scholarly journals Correction of hypertriglyceridemia in order to reduce the residual risk in atherosclerosis-related diseases. Expert Council Opinion

2019 ◽  
pp. 44-51 ◽  
Author(s):  
G. P. Arutyunov ◽  
S. A. Boytsov ◽  
M. I. Voevoda ◽  
O. M. Drapkina ◽  
V. V. Kukharchuk ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Residual Risk ◽  
Risk Level ◽  
Common Condition ◽  
Target Level ◽  
Omega 3 ◽  
Risk Patients ◽  
Very High ◽  
Progression Of Atherosclerosis

In opinion the Expert council provides management tactics for patients with hypertriglyceridemia (HTG). It is demonstrated that HTG is a common condition in overweight patients and is an important component of residual risk. HTG creates additional conditions for the progression of atherosclerosis, so the level of triglycerides (TG) is recommended to be measured in patients with a high, very high and extremely high risk level. An indication for the appointment of drugs that reduce the concentration of TG is its level of more than 2,3 mmol/L. Statins are the agents of choice to reduce the risk of cardiovascular disease in high-risk patients with hypercholesterolemia and HTG. Fenofibrate is used to correct HTG, and in case of intolerance to it or when the target level of TG is not reached, omega-3 ethers of polyunsaturated fatty acids in a dose of 2-4 g/day are recommended. In patients with HTG with a TG level >5,6 mmol/L, fenofibrate is the agent of choice.

scholarly journals Residual Risk of Cardiovascular Complications in Case of Adequate Lipid-Lowering Therapy

2018 ◽  
Vol 3 (2) ◽  
pp. 19-25
Author(s):  
VV V Simerzin ◽  
OV V Fatenkov ◽  
IV V Gagloeva ◽  
MA A Galkina ◽  
YaA A Panisheva
Keyword(s):  
Risk Factors ◽  
High Risk ◽  
Cardiovascular Complications ◽  
Residual Risk ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Target Level ◽  
Lowering Therapy ◽  
Risk Patients ◽  
Very High

This article is devoted to the problems of residual risk of cardiovascu1ar comp1ications deve1opment for high and very high risk patients under adequate lipid-fowering pharmacotherapy in spite of c^lestera! and tow-density 1ipoproteins target level achievement. Afong with classic risk factors the special atte^ton is given to 1ipoprotein (a) [LP (a)] as the most aggressive factor of cardwvascular system atherosclerotic diseases devetopment and their comp1ications. Great importance is attached to 1ipidopheresis.

scholarly journals SPECIFICS OF ANTIHYPERTENSION THERAPY IN HYPERTENSIVES OF VARIOUS CARDIOVASCULAR RISK (BY THE REGISTRY OF CHRONIC NON-COMMUNICABLE DISEASES IN TYUMENSKAYA OBLAST)

2018 ◽  
Vol 17 (3) ◽  
pp. 4-10
Author(s):  
A. Yu. Efanov ◽  
Yu. A. Vyalkina ◽  
Yu. A. Petrova ◽  
Z. M. Safiullina ◽  
O. V. Abaturova ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Risk Group ◽  
High Risk Group ◽  
Risk Level ◽  
Moderate Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Very High

Aim. To assess the specifics of antihypertension therapy (AHT) in hypertensives of various cardiovascular risk, in the registry of chronic non-communicable diseases in Tyumenskaya oblast.Material and methods. A random sample studied, of 1704 patients with hypertension, inhabitants of Tyumenskaya oblast (region), ascribed to dispensary follow-up. Mean age 62±7,5 y.o. Of those 31,5% (n=537) males. The prevalence and efficacy of AHT assessed according to cardiovascular risk level. The significance was evaluated with the criteria χ2.Results. AHT was characterized by the growth of the frequency of treatment approaches with cardiovascular risk consideration. Regular treatment took 33,9% patients of low and moderate risk vs 41,3% of high and very high (p<0,01). In the male group such tendency also took place. Gender specifics of AHT was characterized by that in the groups of high and very high risk females took medications significantly more commonly than males — 46,6% vs 29,1% in high risk group (p<0,01) and 47,5% vs 30% in very high risk group (p<0,01). With the increase of the risk level, there was decline of treatment efficacy — from 95% in low risk group to 32,5% in very high risk group; 53,1% of the participants were taking monotherapy, 32,9% — two drugs, 14,0% — ≥3 drugs. With the increase of risk grade there is tendency to increase of combinational AHT, however with no significant increase of efficacy. Treatment efficacy in high and very high risk patients comparing to patients with low and moderate risk was significantly lower — 33,1% vs 69,7% (p<0,01), respectively. Statins intake among the high and very high risk patients was 10,6-11,0% males and 7,8% females (p<0,05).Conclusion. AHT in hypertensives in Tymenskaya oblast, under dispensary follow-up, is characterized by insufficient usage of combinational drugs. With the raise of cardiovascular risk there is tendency to higher rate of combinational AHT. However there is no significant increase in efficacy of treatment with the increase of medications number. A very low rate of statins intake is noted. The obtained specifics witness for the necessity to optimize AHT among the high and very high risk patients — inhabitants of Tyumenskya oblast.

scholarly journals Statins for primary prevention of cardiovascular disease: modelling guidelines and patient preferences based on an Irish cohort

2019 ◽  
Vol 69 (683) ◽  
pp. e373-e380 ◽  
Author(s):  
Paula Byrne ◽  
John Cullinan ◽  
Paddy Gillespie ◽  
Rafael Perera ◽  
Susan M Smith
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
Clinical Guidelines ◽  
Baseline Risk ◽  
Recommended Treatment ◽  
Risk Patients ◽  
Very High ◽  
Prevention Of Cardiovascular Disease

