin sensitivity [acipimox +2.31 (0.74) vs. placebo −0.21 (0.90) mg glucose per kilogram lean body mass per minute, or +31 vs. −2% change from mean baseline values, P = 0.04]. Improvements in insulin sensitivity were significantly correlated with reductions in FFAs (r = −0.62, P = 0.003) and lipolysis (r = −0.59, P = 0.005). Conclusions: Acipimox resulted in significant sustained reductions in lipolysis, improved glucose homeostasis, and significant but modest reductions in triglycerides in HIV-infected individuals with abnormal fat distribution and hypertriglyceridemia. Improvement in overall metabolic profile with acipimox suggests a potential clinical utility for this agent that requires further investigation.

Development of a Pharmacist-Managed Lipid Clinic

2002 ◽  
Vol 36 (5) ◽  
pp. 892-904 ◽  
Author(s):  
Margaret A Cording ◽  
Emily B Engelbrecht-Zadvorny ◽  
B Jill Pettit ◽  
John H Eastham ◽  
Rheta Sandoval
Keyword(s):  
Primary Care ◽  
Medical Center ◽  
Treatment Algorithm ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Medical Clinic ◽  
Lipid Clinic ◽  
Lipid Panel ◽  
Intermediate Outcomes

OBJECTIVE: To describe the development of a pharmacist-managed lipid clinic within a primary care medical clinic and review its results after approximately 12 months of operation. METHODS: A pharmacist-managed lipid clinic was developed at Naval Medical Center San Diego. Administrative background, treatment algorithm development, operational issues, clinical activities, and barriers to the clinic are discussed. For intermediate outcomes, data from patients who had at least 1 intervention by the pharmacist and 1 follow-up lipid panel were analyzed for medication use, changes in lipid parameters, and percent reaching the low-density-lipoprotein (LDL) target goal. Modified National Cholesterol Education Program — Adult Treatment Panel II guidelines were used to determine the LDL goal. RESULTS: Following approximately 12 months of operation, the clinic received 204 referrals and consisted of 146 active patients. A brief study was conducted to assess clinical outcomes. Of 115 patients who were seen in the clinic and met inclusion criteria, 57% were receiving treatment with a hydroxymethylglutaryl coenzyme A reductase inhibitor (statin) and 17% were receiving fibrates; 17% of the patients were not receiving lipid-lowering medications. Relative to baseline, LDL cholesterol concentrations decreased 20%, high-density-lipoprotein cholesterol increased 11%, and triglycerides decreased 19%. Overall, LDL goals were reached in 77% of the patients. LDL goals were attained by 63%, 79%, and 93% of patients with targets of <100, <130, and <160 mg/dL, respectively. Results are compared with other studies regarding lipid goal attainment. CONCLUSIONS: A pharmacist-managed lipid clinic can be developed and integrated into a primary care medical clinic. Pharmacists can effectively manage lipid-lowering therapy, helping to achieve LDL goals.

scholarly journals Age and gender disparities in the prevalence of lipitension

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
Y U Grinshtein ◽  
R Ruf ◽  
V Shabalin
Keyword(s):  
Blood Pressure ◽  
Density Lipoprotein ◽  
Gender Disparities ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Krasnoyarsk Krai ◽  
Age Group ◽  
Age And Gender ◽  
Lipoprotein Level ◽  
And Gender

Abstract Introduction Lipitension is the presence of hypertension and dyslipidaemia in one person. It multiplies cardiovascular risk up to three-fold and therefore requires timely diagnosing and treatment. Purpose In the present study, we calculated the prevalence of lipitension and its disparities depending on gender and age. Methods We used the randomized sample of the ESSE-RF study that included 1603 urban and rural Krasnoyarsk Krai inhabitants aged 25–64. Each study participant signed informed consent and underwent the questionnaire, office blood pressure measurement, anthropometry, and biochemical blood analysis. Hypertension criteria were the measured systolic blood pressure at 140 mm Hg or higher, the measured diastolic blood pressure at 90 mm Hg or higher, or antihypertensive medications intake. Dyslipidaemia criteria were the total cholesterol level higher than 5.0 mmol/l, the low-density lipoprotein level higher than 3.0 mmol/l, the high-density lipoprotein level lower than 1.0 mmol/l in males and 1.2 mmol/l in females, or triglycerides level higher than 1.7 mmol/l. Results In 40.0% of people, we found a combination of at least one hypertension criterion and at least one dyslipidaemia criterion. The prevalence of lipitension significantly (chi-square for trend; p&lt;0.001) increased from 10.7% in the 25–34 age group to 66.6% in the 55–64 age group. At a younger age, males had dyslipidaemia more frequently than females, while at 55–64, the prevalence of lipitension was higher in females. The details of age and gender disparities are shown in Table 1. Conclusion At least 40% of the general population and two-thirds of people older than 55 have lipitension and need a combined antihypertensive and lipid-lowering therapy. FUNDunding Acknowledgement Type of funding sources: None. Table 1

