BACKGROUND
Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk.
OBJECTIVES
In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels.
METHODS
ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3–74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2–111.0 mg/dL).
RESULTS
In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [Cl]: 0.52–0.90) and 1.11 (95% Cl: 0.83–1.49), with treatment-lipoprotein(a) interaction on MACE (
P
interaction
= 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% Cl: 0.72–0.92) and 0.89 (95% Cl: 0.75–1.06), with
P
interaction
= 0.43.
CONCLUSIONS
In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab;
NCT01663402
)
The paper deals with the investigation of the temporal instabilities and spatial localization due to the Lüders behavior and the Portevin-Le Chatelier effect in the carbon steel C1010 and the aluminummagnesium alloy AA5052, which manifest the unstable plastic flow. The digital image correlation technique and the infrared thermography were used to capture and study the processes of the initiation and propagation of the deformation bands. The main part of the research focuses on the estimation of the influence of the loading system's stiffness on the irregular plastic flow, which was carried out on flat specimens with complicated geometry and on specimens with additional deformable parts.Citation: Tretyakova, T. V., Wildemann, V. E., Influence the loading conditions and the stress concentrators on the spatial-time inhomogeneity due to the yield delay and the jerky flow: study by using the digital image correlation and the infrared analysis, Frattura ed Integrità Strutturale, 42 (2017) 303-314.
В работе рассматривается численная реализация определяющих соотношений вязкоупругой модели сплошной среды. Модель описывает поведение наполненных вулканизатов в случае конечных деформаций. Используются аддитивное разложение тензора скоростей деформации, а также понятия макро-и структурного уровней деформирования. Гиперупругость связующего полимерного композита вводится соотношениями, построенными на базе обобщённой модели полимерной цепи в трубке. Реологические свойства представляются в виде дифференциальных соотношений. Опробованы различные виды слагаемого в потенциале свободной энергии, отвечающего за релаксационные свойства. Предложена зависимость коэффициента вязкого течения от параметров среды и внутренних тензорных переменных. Оценено соответствие результатов численного моделирования данным экспериментов на одноосное циклическое нагружение наполненных вулканизатов.
A need to timely reveal operational damages and technological defects requires a prompt control of states of structures made from composite materials and their consequent repairs aimed at service life extension. This work is devoted to the experimental study of inelastic deformation and fracture of specimens made from layer composite materials with prior introduced technological defects related to a possible inappropriate compacting and inappropriate bonding of material layers at a given restricted domain. The analysis is carried on the evolution of inhomogeneous deformation fields on the surface of carbon plastic specimens with an internal "delamination-type" defect under complex stress state. The method of active infrared thermography was used to identify the location and parameters of defects configurations. The obtained experimental data will be used for further tests related to sufficiency evaluation of signals received from the builtin sensors under complex loadings.Citation: Wildemann, V. V., Tretyakova, T. V., Strungar, E. M., Tretyakov, M. P., Deformation and failure of carbon fiber composite specimens with embedded defects during tension-torsion test, Frattura ed Integrità Strutturale, 46 (2018) 295-305.
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