Abstract P179: Uncontrolled Cholesterol Levels In Patients With Severe Hypercholesterolemia

Circulation ◽  
2020 ◽  
Vol 141 (Suppl_1) ◽  
Author(s):  
Nicole Groth ◽  
Catherine P Benziger
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Heart Association ◽  
Cross Sectional Study ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cross Sectional ◽  
Lowering Therapy ◽  
Cholesterol Guidelines ◽  
European Society Of Cardiology

Introduction: The 2018 American Heart Association/American College of Cardiology cholesterol guidelines recommends patients who have phenotypic severe hypercholesterolemia (SH), defined as a low-density lipoprotein-cholesterol (LDL-c) > 190 mg/dL, be started on maximally tolerated statin therapy without further risk stratification due to high risk for cardiovascular disease (CVD). SH patients on guideline-directed medical therapy (GDMT) should have 50% reduction in their LDL-c levels, with optimal being < 100 mg/dL for primary prevention and <70 mg/dL for secondary prevention. The 2019 European Society of Cardiology/European Atherosclerosis Society cholesterol guidelines recommend an optimal LDL-c level < 55 mg/dL. Hypothesis: LDL-c levels vary by intensity of medication and are not at target in patients with SH in a large rural healthcare system. Methods: We used an electronic medical record-based SH registry defined by ever having an LDL-c > 190 mg/dL since 01/01/2000 (n=17,925) at Essentia Health (MN, WI, and ND). In this cross-sectional study, patients were excluded if they had: no recent visit within the past 5 years (n=209), <20 or >75 years (n=3,153), listed as being on a statin but intensity was unavailable (n=1,934), or had no recent lab (n=998). Methods: We included 12,283 patients (68.5%)(mean age 59.4 + 10.1 years; 59.5% female) with SH and of these only 22.9% were on a high-intensity statin or proprotein convertase subtilisin/kexin type 9 inhibitor. Of the patients that were not on any lipid-lowering therapy (n=4,971; 40.5%), only 16.8% (n=837) had a statin allergy or intolerance documented. Figure 1 shows the most recent LDL-c levels; <10% of patients in each group had a most-recent LDL-c <70 mg/dL, and 9.4% had an LDL-c <55mg/dL. Conclusions: Most SH patients remain untreated or undertreated with GDMT with recent LDL-c levels above target. More aggressive lipid-lowering therapy in patients with SH is needed to reduce risk of CVD.

scholarly journals CENTRALISED SURVEY ON THE UNDERTREATMENT OF THE HYPERCHOLESTEROLEMIA IN RUSSIA (CEPHEUS)

2013 ◽  
Vol 12 (4) ◽  
pp. 67-74 ◽  
Author(s):  
S. A. Boytsov ◽  
Yu. V. Khomitskaya
Keyword(s):  
Task Force ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cross Sectional ◽  
Start Date ◽  
Lowering Therapy ◽  
European Task ◽  
Lowering Drug

Aim.To assess the percentage of the patients who receive lipid-lowering drug therapy and achieve target levels of low-density lipoprotein cholesterol (LDL–CH), in accordance with the recommendations by the Russian Cardiology Society (RCS) and the 4th Joint European Task Force (4JETF).Material and methods.The CEPHEUS study is a multi-centre, cross-sectional observational study with the participation of Russian patients. The study participants received lipid-lowering therapy for at least 3 months (no dose modification for ≥6 weeks). The start-date and end-date of the study were Oct 22nd 2010 and Mar 22nd 2011, respectively. The cross-sectional data were collected during a single visit to the clinic.Results.The study included 1000 Russian patients. Overall, target LDL–CH levels were achieved in 34,5% (RCS criteria) and 48,2% (4JEFT criteria) of the patients who received lipid-lowering therapy in the routine clinical practice. The patients who were treated for secondary prevention of cardiovascular events (CVE) achieved target levels of LDL–CH more often than the patients treated for primary prevention: 38,2% vs. 27,0%, respectively, by the RCS criteria (odds ratio (OR) 1,67; 95% confidence interval (CI) 1,22–2,28; p=0,001) and 54,5% vs. 35,4%, respectively, by the 4JEFT criteria (OR 2,19; 95% CI 1,63–2,95; p<0,001).Conclusion.Target levels of LDL–CH are achieved by <50% of the Russian patients who receive lipid-lowering treatment. This percentage is even lower in patients receiving lipid-lowering treatment for primary CVE prevention.

scholarly journals An innovative lipid-lowering approach to enhance attainment of low-density lipoprotein cholesterol goals

