Abstract 15913: Statin And Ezetimibe in Silent Ambulatory Myocardial Ischemia (SESAMI Trial)

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Waleed Kadro ◽  
Maya Turkmani ◽  
Hussam Rahim ◽  
Oussama Beshir ◽  
Oussama Khatib ◽  
...  
Keyword(s):  
Myocardial Ischemia ◽  
Statin Therapy ◽  
Serum Cholesterol ◽  
Ldl Cholesterol ◽  
Ambulatory Monitoring ◽  
Cholesterol Lowering ◽  
Cholesterol Levels ◽  
St Segment ◽  
Cardiovascular Morbidity And Mortality

Introduction: Cholesterol lowering is associated with a reduction in cardiovascular morbidity and mortality. Statins are the main drugs for cholesterol lowering. Ezetimibe when added to statins gives further reduction in cholesterol but its long-term effect on cardiovascular morbidity and mortality and ischemic events is not known. This study sought to determine whether further cholesterol lowering with ezitimibe will also results in a reduction of myocardial ischemia during daily life. Hypothesis: Further cholestrol with ezetimibe lowering may reduce silent ischemia. Methods: We enrolled 50 patients with proven stable coronary artery disease (CAD) and at least one episode of ST-segment depression on ambulatory ECG monitoring. All of them were receiving optimal therapy for CAD including statin therapy for cholesterol reduction. 25 patients were randomized to continue their statin therapy (Statin only group) and 25 to recieve statin plus Ezitimibe 10mg/day (ezitimibe group). Serum cholesterol and LDL cholesterol levels and ambulatory monitoring were repeated after 4 to 6 months of therapy. The two groups were comparable with respect to baseline characteristics, number of episodes of ST-segment depression, and baseline serum cholesterol levels. Holters were read by a blinded cardiologist. Results: The ezitimibe group had lower mean total and LDL cholesterol levels at study end and experienced a significant reduction in the number of episodes of ST-segment depression compared with the statin only group. ST-segment depression was completely resolved in 13 of 25 patients (52%) in the ezitimibe group versus 3 of 25 (12%) in the statin only group. The ezitimibe group exhibited a highly significant reduction in ambulatory ischemia (P<.001). By logistic regression, treatment with ezitimibe was an independent predictor of ischemia resolution. Conclusions: Further cholesterol lowering with ezitimibe can result in reduction or resolution of myocardial ischemia recorded as episodes of ST-segment depression in ambulatory monitoring of the ECG. A larger study is required to confirm this results. This may be translated into long term mortality reduction for CAD by adding ezetimibe.

Abstract 14994: How Low Should You Go in Secondary Prevention Treatment of LDL Cholesterol: Observational Insights from the Intermountain Heart Collaborative Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Joseph B Muhlestein ◽  
Heidi T May ◽  
Donald L Lappé ◽  
Tami L Bair ◽  
Viet T Le ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Statin Therapy ◽  
Cardiac Death ◽  
Ldl Cholesterol ◽  
Cox Regression ◽  
Collaborative Study ◽  
Cholesterol Levels ◽  
Increased Risk

Introduction: Epidemiologic studies have identified high LDL cholesterol levels as an independent risk factor for cardiovascular (CV) disease, and randomized trials with statin therapy have demonstrated added clinical benefit when LDL levels are reduced to at least 70 mg/dL. However, whether targeting significantly lower secondary prevention LDL levels is beneficial, or perhaps actually may be unsafe, is not known. Methods: Patients undergoing coronary angiography who were documented to have significant (≥50% stenosis) coronary artery disease (CAD), discharged on statin therapy with an LDL level <100 mg/dL and had ≤3y clinical follow-up were studied. Patients were stratified, according to on-statin LDL levels, into ultra low (<40 mg/dL [n=221]), very low (40-69 mg/dL [n=1,684]) and low (70-99 mg/dL [n=3,317]) categories and followed for the long-term endpoints of all-cause death, cardiac death, non-cardiac death, MI, stroke, coronary revascularization (CR) and MACE (death, MI, stroke, CR). Hazard ratios (HRs) comparing the three LDL groups were calculated by Cox regression, adjusting for 17 baseline variables. Results: A total of 5,222 patients (age = 66±12 yrs, men = 72%, hypertension = 69%, diabetes = 30%, smokers = 29%, ACS presentation = 69%) were studied. Follow-up for the ultra low, very low and low LDL categories was 6.1±4.3, 6.4±3.9 and 7.3±4.1 yrs respectively. Event rates and adjusted HRs are shown in the Table. Conclusions: In a large secondary prevention population with significant CAD on statin therapy, treating LDL cholesterol levels to <70 mg/dL compared to 70-99 mg/dL was not associated with superior long-term CV outcomes. From a non-CV standpoint, LDL levels down to 40 mg/dL appeared to be safe, but ultra low LDL levels (<40 mg/dL) were associated with a significantly increased risk of non-CV death. Based on this information, very aggressive secondary prevention treatment of LDL cholesterol to levels below 40 mg/dL may require further study.

