scholarly journals THERAPY COMPLIANCE IN AMBULATORY PATIENTS: PROFILE REGISTRY DATA

2013 ◽  
Vol 12 (5) ◽  
pp. 56-61 ◽  
Author(s):  
Yu. V. Lukina ◽  
S. Yu. Martsevich ◽  
A. V. Zagrebelnyi ◽  
S. G. Tripkosh ◽  
F. A. Aidu ◽  
...  
Keyword(s):  
Questionnaire Survey ◽  
Main Group ◽  
Medical Centre ◽  
Lipid Lowering ◽  
Research Centre ◽  
Control Group ◽  
Lipid Lowering Therapy ◽  
Therapy Goals ◽  
Time Control ◽  
Therapy Compliance

Aim.Using the data from the PROFILE Registry and the patients’ questionnaire survey, to analyse the patients’ compliance with medical recommendations on lipid-lowering therapy (LLT).Material and methods.Over the period from May 1st 2011 to December 31st 2011, 274 patients were included in the PROFILE Registry: 82 were referred to a specialised medical centre for the first time (control group, CG); 167 were regularly attending the medical centre (main group A, MGA); and 25 last visited the centre >2 years ago (main group B, MGB). 262 patients completed a questionnaire on the therapy compliance, while 12 refused to participate in the questionnaire survey.Results.According to the results of the questionnaire survey, MGA patients were better informed about the LLT goals (65%) than their CG and MGB peers (35% and 48%, respectively; p<0,0001). The percentage of patients who took statins every day was 87% in MGA vs. 41,5% in CG and 64% in MGB (p=0,002). Statin therapy effectiveness was controlled regularly in MGA: cholesterol (CH) levels were measured every 6 months in 37,5% and every 12 months in 28%. For CG, these figures were 17% and 16%, while for MGB, they were 15% and 40%, respectively (p<0,0001). One-third of CG patients, every fourth MGB patient, and only 13% of MGA patients did not control their CH levels (p<0,0001).Conclusion.The MGA patients who were regularly attending the State Research Centre for Preventive Medicine were the most LLT-compliant: they were well-informed about their disease and therapy goals, were regularly taking prescribed medications (statins), and had better treatment control and the highest LLT effectiveness.

Efficacy and Safety of Evolocumab in Reducing Low Density Lipoprotein Cholesterol Levels in Chinese Patients with Non-ST-segment Elevation Acute Coronary Syndrome

2020 ◽  
Vol 18 ◽  
Author(s):  
Xiaohan Xu ◽  
Meng Chai ◽  
Yujing Cheng ◽  
Pingan Peng ◽  
Xiaoli Liu ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Statin Treatment ◽  
Chinese Patients ◽  
Lipid Lowering ◽  
Control Group ◽  
Lipid Lowering Therapy ◽  
St Segment Elevation ◽  
Coronary Syndrome ◽  
St Segment

Aims: To explore early intensive lipid-lowering therapy in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS). Background: Lowering low-density lipoprotein cholesterol (LDL-C) levels can reduce cardiovascular morbidity and mortality in patients with atherosclerotic cardiovascular disease. Due to many reasons, the need for early intensive lipid-lowering therapy is far from being met in Chinese NSTE-ACS patients at high-risk of recurrent ischaemic events. Objective: To evaluate the feasibility, safety and efficacy of starting evolocumab in hospital to lower LDL-C levels in Chinese patients with NSTE-ACS. Methods: In this prospective cohort study initiated by researchers, 334 consecutive patients with NSTE-ACS who had sub-standard LDL-C levels (LDL-C ≥2.3 mmol/L after regular oral statin treatment for at least 4 weeks; or LDL-C ≥3.2 mmol/L without regular oral statin treatment) were included. Patients who agreed to treatment with evolocumab (140 mg subcutaneously every 2 weeks, initiated in hospital and used for 12 weeks after discharge) were enrolled in the evolocumab group (n=96) and others in the control group (n=238). All enrolled patients received regular statin treatment (atorvastatin 20 mg/day or rosuvastatin 10 mg/day; doses unchanged throughout the study).The primary endpoint was the change in LDL-C levels from baseline to week 12. Results: Most patients (67.1%) had not received regular statin treatment before. In the evolocumab group, LDL-C levels decreased significantly at week 4 and remained stable at week 8 and 12 (all p<0.001). At week 12, the LDL-C percentage change from baseline in the evolocumab group was -79.2±12.7% (from an average of 3.7 to 0.7 mmol/L), while in the control group it was -37.4±15.4% (from an average of 3.3 to 2.0 mmol/L). The mean difference between these 2 groups was -41.8% (95% CI -45.0 to -38.5%; p<0.001). At week 12, the proportions of patients with LDL-C levels <1.8 mmol/L and 1.4 mmol/L in the evolocumab group were significantly higher than in the control group (96.8 vs 36.1%; 90.6 vs 7.1%; both p<0.001). The incidence of adverse events and cardiovascular events was similar in both groups. Conclusions: In this prospective cohort study we evaluated the early initiation of evolocumab in NSTE-ACS patients in China. Evolocumab combined with statins significantly lowered LDL-C levels and increased the probability of achieving recommended LDL-C levels, with satisfactory safety and well tolerance.

