scholarly journals Main differences between two highly effective lipid-lowering therapies in subclasses of lipoproteins in patients with acute myocardial infarction

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Leticia C. S. Pinto ◽  
Ana P. Q. Mello ◽  
Maria C. O. Izar ◽  
Nagila R. T. Damasceno ◽  
Antonio M. F. Neto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lipid Profile ◽  
Polyacrylamide Gel Electrophoresis ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Highly Effective ◽  
Ldl Subfractions

Abstract Background Large observational studies have shown that small, dense LDL subfractions are related to atherosclerotic cardiovascular disease. This study assessed the effects of two highly effective lipid-lowering therapies in the atherogenic subclasses of lipoproteins in subjects with ST-segment elevation myocardial infarction (STEMI). Methods Patients of both sexes admitted with their first myocardial infarction and submitted to pharmacoinvasive strategy (N = 101) were included and randomized using a central computerized system to receive a daily dose of simvastatin 40 mg plus ezetimibe 10 mg or rosuvastatin 20 mg for 30 days. Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) subfractions were analysed by polyacrylamide gel electrophoresis (Lipoprint System) on the first (D1) and 30th days (D30) of lipid-lowering therapy. Changes in LDL and IDL subfractions between D1 and D30 were compared between the lipid-lowering therapies (Mann-Whitney U test). Results The classic lipid profile was similar in both therapy arms at D1 and D30. At D30, the achievement of lipid goals was comparable between lipid-lowering therapies. Cholesterol content in atherogenic subclasses of LDL (p = 0.043) and IDL (p = 0.047) decreased more efficiently with simvastatin plus ezetimibe than with rosuvastatin. Conclusions Lipid-lowering therapy with simvastatin plus ezetimibe was associated with a better pattern of lipoprotein subfractions than rosuvastatin monotherapy. This finding was noted despite similar effects in the classic lipid profile and may contribute to residual cardiovascular risk. Trial registration ClinicalTrials.gov, NCT02428374, registered on 28/09/2014.

scholarly journals The importance of highly effective lipid-lowering therapy with atorvastatin in the normalization of the autonomic regulation of heart rate in patients with STEMI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Barmenkova ◽  
E Dushina ◽  
N Burko ◽  
V Oleinikov
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Troponin I ◽  
Cardiac Activity ◽  
Autonomic Regulation ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Target Values ◽  
Highly Effective

Abstract Purpose To assess the importance of highly effective lipid-lowering therapy with atorvastatin in the normalization of the autonomic regulation of cardiac activity in patients with myocardial infarction with ST segment elevation (STEMI). Methods The study included 130 patients with STEMI aged 51.3±8.9 years, the majority of males (91%). Inclusion criteria: age from 35 to 70 years, STEMI confirmed by ECG and the level of biomarkers (troponin I, CK-MB), the presence of hemodynamically significant stenosis of a culprit artery according to coronary angiography provided that other coronary arteries are occluded no more than 50%, left main coronary artery - not more than 30%. Exclusion criteria: a history of myocardial infarction, CHF III-IV NYHA, bundle branch block, atrial fibrillation, artificial pacemaker. All patients took atorvastatin at a dose of 40–80 mg/day for 48 weeks after STEMI. As part of a further study at the 7th-9th day and 48 weeks after STEMI, 24-hour ECG monitoring was performed with the Astrocard system. The spectral parameters of heart rate variability (HRV) were evaluated: TotP (ms2), ULF (ms2), VLF (ms2), LF (ms2), HF (ms2), LF / HF. By the 48th week of treatment, patients were divided into groups depending on the achievement of the target level of low density lipoproteins (LDL) of less than 1.4 mmol / l or less than 50% of the initial values: 64 people who reached target values of LDL and formed the group of high-effective lipid-lowering therapy “H”, the group of low effective treatment “L” included 66 patients whose LDL did not meet the recommended level. The groups were matched by gender, age, and anthropometric data. Results In the “H” group, by the 48th week, a pronounced power amplification of all spectral components was obtained. The TotP parameter increased from 13021 (95% CI 10967; 15076) ms2 to 20988 (95% CI 17617; 24358) ms2 (p=0.0001); HF - from 164 (95% CI 105; 222) ms2 to 249 (95% CI 178; 321) ms2 (p=0.003). An increase in the low-frequency components of HRV was observed: an increase in ULF from 10695 (95% CI 8985; 12406) ms2 to 20401 (95% CI 15099; 25703) ms2 (p=0.0001), VLF - from 1473 (95% CI 1212; 1734) ms2 to 1734 (95% CI 1478; 1990) ms2 (p=0.01), LF - from 761 (95% CI 573; 949) ms2 to 909 (95% CI 736; 1082) ms2 (p=0.02). Against the background of an increase in all parameters of the frequency spectrum, the sympathovagal balance coefficient LF / HF decreased from 6.6 (95% CI 5.7; 7.6) to 5.2 (95% CI 4.3; 6.1) ( p=0.004). An analysis of the HRV indicators dynamics in the L group revealed an increase in only the total spectrum power - TotP from 12740 (95% CI 10947; 14533) ms2 to 20195 (95% CI 16619; 23770) ms2. Conclusions Highly effective therapy with atorvastatin in STEMI patients helps to normalize the parameters of the autonomic regulation of heart rate in the post-infarction period due to the increased effects of parasympathetic activity. Funding Acknowledgement Type of funding source: None

