A consensus statement on lipid management after acute coronary syndrome

Angoulvant, Denis; Boccara, Franck; Bonnet, Jacques; Bonnet, Jean‐Louis; Bruckert, Éric; Cayla, Guillaume; Chatot, Marion; Chopard, Romain; Collet, Jean‐Philippe; Danchin, Nicolás; Ducrocq, Grégory; Elbaz, Meyer; Ferrari, Émile; Galinier, Michel; Farnier, Michel; Ferrières, Jean; Gerbaud, Édouard; Guedj, D. S.; Kownator, Serge; Krempf, Michel; Lemesle, Gilles; Levai, Laszlo; Mansencal, Nicolas; Mansourati, Jacques; Meune, Christophe; Morel, Olivier; Paillard, François; Piot, Christophe; Probst, Vincent; Puymirat, Étienne; Roubille, François; Sabouret, Pierre; Schiele, François; Teíger, Emmanuel

doi:10.1177/2048872616679791

Cited by 34 publications

(18 citation statements)

References 66 publications

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“…A decision-making algorithm for optimizing lipidlowering therapy in the context of secondary prevention after MI has recently been published, and considers that all patients after MI are at high risk as long as treatment has not reached the maximum tolerated dose, and it also allows for the possibility of adding ezetimibe if the LDL-C value remains above the target of 70 mg/dl. 89 The place of PCSK9 inhibitors in the treatment armamentarium needs to be discussed, given the cost of this treatment. The American College of Cardiology (ACC) 90 and the European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) 91 have recently published consensus statements for the use of these new agents.…”

Section: Muscle Intolerance Should Be Verified By Ensuringmentioning

confidence: 99%

Coronary artery disease: Risk stratification and patient selection for more aggressive secondary prevention

Schiele

Ecarnot

Chopard

2017

Eur J Prev Cardiolog

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In patients with stable coronary artery disease, clinical outcomes are predominantly characterized by the consequences of atherosclerosis on the myocardium, but also by complications of atherosclerosis, notably recurrent acute coronary syndrome or stroke. Secondary prevention therapy is therefore key in this patient population. Intensification of secondary prevention therapy is possible, at the price of a therapeutic risk or a high cost, therefore justifying careful selection of patients with a high residual risk and low therapeutic risk. Two lines of therapy can be intensified, independently of each other, namely anti-thrombotics and lipid-lowering agents. Intensification of anti-thrombotic therapy is efficacious in terms of ischaemic events and cardiovascular mortality, but incurs an excess haemorrhagic risk. Patients aged over 65 years of age and those with a history of intra-cranial haemorrhage are not eligible for intensification of anti-thrombotic therapy. Conversely, patients with prior or recurrent myocardial infarction may benefit from this strategy, especially if they are current smokers or have diabetes mellitus. Intensification of lipid-lowering therapy can be achieved through an association of high-intensity statins with ezetimibe or PCSK9 inhibitors. This strategy engenders little risk, but the cost of PCSK9 inhibition is high, and should be considered based on the level of low-density lipoprotein cholesterol achieved with statin treatment at the maximal tolerated dose. In addition to this patient selection based on low-density lipoprotein cholesterol levels, the presence of diabetes or documented progression of atherosclerosis should be considered.

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Section: Muscle Intolerance Should Be Verified By Ensuringmentioning

confidence: 99%

Coronary artery disease: Risk stratification and patient selection for more aggressive secondary prevention

Schiele

Ecarnot

Chopard

2017

Eur J Prev Cardiolog

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“… 1 The 2013 Chinese expert consensus also emphasized that regardless of the baseline cholesterol levels, all patients with ACS events should immediately initiate and maintain intensive statin therapy long-term after discharge. 2 , 3 Based on the results of large-scale clinical trials, early intensive statin therapy has been recommended for patients with recent ACS events. Both epidemiological and interventional clinical trials have shown a strong association between elevated LDL-C level and cardiovascular events.…”

Section: Introductionmentioning

confidence: 99%

Uncontrolled hyperlipidemia in Chinese patients who experienced acute coronary syndrome: an observational study

