Cholesterol target value attainment and lipid-lowering therapy in patients with stable or acute coronary heart disease: Results from the Dyslipidemia International Study II

Gitt, Anselm K.; Lautsch, Dominik; Ferrières, Jean; Ferrari, Gaetano M. De; Vyas, Ami; Baxter, Carl A.; Bash, Lori D.; Ashton, Veronica; Horack, Martin; Almahmeed, Wael; Chiang, Fu Tien; Poh, Kian Keong; Brudi, Philippe; Ambegaonkar, Baishali

doi:10.1016/j.atherosclerosis.2017.08.013

Cited by 107 publications

(97 citation statements)

References 33 publications

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“…24% did not receive statins despite a known CHD. This finding is in accordance with a large multicentre observation, which found similar cholesterol target value attainments [14,15]. However, the efficacy of LDL-lowering therapy for patients with CHD is well established for statins and was contemporary proven by the three randomised controlled PCSK9-inhibitor trials [6,[16][17][18][19].…”

Section: Discussionsupporting

confidence: 87%

Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort

et al. 2019

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Background Inflammation drives atherosclerosis and its complications. Anti-inflammatory therapy with interleukin 1 beta (IL-1β) antibody reduces cardiovascular events in patients with elevated high-sensitive C-reactive protein (hsCRP). This study aims to identify the share of patients with coronary heart disease (CHD) and residual inflammation who may benefit from anti-inflammatory therapy. Methods hsCRP and low-density lipoprotein (LDL) levels were determined in 2741 all-comers admitted to the cardiological ward of our tertiary referral hospital between June 2016 and June 2018. Patients without CHD, with acute coronary syndrome, chronic or recurrent systemic infection, use of immunosuppressant or anti-inflammatory agents, chronic inflammatory diseases, chemotherapy, terminal organ failure, traumatic injury and pregnancy were excluded. Results 856 patients with stable CHD were included. 42.7% of those had elevated hsCRP ≥ 2 mg/l. Within the group of patients with LDL-cholesterol < 70 mg/dl, 30.9% shared increased hsCRP indicating residual inflammation. After multivariate adjusted backward selection elevated Lipoprotein (a) (OR 1.61, p = 0.048), elevated proBNP (OR 2.57, p < 0.0001), smoking (OR 1.70, p = 0.022), and obesity (OR 2.28, p = 0.007) were associated with elevated hsCRP. In contrast, the use of ezetimibe was associated with normal hsCRP (OR 0.51, p = 0.014). In the subgroup of patients with on-target LDLcholesterol < 70 mg/dl, backward selection identified elevated proBNP (OR 3.49, p = 0.007) as independent predictor of elevated hsCRP in patients with LDL-cholesterol < 70 mg/dl. Conclusion One-third of all-comers patients with CHD showed increased levels of hsCRP despite a LDL-cholesterol < 70 mg/ dl potentially qualifying for an anti-inflammatory therapy. Elevated proBNP is an independent risk factor for hsCRP elevation.

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Section: Discussionsupporting

confidence: 87%

Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort

et al. 2019

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“…stable CHD or hospitalized for an ACS) patients achieve LDL-C target levels. Data from the international, observational, cross-sectional DYSIS II study showed that fewer than onethird of patients with stable CHD achieved an LDL-C level <70 mg/dL, despite all patients being at very high CV risk [21], and these findings were replicated within Asian DYSIS II cohorts [8,9,22]. Other cross-sectional and real-world evidence clearly demonstrates that many CHD patients with dyslipidemia remain inadequately treated with most patients on statin therapy not achieving treatment targets [23][24][25][26][27][28].…”

Section: Discussionmentioning

confidence: 95%

A Retrospective Study of LDL-Cholesterol in Koreans on Atorvastatin/Ezetimibe or Atorvastatin Monotherapy

