Compliance with lipid-lowering therapy and its impact on cardiovascular morbidity and mortality

Objective: To review relevant literature supporting the need for intensive lipid management in patients with diabetes mellitus. Data Sources: A literature search using MEDLINE (1975–March 2005) was conducted. The search terms coronary disease, diabetes mellitus, hydroxymethylglutaryl-coenzyme A reductase inhibitors (statins), lipoproteins, and low-density lipoprotein cholesterol (LDL-C) were used to identify published trials comparing the effects of intensive LDL-C lowering and cardiovascular morbidity and mortality. Study Selection and Data Extraction: Primary literature was evaluated and included in this review if the study was a large randomized trial containing a significant number of diabetic patients receiving primary prevention. For trials including patients without diabetes, an available sub-analysis of the diabetic population in that trial must have been available. Data Synthesis: The incidence of diabetes mellitus is rising in dramatic proportions throughout the nation. In addition to the diagnosis of diabetes, many of these patients also have preexisting risk factors that increase their risk for cardiovascular morbidity and mortality. In 2004, the National Cholesterol Education Program issued a scientific statement proposing a newer and lower optimal LDL-C goal for high-risk populations. This article reviews pertinent findings from recent clinical trials and guidelines discussing the need to integrate more stringent LDL-C goals into clinical practice. Conclusions: Although data are limited, all patients with diabetes mellitus, regardless of cardiovascular status, may benefit from lipid-lowering therapy with an optimal LDL-C goal of < 70 mg/dL.

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Intensive Lipid-Lowering Therapy in Patients with Coronary Heart Disease

Annals of Pharmacotherapy ◽

10.1345/aph.1e330 ◽

2005 ◽

Vol 39 (2) ◽

pp. 329-334 ◽

Cited By ~ 1

Author(s):

Stacy A Lauderdale ◽

Amy Heck Sheehan

Keyword(s):

Coronary Heart Disease ◽

Heart Disease ◽

Density Lipoprotein ◽

Current Data ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

Coronary Syndrome ◽

Lowering Therapy ◽

Cardiovascular Morbidity And Mortality ◽

Stable Coronary Heart Disease

OBJECTIVE: To describe current data evaluating the use of intensive lipid-lowering therapy in patients with coronary heart disease. DATA SOURCES: A literature search using MEDLINE (1966–September 2004) was conducted using the search terms lipoproteins, low-density lipoprotein cholesterol (LDL-C), hydroxymethylglutaryl-coenzyme A reductase inhibitors, coronary arteriosclerosis, and coronary disease to identify published trials comparing the effects of intensive and conventional lipid-lowering therapy. DATA SYNTHESIS: Intensive lipid-lowering therapy reduces LDL-C levels significantly more than conventional treatment and appears to reduce cardiovascular morbidity and mortality in patients who have recently experienced acute coronary syndrome (ACS). However, evidence suggesting clinical benefits in patients with stable coronary heart disease is currently lacking. CONCLUSIONS: Although data are limited, patients with ACS may benefit from intensive lipid-lowering therapy. Several studies are underway to determine the appropriate role of intensive lipid-lowering therapy.

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Inhibitors in the Management of Patients with Atherosclerotic Cardiovascular Diseases: Guidelines and Reimbursement Issues

Rational Pharmacotherapy in Cardiology ◽

10.20996/1819-6446-2020-08-21 ◽

2020 ◽

Vol 16 (4) ◽

pp. 644-653

Author(s):

M. V. Zhuravleva ◽

A. B. Prokofiev ◽

E. V. Shikh ◽

S. Yu. Serebrova ◽

G. I. Gorodetskaya ◽

...

Keyword(s):

Cardiovascular Diseases ◽

Significant Proportion ◽

Density Lipoprotein ◽

Lipid Lowering ◽

Clear Understanding ◽

Lipid Lowering Therapy ◽

Pcsk9 Inhibitors ◽

Lowering Therapy ◽

Cardiovascular Morbidity And Mortality ◽

Atherosclerotic Cardiovascular Diseases

Current guidelines for the management of patients with dyslipidemia define low-density lipoprotein cholesterol (LDL-C) as the primary target in addressing lipid-lowering therapy. The target level of LDL-C in real clinical practice is achieved in no more than a third of patients who have undergone a coronary event and receive high-intensity lipid-lowering therapy. Achieving the goals of lipid-lowering therapy in a significant proportion of patients with atherosclerotic cardiovascular diseases (ACVD) is impossible with the use of even high doses of statins, which requires its enhancement by other drugs. The article considers the place of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in the prevention of cardiovascular diseases in patients with ACVD in accordance with the latest Russian and international guidelines. A modern decision-making algorithm for the initiation of PCSK9 inhibitors therapy in patients with ACVD is presented. The authors provide a clear understanding about the patient populations that will benefit most from the taking of PCSK9 inhibitors. Particular attention is paid to Guidelines for the management of dyslipidemias developed by European Society of Cardiology and European Atherosclerosis Society in 2019. The issues of patients provision with PCSK9 inhibitors with reference to Russian conditions are described in details in accordance with the requirements for territorial programs of state guarantees. Further improvement in the provision of PCSK9 inhibitors to patients with indications for this therapy is necessary, considering the potential of these drugs in reducing cardiovascular morbidity and mortality in patients with ACVD.

