ASSESSMENT OF THE USE OF DRUG TREATMENT OF DYSLIPIDEMIA AT MILITARY HOSPITAL 105

Dyslipidemia characteristics of outpatients with dyslipidemia for the first time, characteristics of drug use, and effectiveness in controlling dyslipidemia indexes after 3 months of treatment at Military Hospital 105 were studied. A crosssectional, retrospective descriptive study was investigated on adult outpatients who were diagnosed with dyslipidemia for the first time, examined and treated as outpatients at the hospital, and monitored for effectiveness in blood lipid control for 3 months after starting treatment. The decision to use the drug at the start of the study and the achievement of treatment goals at the time points were analyzed based on the ESC\EAS 2019 guidelines for treating DL. The majority of patients were aged > 45 years (80.5%), the most common group of patients was aged 46 - 59 (43.7%). The number of patients with comorbidities accounted for 62.8%. 87% of patients had mixed dyslipidemia, 54.8% of patients were in the group with high and very high cardiovascular risk. 93.5% of patients needed to start treatment with drugs based on LDL-C index at the time of treatment initiation. The majority of patients used monotherapy regimens, in which, Statins were used the most in the study sample with the rate of 95.3% in the initial treatment regimen. 70.4% of patients had an inappropriate decision to initiate treatment, of which the most common was the decision to use statins with insufficient dosage in patients (45.1%). Only 28% of patients reached their LDL-C goal after 3 months of treatment. From the high percentage of patients who did not reach the treatment goal in the study sample, it is necessary to consider using stronger statin therapy, higher dose statin, or using another treatment regimen for patients.

Polymorphism in Genes Apolipoprotein C3 (APOC3) and Fatty Acid-Binding Proteins (FABP2) in Nondiabetic Dyslipidemics: A Tertiary Care Hospital-Based Pilot Study

Context Dyslipidemia is a multifactorial disease in which lipoproteins play an important role as one of the early markers for coronary heart disease (CHD). Mixed dyslipidemia is common in people with diabetes mellitus, but nondiabetic dyslipidemics (NDD) remain unidentified for the risk of developing dyslipidemia and eventually CHD. Objectives This pilot study attempts to analyze the genetic basis of lipid metabolism alterations, emphasizing the association between fatty acid-binding protein-2 (FABP2-Ala54Thr) and apolipoprotein-C3 (APOC3-rs5128) genetic polymorphism, as a risk for developing dyslipidemia and CHD in NDD. Methods and Design Total 90 subjects—30 DD, 30 NDD, and 30 apparently healthy subjects representing Central India—were included. Biochemical analysis and DNA genotyping were done by polymerase chain reaction restriction fragment length polymorphism. Statistical Analysis The biochemical parameters were reported as means ± standard deviation. One-way analysis of variance test was used to compare biochemical parameters of three groups. Chi-squared test was done to compare genotype distributions. The strength of association was assessed by odds ratios (ORs) with 95% confidence intervals (CIs). All statistical analysis was done using SPSS-PC software and Graph Pad. Results In NDD, maximum polymorphism was observed followed by DD and least polymorphism was observed in controls. There was a significant association of APOC3 G allele with occurrence of hypertriglyceridemia (p < 0.05); however, no such association was found for FABP2 A allele (p > 0.05). Logistic regression analysis revealed APOC3 polymorphism to be significantly associated with dyslipidemia (OR = 2.6667, 95% CI = 1.0510–6.7663, p = 0.0341); no such association was found for FABP2 polymorphism (OR = 0.4643, 95% CI = 0.1641–1.3136, p = 0.1347). The triglyceride and cholesterol values in individuals with homozygous genotype indicate that genetic study is comparable to the biochemical findings in carriers of polymorphic allele than noncarriers, especially in NDD patients. Conclusions Pilot study indicates that the presence of APOC3 gene polymorphism is associated with pro-atherogenic dyslipidemia in nondiabetic patients and may raise risk of CHD. This information could be used for preventive strategies in NDD group that may otherwise go unnoticed.