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 <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 Lipid-Lowering Therapy in Patients with Coronary Heart Disease and Prior Stroke: Mission Impossible?

2021 ◽  
Vol 10 (4) ◽  
pp. 886
Author(s):  
Pier Luigi Temporelli ◽  
Marcello Arca ◽  
Laura D’Erasmo ◽  
Raffaele De Caterina
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Lipid Guidelines ◽  
Coronary Events

Hyperlipidemia is a powerful risk factor for coronary heart disease (CHD). It has been known for a long time that lipid-lowering drugs significantly reduce morbidity from CHD, thus proving a causal role for cholesterol in coronary events. Conversely, the relationship between low-density lipoprotein cholesterol (LDL-C) levels and stroke has been less clear and debated for many years. Recent data conclusively demonstrate not only the inverse epidemiological relationship of blood LDL-C with stroke, but also the efficacy of different strategies to attain cholesterol-lowering on stroke. They also dissipate lingering doubts about the possibility that lipid-lowering is linked to an increase in hemorrhagic stroke. However, despite current international lipid guidelines now strongly recommend aggressive lipid-lowering therapy in patients with atherosclerotic cardiovascular disease, including CHD and cerebrovascular disease (CeVD), secondary prevention patients are often undertreated with lipid-lowering therapies in routine clinical practice. This review highlights that patients with CHD and concomitant CeVD do not receive aggressive lipid-lowering therapy despite being at very high risk and with clear evidence of benefit from lowering LDL-C levels below current targets.

scholarly journals What Do US Physicians and Patients Think About Lipid‐Lowering Therapy and Goals of Treatment? Results From the GOULD Registry

2021 ◽  
Author(s):  
Suzanne V. Arnold ◽  
Christopher P. Cannon ◽  
James A. de Lemos ◽  
Robert S. Rosenson ◽  
Christie M. Ballantyne ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Shared Decision ◽  
Low Density Lipoprotein Cholesterol ◽  
Lowering Therapy

Background Because of an increasing number and complexity of treatment options for lipid‐lowering therapy in patients with atherosclerotic cardiovascular disease, guidelines recommend greater active involvement of patients in shared decision‐making. However, patients' understanding and perceptions of the benefits, risks, and treatment objectives of lipid‐lowering therapy are unknown. Methods and Results Structured questionnaires were conducted in 5006 US outpatients with atherosclerotic cardiovascular disease and suboptimal low‐density lipoprotein cholesterol (LDL‐C) control (LDL‐C ≥70 mg/dL) or on a PCSK9 (proprotein convertase subtilisin/kexin type 9) inhibitor and in 113 physician providers as a part of the GOULD (Getting to an Improved Understanding of Low‐Density Lipoprotein Cholesterol and Dyslipidemia Management) Registry. Mean age of the patients was 68±10 years, 60% were men, and 86% were White race. Across all patients, 63% believed heart disease was the leading cause of death in men and 46% the leading cause of death in women. Only 28% of patients thought the primary reason they were taking lipid‐lowering medication was to lower the risk of heart attack or stroke, 68% did not know their approximate LDL‐C level, and 69% did not know their LDL‐C goal. Patients on PCSK9 inhibitors (versus LDL‐C cohort), younger patients (versus age ≥65 years), and men (versus women) were somewhat more knowledgeable about their disease and its management. Most physicians (66%) felt that a lack of understanding of the importance and efficacy of statins was the primary factor contributing to nonadherence, as opposed to costs (9%) or side effects (1%). More education was the most commonly used strategy to address patient‐reported side effects. Conclusions A large proportion of patients with atherosclerotic cardiovascular disease remain unaware of their underlying atherosclerotic cardiovascular disease risk, reasons for taking lipid‐lowering medications, current LDL‐C levels, or treatment goals. These data highlight a large education gap which, if addressed, may improve shared decision‐making and treatment adherence. Registration URL: https://www.clinicaltrials.org ; Unique identifier: NCT02993120.