2020 ◽  
Vol 9 (8) ◽  
pp. 879-887
Author(s):  
Camille Buonvino ◽  
Romain Chopard ◽  
Benoît Guillon ◽  
Etienne Puymirat ◽  
Michel Farnier ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Therapeutic Goals ◽  
Coronary Syndrome ◽  
Lowering Therapy ◽  
Pretreated Patients ◽  
European Society Of Cardiology

Aims To improve attainment of LDL-cholesterol (LDL-c) targets, an expert group proposed an algorithm for lipid-lowering therapy during hospitalization for acute coronary syndrome and during follow-up. We aimed to assess adherence to this algorithm, and evaluate its impact on LDL-c levels and on attainment of therapeutic LDL-c targets in a population of post-acute coronary syndrome patients. Methods and results Prospective, observational study including patients admitted for acute coronary syndrome between February 2017 and September 2018. Patients admitted without statins or ezetimibe were considered ‘naïve’. Baseline LDL-c was admission LDL-c in naïve patients, and for those taking lipid-lowering therapy at admission, baseline LDL-c was back-calculated. In line with the most recent guidelines, the target was a >50% reduction in naïve LDL-c and <55 mg/dL. In total, 270 patients were analysed, mean age 67 ± 12 years, 78% men, 26% diabetic. At admission, 175 (65%) were naïve, 95 (35%) had previous lipid-lowering therapy, of which 13 (5%) statin+ezetimibe. Average LDL-c at admission was 120 ± 47 mg/dL (136 ± 44 mg/dL in naïve, 91 ± 39 mg/dL in pretreated patients). Discharge prescription was in compliance with the algorithm in 204 (76%) patients. Average LDL-c at two months was 57 ± 28 mg/dL; it was <55 mg/dL in 135 (50%), and 178 (66%) achieved a >50% reduction. Overall, 125/270 (46%) achieved the LDL-c goal. The reduction in LDL-c observed at two months persisted at five months. Conclusion Prescription of high-intensity statins, associated with ezetimibe where applicable, achieves LDL-c levels <55 mg/dL in 50% of patients at two months, and attains therapeutic goals defined by the European Society of Cardiology in 46% of cases.

A consensus statement on lipid management after acute coronary syndrome

2016 ◽  
Vol 7 (6) ◽  
pp. 532-543 ◽  
Author(s):  
François Schiele ◽  
Michel Farnier ◽  
Michel Krempf ◽  
Eric Bruckert ◽  
Jean Ferrières ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lipid Management ◽  
Coronary Syndrome ◽  
Dose Adaptation ◽  
Lowering Therapy ◽  
European Society Of Cardiology

In patients admitted for acute coronary syndrome (ACS), the guidelines of the European Society of Cardiology give a Class I, Level A recommendation for the prescription of high-intensity statins to be initiated as early as possible, regardless of the low-density lipoprotein cholesterol (LDL-C) level. Although statins are widely prescribed after ACS, the intensity of therapy and the proportion of patients achieving target LDL-C values are often not in line with recommendations due to a lack of compliance with guidelines by the physicians, a lack of compliance with treatment or poor tolerance by patients, and poor dose adaptation. In this context, a group of French physicians came together to define strategies to facilitate and improve the management of lipid-lowering therapy after ACS. This paper outlines the scientific rationale for the use of statins at the acute phase of ACS, the utility of ezetimibe, the measurement of LDL-C during the course of ACS, the opportunities for detecting familial hypercholesterolaemia and the results of the consensus for the management of lipid-lowering therapy, illustrated in two decision-making algorithms.

scholarly journals U-Shaped Relationship of Low-Density Lipoprotein Cholesterol With Risk of Severe COVID-19 From a Multicenter Pooled Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Jiao Gong ◽  
Yaqiong Chen ◽  
Yusheng Jie ◽  
Mingkai Tan ◽  
Zhaofang Jiang ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Odds Ratios ◽  
Lowering Therapy ◽  
Severe Group

