scholarly journals Do we reach target lipid levels in diabetic and non-diabetic patients with previous myocardial infarction?

2011 ◽  
Vol 139 (1-2) ◽  
pp. 30-36
Author(s):  
Emina Aleksic ◽  
Radmila Stamenkovic ◽  
Mirjana Lapcevic ◽  
Marina Deljanin-Ilic ◽  
Dragan Djordjevic ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
Ldl Cholesterol ◽  
Plasma Concentrations ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
Diabetic Patients ◽  
Prevention Measures ◽  
Previous Myocardial Infarction ◽  
Lipid Lowering Drugs ◽  
Coronary Events

Introduction. Considering that dyslipidaemia is an important factor for cardiovascular diseases, target lipid levels are rarely reached in everyday clinical practice. Objective. The objective of this study was to evaluate how often we achieve the treatment goals for the lipid parameters in the diabetic and non-diabetic patients after the previous myocardial infarction (MI). Methods. The survey included 118 patients (84 males and 34 females), mean age 59.38?9.86 years, 34 (28.8%) of them diabetics, with the history of MI in the previous 3 years. The patients were selected from the database of multicentre prospective interventional study ?Secondary prevention of coronary heart disease and cerebrovascular diseases?, conducted in 2005 on 1,189 patients in Serbia. The patients were further followed in the period from 18 (5th visit) and 36 months (6th visit) after inclusion into the study from 2005-2008. Their lipid status, the use of lipid-lowering drugs, and the independent prognostic factors for major adverse coronary events were identified. In the beginning of the study, all patients were informed about the importance of lifestyle change and active approach to treatment. The accomplishment of secondary preventive measures was estimated on the basis of the European guidelines on secondary prevention of the coronary heart disease. Results. Three years after introduction of the preventive measures, diabetics had a higher prevalence of the target levels of the total cholesterol (21.2% vs. 7.6%) and HDL-cholesterol than non-diabetics (100% vs. 87.3%) (p<0.05). Non-diabetics had significantly higher prevalence of the target levels of LDL-cholesterol than diabetics (19% vs. 3%) (p<0.05). No significant differences were found in the prevalence of the treatment goals of triglycerides in diabetic (42.4%) and non-diabetic patients (60.8%) (p>0.05). At the end of the study, after applying secondary prevention measures, 27.3% of diabetics did not use lipid-lowering drugs. The percentage of non-diabetics using no lipid-lowering drugs was lower (20.3%), but the difference was not statistically significant (p>0.05). By using the method Enter Cox regression multivariant analysis, the change in the level of triglycerides, total and LDL-cholesterol were singled out as independent prognostic factors for major adverse coronary events. Conclusion. Our study has shown high prevalence of increased plasma concentrations in the total, LDL-cholesterol and triglycerides and low plasma concentrations of HDL-cholesterol, as well as the insufficient use of lipid-lowering drugs in diabetic and non-diabetic patients with previous MI. Decreasing the total cholesterol and increasing the HDL-cholesterol are significant, decreasing of triglycerides and LDL-cholesterol does not suffice. Therefore, secondary prevention measures of cardiovascular events should be intensified, especially in patients with diabetes.

scholarly journals The Effect of Egg Consumption in Hyperlipidemic Subjects during Treatment with Lipid-Lowering Drugs

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Theerawut Klangjareonchai ◽  
Supanee Putadechakum ◽  
Piyamitr Sritara ◽  
Chulaporn Roongpisuthipong
Keyword(s):  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Lipid Profiles ◽  
Lipid Lowering ◽  
Cholesterol Ratio ◽  
Regular Diet ◽  
Egg Consumption ◽  
Lipid Lowering Drugs ◽  
Reduce Risk ◽  
Body Compositions

Background. Limiting egg consumption to avoid high cholesterolemia is recommended to reduce risk of cardiovascular disease. However, recent evidences suggest that cholesterol from diet has limited influence on serum cholesterol.Objective. To assess the effect of egg consumption on lipid profiles in hyperlipidemic adults treated with lipid-lowering drugs.Material and Method. Sixty hyperlipidemic subjects, mean age of 61 years, who had been treated with lipid-lowering drugs. Every subject was assigned to consume additional 3 eggs per day with their regular diet for 12 weeks. Measurements for lipid profiles and body compositions were performed.Results. An additional consumption of 3 eggs per day for 12 weeks increased HDL-cholesterol by2.46±6.81 mg/dL (P<0.01) and decreased LDL-cholesterol to HDL-cholesterol ratio by0.13±0.46(P<0.05). No significant changes were found in other lipid profiles. Body weight and body mass index were significantly increased at 12th week by0.52±1.83 kg and0.31±0.99 kg/m2, respectively (P<0.05).Conclusion. In hyperlipidemic adults who were treated with lipid-lowering drugs, the consumption of additional 3 eggs per day to their regular diet will increase the level of HDL-cholesterol and decrease the ratio of LDL-cholesterol to HDL-cholesterol.