Chang¹,

Ihm²,

Kim³

et al. 2019

JED

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Purpose: To investigate low-density lipoprotein cholesterol (LDL-C) goal attainment rates in patients with hypercholesterolemia treated with atorvastatin/ezetimibe or atorvastatin monotherapy. Methods: This was a multicenter, noninterventional, retrospective, chart review study of Korean patients with hypercholesterolemia who were statin-naïve and prescribed atorvastatin/ezetimibe or atorvastatin monotherapy during an observational period, from January 2014 to July 2017, and followed up for 12-18 weeks. Patients were propensity score matched to reduce treatment selection bias. Outcomes included LDL-C goal attainment rate at week 12, defined by risk groups according to Korean Society of Lipidology and Atherosclerosis guidelines; and change in lipid parameters from the index date to week 12. Results: A total of 969 patients were enrolled in the study: atorvastatin/ezetimibe, n = 349; atorvastatin monotherapy, n = 620. Following propensity matching (n = 316 in each group), respective LDL-C goal attainment rates for atorvastatin/ezetimibe and atorvastatin monotherapy groups were 86% and 75%, respectively (p = 0.0004). Atorvastatin/ezetimibe produced significantly larger reductions at week 12 in mean LDL-C (−50.3% vs −42.7%), total cholesterol (−36.8% vs −30.7%) and non-high-density lipoprotein cholesterol (non-HDL-C; −47.3% vs −39.8%) levels compared to atorvastatin monotherapy (all p < 0.0001). Conclusion: More patients achieved LDL-C goal attainment with atorvastatin/ezetimibe than with atorvastatin monotherapy, and atorvastatin/ ezetimibe was associated with significantly larger reductions in mean LDL-C, total cholesterol and non-HDL-C levels than atorvastatin monotherapy, in Korean patients with hypercholesterolemia in a real-world clinical practice.

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“…In order to obtain details on the management of cholesterol in patients with CHD, and to evaluate current treatment practices, DYSIS II was initiated. 10 This was a multinational, observational study investigating lipid abnormalities in patients with either stable CHD or presenting with an acute coronary syndrome (ACS). With the use of standardized methodology, the prevalence of lipid abnormalities, and predictors of LDL-C target attainment, was evaluated in patients from countries throughout the world.…”

mentioning

confidence: 99%

Prevalence of lipid abnormalities and cholesterol target value attainment in patients with stable coronary heart disease or an acute coronary syndrome in Saudi Arabia

Sifri

Shammeri

Jaser

et al. 2018

SMJ

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Objectives:To provide an overview of the extent of hyperlipidemia in very high-risk patients, and how lipid-lowering therapy (LLT) is used in a real-world setting.Methods:In this multicenter observational study, data were collected from LLT-treated patients with stable CHD or an ACS in Saudi Arabia between 2013 and 2014. Individuals were included if they were >18 years and had a full lipid profile available, recorded either prior to the baseline physician visit (CHD patients) or within 24-hours of admission to hospital (ACS patients).Results:A total of 737 patients were included in the study, 597 with stable CHD and 140 with ACS. Few patients in either group had an LDL-C level of <70 mg/dl, which is advocated for very high-risk patients (24.3% and 11.4%, respectively). The median distances to this value were 19.0 mg/dl (CHD) and 25.0 mg/dl (ACS). Low doses of statins were being utilized (31 and 24 mg/day for CHD and ACS, respectively), with only minimal intensification for the ACS patients after hospital admission (41 mg/day at follow-up).Conclusions:Achievement of recommended LDL-C levels was poor for patients with stable CHD or an ACS. Statin intensity was low, indicating huge scope for intensifying the treatment of these very high-risk patients.

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Cholesterol target value attainment and lipid-lowering therapy in patients with stable or acute coronary heart disease: Results from the Dyslipidemia International Study II

Cited by 107 publications

References 33 publications

Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort

Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort

A Retrospective Study of LDL-Cholesterol in Koreans on Atorvastatin/Ezetimibe or Atorvastatin Monotherapy

Prevalence of lipid abnormalities and cholesterol target value attainment in patients with stable coronary heart disease or an acute coronary syndrome in Saudi Arabia

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