P828Low-density lipoprotein cholesterol lowering therapy and target level attainment after a recent myocardial infarction - nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Allahyari ◽  
T Jernberg ◽  
D Lautsch ◽  
P Lundman ◽  
E Hagstrom ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Intensity ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Lipid Lowering Therapy ◽  
Target Level ◽  
Lowering Therapy ◽  
Esc Guidelines

Abstract Background Lowering low-density lipoprotein cholesterol (LDL-C) reduces the risk of cardiovascular disease after a myocardial infarction (MI). The European Society of Cardiology (ESC) guidelines recommend lipid lowering therapy to reach LDL-C treatment targets after an MI. Purpose To assess LDL-C target level attainment according to the ESC guidelines among patients with a recent MI in Sweden. Methods We used data from nationwide registers in Sweden and included patients aged 18–74 years admitted to a hospital with MI (1 January 2013–1 October 2016). Among patients who were alive and had LDL-C data available, we assessed LDL-C target achievement at 6–10 weeks (n=21,505) and 12–14 months (n=17,957) after the MI by category of lipid lowering therapy (no statin; low/moderate-intensity statins; high-intensity statins; any statin plus ezetimibe). The target was defined as an LDL-C of <1.8 mmol/L and a ≥50% reduction from the baseline if LDL-C was 1.8–3.5 mmol/L and the patient was not already receiving statins. Results Most patients were treated with high-intensity statin monotherapy (84.2% and 72.0%) or any statin with ezetimibe (2.1% and 10.4%) at 6–10 weeks and 12–14 months after the MI, respectively. In total, 37.7% (6–10 weeks) and 38.3% (12–14 months) had attained their LDL-C target. The proportion of patients attaining their LDL-C target at 6–10 weeks was 12% (no statin), 30% (low/moderate-intensity statins), 39% (high-intensity statins), and 49% (any statin plus ezetimibe). The corresponding numbers at 12–14 months were 16% (no statin), 29% (low/moderate-intensity statins), 39% (high-intensity statins), and 58% (any statin plus ezetimibe). A total of 11.8% at 6–10 weeks and 12.3% at 12–14 months reached an LDL-C level of <1.8 mmol/L, but did not reach their LDL-C target level due to the ≥50% reduction criteria. (Figure 1) Figure 1 Conclusions In this large population-based study using nationwide data, more than half of patients with a recent MI did not achieve the ESC guidelines LDL-C target levels, despite a large proportion with high-intensity statin therapy. In patients treated with statins and ezetimibe, four out of ten did not reach the ESC LDL-C target level. Our findings indicate that there may be a need for additional LDL-C lowering therapy if the target level is to be attained in all patients. Acknowledgement/Funding This project was supported by funding from Merck Sharp & Dohme.

scholarly journals Evaluation of Two Highly Effective Lipid-Lowering Therapies in Subjects With Acute Myocardial Infarction: A Lipidomic Analysis

2021 ◽  
Author(s):  
Aline Klassen ◽  
Alessandra Sussulini ◽  
Priscilla Derogis ◽  
Carlos Ferreira ◽  
Aline Lopes ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lipid Profile ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Selected Reaction Monitoring ◽  
St Segment Elevation ◽  
Lipidomic Analysis ◽  
Highly Effective ◽  
Negative Ionization

