scholarly journals Possibilities of combined hypolipidemic therapy in different categories of high and very high cardiovascular risk patients (a pilot study)

2022 ◽  
Vol 17 (4) ◽  
pp. 66-73
Author(s):  
O. V. Tsygankova ◽  
O. V. Timoshchenko ◽  
L. D. Latyntseva

Aim of the study was to evaluate the efficacy and safety of the combined use of statins with ezetimibe in patients of various nosological groups of high and very high cardiovascular risk. Material and methods. A prospective interventional non-randomized study included 40 people, mean age 60.7±9.5 years, high and very high cardiovascular risk, who did not receive statin therapy or took statins without reaching the target low density lipoprotein (LDL) cholesterol values. Patients were recommended to receive high-intensity statin therapy in combination with ezetimibe for 3 months. Biochemical parameters were determined by standard enzymatic methods and the beginning of combined lipid-correcting therapy and after 3 months. Results. In patients with high cardiovascular risk, the level of total cholesterol decreased by 39.7 % 3 months after treatment (6.8 ± 2.5 and 4.7 ± 2.5 mmol/L; p = 0.0001), the level of LDL cholesterol by 52.2 % (4.6 ± 2.4 and 2.8 ± 2.2 mmol/L; p = 0.0001), the TG level by 26 % (2.7 ± 1.1 and 2.0 ± 1.0 mmol/L; p = 0.008). In the group of patients with very high cardiovascular risk, we also noted a decrease in the total cholesterol level by 39.1 % (6.4 ± 1.4 and 4.4 ± 1.2 mmol/L; p = 0.0001), the level of LDL cholesterol by 45.5 % (4.4 ± 1.4 and 2.5 ± 0.9 mmol/L; p = 0.0001). We did not find statistically significant changes in the remaining lipid parameters. LDL cholesterol targets were achieved in 64 % of patients with high and 52 % of very high cardiovascular risk. There were no significant changes in activity of alanine and aspartate amino transferases, content creatine phosphokinase, glucose and glycated hemoglobin, glomerular filtration rate. Conclusions. Initial combination therapy with statin and ezetimibe is well tolerated and can reduce LDL cholesterol levels by 2 times within 3 months in various categories of patients with high and very high cardiovascular risk.

2020 ◽  
Vol 25 (6) ◽  
pp. 3578
Author(s):  
N. V. Izmozherova ◽  
A. A. Popov ◽  
V. M. Bakhtin

Aim. To analyze the efficacy and safety of statin therapy in multimorbid outpatients with very high cardiovascular risk in actual clinical practice.Material and methods. The study included 131 patients with an established very high cardiovascular risk. History and anthropometric data were collected. The Charlson Comorbidity Index (CCI) was calculated; patients were divided into groups of moderate (№ 1, ≤6 points) and high (№ 2,> 6 points) multimorbidity. The frequency of prescribing statins, the range of doses used, the achievement of lipid metabolism targets, and the incidence of adverse effects were evaluated.Results. The median of the CCI was 6 (5÷8) points. Group 1 included 72 patients, group 2 — 59 patients. Statins received 87 (66,4%) patients, more often in group 1 (n=54) than 2 (n=33), p=0,026. The minimum doses were taken by 17 patients, the mean — 66, the maximum — 4. Patients of group 2 received higher dosages (χ2 =9,3, p=0,010). The target level of total cholesterol was achieved in 8 (6,1%) patients, low-density lipoprotein cholesterol — no one (0,0%). Of the 106 patients ever taking statins, they were withdrawn in 19 (17,9%) patients. The reason for discontinuation in 7 patients were adverse effects, in 5 — the high cost of therapy; in 7 patients, the reason was identified. Adverse effects were recorded in 12 (11,3%) patients; there were no differences between groups (p=0,118).Conclusion. Patients with a very high cardiovascular risk are characterized by high multimorbidity. Statins are less commonly prescribed for patients with severe polymorbidity, but at higher doses. Despite the sufficient prescribing statins and the use of mean doses, target lipid levels were not achieved. The presence of multimorbidity was not associated with an increase in the incidence of statin adverse effects.