Low-density lipoprotein cholesterol (LDL-C) is a well-known risk factor for coronary heart disease but protects against infection and sepsis. We aimed to disclose the exact association between LDL-C and severe 2019 novel coronavirus disease (COVID-19). Baseline data were retrospectively collected for 601 non-severe COVID-19 patients from two centers in Guangzhou and one center in Shenzhen, and patients on admission were medically observed for at least 15 days to determine the final outcome, including the non-severe group (n = 460) and the severe group (severe and critical cases) (n = 141). Among 601 cases, 76 (12.65%) received lipid-lowering therapy; the proportion of patients taking lipid-lowering drugs in the severe group was higher than that in the non-severe group (22.7 vs. 9.6%). We found a U-shaped association between LDL-C level and risk of severe COVID-19 using restricted cubic splines. Using univariate logistic regression analysis, odds ratios for severe COVID-19 for patients with LDL-C ≤1.6 mmol/L (61.9 mg/dL) and above 3.4 mmol/L (131.4 mg/dL) were 2.29 (95% confidence interval 1.12–4.68; p = 0.023) and 2.02 (1.04–3.94; p = 0.039), respectively, compared to those with LDL-C of 2.81–3.40 mmol/L (108.6–131.4 mg/dL); following multifactorial adjustment, odds ratios were 2.61 (1.07–6.37; p = 0.035) and 2.36 (1.09–5.14; p = 0.030). Similar results were yielded using 0.3 and 0.5 mmol/L categories of LDL-C and sensitivity analyses. Both low and high LDL-C levels were significantly associated with higher risk of severe COVID-19. Although our findings do not necessarily imply causality, they suggest that clinicians should pay more attention to lipid-lowering therapy in COVID-19 patients to improve clinical prognosis.

scholarly journals Application of the 2019 ESC/EAS dyslipidaemia guidelines to nationwide data of patients with a recent myocardial infarction: a simulation study

2020 ◽  
Vol 41 (40) ◽  
pp. 3900-3909 ◽  
Author(s):  
Ali Allahyari ◽  
Tomas Jernberg ◽  
Emil Hagström ◽  
Margrét Leosdottir ◽  
Pia Lundman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Intensity ◽  
Low Density Lipoprotein ◽  
Monte Carlo Model ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Recent Myocardial Infarction ◽  
Lowering Therapy

Abstract Aims To estimate the proportion of patients with a recent myocardial infarction (MI) who would be eligible for additional lipid-lowering therapy according to the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidaemias, and to simulate the effects of expanded lipid-lowering therapy on attainment of the low-density lipoprotein cholesterol (LDL-C) target as recommended by the guidelines. Methods and results Using the nationwide SWEDEHEART register, we included 25 466 patients who had attended a follow-up visit 6–10 weeks after an MI event, 2013–17. While most patients (86.6%) were receiving high-intensity statins, 82.9% of the patients would be eligible for expanded lipid-lowering therapy, as they had not attained the target of an LDL-C level of &lt;1.4 mmol and a ≥50% LDL-C level reduction. When maximized use of high-intensity statins followed by add-on therapy with ezetimibe was simulated using a Monte Carlo model, the LDL-C target was reached in 19.9% using high-intensity statin monotherapy and in another 28.5% with high-intensity statins and ezetimibe, while 50.7% would still be eligible for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. When use of alirocumab or evolocumab was simulated in those who were eligible for PCSK9 inhibitors, around 90% of all patients attained the LDL-C target. Conclusion  Our study suggests that, even with maximized use of high-intensity statins and ezetimibe, around half of patients with MI would be eligible for treatment with PCSK9 inhibitors according to the 2019 ESC/EAS guidelines. Considering the current cost of PCSK9 inhibitors, the financial implications of the new guidelines may be substantial.

scholarly journals GENetic characteristics and REsponse to lipid-lowering therapy in familial hypercholesterolemia: GENRE-FH study

2020 ◽  
Vol 10 (1) ◽  
Author(s):  
Hyoeun Kim ◽  
Chan Joo Lee ◽  
Hayeon Pak ◽  
Doo-Il Kim ◽  
Moo-Yong Rhee ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Genetic Characteristics ◽  
Pathogenic Variants ◽  
Lowering Therapy ◽  
Primary Variable

Abstract Among the 146 patients enrolled in the Korean FH registry, 83 patients who had undergone appropriate LLT escalation and were followed-up for ≥ 6 months were analyzed for pathogenic variants (PVs). The achieved percentage of expected low-density lipoprotein-cholesterol (LDL-C) reduction (primary variable) and achievement rates of LDL-C < 70 mg/dL were assessed. The correlations between the treatment response and the characteristics of PVs, and the weighted 4 SNP-based score were evaluated. The primary variables were significantly lower in the PV-positive patients than in the PV-negative patients (p = 0.007). However, the type of PV did not significantly correlate with the primary variable. The achievement rates of LDL-C < 70 mg/dL was very low, regardless of the PV characteristics. Patients with a higher 4-SNP score showed a lower primary variable (R2 = 0.045, p = 0.048). Among evolocumab users, PV-negative patients or those with only defective PVs revealed higher primary variable, whereas patients with at least one null PV showed lower primary variables. The adjusted response of patients with FH to LLT showed significant associations with PV positivity and 4-SNP score. These results may be helpful in managing FH patients with diverse genetic backgrounds.

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