Abstract Introduction For cardiovascular disease prevention, statins alone or combined with ezetimibe have been recommended to achieve low density lipoprotein - cholesterol targets, but their effects on other lipids are less reported. Objective To examine lipid changes in subjects with ST-segment elevation myocardial infarction (STEMI) after two highly effective lipid-lowering therapies. Methods Twenty patients with STEMI were randomized to be treated with rosuvastatin 20 mg qd or simvastatin 40 mg combined with ezetimibe 10 mg qd during 30 days. Fasting blood samples were collected in the first day (D1) and after 30 days (D30). Lipidomic analysis was performed using the Lipidyzer platform. Selected reaction monitoring (SRM) was used in positive and negative ionization modes with and without differential mobility spectrometry (DMS). Univariate and multivariate analyses were performed. Results Comparable classic lipid profile was observed in both groups of lipid-lowering therapies at D1 and after treatments. However, differences in other lipids were observed between groups at these time points. After treatments, main differences between groups were for lysophosphatidylcholine and triacylglycerides. Conclusion Despite similar changes in the classic lipid profile, differences in lipidomic analysis were found before and after exposure to highly effective lipid-lowering therapies in subjects after STEMI. Trial registration: ClinicalTrials.gov, NCT02428374, registered on 28/09/2014.

scholarly journals Escalation of liPid-lOwering therapy in patientS wiTh vascular disease receiving HIGH-intensity statins: the retrospective POST-HIGH study

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jaehyung Ha ◽  
Bom Lee ◽  
Jung Mi Park ◽  
Moonjong Kang ◽  
Jaewon Oh ◽  
...  
Keyword(s):  
High Intensity ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Control Group ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Kaplan Meier ◽  
Clinical Benefits

AbstractIn this retrospective study, we investigated whether lipid-lowering therapy (LLT) escalation has clinical benefits in patients with atherosclerotic cardiovascular disease (ASCVD) and low-density lipoprotein cholesterol (LDL-C) levels of 55–99 mg/dL (1.4–2.6 mmol/L), post high-intensity. Out of 6317 Korean patients screened in 2005–2018, 1159 individuals with ASCVD and LDL-C levels of 55–99 mg/dL after statin use equivalent to 40 mg atorvastatin were included. After 1:2 propensity score matching, 492 patients (164 with LLT escalation, 328 controls without LLT escalation) were finally analysed. Primary outcome variables were major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause death. At median follow-up (1.93 years), the escalation group had a lower MACCE rate (1.72 vs. 3.38 events/100 person-years; hazard ratio [HR] 0.34, 95% confidence interval [CI] 0.14–0.83; p = 0.018) than the control group. The incidence of all-cause death (0.86 vs. 1.02 events/100 person-years; HR 0.58, 95% CI 0.15–2.19; p = 0.42) and each MACCE component did not differ between groups. Kaplan–Meier curves exhibited lower risk of MACCE in the escalation group (HR 0.36, 95% CI 0.12–0.97; p = 0.040) but a difference not statistically significant in all-cause death (HR 0.30, 95% CI 0.04–2.48; p = 0.26). LLT escalation was associated with reduced cardiovascular risk, supporting more aggressive LLT in this population.

scholarly journals Evaluation of two highly effective lipid-lowering therapies in subjects with acute myocardial infarction

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Aline Klassen ◽  
Andrea Tedesco Faccio ◽  
Carolina Raissa Costa Picossi ◽  
Priscilla Bento Matos Cruz Derogis ◽  
Carlos Eduardo dos Santos Ferreira ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Low Density Lipoprotein Cholesterol ◽  
Residual Cardiovascular Risk ◽  
St Segment Elevation ◽  
Lipidomic Analysis ◽  
St Segment ◽  
Highly Effective

AbstractFor cardiovascular disease prevention, statins alone or combined with ezetimibe have been recommended to achieve low-density lipoprotein cholesterol targets, but their effects on other lipids are less reported. This study was designed to examine lipid changes in subjects with ST-segment elevation myocardial infarction (STEMI) after two highly effective lipid-lowering therapies. Twenty patients with STEMI were randomized to be treated with rosuvastatin 20 mg QD or simvastatin 40 mg combined with ezetimibe 10 mg QD for 30 days. Fasting blood samples were collected on the first day (D1) and after 30 days (D30). Lipidomic analysis was performed using the Lipidyzer platform. Similar classic lipid profile was obtained in both groups of lipid-lowering therapies. However, differences with the lipidomic analysis were observed between D30 and D1 for most of the analyzed classes. Differences were noted with lipid-lowering therapies for lipids such as FA, LPC, PC, PE, CE, Cer, and SM, notably in patients treated with rosuvastatin. Correlation studies between classic lipid profiles and lipidomic results showed different information. These findings seem relevant, due to the involvement of these lipid classes in crucial mechanisms of atherosclerosis, and may account for residual cardiovascular risk.Randomized clinical trial: ClinicalTrials.gov, NCT02428374, registered on 28/09/2014.

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