scholarly journals Alirocumab Administration Experience to Achieve Low Density Lipoprotein Cholesterol Target Levels in Secondary Prevention of Cardiovascular Disease

2020 ◽  
Vol 16 (1) ◽  
pp. 33-39
Author(s):  
A. E. Nikitin ◽  
E. E. Averin ◽  
D. E. Rozhkov ◽  
A. V. Sozykin ◽  
G. A. Procenko
Keyword(s):  
Secondary Prevention ◽  
Initial Level ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Pcsk9 Inhibitor ◽  
Lowering Therapy

Aim. To study the effects of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, alirocumab, on lipid levels in patients who receive secondary prevention of cardiovascular diseases (CVD) and require enhanced lipid-lowering therapy.Material and methods. The study included 49 patients (aged of 61.53±1.14 years; 31 [63.3%] men) receiving alirocumab who did not reach the target low density lipoprotein cholesterol (LDL-C) concentrations despite the ongoing optimal lipid-lowering therapy. In all patients, the initial level of lipids was evaluated, as well as their parameters after subsequent alirocumab injections.Results. LDL-C serum level significantly decreased after the first injection compared to the initial level from 2.92±0.22 to 1.65±0.19 mmol/L (p<0.001; Δ45.31±3.61%) and down to 1.74±0.17 mmol/L for the entire study period (p<0.001; Δ41.52±2.69%). The change in LDL-C level between injections did not show statistically significant differences (p=0.141). A direct strong statistically significant correlation between the LDL-C level after the first injection and its average values for the entire observation period was found (r=0.958, p<0.001).Conclusion. The results of the study indicate that the PCSK9 inhibitor, alirocumab, in patients who need secondary prevention of CVD shows a significant additional decrease in the concentration of LDL-C after the first injection. At the same time, approximately half of the patients were able to achieve the recommended levels of LDL-C. The persistence of the achieved low LDL-C levels over time demonstrated that the average concentration of LDL-C during the observation corresponded to the values after the first injection. This finding shows that there is no need for constant monitoring of lipid metabolism parameters when prescribing such therapy.

scholarly journals Lipid Management in Patients Presenting With Acute Coronary Syndromes: A Review

2020 ◽  
Vol 9 (24) ◽  
Author(s):  
Bimmer E. Claessen ◽  
Paul Guedeney ◽  
C. Michael Gibson ◽  
Dominick J. Angiolillo ◽  
Davide Cao ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Lipid Management ◽  
Current State

Abstract Despite many improvements in its prevention and management, acute coronary syndrome (ACS) remains a major cause of morbidity and mortality in the developed world. Lipid management is an important part of secondary prevention after ACS, but many patients currently remain undertreated and do not attain guideline‐recommended levels of low‐density lipoprotein cholesterol reduction. This review details the current state of evidence on lipid management in patients presenting with ACS, provides directions for identification of patients who may benefit from early escalation of lipid‐lowering therapy, and discusses novel lipid‐lowering medication that is currently under investigation in clinical trials. Moreover, a treatment algorithm aimed at attaining guideline‐recommended low‐density lipoprotein cholesterol levels is proposed. Despite important advances in the initial treatment and secondary prevention of ACS, ≈20% of ACS survivors experience a subsequent ischemic cardiovascular event within 24 months, and 5‐year mortality ranges from 19% to 22%. Knowledge of the current state of evidence‐based lipid management after ACS is of paramount importance to improve outcomes after ACS.

scholarly journals Different perspectives of patients and physicians on LDL-C target achievement in the treatment of hypercholesterolemia: results on secondary prevention from the German PROCYON survey

