scholarly journals Dyslipidemia and Lipid-Lowering in Patients with High Risk of Cardiovascular Diseases and Their Cardiovascular Outcomes in Korea (ENSURE study): Secondary Prevention in Chronic Stable Angina

2015 ◽  
Vol 4 (1) ◽  
pp. 27
Author(s):  
Kyung Taek Park ◽  
Sung Gyun Ahn ◽  
Sang-Ho Jo ◽  
Sungha Park ◽  
Hyun Jae Kang ◽  
...  
Keyword(s):  
Cardiovascular Diseases ◽  
High Risk ◽  
Secondary Prevention ◽  
Stable Angina ◽  
Chronic Stable Angina ◽  
Cardiovascular Outcomes ◽  
Lipid Lowering

scholarly journals Effect of coexisting vascular disease on long-term risk of recurrent events after TIA or stroke

Neurology ◽  
2019 ◽  
Vol 93 (7) ◽  
pp. e695-e707 ◽  
Author(s):  
Marion Boulanger ◽  
Linxin Li ◽  
Shane Lyons ◽  
Nicola G. Lovett ◽  
Magdalena M. Kubiak ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Ischemic Stroke ◽  
High Risk ◽  
Secondary Prevention ◽  
Recurrent Events ◽  
Lipid Lowering ◽  
Prevention Guidelines ◽  
Coronary Events ◽  
Ischemic Events ◽  
Age And Sex

ObjectiveTo determine whether patients with TIA or ischemic stroke with coexisting cardiovascular disease (i.e., history of coronary or peripheral artery disease) are still at high risk of recurrent ischemic events despite current secondary prevention guidelines.MethodsIn a population-based study in Oxfordshire, UK (Oxford Vascular Study), we studied consecutive patients with TIA or ischemic stroke for 2002–2014. Patients were treated according to current secondary prevention guidelines and we determined risks of coronary events, recurrent ischemic stroke, and major bleeding stratified by the presence of coexisting cardiovascular disease.ResultsAmong 2,555 patients (9,148 patient-years of follow-up), those (n = 640; 25.0%) with coexisting cardiovascular disease (449 coronary only; 103 peripheral only; 88 both) were at higher 10-year risk of coronary events than those without (22.8%, 95% confidence interval 17.4–27.9; vs 7.1%, 5.3–8.8; p < 0.001; age- and sex-adjusted hazard ratio [HR] 3.07, 2.24–4.21) and of recurrent ischemic stroke (31.5%, 25.1–37.4; vs 23.4%, 20.5–26.2; p = 0.0049; age- and sex-adjusted HR 1.23, 0.99–1.53), despite similar rates of use of antithrombotic and lipid-lowering medication. However, in patients with noncardioembolic TIA/stroke, risk of extracranial bleeds was also higher in those with coexisting cardiovascular disease, particularly in patients aged <75 years (8.1%, 2.8–13.0; vs 3.4%, 1.6–5.3; p = 0.0050; age- and sex-adjusted HR 2.71, 1.16–6.30), although risk of intracerebral hemorrhage was not increased (age- and sex-adjusted HR 0.36, 0.04–2.99).ConclusionsAs in older studies, patients with TIA/stroke with coexisting cardiovascular disease remain at high risk of recurrent ischemic events despite current management. More intensive lipid-lowering might therefore be justified, but benefit from increased antithrombotic treatment might be offset by the higher risk of extracranial bleeding.

Abstract 18396: Low Rate of LDL-Goal-Attainment in 57,855 High-Risk-Patients in Europe, Canada, South-Africa, Middle East and China - Results of DYSIS

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Anselm K Gitt ◽  
Dominik Lautsch ◽  
Martin Horack ◽  
Baishali Ambegaonkar ◽  
Jean Ferrieres ◽  
...  
Keyword(s):  
Clinical Practice ◽  
High Risk ◽  
Secondary Prevention ◽  
Goal Attainment ◽  
Ldl Cholesterol ◽  
Statin Treatment ◽  
Lipid Lowering ◽  
High Risk Patients ◽  
Risk Patients ◽  
Very High

