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
)
Aim. To establish the factors associated with iron deficiency (ID) in pa- tients with heart failure (HF).Material and methods. We examined 294 patients with NYHA class II-IV HF as follows: 213 — with ID, 81 — without ID. All patients underwent a clinical examination, collection of medical history taking into account the presence, duration and severity of comorbidities, drug history, echocardiography, complete blood count, serum iron, ferritin, transferrin, transferrin saturation, soluble transferrin receptors, hepcidin, erythropoietin, and routine laboratory tests. In addition, we determined the presence and severity of asthenia, anxiety, and depression.Results. Twenty-nine clinical, laboratory and echocardiographic parameters were established, which had significant differences in patients with and without ID and significant correlations with ID. Determining the odds ratio for these 29 parameters revealed 7 factors significantly associated with ID in patients with HF. Using multivariate logistic regression, a significant cumulative effect of these factors on the ID risk was established.Conclusion. ID in patients with HF is associated with age, class II-IV HF, elevated hepcidin levels, duration of hypertension and diabetes, history of using angiotensin-converting enzyme inhibitors and novel oral anticoagulants for >1 year.
Iron deficiency is a frequent comorbid condition in patients with chronic heart failure. At the same time, the factors contributing to iron deficiency in these patients are poorly understood.
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