scholarly journals Association of Contemporary Statin Pretreatment Intensity and LDL-C Levels on the Incidence of STEMI Presentation

Life ◽  
2021 ◽  
Vol 11 (11) ◽  
pp. 1268
Author(s):  
Ziv Dadon ◽  
Mady Moriel ◽  
Zaza Iakobishvili ◽  
Elad Asher ◽  
Tal Y. Samuel ◽  
...  
Keyword(s):  
Statin Therapy ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lower Probability ◽  
Evidence Based ◽  
Low Density Lipoprotein Cholesterol ◽  
Coronary Artery Plaque ◽  
Coronary Syndrome ◽  
Low Intensity ◽  
Pretreated Patients

Constituting hypolipidemic and pleiotropic effects, statins stabilize coronary artery plaque and may prevent STEMI events. This study investigated the association between contemporary statin pretreatment intensity, low-density lipoprotein cholesterol (LDL-C) levels, and the type of acute coronary syndrome (ACS) presentation: STEMI vs. NSTE-ACS. Data were drawn from the ACS Israeli Survey (ACSIS), a biennial prospective national survey that took place in 2008–2018. The rate of STEMI vs. NSTE-ACS was calculated by statin use, including statin intensity (high-intensity statin therapy (HIST) and low-intensity statin therapy (LIST) prior to the index ACS event. Among 5103 patients, 2839 (56%) were statin-naive, 1389 (27%) used LIST and 875 (17%) used HIST. Statin pretreated patients were older and had a higher rates of co-morbidities, cardiovascular disease history and pretreatment with evidence-based medications. STEMI vs. NSTE-ACS was lower among HIST vs. LIST vs. statin-naive patients (31.0%, 37.8%, and 54.0%, respectively, p for trend < 0.001). Multivariate analysis revealed that HIST was independently associated with lower STEMI presentation (ORadj 0.70; 95% CI 0.57–0.86), while LIST (ORadj 0.92; 95% CI 0.77–1.10) and LDL-C < 70 mg/dL (ORadj 0.96; 95% CI 0.82–1.14) were not. In conclusion, among patients admitted with ACS, pretreatment with HIST was independently associated with a lower probability of STEMI presentation, while LIST and LDL-C < 70 mg/dL were not.

scholarly journals Low-density lipoprotein cholesterol levels on admission and long-term outcomes in statin-naive patients with acute coronary syndrome

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
R Satou ◽  
Y Matsuzawa ◽  
E Akiyama ◽  
M Konishi ◽  
T Yoshii ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Coronary Syndrome ◽  
Composite Outcomes

Abstract Introduction Dyslipidemia, especially an increase in the low-density lipoprotein cholesterol (LDL-C) has been established as one of the most important risk factors for atherosclerotic cardiovascular diseases. In contrast, some recent studies have shown that the low LDL-C level was associated with short-term poor prognosis in patients with cardiovascular disease, and this is so-called “cholesterol paradox”. However, there is few data evaluating the effects on long-term outcome of “cholesterol paradox” in patients with acute coronary syndrome (ACS). Purpose The purpose of this study was to examine whether the low LDL-C level on admission affect long-term prognosis in patients with ACS. Methods A total of 434 ACS patients who survived to hospital discharge were enrolled in this study. All patients were statin-naïve on admission, and were received statin therapy after hospitalization. Patients were divided into the low LDL-C (≤114 mg/dl) and high LDL-C (&gt;114 mg/dl) groups using the first tertile of the LDL-C level on admission. The primary endpoint was composite outcomes of all-cause death, myocardial infarction, ischemic stroke, hospitalization for congestive heart failure and unplanned revascularization. Results During a median follow-up period of 5.5 years, primary endpoint occurred in 117 patients. Overall, event-free rates differed significantly between the low and high LDL-C groups, demonstrating the lower event-free rate in patients with the low LDL-C group (38.9% in low LDL-C group versus 20.7% in high LDL-C group, p=0.0002; Figure). Even after adjustment for age, sex, body mass index, and various classical risk factors, the low LDL-C group was significantly at higher risk for primary composite outcomes compared to the high LDL-C group (adjusted hazard ratio 1.65, 95%-confidence interval 1.10–2.49, p=0.02). Conclusion In patients with ACS, the low LDL-C level on admission was significantly associated with long-term worse prognosis, regardless of statin therapy at discharge. In ACS patients with low LDL-C level, it might be necessary for elucidating the residual risk for secondary adverse event to improve their prognosis. Funding Acknowledgement Type of funding source: None