Lipid-lowering drugs

ESC CardioMed ◽  
2018 ◽  
pp. 204-209
Author(s):  
Cesare R. Sirtori ◽  
Massimiliano Ruscica
Keyword(s):  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
High Density Lipoproteins ◽  
Omega 3 ◽  
Transfer Protein ◽  
Increased Risk ◽  
Low Hdl ◽  
Coronary Events ◽  
Systemic Agents

Hyperlipidaemias, multifactorial conditions partly genetically and partly life habit induced, are the most important underlying risk factors for cardiovascular disease. They can lead to arterial lipid deposition with a consequent increased risk of coronary events. The primary effort in hypolipidaemic drug therapy is focused on the lowering of the primary carriers of cholesterol, the low-density lipoproteins (LDLs), but more recent efforts have been placed on the lowering of triglycerides. Reduced levels of the protective high-density lipoproteins (HDLs) are generally considered a primary risk factor, ‘dysfunctional’ HDL may probably be a more important factor. Among drugs primarily reducing LDL cholesterol the most important systemic agents are statins. Non-systemic agents, such as resins, have a lesser use, whereas ezetimibe is frequently given in combination with statins. A new series of systemic compounds, the inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9), recently available, have a higher activity on LDL cholesterol. Drugs indicated for the treatment of the homozygous forms of hypercholesterolaemia are lomitapide, an inhibitor of the microsomal transfer protein, and the antisense nucleotide mipomersen, designed to inhibit synthesis of apolipoprotein B. Treatment of hypertriglyceridaemias mainly relies on fibrates, activating the peroxisomal proliferator-activated receptor-α‎. They treat particularly the atherogenic dyslipidaemias (elevated triglycerides with low HDL cholesterol). Nicotinic acid is less frequently used and the omega-3 fatty acids have an as yet unclear cardiovascular protective activity.

Lipid-lowering drugs

ESC CardioMed ◽  
2018 ◽  
pp. 204-209
Author(s):  
Cesare R. Sirtori ◽  
Massimiliano Ruscica
Keyword(s):  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
High Density Lipoproteins ◽  
Omega 3 ◽  
Transfer Protein ◽  
Increased Risk ◽  
Low Hdl ◽  
Coronary Events ◽  
Systemic Agents

Hyperlipidaemias, multifactorial conditions partly genetically and partly life habit induced, are the most important underlying risk factors for cardiovascular disease. They can lead to arterial lipid deposition with a consequent increased risk of coronary events. The primary effort in hypolipidaemic drug therapy is focused on the lowering of the primary carriers of cholesterol, the low-density lipoproteins (LDLs), but more recent efforts have been placed on the lowering of triglycerides. Reduced levels of the protective high-density lipoproteins (HDLs) are generally considered a primary risk factor, ‘dysfunctional’ HDL may probably be a more important factor. Among drugs primarily reducing LDL cholesterol the most important systemic agents are statins. Non-systemic agents, such as resins, have a lesser use, whereas ezetimibe is frequently given in combination with statins. A new series of systemic compounds, the inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9), recently available, have a higher activity on LDL cholesterol. Drugs indicated for the treatment of the homozygous forms of hypercholesterolaemia are lomitapide, an inhibitor of the microsomal transfer protein, and the antisense nucleotide mipomersen, designed to inhibit synthesis of apolipoprotein B. Treatment of hypertriglyceridaemias mainly relies on fibrates, activating the peroxisomal proliferator-activated receptor-α‎. They treat particularly the atherogenic dyslipidaemias (elevated triglycerides with low HDL cholesterol). Nicotinic acid is less frequently used and the omega-3 fatty acids have an as yet unclear cardiovascular protective activity.

scholarly journals Are current dietary guidelines relevant to subjects on cholesterol-lowering drugs?