The economic impact of hypercholesterolemia and mixed dyslipidemia: A systematic review of cost of illness studies

Hypercholesterolemia is a clinically relevant condition with an ascertained role in atherogenesis. In particular, its presence directly correlates to the risk of atherosclerotic cardiovascular disease (ASCVD). As known, cardiovascular diseases pose a significant economic burden worldwide; however, a clear picture of the economic impact of ASCVD secondary to hypercholesterolemia is lacking. This study aiming at conducting a systematic review of the current literature to assess the economic impact of familial hypercholesterolemia (FH), non-familial hypercholesterolemia (non-FH) or mixed dyslipidemia. A literature search was performed in Medline/PubMed and Embase database up to September 1st, 2020, exploring evidence published from 2010. The literature review was conducted in accordance with PRISMA guidelines. To be included the studies must be conducted on people who have been diagnosed with familial hypercholesterolemia, non-familial hypercholesterolemia or mixed dyslipidemia, and report data/information on costs attributable to these conditions and their sequelae. A total of 1260 studies were retrieved. After reading the titles and abstract, 103 studies were selected for full reading and eight met the criteria for inclusion. All but one studies were published in the American continent, with the majority conducted in US. An observational design with a prevalence approach were used and all estimated the economic burden of CVD. Direct cost estimates as annual average health expenditure on all population, ranging from $17 to $259 million. Few studies assessing the economic impact of hypercholesterolemia are available in the literature and new researches are needed to provide a more updated and reliable picture. Despite this scarceness of evidence, this review adds important data for future discussion on the knowledge of the economic impact of hypercholesterolemia and costs of care associated to this condition, with important implication for public health researches and novel therapies implementation.

Side Effects of Long - Term Glucocorticoid Therapy: Case Report

Glucocorticoids are one of the most common classes of drugs used to treat a diverse variety of inflammatory and autoimmune disorders. Despite their effects, long-term therapy exposes patients to multiple side effects, such as weight gain, high blood pressure, adrenal insufficiency, osteoporosis and a high risk of infections. We present the case of a 61-year-old female with osteoporosis secondary to glucocorticoid therapy, adrenal insufficiency, new-onset diabetes mellitus and mixed dyslipidemia, manifestations that occurred as a result of self-administration of Medrol for one year. The patient presented to the hospital for thoracic back pain, being sent to the endocrinologist due to radiological changes suggestive of vertebral compressions.

POS1086 DIFFERENCES IN PROINFLAMMATORY AND LIPID PROFILE BETWEEN PSORIATIC ARTHRITIS, ANKYLOSING SPONDYLITIS AND RHEUMATOID ARTHRITIS