Background: Statin treatment is routinely used for secondary prevention world-wide. Little is known about the prevalence of persistent lipid abnormalities under chronic statin treatment for secondary prevention and possible differences in LDL-Cholesterol (LDL-C) goal attainment in clinical practice between countries in different parts of the world. Methods: Between 2008 and 2012, consecutive statin-treated outpatients were enrolled in 26 countries worldwide, (DYSIS = Dyslipidemia International Study; list of countries in table) to assess LDL-C goal attainment for secondary prevention. European Society of Cardiology recommendations were used to classify patient risk, and to define LDL-cholesterol treatment goals. Data were collected under real life conditions in physicians’ offices and hospital outpatient wards. Results: Serum lipid values of 57,885 consecutive statin-treated outpatients were studied in the context of their cardiovascular risk factors, and the potency and composition of their lipid-lowering treatment. In the very-high risk patients only 21.7% did reach the currently recommended LDL-Chol target <70mg/dl with large differences between the countries varying from 9.2% to 44.3%. In the high-risk population the LDL-Chol target <100mg/dl was achieved in 38.0% oft he patients, varying between 16.6% and 66.7% between countries Conclusion: Despite chronic statin treatment, only 21.7% of the very-high-risk patients reached the current recommended LDL-Chol target <70mg/dl in this large multinational cross-sectional trial, highlighting the persistent large gap between guideline recommendations and clinical practice. Further treatment escalations are necessary to reduce the risk of subsequent cardiovascular events.

scholarly journals Secondary Prevention of Cardiovascular Diseases and Application of Technology for Early Diagnosis

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Sachith Paramie Karunathilake ◽  
Gamage Upeksha Ganegoda
Keyword(s):  
Risk Factors ◽  
Cardiovascular Disease ◽  
Cardiovascular Diseases ◽  
High Risk ◽  
Secondary Prevention ◽  
Disease Prediction ◽  
Preventive Healthcare ◽  
Factors Associated ◽  
Risk Patients ◽  
Insight Into

Cardiovascular diseases result in millions of deaths around the globe annually, most of which are avoidable if identified early. Preventive healthcare has a major role in the fight against cardiovascular diseases. Primary, secondary, and tertiary prevention have their own applications along with benefits and drawbacks. This paper aims to elevate the sensitivity of “secondary prevention of cardiovascular diseases.” Firstly, it discusses common types of cardiovascular diseases around the globe and their causes. Secondly, it analyzes different risk factors associated with cardiovascular diseases and then discusses incoming technological trends in cardiovascular disease prediction and finally provides an insight into the importance of secondary prevention of cardiovascular diseases and commonly prescribed interventions for high risk patients.

P643Association of adherence and treatment intensity of lipid-lowering therapy with cardiovascular outcomes and all-cause mortality in very high-risk patients in Germany

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A Khachatryan ◽  
B Monga ◽  
E Sidelnikov ◽  
M Hatz ◽  
I Ahrens
Keyword(s):  
High Risk ◽  
Lower Risk ◽  
Cardiovascular Outcomes ◽  
Lipid Lowering ◽  
Study Endpoint ◽  
Treatment Intensity ◽  
High Risk Patients ◽  
All Cause Mortality ◽  
Risk Patients ◽  
Very High