BackgroundChanges in clinical guidelines for primary prevention of cardiovascular disease (CVD) have widened eligibility for statin therapy.AimTo illustrate the potential impacts of changes in clinical guidelines.Design and settingModelling the impacts of seven consecutive European guidelines based on a cohort of people aged ≥50 years from the Irish Longitudinal Study on Ageing.MethodThe eligibility for statin therapy of a sample of people without a history of CVD was established, according to changing guideline recommendations and modelled associated potential costs. The authors calculated the numbers needed to treat (NNT) to prevent one major vascular event in patients at the lowest baseline risk for which each of the seven guidelines recommended treatment, and for those at low, medium, high, and very-high risk according to 2016 guidelines. These were compared with the NNT that patients reported as required to justify taking a daily medicine.ResultsThe proportion of patients eligible for statins increased from approximately 8% in 1987 to 61% in 2016; associated costs rose from €13.9 million to €107.1 million per annum. The NNT for those at the lowest risk for which each guideline recommended treatment rose from 40 to 400. By 2016, the NNT for low-risk patients was 400 compared to ≤25 very-high risk patients. The proportion of patients eligible for statins achieving NNT levels that patients regarded as justified to taking a daily medicine fell as guidelines changed over time.ConclusionIncreased eligibility for statin therapy impacts large proportions of the present population and healthcare budgets. Decisions to take and reimburse statins should be considered on the basis of expected cost-effectiveness and acceptability to patients.

The new LDL-C target <55 mg/dL is achieved by less than 40% of very high risk patients with familial hypercholesterolaemia despite receiving PCSK9 inhibitors: real world data

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
L Rallidis ◽  
C Vlachopoulos ◽  
E Liberopoulos ◽  
I Skoumas ◽  
E Kiouri ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
High Risk ◽  
Familial Hypercholesterolaemia ◽  
Lipid Lowering ◽  
Additional Risk Factor ◽  
Pcsk9 Inhibitors ◽  
High Risk Patients ◽  
Lipid Clinic ◽  
Risk Patients ◽  
Very High

Abstract Background The recently published ESC/EAS guidelines for the management of dyslipidaemias have lowered the low-density lipoprotein cholesterol (LDL-C) target in the very high risk patients below 55 mg/dL. Purpose To examine how achievable is this target in very high risk patients receiving a proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) on top of lipid-lowering treatment (LLT). Methods The cohort comprised 158 patients who attended the lipid clinic of 3 hospitals in Greece and started treatment with PCSK9i. Patients were requested to attend the lipid clinic 3 months after the initiation of PCSK9i. Results Ninety percent of patients had heterozygous familial hypercholesterolaemia (heFH) and 75% had cardiovascular disease (CVD). One hundred forty patients were classified as very high risk because they had either cardiovascular disease (CVD) or heFH with an additional risk factor for whom a target &lt;55 mg/dL is currently recommended. Of those very high risk patients, 105 (75%) were given PCSK9i due to failure to achieve LDL-C targets despite maximum LLT (high intensity statin at maximum tolerated dose + ezetimibe) while in the rest of cases the indication was statin intolerance. The mean reduction of LDL-C at 3 months was 56.2%. Among 105 very high risk patients (all had heFH), LDL-C below 55 mg/dL was achieved by 37.1% while the previously LDL-C target &lt;70 mg/dL was achieved by 60% (Figure 1). Conclusions The new LDL-C target &lt;55 mg/dL is achieved by &lt;40% of very high risk patients with heFH despite receiving triple LLT, i.e. PCSK9i + statin + ezetimibe. This therapeutic gap suggests that there is still need for more effective LLT in very high risk heFH patients to maximize their clinical benefit. Figure 1 Funding Acknowledgement Type of funding source: None

scholarly journals Established and Emerging Approaches for the Management of Dyslipidaemia

Scientifica ◽  
2012 ◽  
Vol 2012 ◽  
pp. 1-14 ◽  
Author(s):  
Giuseppe Danilo Norata
Keyword(s):  
Experimental Data ◽  
Cardiovascular Disease ◽  
Clinical Trials ◽  
Cardiovascular Risk ◽  
High Risk ◽  
Ldl Cholesterol ◽  
Reasonable Doubt ◽  
Risk Patients ◽  
Very High

The key role of dyslipidaemia in determining cardiovascular disease (CVD) has been proved beyond reasonable doubt, and therefore several dietary and pharmacological approaches have been developed. The discovery of statins has provided a very effective approach in reducing cardiovascular risk as documented by the results obtained in clinical trials and in clinical practice. The current efficacy of statins or other drugs, however, comes short of providing the benefit that could derive from a further reduction of LDL cholesterol (LDL-C) in high-risk and very high risk patients. Furthermore, experimental data clearly suggest that other lipoprotein classes beyond LDL play important roles in determining cardiovascular risk. For these reasons a number of new potential drugs are under development in this area. Aim of this review is to discuss the available and the future pharmacological strategies for the management of dyslipidemia.

ApoA1 Remnant Ratio in Very High Risk Patients with LDL-c 55 Years of Age

2018 ◽  
Vol 12 (2) ◽  
pp. 515-516 ◽  
Author(s):  
John Nelson ◽  
Lihong He ◽  
Michael Dansinger
Keyword(s):  
High Risk ◽  
Residual Risk ◽  
High Risk Patients ◽  
Risk Patients ◽  
Very High
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