scholarly journals The Impact of Changes in Population LDL-C Levels on LDL-C Control in Patients After PCI in China: A Retrospective Cohort Study

2020 ◽  
Author(s):  
Huan Liu ◽  
Zhipeng Zhou ◽  
Yanqing Wu ◽  
Jingsong Xu
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Blood Lipid ◽  
Coronary Intervention ◽  
Lifestyle Changes ◽  
Treatment Goal ◽  
Lipid Lowering ◽  
Lipid Control ◽  
The Impact

Abstract BANKGROUND: Mortality from coronary artery disease continues to rise, and secondary prevention and treatment are particularly important. OBJECTIVE: The objective of this study is to evaluate low-density lipoprotein cholesterol (LDL-C) levels in patients after percutaneous coronary intervention (PCI), to describe how treatment outcomes for individual patients changed over time and to examine the potential impact of lipid control rates through population LDL-C levels changes.METHODS: This retrospective study was conducted in patients who underwent PCI between July 2017 and June 2019. The main results included LDL-C levels after PCI. To assess the outcome of prevention, three separate measures of LDL-C were considered: baseline, first follow-up, and final follow-up, and LDL-C control rates were analyzed according to different guidelines. we examine the impact of 0.1mmol/l decreases or increases in population LDL-C levels on LDL-C control.RESULTS: Data were analyzed for 423 patients (mean age, 62 ±10 years), and the baseline LDL-C level was 3.11 ± 0.99 mmol/l. 51.5% of the patients achieved the Chinese Lipids Guidelines treatment goal, 22% and 11.6% of the patients achieved the 2016 ESC Lipids Guidelines and 2019 ESC Lipids Guidelines treatment goal at the final follow-up period respectively. LDL-C levels fluctuated during the follow-up period, and the long-term maintenance results could not be guaranteed after PCI. Population LDL-C levels changes in lifestyle could have a very large impact on LDL-C control in China.CONCLUSION: LDL-C control with statins is not ideal in patients after PCI, which is far from the requirements of the latest guidelines. Although clinicians understand the lipid-lowering effect of statins, they should not give up active lifestyle changes, and should strengthen the comprehensive management of blood lipid control.

scholarly journals Technology-based methods in the improvement of therapy compliance among ambulatory cardiac patients: one-year follow-up data

2012 ◽  
Vol 11 (4) ◽  
pp. 36-41 ◽  
Author(s):  
F. T. Ageev ◽  
T. V. Fofanova ◽  
M. D. Smirnova ◽  
A. Sh. Tkhostov ◽  
A. S. Nelubina ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Self Control ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Telephone Reminder ◽  
Therapy Compliance ◽  
One Year ◽  
The Impact

Aim. To assess the impact of automatic telephone survey with a differentiated reminder text, as well as of the survey combination with the self-control dairy, on the compliance with lipid-lowering and antihypertensive therapy and on therapy effectiveness during the longterm ambulatory follow-up. Material and methods. The study included 604 patients: 323 individuals with high or very high cardiovascular risk levels by SCORE scale and 281 participants with coronary heart disease (CHD). The patients were divided into two groups, according to their agreement to participate in the automatic telephone reminder survey (“Survey” and “Refusal”). All participants were also given a self-control diary. At baseline and one year later, the patients underwent general clinical examination, office blood pressure (BP) measurement, blood biochemistry assessment, and the measurement of therapy compliance (Morisky-Green test), anxiety, and depression levels (HADS scale). Results. The reduction in diastolic BP levels was significantly larger in the Survey group (p=0,04). This group also demonstrated a significantly larger decrease in the levels of total cholesterol (TCH) (p=0,0003) and low-density lipoprotein cholesterol (LDL-CH) (p=0,001), as well as a significantly larger increase in the levels of high-density lipoprotein cholesterol (HDL-CH) (p=0,04). The therapy compliance, assessed by the Morisky-Green test, improved in both groups; however, among CHD patients, a significant improvement was observed only in the Survey group (p<0,00001). The percentage of patients submitting their self-control diaries was higher for the Survey group (p<0,0001). Conclusion. The automatic telephone reminder method provides an opportunity to significantly increase the therapy compliance.

