scholarly journals A Nudge to Physicians to Achieve LDL Goals

2021 ◽  
pp. 122-127
Author(s):  
Reagan F. Cabahug
Keyword(s):  
Risk Factors ◽  
Low Density Lipoprotein ◽  
Healthcare Providers ◽  
Significant Risk ◽  
Density Lipoprotein ◽  
Cardiovascular Death ◽  
Management Tool ◽  
Risk Patients ◽  
Coronary Events ◽  
Artery Disease

Reduction in coronary events rates in high-risk patients is feasible by altering cardiovascular risk factors. In the US and most European Countries, the leading cause of death is coronary heart disease (CHD). Hypercholesterolemia is the principal risk factor for coronary artery disease. High-density lipoprotein (HDL-C) and low-density lipoprotein (LDL-C) are significant risk factors for CHD [1]. Hydroxymethylglutaryl-CoA (HMG-Co-A) inhibitors are the most effective treatment of cutting LDL-C levels with a subsequent reduction in cardiovascular death and morbidity. A nudge happens when a choice architecture is planned to control behaviour predictably without curbing an individual’s choice [2]. For a nudge to be influential, the direction and force should be in line with professional standards. The article detailed how patients' and physicians' actions contributed to the increasing incidence of cardiovascular diseases. Nudges either digital or  manual (use of post-it) can be useful in influencing physicians to be proactive and can increase patients’ adherence to the therapy. Trust between the patient and the physician is crucial in attaining these goals. Nudges can be a valuable management tool for steering correct behaviours among healthcare providers. The technique is to ensure that physicians see them as something constructive and not irritating or controlling noodges.

scholarly journals Plasma Oxidized Low-Density Lipoprotein Is an Independent Risk Factor in Young Patients with Coronary Artery Disease

2011 ◽  
Vol 31 (5) ◽  
pp. 295-301 ◽  
Author(s):  
Yuli Huang ◽  
Yunzhao Hu ◽  
Weiyi Mai ◽  
Xiaoyan Cai ◽  
Yuanbin Song ◽  
...  
Keyword(s):  
Risk Factors ◽  
Independent Risk Factor ◽  
Low Density Lipoprotein ◽  
Young Patients ◽  
Density Lipoprotein ◽  
Low Density ◽  
Oxidized Low Density Lipoprotein ◽  
Male Sex ◽  
Artery Disease ◽  
Conventional Risk Factors

Objectives:Oxidized low-density lipoprotein (ox-LDL) is considered to be a key factor of initiating and accelerating atherosclerosis. The objective of this study was to investigate the role of ox-LDL in young patients with coronary artery disease (CAD).Methods:128 consecutive angiographically proven young CAD patients (aged ≤ 55 years) were enrolled, and 132 age-matched non-CAD individuals (coronary angiography normal or negative finding by coronary ultrafast CT) were set as control group. Conventional risk factors (hypertension, dyslipidemia, diabetes mellitus, obesity, smoking) were evaluated in the two groups. Ox-LDL was measured by competitive ELISA. Framingham risk score (FRS) and absolute 10-year CAD events risk were calculated for each individual.Results:Male sex was more prevalent in group CAD than in control (87.5% vs. 62.1%;P< 0.01). There were significant differences in smoking history (P< 0.01) and triglyeride (TG) and ratio of apolipoprotein B/apolipoprotein A1 (ApoB/ApoA1) (bothP< 0.05) but no remarkable difference in other conventional risk factors (allP> 0.05) between group CAD and control. Level of ox-LDL was significantly higher in group CAD than in control (P < 0.01). Multivariate logistic regression showed that male sex (OR, 4.54; 95%CI, 1.76–9.77), smoking quantity (OR, 2.78; 95%CI, 1.34–4.25), TG (OR, 1.42; 95%CI, 1.18–2.83), ApoB/ApoA1 (OR, 1.73; 95%CI, 1.32–4.23), and ox-LDL (OR, 2.15; 95%CI, 1.37–6.95) were independently correlated with CAD in young patients. Area under the curve (AUC) of receiver operating characteristic (ROC) curve of TG, ApoB/ApoA1, and ox-LDL was 0.831, 0.866, and 0.935, respectively (P< 0.001).Conclusions:Ox-LDL is an important independent risk factor for CAD in young patients after adjusting other risk factors such as smoking, TG, and ApoB/ApoA1.