2019 ◽  
Vol 79 (1) ◽  
pp. 88-94 ◽  
Author(s):  
Andrew M. Salter
Keyword(s):  
Risk Factors ◽  
Ldl Cholesterol ◽  
Dietary Habits ◽  
Hdl Cholesterol ◽  
Premature Mortality ◽  
Dietary Guidelines ◽  
Lipid Lowering ◽  
Dietary Advice ◽  
Processed Meat ◽  
Lipid Lowering Drugs

The present paper reviews the evidence as to whether patients on lipid-lowering drugs should restrict dietary SFA intake. Premature mortality from atherosclerotic CVD has fallen dramatically in many high-income countries. This appears to be due to a combination of improved treatment following a cardiovascular event and reduced risk factors, including LDL-cholesterol. Whether this reduction is due to changes in dietary habits, or the increasing availability of highly potent cholesterol-reducing drugs remains to be firmly established. While reducing dietary SFA intake has been the cornerstone of public health nutrition policy for several decades, the efficacy of such dietary changes has been challenged in recent years. While there remains a lack of consensus in the literature, there is an emerging view that dietary advice should be specifically modified to emphasise replacing SFA with PUFA in the diet rather than carbohydrate. The advice to moderate dietary SFA intake given to the general population is usually also given to those individuals at high risk of CVD who are prescribed lipid-lowering drugs. There is limited evidence to suggest that any potential benefit of such a diet on LDL-cholesterol may be offset by a concurrent decrease in HDL-cholesterol. However, as diets rich in SFA are frequently energy-dense, and rich in red and processed meat (potential risk factors for CVD in themselves), it would seem prudent to continue to advise patients on lipid-lowering drugs to maintain a low-fat diet.

scholarly journals Improving statin treatment strategies to reduce LDL-cholesterol: factors associated with targets’ attainment in subjects with and without type 2 diabetes

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Mario Luca Morieri ◽  
Valentina Perrone ◽  
Chiara Veronesi ◽  
Luca Degli Esposti ◽  
Margherita Andretta ◽  
...  
Keyword(s):  
Secondary Prevention ◽  
High Intensity ◽  
Ldl Cholesterol ◽  
Treatment Strategies ◽  
Hdl Cholesterol ◽  
Statin Treatment ◽  
Lipid Lowering ◽  
Treatment Intensity ◽  
Cross Sectional ◽  
Cholesterol Levels

Abstract Background This cross-sectional study aimed to identify actionable factors to improve LDL-cholesterol target achievement and overcome underuse of lipid-lowering treatments in high- or very-high-cardiovascular risk patients. Methods We evaluated healthcare records of 934,332 subjects from North-Italy, including subjects with available lipid profile and being on statin treatments up to December 2018. A 6-month-period defined adherence with proportion-of-days-covered ≥ 80%. Treatment was classified as high-intensity-statin (HIS) + ezetimibe, HIS-alone, non-HIS (NHIS) + ezetimibe or NHIS alone. Results We included 27,374 subjects without and 10,459 with diabetes. Among these, 30% and 36% were on secondary prevention, respectively. Adherence was high (78–100%) and increased with treatment intensity and in secondary prevention. Treatment intensity increased in secondary prevention, but only 42% were on HIS. 2019-guidelines LDL-cholesterol targets were achieved in few patients and more often among those with diabetes (7.4% vs. 10.7%, p < 0.001). Patients in secondary prevention had mean LDL-cholesterol levels aligned slightly above 70 mg/dl (range between 68 and 73 mg/dl and between 73 and 85 mg/dl in patients with and without diabetes, respectively). Moreover, the differences in mean LDL-cholesterol levels observed across patients using treatments with well-stablished different LDL-lowering effect were null or much smaller than expected (HIS vs. NHIS from − 3 to − 11%, p < 0.001, HIS + ezetimibe vs. HIS—from − 4 to + 5% n.s.). These findings, given the observational design of the study, might suggest that a “treat to absolute LDL-cholesterol levels” approach (e.g., targeting LDLc of 70 mg/dl) was mainly used by physicians rather than an approach to also achieve the recommended 50% reduction in LDL-cholesterol levels. Our analyses suggested that female sex, younger age, higher HDL-c, and elevated triglycerides are those factors delaying prescription of statin treatments, both in patients with and without diabetes and in those on secondary prevention. Conclusions Among patients on statin treatment and high adherence, only a small proportion of patients achieved LDL-cholesterol targets. Late initiation of high-intensity treatments, particularly among those with misperceived low-risk (e.g., female subjects or those with high HDL-cholesterol), appears as pivotal factors needing to be modified to improve CVD prevention.

scholarly journals Plasma PCSK9 Concentrations Correlate with LDL and Total Cholesterol in Diabetic Patients and Are Decreased by Fenofibrate Treatment