2019 ◽  
Vol 70 (6) ◽  
pp. 2159-2161
Author(s):  
Irina Iuliana Costache ◽  
Irina Garleanu ◽  
Viviana Aursulesei ◽  
Razan Al Namat ◽  
Adriana Ion ◽  
...  

Nonalcoholic fatty liver disease (NAFLD) is defined as the presence of hepatic fat accumulation after ruling out other causes of hepatic steatosis. The aim of the study is to identify the role of statin therapy in dyslipidemic patients with very high cardiovascular risk and NAFLD in achieving low density lipoprotein (LDL) cholesterol targets while also evaluating the changes in liver enzymes levels. This prospective study included 140 patients with NAFLD, hyperlipidemia and elevated cardiovascular risk. Serum lipids were assessed and liver function tests were performed at baseline and at 6 months follow up in 10 mg/ 20 mg daily atorvastatin treatment schedule. The results showed that total cholesterol, LDL cholesterol and triglycerides were significantly reduced at 6 months follow-up, while high density lipoprotein (HDL) cholesterol has not undergone important changes. Statin treatment significantly improved alanine aminotransferase serum levels, whereas aspartate aminotransferase levels were not significantly reduced between baseline and follow-up. Although statin therapy appears to be safe and effective for use in patients with NAFLD, an insufficient treatment is commonly observed in clinical practice, in order to avoid liver damage . NAFLD is not only a major cause of liver related morbidity and mortality, but also an independent cardiovascular risk factor, with cardiovascular mortality being the most important cause of death. Therefore, detecting and modifying risk factors without impairing liver function is desirable.


2017 ◽  
Vol 142 (16) ◽  
pp. 1249-1252
Author(s):  
Ulrich Laufs ◽  
Christina Jannowitz ◽  
David Pittrow

AbstractCurrent information on the utilisation of atorvastatin under clinical practice conditions is limited. The cross sectional study DISCOVER documented in the period from June until December 2014 dose and effects on lipids in ambulatory patients at very high cardiovascular risk, who were treated with atorvastatin monotherapy (original drug or generics). Of 2625 patients (mean age 66.1 ± 10.8 years, 62.1 % males), 47.0 % had coronary heart disease (CHD), 25.1 % type 2 diabetes mellitus (DM), and 27.9 % CHD plus concomitant DM. Mean treatment duration on atorvastatin was 92.6 ± 109.6 weeks, mean atorvastatin dose at time of documentation was 27.9 ± 15.8 mg/d. Low-density lipoprotein cholesterol (LDL-C) < 70 mg/dL was achieved by 10.5 % of the total cohort (7.5 % in DM, 9.3 % in CHD, and 15.2 % in CHD+DM). In contrast, according to physicians’ subjective assessment, 62.7 % of patients reached their individual LDL-C target (with small differences between groups). In conclusion, the LDL-C target level < 70 mg/dL as recommended by current guidelines is achieved only in a minority of atorvastatin treated patients at very high cardiovascular risk.


2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
H T Nguyen ◽  
A H Nguyen ◽  
H M Lam ◽  
T T Nguyen

Abstract Introduction Low-density lipoprotein cholesterol (LDL-c) is a well-established risk factor for atherosclerotic cardiovascular disease. Nonetheless, the association of body mass index (BMI) with non-achievement of target LDL-c level in older patients with type 2 diabetes (T2D) at very high cardiovascular risk is unknown. Purpose To investigate whether BMI is associated with non-achievement of target LDL-c level in older patients with T2D at very high cardiovascular risk. Methods From December 2019 to June 2020, in this multicentre prospective cross-sectional study, we enrolled 733 consecutive outpatients aged ≥60 years with T2D at very high cardiovascular risk in whom LDL-c levels could be measured after any stable lipid-lowering therapy for ≥6 months. Achievement of target lipid level was assessed based on the 2019 guidelines of the European Society of Cardiology for dyslipidaemia. Factors associated with non-achievement of target LDL-c level were determined using logistic regression analysis. Results Of the total cases (age, 68.6±7.2 years; men, 51.3%), 654 patients (89.2%) did not achieve an aggressive target LDL-c level of &lt;1.4 mmol/L. Target non-high-density lipoprotein cholesterol level of &lt;2.2 mmol/L and triglyceride level of &lt;1.7 mmol/L were not achieved in 87.9% and 56.2% of the patients, respectively. In the multivariate model, BMI was the only factor associated with failure to achieve target LDL-c level, but not other factors such as age, sex, education level, smoking, and comorbidities. The adjusted odds ratio were 0.88 (95% confidence interval [95% CI], 0.24–3.21; P=0.84) for underweight, 1.57 (95% CI, 0.87–2.81; P=0.13) for overweight, and 2.63 (95% CI, 1.43–4.83; P=0.002) for obesity (normal weight was set as reference) status. Conclusions Non-achievement of target LDL-c level is highly prevalent in older patients with T2D at very high cardiovascular risk. Obesity, defined by BMI, can be a factor associated with non-achievement of the target. The findings highlight the importance of management of lipid levels in older patients with T2D. FUNDunding Acknowledgement Type of funding sources: None. Figure 1