scholarly journals Association of rs556621 Polymorphism with Development of Stroke in Patients with Cardiovascular Pathology

2019 ◽  
Vol 15 (5) ◽  
pp. 634-640
Author(s):  
S. Yu. Nikulina ◽  
V. A. Shulman ◽  
A. A. Chernova ◽  
S. V. Prokopenko ◽  
D. A. Nikulin ◽  
...  
Keyword(s):  
Single Nucleotide Polymorphism ◽  
Arterial Hypertension ◽  
Main Group ◽  
Lipid Lowering ◽  
Control Group ◽  
Nucleotide Polymorphism ◽  
Single Nucleotide ◽  
Cardiovascular Pathology ◽  
Supraventricular Tachycardias ◽  
Brachiocephalic Arteries

Aim. To study the association of single nucleotide polymorphism rs556621 (G> T) with development of stroke in patients of the East Siberian population with cardiovascular pathology and risk factors.Material and methods. The study involved 260 patients (157 men and 103 women) with stroke (mean age 57.0 [51.0-62.0]) and 272 patients (170 men and 102 women) of the control group (mean age 55.0 [51.0-62.0]). The examination of the main group included: collection of complaints, anamnesis, clinical examination, computed tomography of the brain, electrocardiography, echocardioscopy, ultrasound duplex scanning of extracranial brachiocephalic arteries, daily blood pressure and heart rate monitoring, analysis of the blood coagulation system. The patients of the main group have arterial hypertension, paroxysmal supraventricular tachycardias, dyslipidemia, atherosclerosis of the brachiocephalic arteries, disorders of the hemostatic system. The control group was studied in the framework of the HAPIEE international project. Molecular genetic research was performed by real-time polymerase chain reaction.Results. There were no statistically significant differences in the frequencies of genotypes and single nucleotide polymorphism rs556621 alleles (G>T) in the subgroup of patients with stroke and those in the control group. The frequency of the rare TT genotype among patients with stroke was 13.3%±4.16, among healthy individuals – 8.8±3.37% (p=0.1). Gender differences when comparing the frequencies of genotypes and alleles were also not detected (p>0.05). The frequencies of the TT genotype were approximately the same in the subgroup of patients with arterial hypertension (13.1%±4.22) and in the control group (7.4±5.25%; p>0.05). No significant differences were observed in the frequencies of the rare genotype of the studied polymorphism in the subgroup of patients with supraventricular tachycardias (20.0±14.37%), hypercoagulability (15.9±7.64%) and the control group (8.8±3.37%), p>0.05. A statistically significant relationship was found between the rare genotype TT of single nucleotide polymorphism rs556621 (G>T) and the development of stroke in patients with dyslipidemia and atherosclerotic lesions of the coronary arteries (p=0.041; odds ratio 1.86, 95% confidence interval 1.02-3.41).Conclusion. The genotype of TTs of single nucleotide polymorphism rs556621 (G> T) increases the risk of developing stroke in patients with dyslipidemia and atherosclerosis of the brachiocephalic arteries compared with carriers of the GG and GT genotypes. The obtained data are recommended to be considered when prescribing lipid-lowering and antithrombotic therapy. 