The effect of SGLT2 inhibitors on silent myocardial ischemia

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
W Kadro ◽  
M Al Turkmani ◽  
K Kadro ◽  
M.Y Kadro ◽  
D Rigali ◽  
...  
Keyword(s):  
Placebo Group ◽  
Myocardial Ischemia ◽  
Ambulatory Monitoring ◽  
Sglt2 Inhibitors ◽  
Silent Myocardial Ischemia ◽  
Diabetic Patients ◽  
St Segment ◽  
Long Term Mortality

Abstract Background In large cardiovascular (CV) outcome trials, sodium-glucose co-transporter 2 (SGLT2) inhibitors reduced the development of heart failure (HF) in patients with type 2 diabetes (T2DM). Also it reduced CV death and worsening HF events in HFrEF patients. It is unknown whether SGLT2 inhibitors work through glucose-dependent mechanism or it could have other effects not related to glucose on cardiovascular morbidity and mortality in diabetic patients. Its effect on silent ambulatory myocardial ischemia (SAMI) has not been reported yet. In this study we report the effect of SGLT2 inhibitors on (SAMI). Treating silent myocardial ischemia has a prognostic effect and may improve long term mortality of chronic ischemic heart disease (CIHD). Methods We enrolled 44 type 2 diabetic patients with proven stable coronary artery disease (CAD) and at least one episode of on silent ambulatory myocardial ischemia (SAMI) on ambulatory ECG monitoring. All of them were receiving optimal therapy for CIHD and type 2 DM. 22 patients were randomized to receive Dapagliflozin 5mg qd and the other 22 patients received placebo. Ambulatory monitoring was repeated after 4 to 6 months of therapy. The two groups were comparable with respect to baseline characteristics, number of episodes of ST-segment depression, HgbA1c level, and baseline serum cholesterol levels. Holters were read by a blinded cardiologist. Results The Dapagliflozin group experienced a significant reduction in the number of episodes of ST-segment depression compared with the placebo group. ST-segment depression completely resolved in 8 of 22 patients (36%) in the Dapagliflozin group versus 3 of 22 (13%) in the placebo group and the Dapagliflozin group exhibited a highly significant reduction in (SAMI) (P&lt;0.001). By logistic regression, treatment with Dapagliflozin was an independent predictor of (SAMI) resolution. Conclusions Therapy with SGLT2 inhibitors in type2 DM patients results in reduction or resolution of (SAMI) recorded as episodes of ST-segment depression in ambulatory monitoring of the ECG. A larger study is required to confirm this theory and to see the effect of SAMI reduction on long term mortality of CIHD in diabetics. Possible mechanisms for this beneficial effects of SGLT2i includes: Reduction in oxygen supply-demand mismatch, improvement in cardiac microvascular function, modulation of cardiac energy metabolism, reduction in glucotoxicity, reduction in sympathetic nervous system activation and reduction in blood pressure. Funding Acknowledgement Type of funding source: None

Association of a leucine(7)-to-proline(7) polymorphism in the signal peptide of neuropeptide Y with high serum cholesterol and LDL cholesterol levels

10.1038/4027 ◽  
1998 ◽  
Vol 4 (12) ◽  
pp. 1434-1437 ◽  
Author(s):  
Matti K. Karvonen ◽  
Ullamari Pesonen ◽  
Markku Koulu ◽  
Leo Niskanen ◽  
Markku Laakso ◽  
...  
Keyword(s):  
Neuropeptide Y ◽  
Serum Cholesterol ◽  
Signal Peptide ◽  
Ldl Cholesterol ◽  
High Serum ◽  
High Serum Cholesterol ◽  
Cholesterol Levels

Increased Superoxide Anion Production by Platelets in Hypercholesterolemic Patients

2002 ◽  
Vol 87 (05) ◽  
pp. 796-801 ◽  
Author(s):  
Valerio Sanguigni ◽  
Pasquale Pignatelli ◽  
Daniela Caccese ◽  
Fabio Pulcinelli ◽  
Luisa Lenti ◽  
...  
Keyword(s):  
Superoxide Anion ◽  
Ldl Cholesterol ◽  
Experimental Studies ◽  
Human Platelets ◽  
Superoxide Anion Production ◽  
Cholesterol Lowering ◽  
Platelet Production ◽  
Cholesterol Levels ◽  
Anion Production ◽  
O2 Production

