scholarly journals Efficacy of Lipid-Lowering Therapy During Cardiac Rehabilitation in Patients With Diabetes Mellitus and Coronary Heart Disease

2021 ◽  
Author(s):  
Thomas Wittlinger ◽  
Bernhard Schwaab ◽  
Heinz Voeller ◽  
Christa Bongarth ◽  
Viktoria Heinze ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Diabetic Patients ◽  
Lipid Lowering Therapy ◽  
Cholesterol Levels ◽  
Patients With Diabetes

Abstract BackgroundCardiac rehabilitation (CR) in patients with coronary heart disease (CHD) aims to increase adherence to a healthy lifestyle and to secondary preventive medication. CR is able to improve quality of life and prognosis in CHD patients. This is particularly relevant for CHD patients with diabetes mellitus.DesignA prospective, multicenter registry study with patients from six rehabilitation centers in Germany.MethodsDuring CR, 1100 patients with a minimum age of 18 years and CHD documented by coronary angiography were included in a LLT registry.ResultsIn 369 patients (33.9 %), diabetes mellitus was diagnosed. Diabetic patients were older (65.5 ± 9.0 vs. 62.2 ± 10.9 years, p < 0.001) than nondiabetic patients and more likely to be obese (BMI: 30.2 ± 5.2 kg/m2 vs. 27.8 ± 4.2 kg/m2, p < 0.001). Analysis indicated that diabetic patients were more likely to show LDL cholesterol levels below 55 mg/dL than patients without diabetes at the start of CR (Odds Ratio (OR) 1.9; 95 % CI 1.3 to 2.9) until 3 months of follow-up (OR 1.9; 95 % CI 1.2 to 2.9). During 12 months of follow-up, overall and LDL cholesterol levels decreased within the first 3 months and remained at the lower level thereafter (p < 0.001), irrespective of prevalent diabetes. At the end of the follow-up, LDL cholesterol did not differ significantly between patients with or without diabetes mellitus (p = 0.413).ConclusionWithin 3 months after CR, total and LDL cholesterol were significantly reduced, irrespective of prevalent diabetes mellitus. In addition, CHD patients with diabetes responded faster to LTT than nondiabetic patients, suggesting that diabetic patients benefit more from LLT treatment during CR.

scholarly journals Efficacy of Lipid-Lowering Therapy during Cardiac Rehabilitation in Patients with Diabetes Mellitus and Coronary Heart Disease

2021 ◽  
Vol 8 (9) ◽  
pp. 105
Author(s):  
Thomas Wittlinger ◽  
Bernhard Schwaab ◽  
Heinz Völler ◽  
Christa Bongarth ◽  
Viktoria Heinze ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Heart Disease ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Diabetic Patients ◽  
Lipid Lowering Therapy ◽  
Cholesterol Levels ◽  
Lowering Therapy ◽  
Patients With Diabetes

Background: Cardiac rehabilitation (CR) in patients with coronary heart disease (CHD) increases adherence to a healthy lifestyle and to secondary preventive medication. A notable example of such medication is lipid-lowering therapy (LLT). LLT during CR improves quality of life and prognosis, and thus is particularly relevant for patients with diabetes mellitus, which is a major risk factor for CHD. Design: A prospective, multicenter registry study with patients from six rehabilitation centers in Germany. Methods: During CR, 1100 patients with a minimum age of 18 years and CHD documented by coronary angiography were included in a LLT registry. Results: In 369 patients (33.9%), diabetes mellitus was diagnosed. Diabetic patients were older (65.5 ± 9.0 vs. 62.2 ± 10.9 years, p < 0.001) than nondiabetic patients and were more likely to be obese (BMI: 30.2 ± 5.2 kg/m2 vs. 27.8 ± 4.2 kg/m2, p < 0.001). Analysis indicated that diabetic patients were more likely to show LDL cholesterol levels below 55 mg/dL than patients without diabetes at the start of CR (Odds Ratio (OR) 1.9; 95% CI 1.3 to 2.9) until 3 months of follow-up (OR 1.9; 95% CI 1.2 to 2.9). During 12 months of follow-up, overall and LDL cholesterol levels decreased within the first 3 months and remained at the lower level thereafter (p < 0.001), irrespective of prevalent diabetes. At the end of the follow-up period, LDL cholesterol did not differ significantly between patients with or without diabetes mellitus (p = 0.413). Conclusion: Within 3 months after CR, total and LDL cholesterol were significantly reduced, irrespective of prevalent diabetes mellitus. In addition, CHD patients with diabetes responded faster to LTT than nondiabetic patients, suggesting that diabetic patients benefit more from LLT treatment during CR.