scholarly journals Low-density lipoprotein cholesterol goal attainment rates in high-risk patients with cardiovascular diseases and diabetes mellitus in Korea: a retrospective cohort study

2020 ◽  
Vol 19 (1) ◽  
Author(s):  
Ye Seul Yang ◽  
Bo Ram Yang ◽  
Mi-Sook Kim ◽  
Yunji Hwang ◽  
Sung Hee Choi
Keyword(s):  
High Risk ◽  
Retrospective Cohort ◽  
Goal Attainment ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Low Density Lipoprotein Cholesterol ◽  
High Risk Patients ◽  
Risk Patients ◽  
Artery Disease

Abstract Background Real-world evidence of low-density lipoprotein cholesterol (LDL-C) goal attainment rates for Asian patients is deficient. The objective of this study was to assess the status of dyslipidemia management, especially in high-risk patients with cardiovascular disease (CVD) including stroke and acute coronary syndrome (ACS). Methods This was a retrospective cohort study of 514,866 subjects from the National Health Insurance Service-National Health Screening Cohort database in Korea. Participants were followed up from 2002 to 2015. Subjects with a high-risk of CVD prior to LDL-C measurement and subjects who were newly-diagnosed for high-risk of CVD following LDL-C measurement were defined as known high-risk patients (n = 224,837) and newly defined high-risk patients (n = 127,559), respectively. Data were analyzed by disease status: stroke, ACS, coronary heart disease (CHD), peripheral artery disease (PAD), diabetes mellitus (DM) and atherosclerotic artery disease (AAD). Results Overall, less than 50% of patients in each disease category achieved LDL-C goals (LDL-C < 70 mg/dL in patients with stroke, ACS, CHD and PAD; and LDL-C < 100 mg/dL in patients with DM and AAD). Statin use was observed in relatively low proportions of subjects (21.5% [known high-risk], 34.4% [newly defined high-risk]). LDL-C goal attainment from 2009 to 2015 steadily increased but the goal-achiever proportion of newly defined high-risk patients with ACS remained reasonably constant (38.7% in 2009; 38.1% in 2015). Conclusions LDL-C goal attainment rates in high-risk patients with CVD and DM in Korea demonstrate unmet medical needs. Proactive management is necessary to bridge the gap between the recommendations of clinical guidelines and actual clinical practice.

Abstract 14606: Endothelial Injury Biomarkers and Risk Factors Associated With Discordant Risk of Acute Coronary Syndrome Despite Controlled Low-density Lipoprotein Cholesterol Identified by a Novel Coronary Artery Disease Predictive Algorithm

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Ned Premyodhin ◽  
WENJUN FAN ◽  
Masood Younus ◽  
Douglas S Harrington ◽  
Nathan D Wong
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density Lipoprotein Cholesterol ◽  
Predictive Algorithm ◽  
Coronary Syndrome ◽  
History Of ◽  
Artery Disease

Background: Individuals with no history of coronary artery disease can develop acute coronary syndrome (ACS), often in the absence of major risk factors including low-density lipoprotein cholesterol (LDL-C). We identified risk factors and biomarkers that can help identify those at discordantly high risk of ACS who have normal LDL-C using a novel coronary artery disease predictive algorithm (CADPA) incorporating biomarkers of endothelial injury validated in the Multi-Ethnic Study of Atherosclerosis cohort. Methods: Five-year predicted ACS risk was calculated using the CADPA for 8589 patients. Common risk factors and serum levels of 9 biomarkers utilized by the CADPA were tracked. We identified a “discordant high ACS” risk group with serum LDL-C < 130 mg/dL but 5-year CADPA predicted risk ≥ 7.5% and a “discordant low ACS” risk group defined as LDL-C ≥ 130 mg/dL but 5-year CADPA risk of < 7.5%. Multiple logistic regression identified risk factors and biomarkers that predicted discordance in two separate models. Results: The average age and percent male of the high ACS discordant group was higher compared to non-discordant (68±10 vs 54±13 years and 61% vs 43%, respectively). Diabetes (OR 2.84 [2.21-3.66]), male sex (OR 2.83 [2.40-3.35]), family history (OR 2.23 [1.88-2.64]) and active smoking (OR 1.99 [1.50-2.62]) exhibited greatest odds of high ACS discordance compared to other risk factors (all p < 0.01). Increased serum soluble FAS (OR 2.12 [1.97-2.29]), Hemoglobin A1c (OR 1.60 [1.48-1.72]) and interleukin-16 (OR 1.40 [1.32-1.48]) were the biomarkers most associated with discordant risk, independent of global risk factors. Conclusion: Men with diabetes and family history of myocardial infarction who are actively smoking may be at highest risk of developing ACS despite controlled LDL-C. Future studies should examine whether using the CADPA can help identify such individuals that could benefit from earlier targeting of risk factor modification for prevention of ACS.