The association between statin pre-treatment and LDL Levels on the rate of STEMI presentation: data from the ACS Israeli Survey (ACSIS) 2008–2018

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Z Dadon ◽  
M Moriel ◽  
T.Y Samuel ◽  
Y Steinmetz ◽  
E Asher ◽  
...  
Keyword(s):  
Coronary Artery ◽  
High Intensity ◽  
Plaque Rupture ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lower Probability ◽  
Coronary Artery Plaque ◽  
Coronary Syndrome ◽  
Pre Treatment ◽  
Time Of Presentation

Abstract Background ST-elevation myocardial infarction (STEMI) mostly occurs as a result of vulnerable coronary artery plaque rupture. Constituting hypolipidemic and pleiotropic effects, statins stabilize coronary artery plaque and may prevent STEMI events. Purpose To determine the association between statin pre-treatment and its intensity, low-density-lipoprotein cholesterol (LDL-C) levels and presentation of patients with an ACS (STEMI vs. NSTEMI/unstable angina [UAP]). Methods Data was drawn from the Acute Coronary Syndrome Israeli Survey (ACSIS), a biennial prospective survey of ACS patients hospitalized in all CCU/Cardiology departments during 2008–2018. The rate of STEMI vs NSTEMI/UAP at the time of presentation was calculated by LDL-C levels on admission, stratified to 5 subgroups (&lt;50, 50–69, 70–100, 101–130 and &gt;130 mg/dl) and the use of statins, including statin intensity prior to the index ACS event. Results Among 5,103 patients, 875 (17%) were pre-treated with high intensity statin (HIST), 1,389 (27%) with low intensity statin (LIST), and 2,839 (56%) were statin naive patients. Statin-pre-treated patients were older, more likely to suffer from co-morbidities and cardiovascular diseases and were more often pre-treated with anti-platelets. The proportion of patients presenting with STEMI vs. NSTEMI/UAP was significantly lower among HIST vs. LIST vs. statin naive patients (31.0%, 37.8%, 54.0%, respectively, p for trend &lt;0.001). At each LDL-C level, the proportion of STEMI was significantly lower among HIST vs. LIST vs. statin naive patients. Multivariate analysis adjusting for pertinent variables including propensity score for statin use, revealed that HIST was independently associated with lower STEMI presentation, but LDL-C&lt;70 and LIST were not. Conclusions Among patients admitted with ACS, pre-treatment with high intensity statin but not LDL-C level, was independently associated with a lower probability of presenting with STEMI. Funding Acknowledgement Type of funding source: None

scholarly journals The Role of PCSK9 Inhibitors in the Improvement of Outcomes in Patients after Acute Coronary Syndrome: Results of ODYSSEY OUTCOMES Trial

2019 ◽  
Vol 14 (6) ◽  
pp. 922-934 ◽  
Author(s):  
Yu. A. Karpov
Keyword(s):  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
High Intensity ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Lipoprotein Cholesterol ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
Pcsk9 Inhibitors ◽  
Coronary Syndrome

The aim of this review was to present the recently published results of ODYSSEY OUTCOMES trial and discuss the clinical perspective of these data. Patients with acute coronary syndrome are at very high risk of recurrent ischemic cardiovascular complications, especially during the first year after the event. The use of high-intensity statin therapy in this group of patients does not always lead to the achievement of target levels of atherogenic lipoproteins. PCSK9 inhibitors, administered in addition to statins, can provide additional reduction of low-density lipoprotein cholesterol, which leads to further improvements of outcomes in patients with atherosclerotic cardiovascular disease. According to the latest results from ODYSSEY OUTCOMES trial, among patients with recent acute coronary syndrome, who were receiving high-intensity statin therapy, the risk of recurrent ischemic cardiovascular events was lower among those who were treated with alirocumab then among those who received placebo. The treatment with alirocumab in patients with recent acute coronary syndrome was associated with reduction in death from any causes. The absolute risk reduction with alirocumab was the most prominent in the subpopulation of patients with low-density lipoprotein cholesterol ≥2,6 mmol/l at baseline. These results have implication for clinical practice and may play an important role for the improvement of outcomes in patients at highest cardiovascular risk after acute cardiovascular syndrome.