Background:Patients with rheumatic diseases such as rheumatoid arthritis (RA), psoriatic arthritis (PsA), and ankylosing spondylitis (AS) are at increased risk of developing dyslipidaemia and premature cardiovascular disease (CVD)(1).Objectives:To investigate the relationship between proinflammatory cytokines, microRNA, and lipid profile in patients with RA, AS, and PsA.Methods:A group of 65 patients (RA15/ AS25/ PsA25) with high disease activity (mean DAS28 5,98 / ASDAS-CRP 3,7/ DAPSA 38,5) and 25 healthy controls (HC) were compared. Lipid profile comprised triglycerides (TG), total cholesterol(TC), low (LDL), and high-density lipoprotein (HDL). Serum concentrations of IL-6, IL-21, IL-17, TNF and osteoprotegerine (OPG) were measured by commercially available enzyme-linked immunosorbent assays. Expression of miR-233-5p,miR-92-3p,miR-485-3p,miR-10b-5p,let-7d-5p, miR-26 -a-2-3p levels in sera was normalized to miR-16a internal control. The Mann-Whitney test was applied for intergroup comparison, the correlation was assessed using Spearman’s Rank test.Results:Patients with RA revealed mixed dyslipidemia (mean values:TC196; LDL 117; HDL, 48 TG; 124 mg/dl), PsA revealed hypertriglyceridemia (TC 175; LDL 100; HDL 50; TG137 mg/dl) and in AS no specific profile was found (TC 179; LDL98; HDL55; TG103 mg/dl). Higher expression of miR-485was observed in patients with PsA (4,8-fold) and AS (5,9-fold) compared to RA and HC groups (3,1 and 1,5-fold p=0,02). Similarly, miR-26a revealed higher expression in patients with PsA (28,4-fold) and AS (21,5-fold) than in RA and HC (3,5 and 2,9-fold p<0,00). PsA patients had higher expression of miR-146b than patients with RA, AS and HC (40,9-fold vs 12,6 vs 15,7 vs 3,4-fold p=0,002) and higher miR-10b (11,7 vs 1,4 vs 4,9 vs 1,7-fold p=0,004). Patients with RA showed higher expression of let7-d than patients with PsA, AS and HC (22-fold vs 1,8 vs 2,3 vs1,9 -fold p=0,002). In PsA miR-92b expression correlated negatively with HDL levels (r=-0,62 p=0,02) and positively with fasting glucose (r=0,71 p<0,00). TG levels negatively correlated with TNF (r=-0,47 p=0,01), IL-17 (r=-0,49 p=0,01) and OPG (r=-0,51 p=0,00) serum levels. Let-7d correlated negatively with TC (r=-0,58 p=0,03). In RA IL-21 positively correlated with LDL (r=0,71 p=0,00) and TC (r=0,75 p=0,001) concentrations. TG levels correlated positively with expressions of miR-92b (r=6,9 p=0,02) and miR-26a (r=0,69 p=0,03). In AS expression of let-7d was correlated positively with HDL (r=0,41 p=0,00) and TC (r=0,45 p=0,00) levels and negatively with ASDAS-CRP (r=-0,675 p=0,02) and CRP levels (r=-0,53 p=0,01). There were no significant differences in OPG, IL-21 concentrations or miR-146b, miR-92b,miR-233 expressions.Conclusion:Differences in proinflammatory profile in RA, PsA, and AS seem to be associated with different phenotypes of dyslipidemia. In PsA expression of miR-92b and higher levels of TNF, IL-17 and OPG are associated with altered lipid profile and hypertriglyceridemia. High activity of AS is associated with lowered expression of let-7d, possibly influencing TC and HDL levels. Therefore, measuring lipid profile in active disease might be misleading. In active RA increase of TC and LDL levels was associated with high IL-21 concentration, while hypertriglyceridemia with miR-92b and miR-26a expressions.References:[1]Bonek K,et al AB0775 Peripheral joint inflammation is associated with more proatherogenic cardiovascular risk profile in patients with psoriatic arthritis.Annals of the Rheumatic Diseases 2020;79:1685-1686Disclosure of Interests:None declared.

Rosuvastatin and Fenofibrate Combination in The Treatment of Mixed Hyperlipidemia: A Narrative Review

Introduction: Patients with mixed dyslipidemia are presented with high levels of low-density lipid cholesterol (LDL-C), triglycerides (TG), and reduced high-density lipid cholesterol (HDL-C). Though useful in lowering LDL-C, therapy with rosuvastatin is insufficient in optimizing the overall lipid profile, thus putting the patient at risk of residual cardiovascular risk. A combination of statin with other lipid-modifying agents has been used with more efficient lipid control and cardiovascular risk prevention. Of these, fenofibric acid is the most frequently used, along with rosuvastatin. Methods: Authors conducted a literature search of published literature to assess the use of rosuvastatin and fenofibrate combination in the management of mixed hyperlipidaemia. Results and discussion: The authors selected a total of 46 articles to be included in the review. Due to the small number of articles and heterogeneity on the combination of rosuvastatin and fenofibrate combination in mixed hyperlipidemia, the findings herein are presented using narrative summaries. Based on the thorough assessment of the selected literature, the essential themes that emerged from the review include safety and efficacy of rosuvastatin and fenofibrate combination, place of therapy of rosuvastatin, and fenofibrate combination, and potential cardiovascular risk reduction with rosuvastatin and fenofibrate combination. Conclusion: Based on the review, the authors suggested that the combination therapy with fenofibric acid was beneficial, well-tolerated with a similar safety profile compared with statin monotherapy. The combination therapy of moderate dose rosuvastatin and fenofibric acid led to a reduction of cardiovascular risk factors via several pathways.