scholarly journals Reinforcing Adherence to Lipid-lowering Therapy after an Acute Coronary Syndrome: A Pragmatic Randomized Controlled Trial

2020 ◽  
Author(s):  
Stefanos Zafeiropoulos ◽  
Ioannis Farmakis ◽  
Anastasios Kartas ◽  
Alexandra Arvanitaki ◽  
Konstantinos Arvanitakis ◽  
...  
Keyword(s):  
Goal Attainment ◽  
Controlled Trial ◽  
Intervention Group ◽  
Lipid Lowering ◽  
Control Group ◽  
Lipid Lowering Therapy ◽  
Good Adherence ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
One Year

Abstract Aims: Achieving the low-density lipoprotein cholesterol (LDL-C) goal following an acute coronary syndrome (ACS) is a milestone often missed due to suboptimal adherence to secondary prevention treatments. Whether improved adherence could result in reduced LDL-C levels is unclear. We aimed to evaluate an educational-motivational intervention to increase long-term lipid-lowering therapy (LLT) adherence and LDL-C goal attainment rate among post-ACS patients.Methods: IDEAL-LDL was a parallel, two-arm, single-center, pragmatic, investigator-initiated randomized controlled trial. Hospitalized patients for ACS were randomized to a physician-led integrated intervention consisting of an educational session at baseline, followed by regular motivational interviewing phone sessions or usual care. Co-primary outcomes were the LLT adherence (measured by Proportion of Days Covered (PDC); good adherence defined as PDC>80%), and LDL-C goal (<70 mg/dl or 50% reduction from baseline) achievement rate at one year.Results: In total, 360 patients (mean age 62 years, 81% male) were randomized. Overall, good adherence was positively associated with LDL-C goal achievement rate at one year. Median PDC was higher in the intervention group than the control group [0.92 (IQR, 0.82–1.00) vs. 0.86 (0.62–0.98); p=0.03] while the intervention group had increased odds of good adherence (adjusted odds ratio: 1.76 (95% confidence interval 1.02 to 2.62; p=0.04). However, neither the rate of LDL-C goal achievement (49.6% in the intervention vs. 44.9% in the control group; p=0.49) nor clinical outcomes differed significantly between the two groups.Conclusion: Α multifaceted intervention improved LLT adherence in post-ACS patients without a significant difference in LDL-C goal attainment. (IDEAL-LDL, ClinicalTrials.gov: NCT02927808)

scholarly journals ESTIMATION OF THE THICKNESS OF THE INTIMA-MEDIA COMPLEX IN CHILDREN WITH FAMILIAL HYPERCHOLESTEROLEMIA

2018 ◽  
Vol 63 (5) ◽  
pp. 152-154
Author(s):  
D. I. Sadykova ◽  
L. F. Galimova ◽  
I. V. Leontyeva ◽  
E. S. Slastnikova
Keyword(s):  
Carotid Artery ◽  
Familial Hypercholesterolemia ◽  
Common Carotid Artery ◽  
Lipid Lowering ◽  
Control Group ◽  
Lipid Lowering Therapy ◽  
Healthy Children ◽  
Early Diagnostics ◽  
Significant Difference ◽  
The Common

Objective:to evaluate the diagnostic significance of measuring the thickness of the intima-media complex (IMC) in children with autosomal dominant familial hypercholesterolemia for early diagnostics and prompt treatment of atherosclerosis.Materials and methods.The study included 109 children – 64 children with familial hypercholesterolemia and 45 healthy children. Both groups were divided into 2 subgroups according to the age – from 3 to 8 years and from 9 to 18 years. We measured the intimamedia thickness (IMT) of the common carotid artery in all the children. To evaluate IMT we used an ultrasound scanner HD11XE (Philips, USA) with a linear (3–12MHz) sensor IMT.Results.We found a statistically significant difference (p=0.012) of the IMT of the common carotid artery in children with familial hypercholesterolemia (0.61 ± 0.02 mm) in comparison with the control group (0.49±0.02 mm), starting from the age of 9 years. There were no sex differences of IMT in patients older than 9 years.Conclusion.We found that children with familial hypercholesterolemia have higher values of IMT already from the age of 9 as compared with healthy children; the increase in TCIM is an additional criterion for the early diagnostics of atherosclerosis and evaluation of cardiovascular risk. These results emphasize the relevance of lipid-lowering therapy for patients with familial hypercholesterolemia in childhood, before the first signs of atherosclerosis appear.