Abstract P127: Dose-dependent Effects of Comprehensive Lifestyle Changes on Blood Lipid Levels: Results From the PREMIER Trial

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Ramzi Dudum ◽  
Stephen P Juraschek ◽  
Lawrence J Appel
Keyword(s):  
Sodium Intake ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Blood Lipid ◽  
Lifestyle Changes ◽  
Lipid Lowering ◽  
Behavioral Counseling ◽  
Calorie Diet ◽  
Cv Disease ◽  
Dose Dependent

Introduction: Low-density lipoprotein (LDLc) is a major risk factor for cardiovascular (CV) disease. While comprehensive lifestyle change (CLC) lowers LDLc, little is known about how CLC adherence affects LDLc levels. Hypothesis: The PREMIER trial demonstrated CLC reduced LDLc levels. We hypothesized those undergoing CLC will exhibit dose dependent reductions in LDLc proportional to the number of intervention sessions attended. Methods: PREMIER was a multicenter randomized trial in adults with pre-hypertension or stage 1 hypertension. The current analyses were limited to participants randomized to CLC interventions, excluding those who were assigned to control, those on lipid-lowering medication, or those missing follow-up lipid data. One intervention, “Established” (Est.), was a CLC that emphasized increased physical activity, weight reduction, reduced sodium intake, and a reduced fat/calorie diet. A second CLC intervention, “Established+DASH” (Est.+DASH), also included counseling on the DASH diet. Behavioral counseling was delivered via 18 sessions in the first 6 months and 15 sessions in the following 12 months (total 33 sessions). Results: Among the 450 participants, mean age was 50.4, 63% were women, and 31% were black. Baseline LDLc was 134 mg/dL in Est. and 134.8 mg/dL in Est.+DASH. Mean attendance in the first 6 months was 14.2 sessions in Est. and 14.6 in Est.+DASH, and in the last 12 months was 9.6 sessions in Est. and 10.1 sessions in Est.+DASH. There was no difference in attendance by intervention. After adjustment for factors associated with LDLc, every 10 CLC sessions were associated with a 6 mg/dL (P=0.003) lower LDLc ( Table ). This association was attenuated when adjusted for weight change. Similar patterns were noted for triglycerides and total cholesterol. Conclusions: Better attendance at CLC sessions was associated with larger reductions in LDLc over an 18 month period with evidence that weight loss mediated this relationship.

Abstract P43: Frequency and Predictors of Low-Density Lipoprotein Cholesterol Control and Appropriate Response to Elevated LDL-C Levels in Patients with Cardiovascular Disease

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Salim S Virani ◽  
Lechauncy D Woodard ◽  
Supicha Sookanan ◽  
Cassie R Landrum ◽  
Tracy H Urech ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Low Density Lipoprotein ◽  
Medication Possession Ratio ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Lipid Lowering ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
To Receive

