Abstract 13249: European and American Blood Cholesterol Guidelines Result in Similar Rates of Statin Recommendations when Applied to a Country with High Cardiovascular Disease Risk

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Ann M Navar-Boggan ◽  
Tomasz Zdrojewski, ◽  
Adam Wyszomirski ◽  
Mateusz Lachacz ◽  
Grzegorz Opolski ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
Statin Therapy ◽  
Blood Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cvd Risk ◽  
European Guidelines ◽  
Lowering Therapy ◽  
Cholesterol Guidelines

Introduction: The American Heart Association and American College of Cardiology (AHA/ACC) recently released updated guidelines for management of blood cholesterol, which differ from current European Society of Cardiology and European Atherosclerosis Society (ESC/EAS) guidelines. How these differences affect the overall number of individuals recommended for statin therapy in a country with high cardiovascular disease (CVD) risk remains unclear. Hypothesis: Due to the lower threshold for statin recommendations for primary prevention based on 10-year CVD risk under the AHA/ACC guidelines, more adults overall would be recommended for statin therapy under American compared to European guidelines. Methods: Using 2011 data from a nationwide cross-sectional survey in Poland (NATPOL), we estimated the number and characteristics of adults aged 40-65 recommended for lipid lowering therapy under the ESC/EAS and AHA/ACC guidelines. The survey sample of 1060 adults represented 13.5 million adults in Poland aged 40-65. Results: Under ESC/EAS guidelines, 47.6% of adults (44.6-50.7%) aged 40-65 were recommended for immediate statin therapy, compared to 49.9% (46.9-52.9%) under AHA/ACC guidelines. Among adults free of cardiovascular disease (CVD), 10.5% had discordant recommendations between guidelines. Individuals recommended for statin therapy under ACC/AHA but not ESC/EAS guidelines had less chronic kidney disease, higher HDL cholesterol, higher 10-year (AHA/ACC calculator) risk, and higher 30-year (Framingham) risk than adults recommended under ESC/EAS but not under ACC/AHA guidelines. Ten-year CVD mortality risk estimated by the SCORE algorithm was similar between the two groups. Conclusions: In spite of differences between current European and American cholesterol guidelines, when applied to a nationwide representative sample from a country with high CVD risk, the number of adults aged 40-65 recommended for cholesterol lowering therapy under each guideline was nearly identical. Although more adults met criteria for primary prevention based on 10-year CVD risk under new American guidelines, the impact of this is offset by additional criteria for statin therapy in current European guidelines.

Abstract 12119: Class I Indication for Statin Therapy in Primary Prevention by Three Cholesterol Guidelines and Prevalence of Coronary Artery Calcium in Asymptomatic Adults: Multi-ethnic Study of Atherosclerosis (MESA)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Peter Flueckiger ◽  
Waqas Qureshi ◽  
Michael Blaha ◽  
Gregory Burke ◽  
Veit Sandfort ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Primary Prevention ◽  
Statin Therapy ◽  
Coronary Artery Calcium ◽  
Predictive Value ◽  
Class I ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Cholesterol Guidelines

Introduction:Statin therapy for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) events provides greater relative risk reduction compared with primary prevention. Coronary artery calcium (CAC) identifies individuals with established but subclinical ASCVD disease. Identifying a population with a higher prevalence of CAC may improve the benefit and efficacy of statin therapy in the primary prevention of ASCVD. We assessed the accuracy of class I statin eligibility criterion for primary prevention by the 2013 ACC/AHA cholesterol guidelines for the presence of CAC and compared it with class I criterion for lipid lowering therapy eligibility by the 2004 NCEP/ATP III and 2011 ESC/EAS cholesterol guidelines. Methods:4723 out of the 6814 total participants not taken statins during the baseline exam and with complete data including CAC were included in analysis. We evaluated the sensitivity (SN), specificity (SP), positive predictive value (PPV), negative predictive value (NPV) of class I recommendation for lipid lowering therapy (high risk designation) by the three cholesterol guidelines for three categories of prevalent CAC [CAC present/absent; CAC ≥ 100; CAC ≥300 Agatston] in participants of the Multi Ethnic Study of Atherosclerosis (MESA) Results:Mean age 59±9 years, 47% male, 37% white, 28% black, 23% Hispanic, 12% Asian, 7.5% with diabetes, 35% current/former smokers, mean glomerular filtration rate of 83±18 ml/min and mean BMI of 28±6 kg/m2. 1978(41.9%), 816(17.3%) and 392(8.3%) had CAC present, CAC ≥100 and CAC ≥300 respectively. Table 1 shows the results. Conclusions:The SN, SP, PPV and NPV of class I statin eligibility criteria by the 3 guidelines for subclinical ASCVD depends significantly on the definition of CAC. The 2013 ACC/AHA class I statin eligibility has a higher SN, lower SP, and higher NPV when compared with the 2004 NCEP/ATP III and 2011 ESC/EAS class I criterion for statin therapy across all three CAC categories.