scholarly journals Effects of Statin versus the Combination of Ezetimibe plus Statin on Serum Lipid Absorption Markers in Patients with Acute Coronary Syndrome

2015 ◽  
Vol 2015 ◽  
pp. 1-8 ◽  
Author(s):  
Erisa Watanabe ◽  
Junichi Yamaguchi ◽  
Hiroyuki Arashi ◽  
Hiroshi Ogawa ◽  
Nobuhisa Hagiwara
Keyword(s):  
Acute Coronary Syndrome ◽  
Statin Therapy ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Poor Response ◽  
Lipid Absorption ◽  
Lipid Lowering ◽  
Low Density Lipoprotein Cholesterol ◽  
Coronary Syndrome ◽  
The Impact

Background. The use of statins is essential for aggressive lipid-lowering treatment in acute coronary syndrome (ACS) patients with dyslipidemia. Recently, elevation of sitosterol, a lipid absorption marker, was reported to be associated with premature atherosclerosis. The purpose of the present study was to examine the impact of ezetimibe, a selective intestinal cholesterol transporter inhibitor, in ACS patients.Methods. A total of 197 ACS patients were randomized to pitavastatin + ezetimibe (n=100) or pitavastatin (n=97). Low-density lipoprotein cholesterol (LDL-C) and sitosterol levels were evaluated on admission and after 12 weeks.Results. After 12 weeks, the pitavastatin + ezetimibe group showed a significantly greater decrease of sitosterol (baseline versus after 12 weeks; 2.9 ± 2.5 versus 1.7 ± 1.0 ng/mL,P<0.001) than the pitavastatin group (2.7 ± 1.5 versus 3.0 ± 1.4 ng/mL). The baseline sitosterol level was significantly higher in patients with achieved LDL-C levels ≥ 70 mg/dL than in patients with levels < 70 mg/dL (3.2 ± 2.5 versus 2.4 ± 1.3 ng/mL,P=0.006).Conclusions. Ezetimibe plus statin therapy in ACS patients with dyslipidemia decreased LDL-C and sitosterol levels more than statin therapy solo. Sitosterol Elevation was a predictor of poor response to aggressive lipid-lowering treatment in ACS patients.

scholarly journals The values of low-density lipoprotein cholesterol and acute coronary syndrome

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
LM Ferraz ◽  
A Faustino ◽  
A Neves
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density Lipoprotein Cholesterol ◽  
Coronary Syndrome ◽  
Low Intensity ◽  
History Of ◽  
C Value ◽  
The Mean ◽  
European Society Of Cardiology

Abstract Funding Acknowledgements Type of funding sources: None. Introduction All individuals with a history of acute coronary syndrome (ACS) should receive intensive statin therapy in order to achieve the desirable low-density lipoprotein cholesterol (LDL-C) values recently modified in the guidelines of the European Society of Cardiology. Purpose To evaluate the lipid profile control of ACS patients with 6 year follow-up. Methods Retrospective study of 138 consecutive patients (P) admitted in our hospital for ACS during one year: 63 ± 13 years, 76.8% male, 26.9% with history of coronary artery disease and 56.5% of dyslipidemia. A 6 year follow-up was performed and a therapeutic goal was defined as LDL-C values below 55mg/dL and an LDL-C reduction of ≥50% from baseline, according to the guidelines of the European Society of Cardiology. High/moderate/low intensity statins were defined according to the therapeutic recommendations of the American College of Cardiology. Univariate analysis was performed. Results The mean LDL-C value at ACS admission was 112.5 ± 36.9mg/dL. 96.4% of patients were discharged on statins: 41.3% with rosuvastatin 10mg, 15.2% with simvastatin 20mg, 15.2% with atorvastatin 10mg, 10.9% with pitavastatin 2mg and 6.5% with atorvastatin 20mg. Antidislipidemic therapy was changed in 7.9% of patients in the scheduled evaluation 1 month after discharge. The mean LDL-C value after a 6 year follow-up was 83.6 ± 27.2mg/dL, with 85.8% P not meeting the defined therapeutic goal. Most of them (97.5%) continued medicated with statin, however, only 28.3% of P were on high-intensity statins and 3.8% were on low-intensity statins, despite the verified statistically significant association between LDL-C values and statin type used (high/medium/low intensity, p &lt; 0.05). Conclusion Despite the proven benefit of statins, especially in high-risk patients, there are still aspects to improve, notably in the establishment of more effective therapies in order to achieve the desired new goals.

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