Background: Although current cholesterol performance measures define good quality as low density lipoprotein cholesterol (LDL-C) levels < 100mg/dl in cardiovascular disease (CVD) patients, they provide a snap shot at one time point and do not inform whether an appropriate action was taken to manage elevated LDL-C levels. We assessed frequency and predictors of this appropriate response (AR). Methods: We used administrative data to assess 22,902 CVD patients receiving care in a Veterans Affairs network of 7 hospitals and affiliated clinics. We determined the proportion of CVD patients at LDL-C goal <100 mg/dl, and the proportion of patients with uncontrolled LDL-C levels (>100 mg/dl) who had an AR [defined as the initiation or dosage increase of a lipid lowering medication (LLM), addition of a new LLM, receipt of maximum dosage or >1 LLM, or LDL-C reading <100 mg/dl] at 45 days follow-up. Logistic regression was performed to evaluate facility, provider and patient characteristics associated with AR. Results: LDL-C levels were at goal in 16,350 (71.4%) patients. An additional 2,110 (9.2%) had an AR at 45 days of follow-up. Controlling for clustering between facilities and patient's illness severity, history of diabetes (OR 1.18, 95% CI 1.03-1.35), hypertension (OR 1.21, 95% CI 1.02-1.44), patients showing good medication adherence (medication possession ratio > 0.8) [OR 2.29, 95% CI 1.99-2.64] were associated with AR. Older CVD patients (age >75 years) were less likely to receive AR (OR 0.60, 95% CI 0.52-0.70). Teaching vs. non-teaching facility (p=0.40), physician vs. non-physician provider (p=0.14), specialist vs. non-specialist primary care provider (p=0.12), and patient's race (p=0.12) were not predictors of AR. Conclusion: Among patients with CVD and LDL-C above guideline recommended levels, only one-third receive AR. Diabetic and hypertensive CVD patients are more likely to receive AR, whereas older Veterans with CVD receive AR less often likely reflecting providers' belief of lack of efficacy from treatment intensification in older CVD patients. Our findings are important for quality improvement and policy making initiatives as they provide more actionable information compared with isolated LDL-C goal attainment as a quality indicator.

Abstract P183: Lipid Control in Veterans Following Percutaneous Intervention

2011 ◽  
Vol 4 (suppl_2) ◽  
Author(s):  
Sloane A McGraw ◽  
Chris Healy ◽  
Burhan Mohamedali ◽  
Anupama Shivaraju ◽  
Adhir Shroff
Keyword(s):  
Total Cholesterol ◽  
Therapeutic Option ◽  
Coronary Intervention ◽  
Lipid Lowering ◽  
Lipid Management ◽  
Beneficial Effects ◽  
The Mean ◽  
Lipid Control ◽  
Statin Use

Background: Management of lipids is vital in patients with underlying coronary artery disease (CAD). According to the American College of Cardiology (ACC) guidelines, all patients with CAD should have low density lipoproteins (LDL) goals to be less than 100 mg/dl with the therapeutic option of treatment to less than 70 mg/dl. This can be achieved using multiple lipid lowering agents, however statin use is encouraged in CAD patients due to its multiple beneficial effects. Methods: We conducted a retrospective cohort study focusing on lipid management and statin use in 857 veterans undergoing percutaneous coronary intervention (PCI) between September 2004 and December 2009 at the Jesse Brown Veterans Hospital in Chicago, IL. Values were collected both pre-intervention as well as at six month follow up. Results: Both pre and post PCI, focus was maintained on the total cholesterol as well as the LDL levels. The mean total cholesterol prior to intervention was 166mg/dl and decreased to150mg/dl at six month follow up. The LDL mean pre-PCI was 98mg/dl and at six months the mean LDL decreased to 86mg/dl. With regards to ACC guidelines, the percent at goal for LDL less than 100mg/dl increased from 59% pre-PCI to 74% post-PCI Furthermore, treatment to less than 70mg/dl increased from 22 to 32% at six months. Lastly, the use of statins increased from 72 to 89%. Conclusions: There were in improvements in both total cholesterol and LDL values at six months post-PCI. There were also improvements in the percentage of patients who met the ACC recommended goal of LDL cholesterol less than 100mg/dl and the suggested goal of 70mg/dl. At six months, there was also an increase in usage of statin therapy.