Atherosclerotic Cardiovascular Risk in Adult Patients with Hemophilia: What We Can Do to Reduce Risk of Cardiovascular Events? Implementation of 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol in Patients with Hemophilia

Blood ◽  
2015 ◽  
Vol 126 (23) ◽  
pp. 4687-4687
Author(s):  
Kamila Izabela Cisak ◽  
Jianmin Pan ◽  
Shesh Nath Rai ◽  
Patricia Ashby ◽  
Vivek R. Sharma
Keyword(s):  
Cardiovascular Disease ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Events ◽  
Blood Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Artery Disease

Abstract Introduction Hemophilia A and B are genetic disorders characterized by deficiency of clotting factors resulting in delayed bleeding. Despite hypocoagulable state, patients with hemophilia are prone to developing coronary artery disease or its equivalents. It is known that proper treatment of dyslipidemia has relevant impact of atherosclerotic cardiovascular events reduction. The goal of our study was to determine implementation of newest 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol in our patients with hemophilia and assess how many more patients currently may require lipid-lowering therapy. Methods We performed retrospective chart review of patients followed at single hemophilia treatment center in United States. We included 30 patients with factor VIII or IX deficiency, age 30 and older, followed in clinic between 2005 and 2014 with available lipid profile results. Patients with acquired hemophilia were excluded from study. We used stepwise approach proposed by above guidelines and divided patients into four groups. Results 4 patients among 30 were already on lipid lowering therapy. 1 (3.3%) additional patient [95% CI 0.001-0.17] required lipid lowering therapy due to presence of clinical atherosclerotic cardiovascular disease (group 1), 0 patients had LDL-C at least 190 mg/dl (group 2), 2 (6.7%) additional patients [95% CI 0.008-0.21] required therapy due to presence of diabetes mellitus and 40 to 75 year of age and LDL-C levels of 70 to 189 mg/dl (group 3); 9 (30%) additional patients [95% CI 0.17-0.51] should receive therapy due to age 40 to 75 and estimated 10-year ASCVD risk above 7.5%. We had total 12 (40%) additional patients among 30 with known lipid profile who were not on lipid lowering therapy but who require such therapy based on the latest 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol. Conclusion Aggressive cardiovascular risk factor modifications play a significant role in prevention of coronary artery disease, stroke and peripheral vascular disease. This may be even more relevant in patients with hemophilia who have an increased baseline risk of bleeding and may therefore be at greater risk of complications from anti-thrombotic therapies used for treating cardiovascular disease. Above results suggest that according to actual 2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol, a significant number of patients with hemophilia may require lipid lowering therapy. It is important for hemophilia treatment centers to screen their patients with regard to this since many of them may either not have primary care physicians or may not be perceived as having high risk for cardiovascular disease due to their bleeding disorder. Disclosures No relevant conflicts of interest to declare.

scholarly journals Cardiovascular risk factors and COVID-19 outcomes in hospitalised patients: a prospective cohort study

BMJ Open ◽  
2021 ◽  
Vol 11 (2) ◽  
pp. e045482
Author(s):  
Didier Collard ◽  
Nick S Nurmohamed ◽  
Yannick Kaiser ◽  
Laurens F Reeskamp ◽  
Tom Dormans ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cox Regression ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cvd Risk Factors ◽  
Cvd Risk ◽  
Icu Admission ◽  
Lowering Therapy ◽  
Secondary Outcomes ◽  
Age And Sex