2020 ◽  
Vol 16 (2) ◽  
pp. 213-220
Author(s):  
O. V. Fedorishina ◽  
K. V. Protasov ◽  
A. M. Torunova

Aim. To study the long-term dynamics of vascular remodeling in patients with hypertension and high and very high cardiovascular risk when statin is added to antihypertensive therapy with a fixed combination of calcium antagonist and angiotensin converting enzyme (ACE) inhibitor.Material and methods. Hypertensive patients (n=75) with high and very high cardiovascular risk (age 51.5 [44;58] years) were included in the study. Patients were randomized into two groups. The first group (n=36) received a fixed combination of amlodipine and lisinopril in starting dose of 5/10 mg/day. The second group (n=39) received the same antihypertensive therapy and additionally rosuvastatin (20 mg/day). The follow-up period was 52 weeks. The effect of therapy on the following parameters was evaluated: level of office and average daily blood pressure (BP), central BP in the aorta, augmentation index (AIx), pulse wave velocity (PWV), endothelium-dependent brachial artery vasodilation, carotid intima-media complex thickness, carotid arteries plaque height, and blood lipid profile indicators.Results. A significant decrease in office and average daily BP was found in both groups: from 171.5 (152;194)/104.5 (97;112) to 140.0 (129;154)/87.0 (83;95) mm Hg and from 142.1 (135;153)/86.7 (83;97) to 124.6 (119;133)/76.5 (73;80) mm Hg, respectively, in the 1st group; from 169.5 (160;190)/103.5 (95;109) to 135.0 (125;141)/83.0 (77;88) mm Hg and from 139.9 (136;152)/86.2 (80;92) to 125.1 (118;134)/74.0 (70;81) mm Hg, respectively, in the 2nd group (p<0.001 for all changes). The frequency of reaching the target office BP level was higher in the 2nd group (p=0.031). Significant decrease in total cholesterol by 33.1% and low-density lipoprotein cholesterol by 50.0% was observed in the group 2. Central BP in the aorta decreased in both groups; the degree of central BP reduction did not differ significantly. AIx decreased from 36.5 (24;41)% to 25.0 (15;36)% (p=0.04) in the 1st group and from 36.0 (30;41)% to 24.0 (20;32)% in the 2nd group (p<0.0001) with a more pronounced decrease in AIx after 24 weeks of therapy (-4.8% and -9.4%, respectively, p=0.036). This trend continued at the end of the observation (-6.4% and -10.8%, respectively, p=0.08). Carotid-femoral and carotid-radial PWV decreased only in the 2nd group from 9.5 (8.2;10.7) to 8.3 (7.6;8.9) m/s (p=0.003) and from 9,6 (8.5;10.6) to 8.4 (7.9;9.3) m/s (p=0.01), respectively. A significant decrease in the thickness of the intima-media from 1.08 (1.0;1.2) to 1.02 (0.9;1.1) cm (p<0.0001) and the height of the plaque from 2.2 (2,2;1.7) to 2.1 (2.1;1.7) mm (p=0.001) was found in the 2nd group.Conclusion. Addition of rosuvastatin to the fixed combination of amlodipine and lisinopril in treatment of hypertensive patients with high and very high cardiovascular risk was accompanied by a more frequent (compared with amlodipine and lisinopril only) achievement of the target office BP level and more pronounced reduction in the following indicators: augmentation index, carotid-femoral and carotid-radial PWV, intima-media thickness, plaque height, total cholesterol and low density lipoprotein cholesterol blood levels.