The current LDL-C target <1.4mmol/l of the ESC is achieved in less than 16% of patients with Coronary Heart Disease despite effective lipid-lowering therapy: data from the LLT-R registry

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Noack ◽  
B Schwaab ◽  
H Voeller ◽  
K Eckrich ◽  
M Guha ◽  
...  
Keyword(s):  
Coronary Heart Disease ◽  
Heart Disease ◽  
Cardiac Rehabilitation ◽  
Lipid Lowering ◽  
Funding Source ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Lowering Therapy ◽  
Rehabilitation Clinic

Abstract Background In the current guideline of the ESC, in patients with very high cardiovascular risk such as coronary heart disease (CHD) a treatment target for LDL-C &lt;1.4mmol/l and/or a halving of the initial value are defined. It is unclear whether these treatment targets are achievable with standard therapy including statins and/or ezetemibe. Methods The primary objective of this prospective, multi-centre register study was the question of the guidance-based adaptation and adherence to lipid-lowering therapy during and after a cardiac rehabilitation in 1,100 patients with CHD up to 12 months after discharge from the six rehabilitation clinics involved. Patients were included from 2016 to 2018. Results The median age of the 1,100 patients was 63.4±10.4 years, the mean BMI was 28.5±4.7kg/m2, and 24.1% of patients were female. 12.2% were active smokers, 91.6% reported dyslipoproteinemia, 33.9% suffered from diabetes mellitus and 86.5% from hypertension. The majority of patients were included with the main indications NSTEMI (31.6%), STEMI (29.6%) and after CABG surgery (26.4%). The proportion of patients treated with statins was more than 94% when admitted and discharged from the rehabilitation clinic, as well as in 3- and 12-months follow-ups. Approximately 9% of patients were treated with ezetemibe at baseline. On discharge from the rehabilitation clinic 23% of patients were treated with ezetemibe, which remains stable at 3 and 12 months. PCSK9 inhibitors were used in 0.1–0.3% of patients at all times. The adjustment of LLT during three week cardiac rehabilitation resulted in median LDL-C values of 2.27mmol/l (1.80/2.84) at baseline, 1.97mmol/l (1.57/2.47) on discharge (p&lt;0.001 compared to baseline), 1.94mmol/l (1.57/2.49) after three months and 1.94mmol/l (1.53/2.40) after 12 months. The proportion of patients with LDL-C &lt;1.4mmol/l was 9% at baseline, 15.7% on discharge (p&lt;0.001 compared to baseline), 15.6% at three-month follow-up and 15.1% at 12-month follow-up (Figure 1). Discussion In the context of cardiac rehabilitation, an effective adjustment of LLT is carried out, which resulted in a significant reduction of LDL-C. However, despite a high percentage of patients on statins and ezetemibe, the proportion of patients in the new target range &lt;1.4mmol/l was only achievable in a small percentage and the question arises whether these treatment targets can be achieved without additional administration of PCSK9 inhibitors in majority of patients with CHD. Figure 1 Funding Acknowledgement Type of funding source: Private company. Main funding source(s): This study was supported by an unrestricted grant from Sanofi-Aventis Germany.

scholarly journals Efficacy of a nurse-led lipid-lowering secondary prevention intervention in patients hospitalized for ischemic heart disease: A pilot randomized controlled trial

2019 ◽  
Vol 18 (5) ◽  
pp. 366-374
Author(s):  
Sonia Ruiz-Bustillo ◽  
Consol Ivern ◽  
Neus Badosa ◽  
Nuria Farre ◽  
Esther Marco ◽  
...  
Keyword(s):  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Ldl Cholesterol ◽  
Controlled Trial ◽  
Lipid Level ◽  
Standard Of Care ◽  
Lipid Lowering ◽  
P Value ◽  
Cholesterol Levels

Background and aims: Lack of achievement of secondary prevention objectives in patients with ischaemic heart disease remains an unmet need in this patient population. We aimed at evaluating the six-month efficacy of an intensive lipid-lowering intervention, coordinated by nurses and implemented after hospital discharge, in patients hospitalized for an ischaemic heart disease event. Methods: Randomized controlled trial, in which a nurse-led intervention including periodic follow-up, serial lipid level controls, and subsequent optimization of lipid-lowering therapy, if appropriate, was compared with standard of care alone in terms of serum lipid-level control at six months after discharge. Results: The nurse-led intervention was associated with an improved management of low-density lipoprotein (LDL) cholesterol levels compared with standard of care alone: LDL cholesterol levels ⩽100 mg/dL were achieved in 97% participants in the intervention arm as compared with 67% in the usual care arm ( p value <0.001), the LDL cholesterol ⩽70 mg/dL target recommended by the 2016 European Society of Cardiology guidelines was achieved in 62% vs. 37% participants ( p value 0.047) and the LDL cholesterol reduction of ⩾50% recommended by the American College of Cardiology/American Heart Association in 2013 was achieved in 25.6% of participants in the intervention arm as compared with 2.6% in the usual care arm ( p value 0.007). The intervention was also associated with improved blood pressure control among individuals with hypertension. Conclusions: Our findings highlight the opportunity that nurse-led, intensive, post-discharge follow-up plans may represent for achieving LDL cholesterol guideline-recommended management objectives in patients with ischaemic heart disease. These findings should be replicated in larger cohorts.