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
O Weingaertner ◽  
L Beier ◽  
K Stein
Keyword(s):  
Secondary Prevention ◽  
Online Survey ◽  
Patient Adherence ◽  
Patient Activation ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Private Company ◽  
Lipid Lowering Drugs ◽  
Adherence To Medication

Abstract Background Lowering low-density lipoprotein cholesterol (LDL-C) in hypercholesterolemia patients at very high cardiovascular (CV) risk is essential in preventing future CV events. However, LDL-C targets often remain unattained. Purpose The purpose of the present survey was to identify possible reasons for insufficient LDL-C target achievement despite the availability of efficacious lipid lowering drugs in the clinical setting of hypercholesterolemia management in secondary prevention patients in Germany. Methods PROCYON was an online survey with over 5,000 participants on disease perception, awareness, burden, and management of hypercholesterolemia consisting of a patient survey (PROCYON A) and a healthcare practitioner (HCP) survey (PROCYON B). To quantify patient self-activation, the PAM-13 Patient Activation Measure by Insignia Health was incorporated. Results on 1,696 patients in secondary prevention are presented. Results Most post-CV event patients do not achieve their LDL-C target. HCPs assume patients' poor adherence to medication and lifestyle adaptions to be the most important reason (Figure 1). However, this contradicts the patients' perception. Accordingly, 87% of the patients are on a lipid lowering therapy and 81% of them have stated to take their medication regularly. They rank their medication for LDL-C reduction as equally important as that for other diseases. In contrast, HCPs think that 46% of their patients do not take hypercholesterolemia seriously. However, HCPs also believe, that LDL target attainment is still “important” or “very important” to 81% of their patients. This is in line with the patients' perception: 84% of the patients consider reaching their target as “important” or “very important”. PAM-13 results underline these results: 60% of the patients are already activated and want to gain control over their disease (PAM-13 level 3 of 4) and 12% reach highest self-activation levels (level 4 of 4). The HCP remains the major source of information for 77% of the patients and only 42% reach out for online resources. The importance of educating patients on adherence is acknowledged by all HCPs. Therefore, 71% express their desire of educational material. With respect to LDL-C levels, 49% of the patients reported no improvement. Of the patients under treatment without LDL-C improvement, only 23% take more than one drug, and 47% reported a change of dose. Furthermore, collaboration between GPs and specialists (cardiologists, diabetologists, lipidologists) was not evident. Conclusion Although secondary prevention patients are motivated to pursue their LDL-C targets, HCPs consider patient adherence as major reason for failure. Instead, the survey indicated that therapeutic strategies are not fully exhausted and there is space for treatment improvement either by dose escalation or addition of further lipid lowering drugs. Furthermore, patient education and specialist collaboration could improve patient management. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Novartis Pharma GmbH Figure 1

Structure and Function of Proprotein Convertase Subtilisin/kexin Type 9 (PCSK9) in Hyperlipidemia and Atherosclerosis

2019 ◽  
Vol 20 (10) ◽  
pp. 1029-1040 ◽  
Author(s):  
Xinjie Lu
Keyword(s):  
Low Density Lipoprotein ◽  
Ldl Receptor ◽  
Density Lipoprotein ◽  
Structure And Function ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Proprotein Convertase ◽  
Novel Target ◽  
New Treatments ◽  
And Function

Background:One of the important factors in Low-Density Lipoprotein (LDL) metabolism is the LDL receptor (LDLR) by its capacity to bind and subsequently clear cholesterol derived from LDL (LDL-C) in the circulation. Proprotein Convertase Subtilisin-like Kexin type 9 (PCSK9) is a newly discovered serine protease that destroys LDLR in the liver and thereby controls the levels of LDL in plasma. Inhibition of PCSK9-mediated degradation of LDLR has, therefore, become a novel target for lipid-lowering therapy.Methods:We review the current understanding of the structure and function of PCSK9 as well as its implications for the treatment of hyperlipidemia and atherosclerosis.Results:New treatments such as monoclonal antibodies against PCSK9 may be useful agents to lower plasma levels of LDL and hence prevent atherosclerosis.Conclusion:PCSK9's mechanism of action is not yet fully clarified. However, treatments that target PCSK9 have shown striking early efficacy and promise to improve the lives of countless patients with hyperlipidemia and atherosclerosis.