Contemporary Practice: Treatment Gap in Lipid-Lowering Therapy

1998 ◽  
Vol 11 (5) ◽  
pp. 318-322
Author(s):  
Laurel B. Evers ◽  
Ralph H. Raasch
Keyword(s):  
Chart Review ◽  
Dosage Adjustment ◽  
Retrospective Chart Review ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Therapy Goals ◽  
Monitoring Strategies ◽  
Dose Response Effect ◽  
Contemporary Practice

Pharmacists can play a key role in preventing many adverse sequelae from improperly treated hypercholes-terolemia through treatment and monitoring strategies. Simvastatin and lovastatin utilization in an outpatient population was evaluated in this retrospective chart review. A dose-response effect for total cholesterol reduction was observed. Only 33% (13/40) of patients achieved consensus National Cholesterol Education Program (NCEP) therapy goals. Of those not meeting NCEP guidelines, 11% (3/27) were on maximum doses. Dosage adjustment occurred for 56% (15/27) but 27% (4/15) had no follow-up level. These results suggest that more aggressive lipid-lowering treatment and monitoring are necessary if guidelines are to be met.

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 Study on association of serum lipoprotein(a) with coronary artery disease

2019 ◽  
Vol 7 (2) ◽  
pp. 496
Author(s):  
P. Mohanraj ◽  
S. Sandhya
Keyword(s):  
Density Lipoprotein ◽  
Hdl Cholesterol ◽  
Serum Lipoprotein ◽  
Lipid Lowering ◽  
Control Group ◽  
P Value ◽  
Case Group ◽  
Lipid Lowering Therapy ◽  
Blood Draw ◽  
Lipoprotein A

Background: Most studies of lipid-lowering therapy for the prevention of coronary heart disease (CAD), focused on lowering low density lipoprotein cholesterol and non-HDL cholesterol. Other dyslipidemias, such as an elevated level of lipoprotein(a), also may promote atherosclerosis, establishment of relationship between lipoprotein(a) excess and risk for CAD, interventions directed toward altering these have only infrequently been evaluated in clinical trials. Objectives was to study the association of raised serum lipoprotein(a) in coronary heart disease.Methods: This study was conducted in 50 patients of CAD and 50 people as control group. All patients underwent a standard clinical examination and a blood draw for a lipid profile and lipoprotein(a) assay. Pearson chi-square test was used to assess the statistical significance.Results: Lipoprotein(a) value of more than 30 mg/dl is considered as elevated. In case group 19 patients (38%) were showed elevated lipoprotein(a) and in control group these were 9 patients (18%). p value is 0.026. It shows elevated lipoprotein(a) is statistically significant with the relative risk of 2.79.Conclusions: The association of elevated lipoprotein(a) with CAD was statistically significant. Higher lipoprotein(a) levels were observed in patient with family history of premature CAD.

scholarly journals Reinforcing Adherence to Lipid-lowering Therapy after an Acute Coronary Syndrome: A Pragmatic Randomized Controlled Trial

2020 ◽  
Author(s):  
Stefanos Zafeiropoulos ◽  
Ioannis Farmakis ◽  
George Giannakoulas ◽  
Anastasios Kartas
Keyword(s):  
Goal Attainment ◽  
Controlled Trial ◽  
Intervention Group ◽  
Lipid Lowering ◽  
Control Group ◽  
Lipid Lowering Therapy ◽  
Good Adherence ◽  
Coronary Syndrome ◽  
Randomized Controlled ◽  
One Year