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Early Recognition and Treatment of Diabetic Kidney Disease

Medicine Today ◽

10.3329/medtoday.v26i1.21317 ◽

2014 ◽

Vol 26 (1) ◽

pp. 56-62

Author(s):

Sheikh Salahuddin Ahmed ◽

Md Abu Saleh Mohammad Rizwan ◽

Md Abdul Mahid Khan ◽

Tarafdar Runa Laila ◽

Md Abdul Hafez

Keyword(s):

Risk Factor ◽

Kidney Disease ◽

Diabetic Kidney Disease ◽

Early Stage ◽

Kidney Damage ◽

Cardiovascular Morbidity ◽

Morbidity And Mortality ◽

Lipid Lowering ◽

Diabetic Kidney ◽

Cardiovascular Morbidity And Mortality

Diabetic kidney disease (DKD) is a progressive condition and is an important cause of end stage renal disease (ESRD) as well as a risk factor for cardiovascular morbidity and mortality. This paper reviews various evidence based clinical guidelines, scientific papers and research studies on early detection and treatment of DKD. Microalbuminuria describes the urinary excretion of small amounts of albumin which identifies the early stage of DKD. In addition to an earliest marker of kidney damage, microalbuminuria is an established high risk factor for cardiovascular morbidity and mortality. Patients with microalbuminuria who progress to macroalbuminuria are likely to progress to ESRD. However effective treatment in the early stage of DKD reduces the risk and slows the progression of kidney damage. There is general agreement that people with diabetes should be screened regularly to detect early markers of kidney damage. People with diabetes and microalbuminuria should be treated with a multifactorial intervention approach to retard the progression of DKD. Studies have clearly demonstrated that the use of angiotensin converting enzyme inhibitors or angiotensin 2 receptor blockers with improved glycemic control, hypertension control, lipid lowering, aspirin use, smoking cessation, exercise programs and dietary intervention reduced the development of overt nephropathy and ESRD. DOI: http://dx.doi.org/10.3329/medtoday.v26i1.21317 Medicine Today 2014 Vol.26(1): 56-62

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A four-year naturalistic prospective study of cardiometabolic disease in antipsychotic-treated patients

European Psychiatry ◽

10.1016/j.eurpsy.2010.08.011 ◽

2012 ◽

Vol 27 (1) ◽

pp. 50-55 ◽

Cited By ~ 5

Author(s):

P. Mackin ◽

T. Waton ◽

H.M. Watkinson ◽

P. Gallagher

Keyword(s):

Cardiovascular Risk ◽

Prospective Study ◽

Lipid Lowering ◽

Antipsychotic Treatment ◽

Oral Glucose ◽

Lipid Lowering Therapy ◽

Model Assessment ◽

The Metabolic Syndrome ◽

Lowering Therapy ◽

Cardiovascular Morbidity And Mortality

AbstractThe relationship between antipsychotic use and cardiovascular morbidity and mortality is controversial. There is a lack of long-term prospective studies investigating changes in cardiometabolic risk in patients treated with antipsychotic drugs. We report data from a 4-year prospective study. Patients (89) underwent detailed metabolic and cardiovascular risk assessment at 4-years which included anthropometric assessment, blood pressure, lipid profile, and an oral glucose tolerance test. We used the homeostatic model assessment to determine insulin resistance, and calculated 10-year cardiovascular risk scores. Mean age of subjects was 44.7 (±11.5) years, and 52% were male. The prevalence of type 2 diabetes was 8%, and 38.4% fulfilled diagnostic criteria for the metabolic syndrome. With the exception of increased central adiposity over the 4-year follow-up period (p < 0.001), other cardiometabolic parameters were generally unchanged. There was a high prevalence of dyslipidaemia, but only 16.9% were prescribed lipid-lowering treatment. Commencing lipid-lowering therapy was associated with a reduction in cardiovascular risk score (OR 7.9, 95% CI = 1.3 to 48.7; p = 0.02). Patients established on longer-term antipsychotic treatment show less dramatic metabolic changes than those occurring in the early stages of treatment, but have a high burden of cardiovascular risk. Lipid-lowering therapy is associated with a significant reduction in cardiovascular risk.

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