Jiang

Zhou

et al. 2018

TCRM

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ObjectiveDespite current standard of care, the overall lipid goal attainment rate for hyperlipidemia patients, especially those who have experienced acute coronary syndrome (ACS), is suboptimal, which predisposes them to a higher residual risk of atherothrombotic events. This study aimed to describe characteristics of Chinese patients who recently experienced an ACS event and were on lipid-lowering treatment, yet failing to reach targeted goal.MethodsA multicenter, cross-sectional study was conducted to recruit 2,034 Chinese patients who experienced an ACS (ST segment elevation myocardial infarction [STEMI], non-STEMI, or unstable angina) event within the past 4–40 weeks and were on statin treatment (>2 weeks) from March 2015 to December 2016. All eligible patients underwent a fasting lipid test after enrollment and data on medical history were collected.ResultsThe mean age of 1,994 eligible patients was 61.0±9.84 years. Among them, 1,493 (74.9%) patients received intensive statin therapy (defined as atorvastatin 40 or 80 mg, or rosuvastatin 20 mg per protocol) and 499 (25.0%) patients were on maximum tolerated dose statin. Of the 1,994 eligible subjects, 1,273 (63.8%) patients did not achieve the lipid goal at the time of enrollment. Among the not-at-goal patients, 910 (71.5%) received intensive statin therapy; the majority (73.4%) of them were male; the mean age was 61.2±10.1 years old; 699 (54.9%) patients had a history of hypertension; 25.3% had diabetes mellitus; and 29.5% were current smokers. The mean low-density lipoprotein-cholesterol (LDL-C), non-high-density lipoprotein-cholesterol (non-HDL-C), and ApoB levels at enrollment of this group of patients were 2.460±0.7139 mmol/L, 3.094±0.8861 mmol/L, and 0.840±0.3015 g/L, respectively.ConclusionThe study result demonstrates that overall more than half of the patients who recently (4–40 weeks) experienced ACS who were treated did not reach the guideline-recommended LDL-C and non-HDL-C goal. These results highlight the potential necessity for a new drug beyond statins to further reduce disease burden in the future.

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“…4,5 In Korea, the other phenotype of dyslipidemia showing high triglyceride or/and low high density lipoprotein cholesterol (HDL-C) levels is commonly found and is usually combined with abdominal obesity and elevated blood pressure and fasting glucose levels as co-morbidities for metabolic syndrome (MS). The prevalence of MS among Korean adult population is reported as high as 23.7%…”

Section: Introductionmentioning

confidence: 99%

Metabolic Syndrome Causes Cardiovascular Disease under Stable Statin Medication

Cho

Lee

Nam

et al. 2017

J Lipid Atheroscler

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Objective: Statins are known to prevent only 30-50% of cardiovascular disease(CVD) by reducing low-density lipoprotein cholesterol (LDL-C). There is a controversy about whether metabolic syndrome(MS) can increase the risk of CVD. The aim of this study is to investigate whether MS can increase the risk of CVD, even after LDL-C is ideally controlled by taking statins. Methods: As a retrospective observational study, we investigated CVD events of 909 patients (61.3±10.2 years old) by reviewing medical records for at least 1 year before and after taking statins respectively, from June 2005 to February 2008, and analyzed the risk factors of CVD. Results: During the study period (881.4±232.8 days), 46 cases of CVD events occurred in patients with a very high risk of CVD and in patients with a high risk of CVD. In patients with a very high risk of CVD, 56.8% (21 cases over 37) of CVD events occurred in patients who achieved LDL-C goal (<70 mg/dL). A total of 9 events developed among high risk patients who reached LDL-C goal (<100 mg/dL).

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A consensus statement on lipid management after acute coronary syndrome

Cited by 34 publications

References 66 publications

Coronary artery disease: Risk stratification and patient selection for more aggressive secondary prevention

Coronary artery disease: Risk stratification and patient selection for more aggressive secondary prevention

Uncontrolled hyperlipidemia in Chinese patients who experienced acute coronary syndrome: an observational study

Metabolic Syndrome Causes Cardiovascular Disease under Stable Statin Medication

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