2018

DOI: 10.5551/jat.gl2017

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Japan Atherosclerosis Society (JAS) Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases 2017

Makoto Kinoshita

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Cited by 579 publications

(539 citation statements)

References 937 publications

(1,023 reference statements)

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“…The recent guidelines from the Japanese Atherosclerosis Society also underline the need to evaluate the treatment options on an individual basis, in patients aged >75 years …”

Section: Clues To Optimal Treatment Choicementioning

confidence: 99%

Management of high cholesterol levels in older people

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2019

Geriatrics Gerontology Int

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The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol‐lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug‐related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid‐lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375–383.

“…The recent guidelines from the Japanese Atherosclerosis Society also underline the need to evaluate the treatment options on an individual basis, in patients aged >75 years …”

Section: Clues To Optimal Treatment Choicementioning

confidence: 99%

Management of high cholesterol levels in older people

¹

,

²

,

³

2019

Geriatrics Gerontology Int

View full text Add to dashboard Cite

The management of hypercholesterolemia in older adults still represents a challenge in clinical medicine. The pathophysiological alterations of cholesterol metabolism associated with aging are still incompletely understood, even if epidemiological evidence suggests that serum cholesterol levels increase with ongoing age, possibly with a plateau after the age of 80 years. Age is also one of the main determinants of cardiovascular disease, according to all cardiovascular risk estimate tools. Cholesterol‐lowering treatment, therefore, would be expected to bring significant protection, even in these patients. Unfortunately, direct experimental evidence is extremely limited, particularly in the very old age strata of the population; a clinical benefit still seems to be present, but the risk for drug‐related adverse events is clearly higher. At any rate, at the present time, definite guidelines for the correct management of hypercholesterolemia in older patients are not available. Therefore, the decision whether or not a pharmacological treatment should be set up, and the choice of the drug, need to be tailored to the individual patient, and requires accurate clinical judgment. The specific aspects of frailty and disability, along with the actual age of the patients, have to be considered together, with a comprehensive assessment approach. The present review summarizes the evidence regarding the modifications of cholesterol metabolism in older patients, the impact of lipid‐lowering drugs on cardiovascular outcomes and focuses on the considerations that can help to define the most appropriate treatment strategy, in view of the individual functional profile. Geriatr Gerontol Int 2019; 19: 375–383.

“…1 The 2017 Japanese Atherosclerosis Society guidelines recommend a reduction of the LDL-C level to 70 mg/dL in patients with acute coronary syndrome (ACS), for secondary prevention of familial hypercholesterolemia (FH), and in patients with diabetes mellitus (DM) with additional risk factors. 2 Statins are first-line drugs that significantly reduce serum LDL-C concentrations, but other drugs that effectively lower LDL-C concentrations include ezetimibe and eicosapentaenoic acid (EPA). However, not all patients respond sufficiently to these treatments.…”

mentioning

confidence: 99%

Cost-Effectiveness of PCSK9 Inhibitor Plus Statin in Patients With Triple-Vessel Coronary Artery Disease in Japan

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Background: The addition of a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor to statin therapy reduces the rate of cardiovascular events. This study examined the cost-effectiveness of PCSK9 inhibitor+statin compared with standard therapy (statin monotherapy) in the treatment of triple-vessel coronary artery disease (CAD) in Japan. Methods and Results:A Markov model was applied to assess the costs and benefits associated with PCSK9 inhibitor+statin over a projected 30-year period from the perspective of a public healthcare payer in Japan. The incremental cost-effectiveness ratio (ICER), expressed as the quality-adjusted life-years (QALYs), was estimated. The effects on survival and numbers of events were based on the FOURIER trial and the CREDO Kyoto registry. The ICER of PCSK9 inhibitor+statin over standard therapy was 13.5 million (95% confidence interval 7.6-23.5 million) Japanese Yen (JPY) per QALY gained for triple-vessel CAD. The probability of the cost-effectiveness of PCSK9 inhibitor+statin vs. standard therapy was 0.0008% at a cost-effectiveness threshold of 5 million JPY. In patients with poorly controlled familial hypercholesterolemia (FH) with triple-vessel CAD, the ICER was 3.4 million JPY per QALY gained.Conclusions: PCSK9 inhibitor plus statin did not show good cost-effectiveness for triple-vessel CAD; however, it showed good cost-effectiveness for patients with triple-vessel CAD and poorly controlled FH in Japan.

“…The lifestyle management such as regular physical exercise, weight loss, and smoking cessation is also essential. Among those factors, LDL‐C level has been reported to have a direct relationship with the cardiovascular event rate, and the target LDL‐C level has been proposed in the guidelines …”

Section: Discussionmentioning

confidence: 99%

“…Based on their findings, LDL‐C less than 70 mg/dL, which was a cutoff level in this study, appears to be sufficient to prevent lesion progression. The guidelines also adopt the LDL‐C < 70 mg/dL as the target for the patients with a very high cardiovascular event risk . FFR assessment is usually performed for the patients with intermediate coronary stenosis, and the progression of these atherosclerotic lesions is supposed to cause deferred‐lesion related events.…”

Section: Discussionmentioning

confidence: 99%

Impact of intensively lowered low‐density lipoprotein cholesterol on deferred lesion prognosis

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et al. 2019

Cathet Cardio Intervent

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Objectives The aim of this study was to investigate the impact of intensively lowered low‐density lipoprotein cholesterol (LDL‐C) level on the deferred lesion prognosis after revascularization deferral based on fractional flow reserve (FFR). Background Lowering LDL‐C is associated with lower cardiovascular event rate, but its benefit on the deferred lesion prognosis has not been well evaluated. Methods This retrospective, single‐center, observational study analyzed 192 deferred lesions with FFR value >0.80 in 192 patients with stable coronary artery disease. According to the first follow‐up LDL‐C level, they were assigned to the LOW group (<70 mg/dL) or the HIGH group (≥70 mg/dL). Deferred lesion failure (DLF) was defined as the composite of deferred lesion revascularization and deferred vessel myocardial infarction. Results Of all participants, 61 and 131 patients were assigned to the LOW and the HIGH group, respectively. During the median follow‐up of 2.8 years, DLF occurred in 1 and 14 patients in the LOW group and the HIGH group (1.6% and 10.7%, log‐rank p = .043), respectively. The incidence of any unplanned revascularization was also significantly lower in the LOW group than in the HIGH group (3.3% vs. 14.5%, log‐rank p = .032). Conclusions The incidence of DLF was significantly lower in the patients with LDL‐C < 70 mg/dL than in those with LDL‐C ≥ 70 mg/dL at the first follow‐up after FFR‐based deferral of revascularization.

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