An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia-Full report

Grundy, Scott M.; Arai, Hidenori; Barter, Philip J.; Bersot, Thomas P.; Betteridge, D.; Carmena, Rafael; Cuevas, Ada; Davidson, Michael; Genest, Jacques; Ya, Kesäniemi; Sadikot, S.M.; Santos, Raúl D.; Сусеков, А. В.; Sy, Rody G.; LaleTokgözoglu, S.; Watts, Gerald F.; Zhao, Dong

doi:10.1016/j.jacl.2013.12.005

Cited by 283 publications

(129 citation statements)

References 340 publications

(298 reference statements)

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“…We compared the cardiovascular risk factors in accordance with the guidelines of the International Atherosclerosis Society [32], such as arterial hypertension, diabetes mellitus, hypercholesterolemia, hyperlipidemia, obesity, tobacco smoking, and former smoking in very elderly patients over 90 years of age with and without CAD (ICD I25.0–I25.10) after completing cardiac catheterization.…”

Section: Methodsmentioning

confidence: 99%

Weak Prediction Power of the Framingham Risk Score for Coronary Artery Disease in Nonagenarians

Yayan

2014

PLoS ONE

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BackgroundCoronary artery disease (CAD) is caused by an acute myocardial infarction and is still feared as a life-threatening heart disease worldwide. In order to identify patients at high risk for CAD, previous studies have proposed various risk assessment scores for the prevention of CAD. The most commonly used risk assessment score for CAD worldwide is the Framingham Risk Score (FRS). The FRS is used for middle-aged people; hence, its appropriateness has not been demonstrated to predict the likelihood of CAD occurrence in very elderly people. This article examines the possible predictive value of FRS for CAD in very elderly people over 90 years of age.MethodsData on all patients over 90 years of age who received a cardiac catheter were collected from hospital charts from the Department of Internal Medicine, Saarland University Medical Center, and HELIOS Hospital Wuppertal, Witten/Herdecke University Medical Center, Germany, within a study period from 2004 to 2013. The FRSs and cardiovascular risk profiles of patients over 90 years of age with and without CAD after cardiac catheterization were compared.ResultsOne hundred and seventy-five (91.15%, mean age 91.51±1.80 years, 74 females [42.29%]; 95% confidence interval [CI], 0.87–0.95) of a total 192 of the very elderly patients were found to have CAD. Based on the results of our study, the FRS seems to provide weak predictive ability for CAD in very elderly people (P = 0.3792).ConclusionWe found weak prediction power of FRS for CAD in nonagenarians.

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Section: Methodsmentioning

confidence: 99%

Weak Prediction Power of the Framingham Risk Score for Coronary Artery Disease in Nonagenarians

Yayan

2014

PLoS ONE

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“…This residual risk may be attributed in part to atherogenic dyslipidemia, characterized by high levels of triglycerides, low levels of high‐density lipoprotein (HDL) cholesterol (HDL‐C), and high LDL‐particle (LDL‐P) numbers in these patients 1. In addition to LDL‐C lowering, non–HDL‐C and apolipoprotein B (apoB) have been recommended as treatment targets for assessment of individuals with diabetic dyslipidemia 1, 7, 12, 13, 14, 15…”

Section: Introductionmentioning

confidence: 99%

“…Several international guidelines endorse statin uptitration, switching to a more‐potent statin therapy, and/or combination therapy for high‐risk individuals in need of additional cholesterol lowering 7, 12, 13, 14, 15. US guidelines recommend using the maximum tolerated statin dose with consideration given to the addition of a nonstatin cholesterol‐lowering drug if the clinical benefit outweighs the safety risk in these patients 16.…”

Section: Introductionmentioning

confidence: 99%

Effect of Switching From Statin Monotherapy to Ezetimibe/Simvastatin Combination Therapy Compared With Other Intensified Lipid‐Lowering Strategies on Lipoprotein Subclasses in Diabetic Patients With Symptomatic Cardiovascular Disease