Evidence-based data on Simvastatin: A 15-year experience

2010 ◽  
Vol 16 (3) ◽  
pp. 238-249
Author(s):  
A. V. Susekov ◽  
N. B. Gornyakova ◽  
M. Y. Zubareva ◽  
S. A. Boitsov
Keyword(s):  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Total Mortality ◽  
Cardiovascular Death ◽  
Coronary Death ◽  
Randomized Controlled ◽  
Fixed Drug ◽  
Risk Patients ◽  
Reduce Risk

Inhibitors of 3-hydroxy-3-methyl-glutaryl-CoA (HMG-Ko-A) reductase (statins) are widely used in treatment hyperlipideamia and atherosclerosis for more than 30 years. Results of randomized controlled trials studying statins have demonstrated that for each 1 % reduction of low-density lipoprotein (LDL) one can achieve 0,88 % reduction of cardiovascular risk. Simvastain (Zocor™) is the fi rst-generation semisynthetic statin registered by FDA in 1988. Over the past 15 years simvastatin has been widely studied in clinical trials with hard end points (4S, HPS, IDEAL, ACCORD). These trials showed that treatment with Simvastatin 20-40 mg/day may signifi cantly reduce risk of cardiovascular death by 24-35 %, coronary death - by 42 %, risk of stroke - by 27 % and total mortality - by 13-30 %. Simvastatin was also well studied in regression trials (FHRS, MAAS and CIS). Simvastatin - is the best-investigated statin in terms of long-term safety and tolerability. In particular, in HPS study the incidence of liver damage did not exceeded 0,1 %, myopathy - 0,05 %. Zocor is well studied in combination therapy with fi brates, niacin and ezetimibe. Fixed drug combination ezetemibe 10 mg/sim vastatin 20 mg may reduce LDL for more than 50 %, most of high-risk patients can achieve target LDL-C goals. According to DYSIS study (2009) simvastatin is the most reliable and widely used statin in the world.

scholarly journals Polymorphisms of rs2483205 and rs562556 in the PCSK9 gene are associated with coronary artery disease and cardiovascular risk factors

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Min-Tao Gai ◽  
Dilare Adi ◽  
Xiao-Cui Chen ◽  
Fen Liu ◽  
Xiang Xie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Blood Glucose ◽  
Coronary Artery ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Nucleotide Polymorphisms ◽  
Pcsk9 Gene ◽  
Increased Risk ◽  
Artery Disease

AbstractPCSK9 plays a crucial role in lipid metabolism. This case–control study explored the associations of novel single nucleotide polymorphisms (SNPs) of the PCSK9 gene with coronary artery disease (CAD) (≥ 1 coronary artery stenosis ≥ 50%) and its risk factors in the Han population in Xinjiang, China. Four tag SNPs (rs11583680, rs2483205, rs2495477 and rs562556) of the PCSK9 gene were genotyped in 950 CAD patients and 1082 healthy controls. The distributions of genotypes in rs2483205 and rs562556 were significantly different between the groups (all p < 0.05). The TT genotype of rs2483205, GG genotype of rs562556, and their H4 (T-G) haplotype were associated with CAD [odds ratio (OR) 0.65, confidence interval (CI) 0.45–0.95, p = 0.024; 0.63, 0.45–0.90, p = 0.011; 0.50, 0.35–0.70, p < 0.001, respectively]. Additionally, the model (TT + CT vs. CC) of rs2483205 was associated with increased risk of obesity, and the G allele of rs562556 was associated with lower low-density lipoprotein cholesterol (LDL-C), blood glucose, body mass index (BMI), and mean platelet volume (MPV) (all p < 0.05). rs2483205, rs562556, and their H4 haplotype of the PCSK9 gene were associated with CAD. Additionally, rs2483205 is associated with obesity, and rs562556 is associated with LDL-C, blood glucose, BMI, and MPV.