Importance of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors in the treatment of dyslipidemia and atherosclerosis

2019 ◽  
pp. 40-52
Author(s):  
Maksim Maksimov ◽  
Anastasia Shikaleva ◽  
Aleksandra Kuchaeva
Keyword(s):  
Clinical Studies ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Blood Lipid ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Pcsk9 Inhibitors ◽  
Lipid Lowering Drugs ◽  
Antibody Preparations

Representatives of different groups of lipid-lowering drugs may have some differences in the nature and severity of the effect on the blood lipid spectrum. A new class of drugs, PCSK9 inhibitors, whose activity is associated with a protein involved in the control of low density lipoprotein receptors, has recently appeared. In clinical practice, this group is represented by monoclonal antibody preparations evolocumab and alirocumab. PCSK9 inhibitors are promising drugs for use in combination lipid-lowering therapy, which so far, given the results of clinical studies, can be recommended in the third place after statins and ezetimibe. In clinical studies, it was shown that alirocoumab and evolocumab alone or in combination with statins and/or other lipid-lowering drugs significantly reduce cholesterol levels in low density lipoproteins – by an average of 60%, depending on the dose.

Abstract 3330: Effect of Achieved Low-density Lipoprotein Cholesterol Level by Atorvastatin on Stabilization of Coronary Plaques - Results from TWINS study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Katsuki Okada ◽  
Yasunori Ueda ◽  
Satoshi Saito ◽  
Atsushi Hirayama ◽  
Kazuhisa Kodama
Keyword(s):  
Cholesterol Level ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Coronary Plaque ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Yellow Plaque ◽  
The Mean

Background We have previously reported the stabilization and regression of coronary plaque by atorvastatin using both angioscopy and IVUS. However, it has not been clarified if plaque stabilization is achieved through the reduction of cholesterol level or the direct effect of statin. Then, we analyzed the effect of achieved low-density lipoprotein (LDL) cholesterol level on the stabilization of coronary plaque. Methods Twenty-nine patients with hypercholesterolemia and coronary heart disease were studied. They received lipid-lowering therapy with atorvastatin (10 –20 mg/day) for 80 weeks and were divided into 2 groups by the achieved LDL cholesterol level at 80-week follow up (low LDL group: LDL cholesterol < median value, and high LDL group: LDL cholesterol ≥ median value). Angioscopic examination was performed before and after 80 weeks treatment with atorvastatin. Angioscopic findings of coronary yellow plaque characteristics were divided into six grades (grade 0 to 5) to evaluate vulnerability of plaques; and the mean grade of each patient was evaluated. Results In all 29 patients, LDL cholesterol level was reduced (146.2 to 87.9 mg/dl; p<0.001) and the mean yellow plaque grade was decreased (1.4 to 1.2; p=0.002) at 80-week follow up. LDL cholesterol level was reduced both in low LDL group (140.3 to 75.9 mg/dl; p<0.001) and in high LDL group (151.7 to 99.1 mg/dl; p<0.001). Angioscopic examination showed significant improvement of the grade in low LDL group (1.4 to 1.1; p=0.012) at 80-week follow up, but no significant difference in high LDL group (1.4 to 1.3; p=0.11). Conclusions Lipid-lowering therapy with atorvastatin stabilized coronary plaques, and this effect was larger in the patients LDL cholesterol was reduced more.

scholarly journals Impact of Collaborative Shared Medical Appointments on Diabetes Outcomes in a Family Medicine Clinic

2018 ◽  
Vol 44 (4) ◽  
pp. 361-372 ◽  
Author(s):  
Melody L. Hartzler ◽  
McKenzie Shenk ◽  
Julie Williams ◽  
James Schoen ◽  
Thomas Dunn ◽  
...  
Keyword(s):  
Family Medicine ◽  
Patient Adherence ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Short Term ◽  
Low Literacy ◽  
Antihypertensive Medications ◽  
Shared Medical Appointments ◽  
Lipid Control ◽  
The Impact