2008 ◽  
Vol 54 (6) ◽  
pp. 1038-1045 ◽  
Author(s):  
Gilles Lambert ◽  
Nicolas Ancellin ◽  
Francesca Charlton ◽  
Daniel Comas ◽  
Julia Pilot ◽  
...  
Keyword(s):  
Ldl Cholesterol ◽  
Polyclonal Antibodies ◽  
Sandwich Elisa ◽  
Ldl Receptor ◽  
Hdl Cholesterol ◽  
Diabetic Patients ◽  
Plasma Triglycerides ◽  
Fenofibrate Treatment ◽  
Before And After ◽  
Fenofibrate Intervention

Abstract Background: Proprotein convertase subtilisin/kexin type 9 (PCSK9) promotes the degradation of the LDL receptor (LDLr) in hepatocytes, and its expression in mouse liver has been shown to decrease with fenofibrate treatment. Methods: We developed a sandwich ELISA using recombinant human PCSK9 protein and 2 affinity-purified polyclonal antibodies directed against human PCSK9. We measured circulating PCSK9 concentrations in 115 diabetic patients from the FIELD (Fenofibrate Intervention and Event Lowering in Diabetes) study before and after fenofibrate treatment. Results: We found that plasma PCSK9 concentrations correlate with total (r = 0.45, P = 0.006) and LDL (r = 0.54, P = 0.001) cholesterol but not with triglycerides or HDL cholesterol concentrations in that cohort. After 6 weeks of treatment with comicronized fenofibrate (200 mg/day), plasma PCSK9 concentrations decreased by 8.5% (P = 0.041 vs pretreatment). This decrease correlated with the efficacy of fenofibrate, as judged by a parallel reduction in plasma triglycerides (r = 0.31, P = 0.015) and LDL cholesterol concentrations (r = 0.27, P = 0.048). Conclusions: We conclude that this decrease in PCSK9 explains at least in part the LDL cholesterol–lowering effects of fenofibrate. Fenofibrate might be of interest to further reduce cardiovascular risk in patients already treated with a statin.

Cost offset of lipid-lowering drugs for primary and secondary prevention of cardiovascular disease

2005 ◽  
Vol 5 (2) ◽  
pp. 193-205 ◽  
Author(s):  
Luca Degli Esposti ◽  
Mirko Di Martino ◽  
Stefania Saragoni ◽  
Alessandro Capone ◽  
Pierluigi Russo ◽  
...  
Keyword(s):  
Cardiovascular Disease ◽  
Secondary Prevention ◽  
Lipid Lowering ◽  
Primary And Secondary Prevention ◽  
Lipid Lowering Drugs ◽  
Cost Offset ◽  
Prevention Of Cardiovascular Disease

Complex lipid-lowering treatment options in patients with a history of acute coronary syndrome

2011 ◽  
Vol 152 (8) ◽  
pp. 296-302 ◽  
Author(s):  
Győző Dani ◽  
László Márk ◽  
András Katona
Keyword(s):  
Acute Coronary Syndrome ◽  
Serum Lipid ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
Coronary Syndrome ◽  
Target Values ◽  
History Of ◽  
Lipid Parameters

Authors aimed to assess how target values in serum lipid concentrations (LDL- and HDL-cholesterol, triglyceride) can be achieved in patients with a history of acute coronary syndrome during follow up in an outpatient cardiology clinic. Methods: 201 patients with a history of acute coronary syndrome were included and were followed up between January 1 and May 31, 2007.Authors analyzed serum lipid parameters of the patients and the lipid-lowering medications at the time of the first meeting and during follow up lasting two years. Results: During the enrollment visit only 26.4% of the patients had serum LDL cholesterol at target level, whereas high triglycerides and low HDL cholesterol levels were observed in 40.3% and 33.3% of the patients, respectively. Only 22 patients (10.9%) achieved the target levels in all three lipid parameters. Of the 201 patients, 179 patients participated in the follow up, and data obtained from these patients were analyzed. There was a positive trend toward better lipid parameters; 42.5% of the patients reached the desired LDL-cholesterol target value and 17.3% of the patients had HDL-cholesterol and triglycerides target values. Conclusions: These findings are consistent with those published in the literature. Beside the currently used therapeutic options for achieving optimal LDL-cholesterol, efforts should be made to reduce the so-called “residual cardiovascular risk” with the use of a widespread application of combination therapy. Orv. Hetil., 2011, 152, 296–302.

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