Abstract Introduction Both intensity and adherence to lipid lowering therapies (LLT) play an important role in effectiveness of the therapies in patients at risk for cardiovascular events. Purpose To evaluate the association of adherence and treatment intensity with cardiovascular outcomes and all-cause mortality in very high-risk patients (as defined by the current ESC guidelines) treated with statin and/or ezetimibe. Methods Retrospective cohort study was based on German health claims data (2010–2015) obtained from German Institute for Health Research (InGef) database and included patients ≥18 years with an initial LLT treatment (statin and/or ezetimibe) in 2011–2013, and diagnoses of cardiovascular disease (CVD), stage 4 or 5 chronic kidney disease (CKD) or type 2 diabetes mellitus (DM). Patients must have had at least 2 LLT prescriptions in the first year to ensure intention of treatment. Follow-up period started 1 year after the second LLT prescription and continued until one of the events of the composite study endpoint (hospitalisation for myocardial infarction, unstable angina, ischemic stroke, heart failure, revascularization, or all-cause death) or 31.12.2015, whichever occurred earlier. Adherence was measured annually by the proportion of days covered (PDC) using prescription data. Treatment intensity was quantified based on expected LDL-C reduction as described in the American College of Cardiology and American Heart Association (ACC/AHA) 2018 guidelines. Adherence and treatment intensity were multiplied to create a combined measure of intensity after accounting for adherence. Results 73,257 patients of the CVD cohort were 68 (SD=12) years old, 59% men; the DM cohort (no CVD) had 13,584 patients, age 64 (10), 47% men; 472 patients in the CKD cohort (no CVD) were 65 (15) years old, 46% men. In a Cox proportional hazards model, each 10% increase in treatment intensity (LDL-C lowering) was associated with 18% lower risk of CV event in the CVD (HR 0.82, 95% CI 0.82–0.83), 21% - in the DM (HR 0.79, 95% CI 0.76–0.83), and 15% - in the CKD (HR 0.85, 95% CI 0.75–0.97) cohorts. Similarly, each 10% increase in adherence (PDC) was associated with 6% lower risk of CV event in the CVD (HR 0.94, 95% CI 0.93–0.94), 7% - in the DM (HR 0.93, 95% CI 0.91–0.94), and 7% - in the CKD (HR 0.93, 95% CI 0.89–0.97) cohorts. Each 10% increase in adherence-adjusted intensity was associated with 16% lower risk of CV event in the CVD (HR 0.84, 95% CI 0.83 - 0.85), 19% - in the DM (HR 0.81, 95% CI 0.78–0.85), and 17% - in the CKD (HR 0.83, 95% CI 0.72–0.96) cohorts. The models controlled for age, sex, Charlson comorbidity index and other cardiovascular risk factors at baseline. Conclusions A higher adherence and/or treatment intensity of LLT was associated with significantly lower risk of CV outcomes or all-cause death in German very high-risk patients. Strategies to tailor intensity to patient profile and improve adherence could further lower risk of CV events. Acknowledgement/Funding Amgen Europe GmbH

scholarly journals Management Options in Chronic Stable Angina Pectoris: Focus on Ranolazine

2009 ◽  
Vol 1 ◽  
pp. CMT.S2214
Author(s):  
David S. Vadnais ◽  
Nanette K. Wenger
Keyword(s):  
Angina Pectoris ◽  
Stable Angina ◽  
Beta Blockers ◽  
Chronic Stable Angina ◽  
Left Ventricular ◽  
Lipid Lowering ◽  
Current Therapy ◽  
Lipid Lowering Therapy ◽  
Stable Angina Pectoris ◽  
Management Options

Chronic stable angina pectoris results from a fixed coronary arterial obstruction causing an imbalance between myocardial oxygen supply and demand. Current therapy aims to reduce cardiovascular events (vasculoprotective) thereby improving survival, and/or relieve ischemic symptoms (antianginal) thereby improving the quality of life. Vasculoprotective therapy consists of lifestyle modification, antiplatelet agents, lipid lowering therapy and angiotensin-converting enzyme (ACE) inhibitors. Conventional antianginal therapy for patients with chronic stable angina consists of beta-blockers, calcium channel blockers and nitrates, with surgical or percutaneous revascularization serving an adjunctive role. Despite the investigation of multiple novel therapies and medications over the past 25 years, arguably the most significant contribution to antianginal therapy during that time involved the recent introduction of ranolazine. Ranolazine acts via a distinctive pathway, inhibiting the late sodium current of the action potential in ischemic myocytes. Multiple studies have demonstrated that ranolazine significantly reduces anginal symptoms and improves exercise performance in patients with chronic stable angina but does not reduce mortality. Ranolazine does not affect either heart rate or blood pressure, a unique property among the current antianginal agents. Despite its QT prolongation, ranolazine has a proven safety profile and is not proarrhythmic. In fact, in a recent large randomized trial, ranolazine reduced the incidence of supraventricular tachycardia, ventricular tachycardia, new-onset atrial fibrillation and bradycardic events. Ranolazine may confer some additional benefits such as a reduction in HbA1c levels and improved left ventricular diastolic function. Ranolazine is now approved for use in chronic stable angina. Current guidelines recommend beta-blockers as the first line antianginal agent due to the proven mortality reduction. However, for patients with bradycardia or hypotension, ranolazine may be considered as initial antianginal therapy.

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