Purpose The purpose of this study is to evaluate the impact of a collaborative diabetes shared medical appointment on patient outcomes in an urban family medicine practice. Methods Fifty-nine patients were enrolled to participate in multiple shared medical appointments (SMAs) over 12 months. Baseline data included hemoglobin (A1C), lipids, systolic blood pressure (SBP), weight, adherence to American Diabetes Association (ADA) guidelines, and surveys, including the Problem Areas in Diabetes (PAID-2) scale and the Spoken Knowledge in Low Literacy in Diabetes Scale (SKILLD). A1C and SBP were evaluated at each visit. Lipid control was assessed at baseline and at 6 and 12 months. Adherence to ADA guidelines, SKILLD and PAID-2 survey scores, and number of antihyperglycemic and antihypertensive medications were also evaluated at 12 months. Results Thirty-eight patients completed the study. Compared with baseline, A1C and low-density lipoprotein cholesterol (LDL-C) levels decreased significantly over 12 months ( P < .001 and P = .004, respectively). More patients became compliant with the ADA guidelines throughout the course of the study. Specifically, more patients achieved the LDL-C goal of ≤100 mg/dL (2.59 mmol/L; P < .001), were prescribed appropriate antihypertensive medications ( P < .001) and aspirin ( P < .001), and received the pneumonia vaccine ( P < .001). PAID-2 and SKILLD survey scores also significantly improved over the course of the study ( P ≤ .001 and P = .003, respectively). Conclusion Short-term interdisciplinary SMAs decreased A1C and LDL-C, improved patient adherence to ADA guidelines, improved emotional distress related to diabetes, and increased knowledge of diabetes.

scholarly journals Cumulative burden of lipid profiles predict future incidence of ischaemic stroke and residual risk

2021 ◽  
pp. svn-2020-000726
Author(s):  
Liye Dai ◽  
Jie Xu ◽  
Yijun Zhang ◽  
Anxin Wang ◽  
Zimo Chen ◽  
...  
Keyword(s):  
Ischaemic Stroke ◽  
Primary Outcome ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Profiles ◽  
Lipoprotein Cholesterol ◽  
Confounding Variables ◽  
Registration Number ◽  
The Impact

ObjectivesIncident ischaemic stroke (IS) risk may increase not only with lipids concentration but also with longer duration of exposure. This study aimed to investigate the impact of cumulative burden of lipid profiles on risk of incident IS.MethodsA total of 43 836 participants were enrolled who participated in four surveys during 2006–2013. Individual cumulative lipid burden was calculated as number of years (2006–2013) multiplied by the levels of low-density lipoprotein cholesterol (LDL-C), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C), non-HDL-C and triglyceride (TG), respectively. The primary outcome was defined as the incident IS during 2012–2017.ResultsDuring 4.67 years (±0.70 years) follow-up on average, we identified 1023 (2.33%) incident IS. Compared with respective reference groups, the HRs (95% CIs) of the upper tertile in cumulative TG burden, cumulative LDL-C burden, cumulative TC burden and cumulative non-HDL-C burden were 1.26 mmol/L (1.02–1.55 mmol/L), 1.47 mmol/L (1.25–1.73 mmol/L), 1.33 mmol/L (1.12–1.57 mmol/L) and 1.51 mmol/L (1.28–1.80 mmol/L) for incidence of IS, respectively. However, this association was not significant in cumulative HDL-C burden and IS (HR: 1.09; 95% CI: 0.79 to 1.52), after adjustment for confounding variables. Among 16 600 participants with low cumulative LDL-C burden, HRs (95% CI) for TC, TG, non-HDL-C and HDL-C with IS were 1.63 mmol/L (1.03–2.57 mmol/L), 1.65 mmol/L (1.19–2.31 mmol/L), 1.57 mmol/L (1.06–2.32 mmol/L) and 0.98 mmol/L (0.56–1.72 mmol/L), respectively.ConclusionsWe observed the correlation between cumulative burden of lipid profiles, except for cumulative burden of HDL-C, with the risk of incident IS. Cumulative burden of TC, TG and non-HDL-C may still predict IS in patients with low cumulative LDL-C burden.Trial registration numberChiCTR-TNRC-11001489.

scholarly journals Effect of Low-Density Lipoprotein Cholesterol Goal Achievement on Vascular Physiology Evaluated by Quantitative Flow Ratio in Patients Who Underwent Percutaneous Coronary Intervention

