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.

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.

5130Association between degree of LDL-cholesterol decrease after a myocardial infarction and mortality - a nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Schubert ◽  
B Lindahl ◽  
H Melhus ◽  
H Renlund ◽  
M Leosdottir ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lower Risk ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Index Event ◽  
Risk Of Death ◽  
Lowering Therapy ◽  
Statin Use

Abstract Background In clinical trials, patients with myocardial infarction (MI) and elevated LDL-cholesterol (LDL-C) benefit the most from lipid lowering therapy, and more intensive LDL-C lowering therapy is associated with better prognosis. Purpose To investigate the association between degree of LDL-C lowering and prognosis in MI patients from a large real-world setting. Methods Patients admitted with an MI between 2006 and 2016 and registered in the Swedish MI-registry (SWEDEHEART) were followed until 2018. The difference in LDL-C between the MI hospitalization and a 6–10 week follow-up was measured. In multivariable Cox regression analysis adjusting for clinical risk factors (eg. age, diabetes, prior cardiovascular disease), the association between LDL-C change, mortality and recurrent MI was assessed using restricted cubic splines. Further, the patients were stratified according to quartile decrease in LDL-C from MI hospitalization to the follow-up. Results A total of 44,148 patients (median age: 64) had an LDL-C measured during the MI hospitalization and at follow-up. Of these, 9,905 (22.4%) had ongoing statin treatment prior to admission. The median LDL-C at the MI hospitalization was 2.96 (interquartile range 2.23, 3.74) mmol/L and the median decrease in LDL-C was 1.17 (0.37, 1.86) mmol/L. During a median follow-up of 3.9 years, 3,342 patients died and 3,210 had an MI. Patients with the highest quartile of LDL-C decrease (1.86 mmol/L) from index event to follow-up, had a lower risk of mortality, hazard ratio (HR) 0.59 (95% confidence interval [CI] 0.44–0.80) compared to those with the lowest quartile of LDL-C decrease (0.37 mmol/L) (figure). For MI, the corresponding HR was 0.83 (95% CI 0.68–1.02). Ongoing statin-use prior to admission did not alter the effect of LDL-C decrease and outcome in the analysis. Conclusions In this large nationwide cohort of MI patients, a gradually lower risk of death was observed in patients with larger decrease in LDL-C from index event to follow-up, regardless of statin use prior to admission. The same trend was observed for recurrent MI, although not reaching statistical significance. This confirms previous findings that efforts should be made to lower LDL-C after MI.

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 Inclisirán as an alternative treatment for Hypercholesterolemia

2021 ◽  
Vol 12 (3) ◽  
pp. 517-521
Author(s):  
Jorge Andrés Ojeda Villota ◽  
Javier Alfredo Pérez Martínez ◽  
Luis Alberto Burgos de Moya ◽  
Rodrigo Alfonso Chavez Vega ◽  
Roxana Rivera Valencia ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Low Density ◽  
Pcsk9 Inhibitors ◽  
Cholesterol Levels ◽  
Lowering Therapy

Hypercholesterolemia (CH) is defined as the elevation of serum cholesterol levels, especially low-density lipoprotein (LDL) cholesterol, which is considered to be one of the most relevant risk factors for triggering cardiovascular disease, for This is vitally important to start treatment, there are several highly useful pharmacological groups for lipid-lowering therapy, among them we highlight the PCSK9 inhibitors, among the molecules that are part of this group we find inclisirán, this being a structure that promises a lot in regarding the management of hypercholesterolemia.

P821Treatment patterns of lipid lowering therapy in patients with coronary artery disease above vs. below 75 years of age

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
A A Mahabadi ◽  
D Wiefhoff ◽  
I Dykun ◽  
S Hendricks ◽  
F Al-Rashid ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Elderly Patients ◽  
Ldl Cholesterol ◽  
Age Groups ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Cholesterol Levels ◽  
Lowering Therapy ◽  
Artery Disease

Abstract Introduction In patients with coronary artery disease (CAD), lipid lowering therapy is recommended as cornerstone of secondary prevention. Treatment of elderly patients inherits a medical challenge, as they experience higher absolute risk reduction with more intensive lipid lowering regimes but may be more prone to side effects by therapy. Purpose To evaluate the treatment patterns in lipid lowering therapy comparing CAD-patients above vs. below 75 years of age. Methods We retrospectively included patients with known CAD, admitted to the West German Heart and Vascular Center in the years of 2009–2010 (n=500), 2012–2013 (n=500), and 2015–2016 (n=500). LDL-cholesterol levels and intensity of stain therapy (based on dosage and type of statin) were assessed from all available hospital records. Lipid levels and treatment regimens were evaluated comparing patients ≥75 vs. <75 years of age. The analysis was approved by the local ethics committee (17–7458-BO). Results A total of 1,500 patients (mean age: 68.4±11.2 years, 75.8% male) from 813 referring treating primary care physicians in 98 cities of Germany were included in our analysis. 983 patients were <75, whereas 517 were ≥75 years of age. Elderly patients were less likely male (67.9% vs. 79.9%, p<0.0001), had lower BMI (26.8kg/m2 vs. 28.4kg/m2, p<0.0001), and less likely current smokers (7.6% vs. 19.2%, p<0.0001, for patients ≥75 vs. <75 years of age, respectively). LDL-cholesterol levels were not significantly different between age groups (≥75: 96.1±35.1 mg/dl; <75: 98.9±35.7mg/dl, p=0.14). In contrast, elderly patients had higher HDL-cholesterol levels (49.9±15.1 mg/dl vs. 46.7±15.2, p=0.0002) and markedly lower triglycerides (135.6±90.0mg/dl vs. 171.4±124.6mg/dl, p<0.0001). Simvastatin was most frequently prescribed in both age groups (54.9% vs. 50.7%, p=0.16), followed by Atorvastatin (31.6% vs. 33.3%, p=0.53). Elderly patients received significantly lower dosages of statin (28.8±12.8mg vs. 31.4±13.7mg, p=0.0007). Interestingly, patients ≥75 years of age archived LDL<70mg/dl slightly more frequently than younger patients (24.0% vs. 20.1%, p=0.09). Excluding patients with myocardial infarction at presentation, CK-levels were not relevantly different between age groups (131.9±450.0U/l vs. 127.5±111.4U/l, p=0.78). Excluding patients with signs of systemic inflammation, high-sensitive CRP levels did not differ when comparing patients ≥75 vs. <75 years of age (0.15±0.12mg/dl vs. 0.14±0.12mg/dl, p=0.33). Conclusion Evaluating lipid lowering treatment patters of 1500 patients from 813 treating physicians, we observed that patients ≥75 years of age receive lower doses of statin therapy, but reached slightly lower LDL-cholesterol-levels. However, the majority of elderly patients miss current recommendations regarding LDL-thresholds. Interestingly, no signs of a higher frequency of statin-induced myopathy in the elderly were observed in our analysis.

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