2018 ◽  
Vol 38 (6) ◽  
Author(s):  
Li-ping He ◽  
Xing-sheng Zhao ◽  
Le-ping He

Background: The prevalence of coronary heart disease (CHD) appears to be high among Chinese Mongolians. MiR-23b has been proven to play a key role in atherosclerosis. The expression and role of miR-23b in the Mongolians at high cardiovascular risk were explored in the present study. Methods: Forty cases of blood samples from the Mongolians at high cardiovascular risk were enrolled in the present study. The expression of miR-23b was quantified by quantitative real-time PCR. To induce monocytes differentiation into macrophages, HP-1 cells were cultured with phorbol 12-myristate 13-acetate. The level of inflammatory markers was determined by the enzyme-linked immunosorbent assay. The interaction between miR-23b and A20 was explored by the dual luciferase reporter assay. Results: The expression of miR-23b in the Mongolian at high cardiovascular risk was higher than that in healthy Mongolian volunteers. Decrease in ATP-binding cassette transporter A1 caused by miR-23b is responsible for TC accumulation in the Mongolian at high cardiovascular risk. MiR-23b enhanced the oxidized low-density lipoprotein (oxLDL)-induced inflammatory response of THP-1 derived macrophage. MiR-23b regulated nuclear factor-κB (NF-κB) pathway through targeting A20. MiR-23b mediated oxLDL-induced inflammatory response of peripheral blood mononuclear cell in the Mongolian at high cardiovascular risk. Conclusion MiR-23b enhanced oxLDL-induced inflammatory response of macrophages in the Mongolian at high cardiovascular risk through the A20/NF-κB signaling pathway, and thus contributing to atherosclerosis.


2019 ◽  
Vol 26 (4) ◽  
pp. 23-31
Author(s):  
O. I. Mitchenko ◽  
V. Y. Romanov ◽  
N. M. Chulaevska ◽  
K. O. Timokhova

Familial hypercholesterolemia (FH) is one of the most common, inherited autosomal dominant diseases. Most often, FH is caused by dominant mutation of the gene, responsible for the synthesis of low density lipoprotein (LDL) membrane receptors that remove LDL from the blood plasma. As a result, individuals with a mutation of this gene from birth have a significantly increased level of cholesterol LDL in the blood. FH mediates the accelerated development of cardiovascular disease of atherosclerotic genesis, especially coronary heart disease (CHD), so the level of cardiovascular mortality in the population of such patients is extremely high. The article focuses on the fact that the main threat of these lipid disorders is the early and rapid initiation of atherosclerotic lesions of coronary vessels: in patients with heterozygous FH with a total cholesterol level of 8–15 mmol/l, CHD usually manifests up to 55 and 60 years, whereas in homozygous patients with a total cholesterol level of 12–30 mmol/l, CHD manifests at the start of their life and if left untreated, death occurs by the age of 20 years. The major genetic disorders in familial hypercholesterolemia and the frequency of their detection in the population are characterized. There are definitions of clinical screening options for FH: targeted, opportunistic, universal, cascadic. A comprehensive view of the diagnosis of FH according to the Dutch Lipid Clinic Network (DLCN) is provided. The basic principles of non-medication and three-step medication treatment of FH are presented. The article presents a clinical case of the homozygous FH taking into account the peculiarities of the disease course, the results of laboratory and instrumental studies and step-by-step treatment in the department of dyslipidemia of M.D. Strazhesko Institute of Cardiology of NAMS of Ukraine. The epidemiological data of the Ukrainian population survey on the possible prevalence of FH in Ukraine are presented. The preliminary analysis of the Ukrainian registry of patients with FH as a national fragment of the international ScreenProFH Registry and the European Register EAS-FHSC is provided.


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