Tomassini

Tershakovec

et al. 2015

JAHA

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BackgroundPatients with diabetes mellitus and cardiovascular disease may not achieve adequate low‐density lipoprotein cholesterol (LDL‐C) lowering on statin monotherapy, attributed partly to atherogenic dyslipidemia. More intensive LDL‐C–lowering therapy can be considered for these patients. A previous randomized, controlled study demonstrated greater LDL‐C lowering in diabetic patients with symptomatic cardiovascular disease who switched from simvastatin 20 mg (S20) or atorvastatin 10 mg (A10) to combination ezetimibe/simvastatin 10/20 mg (ES10/20) therapy, compared with statin dose‐doubling (to S40 or A20) or switching to rosuvastatin 10 mg (R10). The effect of these regimens on novel biomarkers of atherogenic dyslipidemia (low‐ and high‐density lipoprotein particle number and lipoprotein‐associated phospholipase A2 [Lp‐PLA2]) was assessed.Methods and ResultsTreatment effects on low‐ and high‐density lipoprotein particle number (by NMR) and Lp‐PLA2 (by ELISA) were evaluated using plasma samples available from 358 subjects in the study. Switching to ES10/20 reduced low‐density lipoprotein‐particle number numerically more than did statin dose‐doubling and was comparable with R10 (−133.3, −94.4, and −56.3 nmol/L, respectively; P>0.05). Increases in high‐density lipoprotein particle number were significantly greater with switches to ES10/20 versus statin dose‐doubling (1.5 and −0.5 μmol/L; P<0.05) and comparable with R10 (0.7 μmol/L; P>0.05). Percentages of patients attaining low‐density lipoprotein particle number levels <990 nmol/L were 62.4% for ES10/20, 54.1% for statin dose‐doubling, and 57.0% for R10. Switching to ES10/20 reduced Lp‐PLA2 activity significantly more than did statin dose‐doubling (−28.0 versus −3.8 nmol/min per mL, P<0.05) and was comparable with R10 (−28.0 versus −18.6 nmol/min per mL; P>0.05); effects on Lp‐PLA2 concentration were modest.ConclusionsIn diabetic patients with dyslipidemia, switching from statins to combination ES10/20 therapy generally improved lipoprotein subclass profile and Lp‐PLA2 activity more than did statin dose‐doubling and was comparable with R10, consistent with its lipid effects.Clinical Trial RegistrationURL: http://www.clinicaltrials.gov. Unique identifier: NCT00862251.

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“…Since the publication of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III (ATP III) Guidelines in 2002 [3], four new cholesterol guidelines from various professional organizations have been released between 2011 and 2014, including the those of the European Society of Cardiology and European Atherosclerosis Society (ESC/EAS) [6], International Atherosclerosis Society (IAS) [7], American College of Cardiology and American Heart Association (ACC/AHA) [8], and National Lipid Association (NLA) [9]. Table 1 provides a summary of key recommendations from each guideline.…”

Section: Recent Clinical Practice Guidelinesmentioning

confidence: 99%

“…While the efficacy of statin therapy has been well established, the safety of these agents, particularly in older adults, remains unclear [7,33,34]. As evidence of this uncertainty, the US FDA provided additional label guidance related to adverse drug events with statin utilization in 2012 [35].…”

Section: Statin Safety In Older Adultsmentioning

confidence: 99%

Current Drug Treatment of Hyperlipidemia in Older Adults

2015

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Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of death, especially in older adults. Managing modifiable risk factors (e.g., hyperlipidemia, hypertension) remains the primary approach to prevent ASCVD events and ASCVD-related mortality. Statins are generally considered one of the most effective approaches to reduce ASCVD risk, especially for secondary prevention, yet remain underutilized in older adults. The evidence to support statin therapy in older adults is less robust than in their younger counterparts, especially in individuals aged 75 years and older. Recent lipid guidelines have raised this concern, yet statin therapy is recommended in 'at risk' older adults. Determining which older adults should receive statin therapy for primary prevention of ASCVD is challenging, as the currently available risk estimation tools are of limited use in those aged over 75 years. Furthermore, non-statin therapies have been de-emphasized in recent clinical practice guidelines and remain understudied in the older adult population. This is unfortunate given that older adults are less likely to tolerate moderate- to high-intensity statins. Non-statin therapies could be viable options in this population if more was understood about their ability to lower ASCVD risk and safety profiles. Nevertheless, lipid-lowering agents remain an integral component of the overall strategy to reduce atherogenic burden in older adults. Future research in this area should aim to enroll more older adults in clinical trials, determine the utility of ASCVD risk estimation for primary prevention, and investigate the role of non-statin therapies in this population.

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An International Atherosclerosis Society Position Paper: Global recommendations for the management of dyslipidemia-Full report

Cited by 283 publications

References 340 publications

Weak Prediction Power of the Framingham Risk Score for Coronary Artery Disease in Nonagenarians

Weak Prediction Power of the Framingham Risk Score for Coronary Artery Disease in Nonagenarians

Effect of Switching From Statin Monotherapy to Ezetimibe/Simvastatin Combination Therapy Compared With Other Intensified Lipid‐Lowering Strategies on Lipoprotein Subclasses in Diabetic Patients With Symptomatic Cardiovascular Disease

Current Drug Treatment of Hyperlipidemia in Older Adults

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