ObjectivesRecent reports suggest a high prevalence of hypertension and diabetes in COVID-19 patients, but the role of cardiovascular disease (CVD) risk factors in the clinical course of COVID-19 is unknown. We evaluated the time-to-event relationship between hypertension, dyslipidaemia, diabetes and COVID-19 outcomes.DesignWe analysed data from the prospective Dutch CovidPredict cohort, an ongoing prospective study of patients admitted for COVID-19 infection.SettingPatients from eight participating hospitals, including two university hospitals from the CovidPredict cohort were included.ParticipantsAdmitted, adult patients with a positive COVID-19 PCR or high suspicion based on CT-imaging of the thorax. Patients were followed for major outcomes during the hospitalisation. CVD risk factors were established via home medication lists and divided in antihypertensives, lipid-lowering therapy and antidiabetics.Primary and secondary outcomes measuresThe primary outcome was mortality during the first 21 days following admission, secondary outcomes consisted of intensive care unit (ICU) admission and ICU mortality. Kaplan-Meier and Cox regression analyses were used to determine the association with CVD risk factors.ResultsWe included 1604 patients with a mean age of 66±15 of whom 60.5% were men. Antihypertensives, lipid-lowering therapy and antidiabetics were used by 45%, 34.7% and 22.1% of patients. After 21-days of follow-up; 19.2% of the patients had died or were discharged for palliative care. Cox regression analysis after adjustment for age and sex showed that the presence of ≥2 risk factors was associated with increased mortality risk (HR 1.52, 95% CI 1.15 to 2.02), but not with ICU admission. Moreover, the use of ≥2 antidiabetics and ≥2 antihypertensives was associated with mortality independent of age and sex with HRs of, respectively, 2.09 (95% CI 1.55 to 2.80) and 1.46 (95% CI 1.11 to 1.91).ConclusionsThe accumulation of hypertension, dyslipidaemia and diabetes leads to a stepwise increased risk for short-term mortality in hospitalised COVID-19 patients independent of age and sex. Further studies investigating how these risk factors disproportionately affect COVID-19 patients are warranted.

Standard and intensive lipid-lowering therapy with statins for the primary prevention of vascular diseases: a population-based study

2013 ◽  
Vol 70 (1) ◽  
pp. 99-108 ◽  
Author(s):  
D. Macías Saint-Gerons ◽  
C. de la Fuente Honrubia ◽  
D. Montero Corominas ◽  
M. J. Gil ◽  
F. de Andrés-Trelles ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Vascular Diseases ◽  
Population Based ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Population Based Study ◽  
Lowering Therapy

Abstract P199: Mean Lipoprotein Levels and Composition in South Asian-Americans Compared to the US Population

Circulation ◽  
2012 ◽  
Vol 125 (suppl_10) ◽  
Author(s):  
Elena Flowers ◽  
Cesar Molina ◽  
Ashish Mathur ◽  
Bradley Aouizerat ◽  
Mintu Turakhia
Keyword(s):  
South Asian ◽  
South Asians ◽  
Low Density Lipoproteins ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Cvd Risk ◽  
South Asian Americans ◽  
Lowering Therapy ◽  
The Us

Background South Asians have increased disk for cardiovascular disease (CVD) that is not captured by traditional risk factors, including TC and LDL-c. Low-density apolipoprotein-B (apoB) containing lipoproteins are heterogeneous in size and composition, and the particles with the greatest triglyceride content are thought to ultimately be the most atherogenic. Specific composition of low-density lipoproteins is not captured by common lipid measures (i.e. TC, LDL-c). A high proportion of triglyceride-rich low-density lipoproteins could be a mechanism for CVD risk in South Asians. Our objective was to compare mean TC, LDL-c, HDL-c, triglycerides, and apoB-triglyceride ratio (an estimate of low-density lipoprotein content) between South Asian-Americans and the US population. Methods We studied 2,876 South Asian adults living in the United States participating in a wellness program. Demographics were obtained by self-report. Lipoprotein levels were measured after 10-hour fast. US population means were calculated from NHANES (2007-2008, n = 5,113). Individuals on lipid-lowering therapy were excluded (780 (33%) South Asians, 1,194 (19%) NHANES). Results LDL-c (118mg/dL vs 116mg/dL, p<0.05) and triglycerides (139mg/dL vs 131 mg/dL, p<0.05) were higher in South Asians than the US population, whereas TC was lower (192mg/dL vs 197 mg/dL, p<0.05). HDL-c was lower in South Asians (46mg/dL vs 52mg/dL, p<0.05). ApoB was not statistically significantly different (93mg/dL vs 92mg/dL, p = 0.1), however the apoB/triglyceride ratio was lower in South Asians (0.8 vs 0.9, p<0.05). After stratifying for age by decade and gender, we found that South Asians have lower HDL-c until the age of 50, and lower apoB/triglyceride ratio until the age of 60, with no substantial differences between men and women. Conclusions Mean TC, LDL-c, and triglycerides were normal in South Asians, however the apoB/triglyceride ratio was lower in South Asians than in the US population. This finding indicates that a higher proportion of low-density lipoproteins in South Asians are of the triglyceride-rich atherogenic type. This may portend non-HDL-c as a better indicator of CVD risk than LDL-c in South Asians. Further, low apoB/triglyceride ratio and low HDL-c occurs at a young age in South Asians, suggesting that onset of risk is early. The disappearance of these patterns after age 60 may be the result of sample bias (excluding individuals on lipid lowering therapy), and/or survival bias.

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