Abstract Aims: Achieving the low-density lipoprotein cholesterol (LDL-C) goal following an acute coronary syndrome (ACS) is a milestone often missed due to suboptimal adherence to secondary prevention treatments. Whether improved adherence could result in reduced LDL-C levels is unclear. We aimed to evaluate an educational-motivational intervention to increase long-term lipid-lowering therapy (LLT) adherence and LDL-C goal attainment rate among post-ACS patients.Methods: IDEAL-LDL was a parallel, two-arm, single-center, pragmatic, investigator-initiated randomized controlled trial. Hospitalized patients for ACS were randomized to a physician-led integrated intervention consisting of an educational session at baseline, followed by regular motivational interviewing phone sessions or usual care. Co-primary outcomes were the LLT adherence (measured by Proportion of Days Covered (PDC); good adherence defined as PDC>80%), and LDL-C goal (<70 mg/dl or 50% reduction from baseline) achievement rate at one year.Results: In total, 360 patients (mean age 62 years, 81% male) were randomized. Overall, good adherence was positively associated with LDL-C goal achievement rate at one year. Median PDC was higher in the intervention group than the control group [0.92 (IQR, 0.82–1.00) vs. 0.86 (0.62–0.98); p=0.03] while the intervention group had increased odds of good adherence (adjusted odds ratio: 1.76 (95% confidence interval 1.02 to 2.62; p=0.04). However, neither the rate of LDL-C goal achievement (49.6% in the intervention vs. 44.9% in the control group; p=0.49) nor clinical outcomes differed significantly between the two groups.Conclusion: Α multifaceted intervention improved LLT adherence in post-ACS patients without a significant difference in LDL-C goal attainment. (IDEAL-LDL, ClinicalTrials.gov: NCT02927808)

scholarly journals Intraoperative Intraluminal Endoscopy in the Surgical Treatment of Patients with Esophageal Diverticula of Various Localization

2019 ◽  
Vol 29 (3) ◽  
pp. 33-37 ◽  
Author(s):  
A. L. Shestakov ◽  
M. V. Khrustaleva ◽  
M. E. Shahbanov ◽  
N. A. Bulganina ◽  
T. T. Bitarov ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Main Group ◽  
Research Centre ◽  
Linear Stapler ◽  
Esophageal Wall ◽  
Control Group ◽  
Surgical Removal ◽  
Esophageal Lumen ◽  
Esophageal Diverticula ◽  
Duration Of Surgery

Aim. To improve the results of surgical treatment of patients with esophageal diverticulum of various localization using intraoperative intraluminal endoscopy. Materials and Methods: The Department of Surgery of the Esophagus and Stomach, the Petrovsky National Research Centre of Surgery, has accumulated a large experience in treating diverticulosis patients. Thus, during the 2010–2018 period, 74 patients with esophageal diverticula of various localization were operated. Out of them, 56 (75.7 %), 10 (13.5 %) and 8 (10.8 %) patients underwent surgical treatment with respect to faringo-esophageal, bifurcation and epiphrenic diverticula, respectively. The patients were divided into two groups: 31 people (41.9 %) in the main group underwent diverticulectomy with intraoperative intraluminal endoscopic assistance (IVEA), while 43 (58.1 %) people in the control group underwent diverticulectomy without IVEA. Intraoperatively, at the stage of discovering diverticulum, the endoscopist applied transillumination and air insufflation in the cavity of the diverticulum, followed by controlling the mobilization of diverticulum. At the resection stage, the completeness of the surgical removal was controlled, along with the absence of esophageal lumen narrowing after sewing the neck of the diverticulum using a linear stapler.Results. The average duration of the operation in patients with Zenker’s diverticula and those in the control group was 45.5 ± 8.8 min and 73.8 ± 12.7 min (p < 0.05), respectively. In patients with the diverticula of the middle and lower third of the esophagus, the average surgery duration was equal to 120.3 ± 11.2 min and 150.5 ± 17.3 (p <0.05) min in the main and control groups, respectively. Radiological examination 2–3 days after surgery revealed no complications in the main group. In the control group, 2 (4.7 %) patients showed a small leakage of the contrast agent outside the esophagus (stopped conservatively). Signs of mild dysphagia when taking solid foods were detected in 1 (2.4 %) patient of the control group. This condition was associated with excessive ingress of the esophageal wall into the apparatus suture, which led to a slight narrowing of its lumen. No patients with dysphagia in the postoperative period were recorded in the main group. Conclusion: The combination of surgical treatment of esophageal diverticula with IVEA allows the duration of surgery to be optimized, deformation of the esophageal lumen to be avoided, possible complications to be minimized, thereby improving the results of surgical treatment. 

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