scholarly journals GAMBARAN KADAR ALBUMINURIA PADA SUBJEK DIABETES MELITUS DENGAN DAN TANPA PENYAKIT JANTUNG KORONER

e-CliniC ◽  
2014 ◽  
Vol 2 (2) ◽  
Author(s):  
Sandy Cendra ◽  
Emma Moeis ◽  
Yuanita Langi
Keyword(s):  
Diabetes Mellitus ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Renal Physiology ◽  
Diabetic Patients ◽  
Cross Sectional ◽  
Female Patients ◽  
Patients With Diabetes ◽  
Male Patients ◽  
Diabetes Melitus

Abstract: Albuminuria is a marker of the decline in renal physiology and function of endothelial. Endothelial dysfunction is an early pathogenesis of coronary heart disease (CHD). High coronary heart disease complications in patients with diabetes mellitus (DM). Objective To know the description and differences in levels of albuminuria in diabetic patients with and without CHD inpoli Metabolic and Endocrine and poli Heart BLU. RSU. Prof. dr. R. D Kandou Manado. Research Method: Cross Sectional descriptive analytic study conducted in patients with diabetes mellitus pieces with and without coronary heart disease in Poli Endocrine Metabolic and poli heart BLU. RSU. Prof. dr. R. D Kandou Manado period November 2012 - November 2013. Results: From 34 patients with diabetes mellitus found the number of diabetic patients with CHD were 17 patients and 17 patients for diabetes without CHD, which consisted of 14 male patients and 20 female patients. The distribution of the sample based on CHD and sex, showed that diabetic patients with CHD were 9 men (26.47%) and 8 women (23.53%). As for diabetic patients without CHD as many as 5 male patients (14.70%) and 12 female patients (35.30%). Distribution of the study sample by CHD and RAKU categories showed diabetic patients with CHD were 7 patients (20.59%) and normal RAKU 10 patients (29.41%) RAKU abnormal. As for diabetic patients without CHD by 16 patients (47.06%) and 1 patient RAKU normal (2.94%) RAKU abnormal. Conclusion: Albuminuria occurs more frequently in patients with diabetes mellitus with coronary heart disease than diabetes mellitus without coronary heart diseaseKeywords: Albuminuria, diabetes mellitus, coronary heart disease.    Abstrak: Albuminuria merupakan petanda terjadinya penurunan faal ginjal dan disfungsi endotel. Disfungsi endotel merupakan patogenesis awal penyakit jantung koroner (PJK). Komplikasi penyakit jantung koroner tinggi pada pasien diabetes melitus (DM). Tujuan: Untuk mengetahui gambaran dan perbedaan kadar albuminuria pada pasien DM dengan dan tanpa PJK di Poli Endokrin Metabolik dan Poli Jantung BLU. RSU. Prof. dr. R. D Kandou  Manado. Metode Penelitian: Dilakukan penelitian deskriptif analitik lintang potong pada penderita diabetes melitus dengan dan tanpa penyakit jantung koroner di Poli Endokrin Metabolik dan Poli Jantung BLU.RSU. Prof. dr. R. D Kandou  Manado periode November 2012 – November 2013. Hasil: Dari 34 pasien Diabetes Melitus ditemukan jumlah pasien DM dengan PJK sebanyak 17 pasien dan 17 pasien untuk DM tanpa PJK, yang terdiri atas 14 orang pasien laki-laki dan 20 pasien wanita. Distribusi sampel berdasarkan PJK dan jenis kelamin, didapatkan hasil pasien DM dengan PJK yaitu sebanyak 9 orang laki-laki (26,47 %) dan 8  orang perempuan (23,53%). Sedangkan untuk pasien DM tanpa PJK yaitu sebanyak 5 orang pasien laki-laki (14,70%) dan 12 orang pasien perempuan (35,30%). Distribusi sampel penelitian berdasarkan PJK dan RAKU Kategori didapatkan hasil pasien DM dengan PJK sebanyak 7 pasien (20,59%) RAKU normal dan 10 pasien (29,41%) RAKU abnormal. Sedangkan untuk pasien DM tanpa PJK sebanyak 16 pasien (47,06%) RAKU normal dan 1 pasien (2,94%) RAKU abnormal. Simpulan: Albuminuria lebih banyak terjadi pada pasien diabetes melitus dengan penyakit jantung koroner dibandingkan diabetes melitus tanpa penyakit jantung koroner Kata kunci: Albuminuria, diabetes melitus, penyakit jantung koroner.

The Need for a More Stringent LDL-C Goal in Patients with Diabetes

2005 ◽  
Vol 21 (6) ◽  
pp. 325-329
Author(s):  
Julie S Altman ◽  
Jessica L Kerr ◽  
Margaret R Thrower
Keyword(s):  
Diabetes Mellitus ◽  
Relevant Literature ◽  
Cardiovascular Morbidity ◽  
Morbidity And Mortality ◽  
Lipid Lowering ◽  
Diabetic Patients ◽  
Lipid Lowering Therapy ◽  
Lipid Management ◽  
Cardiovascular Morbidity And Mortality ◽  
Patients With Diabetes

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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