SummaryThe purpose of this study was to investigate the relationship between hypercholesterolemia and superoxide anion production.Experimental studies demonstrated that hypercholesterolemia is associated with enhanced cellular superoxide anion (O2 −) production. Aim of the study was to assess whether the same phenomenon occurs in humans.Lipid profile and platelet O2 − production were measured in 28 patients with hypercholesterolemia, compared with 25 age- and sexmatched healthy subjects, and in 21 out of the 28 patients after 8-week treatment with 10 mg/day atorvastatin (a HMGCoA reductase inhibitor). In order to assess the mechanism by which LDL cholesterol interferes with platelet production of O2 −, human platelets were incubated with LDL cholesterol in the presence of either an inhibitor of the phospholipaseA2 enzyme, AACOCF3, or an inhibitor of NADH/NADPH oxidases, DPI.O2 − platelet generation was significantly higher (p <0.001) and significantly related to LDL cholesterol (p < 0.001 ) in patients as compared to controls. 8-week treatment with 10 mg/day atorvastatin significantly reduced both LDL cholesterol and O2 − platelet production. This effect was partially related to the cholesterol-lowering, in that three days of treatment with atorvastatin significantly decreased platelet O2 − production, while no significant change in LDL-cholesterol levels was observed. Platelets incubated with LDL cholesterol showed O2 − release by atorvastatin is partially related to cholesterol lowering effect, suggesting that other mechanisms could be responsible for the antioxidant activity of the drug.

Relationships between the Serum Cholesterol Levels, Production of Monocyte Proinflammatory Cytokines and Long-term Prognosis in Patients with Chronic Heart Failure

2014 ◽  
Vol 53 (21) ◽  
pp. 2415-2424 ◽  
Author(s):  
Akihiro Nakagomi ◽  
Yoshihiko Seino ◽  
Satsuki Noma ◽  
Keiichi Kohashi ◽  
Munenori Kosugi ◽  
...  
Keyword(s):  
Heart Failure ◽  
Chronic Heart Failure ◽  
Serum Cholesterol ◽  
Proinflammatory Cytokines ◽  
Cholesterol Levels ◽  
Long Term Prognosis

Abstract 330: Ezetimibe Prevents Atherogenesis Through Increased Catabolism and Fecal Excretion of LDL-cholesterol and Reduced Atherosclerotic Plaque Inflammation in Apolipoprotein E Knock-out Mice Fed a Paigen Diet

2015 ◽  
Vol 35 (suppl_1) ◽  
Author(s):  
Francois Briand ◽  
Laurent Dumas ◽  
Alexis Broisat ◽  
Mitra Ahmadi ◽  
Sandrine Bacot ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Ldl Cholesterol ◽  
Cholesteryl Oleate ◽  
Fecal Excretion ◽  
Atherosclerotic Plaques ◽  
Knock Out ◽  
Cholesterol Levels ◽  
Paigen Diet ◽  
Apoe Ko Mice ◽  
Fecal Cholesterol

Background: Intestinal cholesterol absorption inhibitor ezetimibe (EZE) added to a statin therapy has demonstrated benefits in the IMPROVE-IT trial by further reducing LDL-cholesterol levels than statin therapy alone. We investigated the mechanisms by which EZE could contribute to cardiovascular events reduction in apolipoprotein E knock-out (apoE ko) mice. Methods: ApoE ko mice were fed a Paigen diet without (control) or with EZE (7mg/kg/day) for 6 weeks. To evaluate the effects of EZE on LDL-cholesterol metabolism and excretion, a first set of mice was injected intravenously with 3 H-cholesteryl oleate labeled human LDL. A second set of mice was used for in vivo SPECT/CT imaging of 99m Tc-cAbVCAM1-5, a single domain antibody directed against the Vascular Cell Adhesion Molecule-1 (VCAM-1), which was used as a marker of inflamed atherosclerotic plaques. The same mice were sacrificed for autoradiography and histology of aortic atherosclerotic plaques. Results: Compared with control, EZE treatment for 6 weeks induced a significant 41% and 65% reduction in plasma total cholesterol levels and atherosclerotic plaque area, respectively. After injection of 3 H-cholesteryl oleate labeled human LDL, mice treated with EZE showed a 173% higher LDL-cholesteryl ester catabolism (p<0.001 vs. control). At time 96 hours after radiolabeled LDL injection, 3 H-tracer hepatic recovery was reduced by 61% with EZE (p<0.001). Meanwhile, LDL-derived 3 H-tracer excretion in the feces was increased by 107% in the fecal cholesterol fraction (p<0.001). Similar trends were observed for hepatic cholesterol levels and fecal cholesterol mass excretion, with a 75% reduction and 99% increase with EZE, respectively (both p<0.001). After intravenous injection of 99m Tc-cAbVCAM1-5, mice treated with EZE also showed a significant 52% reduction in aortic uptake, which was confirmed by significant reduction in tracer uptake in ex vivo biodistribution and autoradiography analysis. Conclusion: EZE promotes anti-atherosclerotic effects through increased LDL-cholesterol catabolism and LDL-derived cholesterol fecal excretion, and reduced inflamed atherosclerotic plaques. These mechanisms may contribute to the benefits of adding EZE to a statin therapy.