Comparative assessment of LDL-C and VLDL-C estimation in Familial Combined Hyperlipidemia using Sampson’s, Martin’s and Friedewald’s equations

Background: Sampson et al developed a novel method to estimate very low-density lipoprotein cholesterol (VLDL-C) and low-density lipoprotein cholesterol (LDL-C) in the setting of hypertriglyceridemia. Familial Combined Hyperlipidemia (FCHL) is a common primary dyslipidemia in which lipoprotein composition interferes with LDL-C estimation. This study aimed to evaluate performance of LDL-C using this new method (LDL-S) compared with LDL-C estimated by Friedewald’s and Martin equation (LDL-F, LDL-M) in FCHL.Methods: Data were collected from 340 subjects with confirmed FCHL. Concordance for VLDL-C measured by ultracentrifugation and LDL-C estimated using these measures compared to Sampson’s, Martin’s and Friedewald’s equations was performed using correlation coefficients, root mean squared error (RMSE) and bias. We also assessed concordance of misclassified metrics according to LDL-C (<70 and <100mg/dL) and ApoB (<80 and <65mg/dL) thresholds.Results: Sampson’s equation was more accurate (RMSE 11.21 mg/dL; R2=0.88) compared to Martin’s (RMSE 13.15 mg/dL; R2=0.875) and the Friedewald equation (RMSE 13.7 mg/dL; R2= 0.869). When assessing performance according to LDL-C, Sampson’s had highest correlation and lowest RMSE compared to other equations (RMSE 19.99 mg/dL; R2=0.840). Comparing performance strength across triglyceride levels, Sampson’s showed consistently improved correlations compared to Martin’s and Friedewald’s formulas for increasing triglycerides and for the FCHL phenotype of mixed dyslipidemia. Sampson’s also had improved concordance with treatment goals.Conclusions: In FCHL, VLDL-C and LDL-C estimation using Sampson’s formula showed higher concordance with lipid targets assessed using VLDL-C obtained by ultracentrifugation compared with Friedewald’s and Martin’s equations. Implementation of Sampson’s formula could improve treatment monitoring in FCHL.

Existing problems and new possibilities in the treatment of dyslipidemia Joint Conclusion Based on the Results of the Expert Council

The meeting of the expert council of cardiologists-lipidologists, organized with the support of Novartis and dedicated to the discussion of the existing system of medical care for patients with familial hypercholesterolemia / mixed dyslipidemia, the modern evidence base for lipid-lowering therapy and the practical value of the strategy of early combined lipid-lowering therapy for doctors and these categories of patients was held in Moscow on November 11, 2020.

Comparative Assessment of LDL-C and VLDL-C Estimation in Familial Combined Hyperlipidemia using Sampson’s, Martin’s and Friedewald’s Equations.

Background: Sampson et al developed a novel method to estimate very low-density lipoprotein cholesterol (VLDL-C) and low-density lipoprotein cholesterol (LDL-C) in the setting of hypertriglyceridemia. Familial Combined Hyperlipidemia (FCHL) is a common primary dyslipidemia in which lipoprotein composition interferes with LDL-C estimation. This study aimed to evaluate performance of LDL-C using this new method (LDL-S) compared with LDL-C estimated by Friedewald’s and Martin equation (LDL-F, LDL-M) in FCHL.Methods: Data were collected from 340 subjects with confirmed FCHL. Concordance for VLDL-C measured by ultracentrifugation and LDL-C estimated using these measures compared to Sampson’s, Martin’s and Friedewald’s equations was performed using correlation coefficients, root mean squared error (RMSE) and bias. We also assessed concordance of misclassified metrics according to LDL-C (<70 and <100mg/dL) and ApoB (<80 and <65mg/dL) thresholds.Results: Sampson’s equation was more accurate (RMSE 11.21 mg/dL; R2=0.88) compared to Martin’s (RMSE 13.15 mg/dL; R2=0.875) and the Friedewald equation (RMSE 13.7 mg/dL; R2= 0.869). When assessing performance according to LDL-C, Sampson’s had highest correlation and lowest RMSE compared to other equations (RMSE 19.99 mg/dL; R2=0.840). Comparing performance strength across triglyceride levels, Sampson’s showed consistently improved correlations compared to Martin’s and Friedewald’s formulas for increasing triglycerides and for the FCHL phenotype of mixed dyslipidemia. Sampson’s also had improved concordance with treatment goals.Conclusions: In FCHL, VLDL-C and LDL-C estimation using Sampson’s formula showed higher concordance with lipid targets assessed using VLDL-C obtained by ultracentrifugation compared with Friedewald’s and Martin’s equations. Implementation of Sampson’s formula could improve treatment monitoring in FCHL.