2021 ◽  
Vol 8 ◽  
Author(s):  
Long Chen ◽  
Qin Chen ◽  
Jiaxin Zhong ◽  
Zhen Ye ◽  
Mingfang Ye ◽  
...  
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Coronary Intervention ◽  
Goal Achievement ◽  
Flow Ratio ◽  
Low Density Lipoprotein Cholesterol ◽  
Coronary Physiology ◽  
Percutaneous Coronary ◽  
Quantitative Flow Ratio

Purpose: The change in coronary physiology from lipid-lowering therapy (LLT) lacks an appropriate method of examination. Quantitative flow ratio (QFR) is a novel angiography-based approach allowing rapid assessment of coronary physiology. This study sought to determine the impact of low-density lipoprotein cholesterol (LDL-C) goal achievement on coronary physiology through QFR.Methods: Cases involving percutaneous coronary intervention (PCI) and 1-year angiographic follow-up were screened and assessed by QFR analysis. Patients were divided into two groups according to the LDL-C level at the 1-year follow-up: (1) goal-achievement group (LDL-C &lt; 1.8 mmol/L or reduction of ≥50%, n = 146, lesion = 165) and (2) non-achievement group (n = 286, lesion = 331). All QFR data and major adverse cardiovascular and cerebrovascular events (MACCEs) at 1 year were compared between groups.Results: No differences between the groups in quantitative coronary angiography (QCA) data or QFR post-PCI were found. At the 1-year follow-up, lower percentage diameter stenosis (DS%) and percentage area stenosis (AS%) were recorded in the goal-achievement group (27.89 ± 10.16 vs. 30.93 ± 12.03, p = 0.010, 36.57 ± 16.12 vs. 41.68 ± 17.39, p = 0.003, respectively). Additionally, a better change in QFR was found in the goal-achievement group (0.003 ± 0.068 vs. −0.018 ± 0.086, p = 0.007), with a lower incidence of physiological restenosis and MACCEs (2.1 vs. 8.4%, p = 0.018, 5.4 vs. 12.6%, p = 0.021, respectively).Conclusion: Evaluated by QFR, patients who achieved the LDL-C goal appear to have a better coronary physiological benefit. This group of patients also has a better clinical outcome.

scholarly journals The plasma levels of free melatonin is not associated with cardiovascular events after acute myocardial infarction

2019 ◽  
Author(s):  
Jingwei Li ◽  
Qiang Ma ◽  
Zhi-Wei Liu ◽  
Jie Liu ◽  
Shun-Ying Hu ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Plasma Levels ◽  
Cox Regression ◽  
Blood Lipid ◽  
Coronary Intervention ◽  
Cardiovascular Death ◽  
Unit Increase ◽  
Lipid Control

Abstract Background Lower circulating levels of total melatonin is associated with adverse cardiovascular (CV) events in acute myocardial infarction (AMI) patients. Free melatonin is easier to measure in clinical practice compared with total melatonin. Whether free melatonin is associated with follow-up CV events in AMI patients has not been determined yet. Methods A total of 732 consecutive AMI patients treated with percutaneous coronary intervention between January 2013 and January 2015 participated in the study. Blood samples were collected as fast samples on the first morning after admission. The plasma levels of free melatonin were determined using non-extraction radioimmunoassays. The cox regression was used to explore the association between circulating melatonin and endpoints. The median follow-up was 31.6 months. Results Patients with high melatonin levels were more likely to be younger and to have poorer blood lipid control. Multivariate cox-regression analyses (adjusted for confounding variables) showed that one unit increase in log-transformed melatonin was not associated with increased risks of major adverse CV events (MACE, composite of cardiovascular death, myocardial infarction, stroke and heart failure, hazard ratio [HR], 1.74; 95% confidence interval [CI] 0.94 to 3.21; p =0.078). Conclusions Higher free melatonin levels on the onset of AMI is not associated with MACE in AMI patients, independent of established conventional risk factors.

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