scholarly journals Safety and efficacy of a 48-week long-term ingestion of D-allulose in subjects with high LDL cholesterol levels

2020 ◽  
Vol 7 (1) ◽  
pp. 15-31 ◽  
Author(s):  
Misuzu Tanaka ◽  
Akane Kanasaki ◽  
Noriko Hayashi ◽  
Tetsuo Iida ◽  
Koji Murao
Keyword(s):  
Ldl Cholesterol ◽  
Safety And Efficacy ◽  
Cholesterol Levels

P5362Impact of statin therapy on long-term clinical outcomes between STEMI and NSTEMI after stent implantation

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
Y H Kim ◽  
A.-Y Her ◽  
M H Jeong ◽  
B.-K Kim ◽  
S.-Y Lee ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Propensity Score ◽  
Statin Therapy ◽  
Clinical Outcomes ◽  
Stent Implantation ◽  
Cardiac Death ◽  
Hazard Ratio ◽  
St Segment Elevation ◽  
St Segment

Abstract Background Although European guideline recommends that statin should be given to all patients with acute myocardial infarction (AMI), irrespective of cholesterol concentration, limited studies were focused on the long-term effects of statin therapy between ST-segment elevation MI (STEMI) and non-ST-segment elevation MI (NSTEMI). Purpose The authors conducted the study to compare the relative beneficial role of statin on 2-year major clinical outcomes between STEMI and NSTEMI in patients who underwent successful PCI with DES. Methods Finally, a total of 26317 AMI patients who underwent stent implantation and who were prescribed the statin were enrolled and they were separated into two groups; the STEMI group (n=15002) and the NSTEMI group (n=11315). The clinical endpoint was the occurrence of major adverse cardiac events (MACE) defined as all-cause death, recurrent myocardial infarction (re-MI), total coronary revascularization (target lesion revascularization [TLR], target vessel revascularization [TVR], non-TVR) during 2-year follow-up period. Results After propensity score-matched (PSM) analysis, two PSM groups (7746 pairs, n=15492, C-statistic = 0.766) were generated. In the total study population, the cumulative incidences of MACE, all-cause death, and cardiac death were significantly higher in the NSTEMI group. However, after PSM, the cumulative incidence of all-cause death (Hazard ratio, 1.386; 95% CI, 1.133–1.696; p=0.002) was significantly higher in the NSTEMI group. The cumulative incidences of MACE, cardiac death, re-MI, total revascularization, TLR, TVR, and non-TVR were similar between the two groups (Table 1). Outcomes Cumulative Events at 2-year (%) Hazard Ratio (95% CI) p value STEMI NSTEMI Log-rank Propensity score matched patients MACE 532 (7.2) 584 (8.1) 0.092 1.106 (0.984–1.244) 0.092 All-cause death 163 (2.2) 224 (3.1) 0.001 1.386 (1.133–1.696) 0.002 Cardiac death 121 (1.5) 148 (2.0) 0.088 1.232 (0.969–1.566) 0.089 Re-MI 117 (1.6) 107 (1.5) 0.545 0.922 (0.710–1.199) 0.545 Total revascularization 291 (4.1) 307 (4.4) 0.422 1.068 (0.910–1.254) 0.423 TLR 92 (1.3) 89 (1.2) 0.880 0.978 (0.731–1.309) 0.880 TVR 173 (2.4) 184 (2.6) 0.478 1.078 (0.876–1.327) 0.478 Non-TVR 123 (1.7) 130 (1.9) 0.593 1.070 (0.836–1.369) 0.539 Conclusion The mortality reduction capability of statin was more prominent in the STEMI group compared with the NSTEMI group.

MR Aortography and Serum Cholesterol Levels in Patients With Long-Term Nonspecific Lower Back Pain

Spine ◽  
2004 ◽  
Vol 29 (19) ◽  
pp. 2147-2152 ◽  
Author(s):  
Leena I. Kauppila ◽  
Raija Mikkonen ◽  
Pekka Mankinen ◽  
Kia Pelto-Vasenius ◽  
Ilkka Mäenpää
Keyword(s):  
Back Pain ◽  
Serum Cholesterol ◽  
Lower Back Pain ◽  
Cholesterol Levels ◽  
Lower Back
Sign in / Sign up

Export Citation Format

Share Document