Efficacy and Safety of Evolocumab in Reducing Low Density Lipoprotein Cholesterol Levels in Chinese Patients with Non-ST-segment Elevation Acute Coronary Syndrome

2020 ◽  
Vol 18 ◽  
Author(s):  
Xiaohan Xu ◽  
Meng Chai ◽  
Yujing Cheng ◽  
Pingan Peng ◽  
Xiaoli Liu ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Chinese Patients ◽  
Lipid Lowering ◽  
Control Group ◽  
Lipid Lowering Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aims: To explore early intensive lipid-lowering therapy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Background: Lowering low-density lipoprotein cholesterol (LDL-C) levels can reduce cardiovascular morbidity and mortality in patients with atherosclerotic cardiovascular disease. Due to many reasons, the need for early intensive lipid-lowering therapy is far from being met in Chinese NSTE-ACS patients at high-risk of recurrent ischaemic events. Objective: To evaluate the feasibility, safety and efficacy of starting evolocumab in hospital to lower LDL-C levels in Chinese patients with NSTE-ACS. Methods: In this prospective cohort study initiated by researchers, 334 consecutive patients with NSTE-ACS who had sub-standard LDL-C levels (LDL-C ≥2.3 mmol/L after regular oral statin treatment for at least 4 weeks; or LDL-C ≥3.2 mmol/L without regular oral statin treatment) were included. Patients who agreed to treatment with evolocumab (140 mg subcutaneously every 2 weeks, initiated in hospital and used for 12 weeks after discharge) were enrolled in the evolocumab group (n=96) and others in the control group (n=238). All enrolled patients received regular statin treatment (atorvastatin 20 mg/day or rosuvastatin 10 mg/day; doses unchanged throughout the study).The primary endpoint was the change in LDL-C levels from baseline to week 12. Results: Most patients (67.1%) had not received regular statin treatment before. In the evolocumab group, LDL-C levels decreased significantly at week 4 and remained stable at week 8 and 12 (all p<0.001). At week 12, the LDL-C percentage change from baseline in the evolocumab group was -79.2±12.7% (from an average of 3.7 to 0.7 mmol/L), while in the control group it was -37.4±15.4% (from an average of 3.3 to 2.0 mmol/L). The mean difference between these 2 groups was -41.8% (95% CI -45.0 to -38.5%; p<0.001). At week 12, the proportions of patients with LDL-C levels <1.8 mmol/L and 1.4 mmol/L in the evolocumab group were significantly higher than in the control group (96.8 vs 36.1%; 90.6 vs 7.1%; both p<0.001). The incidence of adverse events and cardiovascular events was similar in both groups. Conclusions: In this prospective cohort study we evaluated the early initiation of evolocumab in NSTE-ACS patients in China. Evolocumab combined with statins significantly lowered LDL-C levels and increased the probability of achieving recommended LDL-C levels, with satisfactory safety and well tolerance.

Evaluation on the compliance with secondary prevention and influence factors of ischemic stroke in Hainan province, China

Vascular ◽  
2013 ◽  
Vol 22 (3) ◽  
pp. 181-187 ◽  
Author(s):  
Qingjie Su ◽  
Kunxiong Yuan ◽  
Faqing Long ◽  
Zhongqin Wan ◽  
Chaoyun Li ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Health Education ◽  
Secondary Prevention ◽  
Antiplatelet Therapy ◽  
Influence Factors ◽  
Significant Risk ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Logistic Regression Models ◽  
Prevention Therapy

Survivors of ischemic stroke are still at a significant risk for recurrence. Numerous effective strategies for the secondary prevention of ischemic stroke have now been established; however, these guidelines are not widely known. In this retrospective, a multicenter study was conducted from January 2011 to February 2012 in 10 general hospitals, which included 1300 elderly patients who had previously been diagnosed with ischemic stroke and re-admitted to hospitals. Logistic regression models were fitted to determine the relationship between compliance with secondary prevention therapy and each variable of interest. The treatment rates of antihypertensive, antiplatelet and lipid-lowering therapy were only 56.3%, 48.9% and 19.6%, respectively. Multivariate analysis presented that cardiovascular risk factors would motivate patients with hypertension and hyperlipidemia to receive corresponding treatments. However, it is worth noting that they did not influence the use of antiplatelet therapy. In addition, high education, health education and insurance promote the use of secondary prevention in patients. In conclusion, the importance of antiplatelet therapy should not be ignored any more. Besides, health education will raise patients’ attention to ischemic stroke.

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