Genetic Polymorphism of Il-16 and Risks of Coronary Artery Disease in Sudan

2020 ◽  
Vol 01 (01) ◽  
pp. 37-53
Author(s):  
Mawada Yahia ◽  
◽  
Idriss Hussein Musa ◽  
Elbagire Abdel Rahman Elbashir ◽  
Taha Hussein Musa ◽  
...  
Keyword(s):  
Physical Activity ◽  
Risk Factors ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Family History ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Blood Levels ◽  
P Value ◽  
Artery Disease

The inflammatory process in the atherosclerotic artery may lead to increased blood levels of inflammatory cytokines. The aim of this study is to understand the role of inflammatory markers in the development of coronary artery disease. Therefore, a case-control study was conducted amongst coronary artery disease patients who attended the Sudan Heart Institute and healthy controls. Questionnaires were designed to determine the lifestyle and environmental factors for 200 participants (100 cases, 100 controls). Blood samples were collected to measure lipids profiles using enzymatic colorimetric and DNA extraction using the G-spin Kits. Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) was used for IL-6 and IL-16 genotyping. A total of 64% patients were males, 41% were at 51-61 years, and physical activity was common in 60% of the patients. The risk factors for coronary artery disease were hypertension 62%, angina 62%, cigarette smoking 38%, diabetes 33%, tobacco user 31%, drinking alcohol 24% and stroke 2%. Most patients had a family history of stroke 93%, hypertension 36%, diabetes 34%, angina 9%, and heart attack 4%. Total cholesterol and low-density lipoprotein were significantly different (P>0.05) between cases and controls, and they were significantly associated with IL-16 genotype. All risk factors for coronary artery diseases were strongly associated with IL-6 genotype (P-value < 0.05, OR >1). Whereas, IL-16 homozygous TT genotype was significantly associated with gender and physical activity. Lifestyle, family history, and IL-16 (TT) genotype are risk factors for coronary artery disease in Sudanese patients.

scholarly journals Investigation of Serum Oxidized Low-Density Lipoprotein IgG Levels in Patients with Angiographically Defined Coronary Artery Disease

2014 ◽  
Vol 2014 ◽  
pp. 1-8 ◽  
Author(s):  
Mohsen Moohebati ◽  
Vahid Kabirirad ◽  
Majid Ghayour-Mobarhan ◽  
Habibollah Esmaily ◽  
Shima Tavallaie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Coronary Artery Disease ◽  
Cardiovascular Risk ◽  
Coronary Artery ◽  
Cardiovascular Risk Factors ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
Low Density ◽  
Significant Difference ◽  
Artery Disease

It has been suggested that antioxidized low-density lipoprotein (anti-oxLDL) antibodies play a role in the pathogenesis of atherosclerosis. The aim of this study was to measure serum ox-LDL IgG levels in 31 patients with angiographically defined coronary artery disease (CAD) (≥50% stenosis in at least one major coronary artery; CAD+group) and compare these levels with those of 32 subjects with <50% coronary stenosis (CAD−group) and 24 healthy age- and sex-matched controls using ELISA. We did not find any significant difference between CAD+, CAD−, and control groups in regard to oxLDL IgG levels (P=0.83). Serum oxLDL IgG levels did not differ between 1VD (one vessel disease), 2VD (2 vessels disease), and 3VD (3 vessels disease) subgroups of CAD+patients (P=0.20). Serum anti-oxLDL titers were only significantly correlated with LDL-C in the CAD+group (P<0.05) and waist and hip circumference (P<0.05andP<0.01, resp.) in the CAD−group. In stepwise regression analysis, none of the conventional cardiovascular risk factors was associated with serum ox-LDL IgG levels. The present results suggest that serum levels of ox-LDL IgG are neither associated with the presence and severity of CAD nor with the conventional cardiovascular risk factors.

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