Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial

Zafeiropoulos, Stefanos; Farmakis, Ioannis; Κάρτας, Αναστάσιος; Arvanitaki, Alexandra; Pagiantza, Areti; Boulmpou, Aristi; Tampaki, Athina; Kosmidis, Diamantis; Nevras, Vasileios; Markidis, Eleftherios; Vlachou, Anastasia; Arvanitakis, Konstantinos; Miyara, Santiago J.; Ziakas, Antonios; Molmenti, Ernesto P.; Kassimis, George; Zanos, Stavros; Karvounis, Haralambos; Giannakoulas, George

doi:10.1016/j.atherosclerosis.2021.03.013

Cited by 8 publications

(4 citation statements)

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“…However, despite this, not all patients who were considered to have good adherence achieved the targeted LDL value from the guidelines. 29 This was also observed in an analysis of UK primary care data using prescribing data, following a cardiovascular event, approximately 70% of patients achieved ≥80% statin adherence (as measured by PDC) in the first year, despite a higher percentage failing to have LDL ≤1.8 mmol/L. 10 Therefore, while adherence appears to be associated with cholesterol levels, it is not the only contributing factor.…”

Section: Open Accessmentioning

confidence: 76%

Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors: a retrospective cohort study

et al. 2021

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ObjectivesTo examine associations between statin adherence and lipid target achievement in myocardial infarction (MI) survivors, and their associations with mortality and recurrent MIs.DesignRetrospective cohort study using linked clinical records within the National Health Service Greater Glasgow and Clyde (NHS GGC) Data Safe Haven.SettingRoutine clinical practice in the NHS GGC area between January 2009 and July 2017.ParticipantsPatients ≥18 years who experienced a non-fatal MI hospital admission (ICD10: I21, I22) between January 2009 and July 2014 (n=11 031), followed up from the date of MI admission until July 2017 or death, whichever occurred first.Primary and secondary outcome measuresStatin adherence was estimated using encashed prescriptions and lipid results from routine biochemistry data. Primary lipid and statin adherence targets were LDL ≤1.8 mmol/L and adherence ≥50%, and were related to all-cause death, deaths due to cardiovascular disease (CVD) (ICD10: I00–I99 as the underlying cause), and recurrent MI in unadjusted models and models adjusting for age, sex, socioeconomic deprivation and year of MI.ResultsOver 4.5 years follow-up, 76% achieved LDL ≤1.8 mmol/L, and 84.5% had average adherence ≥50%. Patients with adherence <50% had an increased risk of not meeting LDL ≤1.8 mmol/L, in adjusted models (OR 2.03, 95% CI 1.78 to 2.31, p<0.0001). In univariable models, not meeting LDL ≤1.8 mmol/L was associated with increased risks of all-cause mortality (HR 1.27, 95% CI 1.16 to 1.39, p<0.0001) and CVD mortality (HR 1.29, 95% CI 1.11 to 1.51, p=0.0013). Adherence <50% was associated with increased risks of all-cause mortality (HR 1.58, 95% CI 1.44 to 1.74, p<0.0001) and CVD mortality (HR 1.60, 95% CI 1.36 to 1.88, p<0.0001). Adjustment for confounders did not abrogate these associations. Neither exposure was associated with recurrent MIs.ConclusionsNon-achievement of lipid and adherence targets are associated with increased risks of all-cause and CVD mortality. Further work is required to optimise their use to improve outcomes in clinical practice.

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Section: Open Accessmentioning

confidence: 76%

Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors: a retrospective cohort study

et al. 2021

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“…Our results show an improvement in this behaviour. Despite not exploring the type of medication, other studies measuring adherence to statins, antihypertensives, etc., highlight the importance of this intervention being implemented in primary care (Kavita et al, 2020;Sotorra-Figuerola et al, 2021;Zafeiropoulos et al, 2021) in secondary prevention showed that a 12-week nursing intervention after AMI in the community setting improved self-management of the disease, adherence to medication, and physical activity. This study, unlike ours, took less of an individual approach and relied more on group and telephone management (Shen et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

Intensive nurse‐led follow‐up in primary care to improve self‐management and compliance behaviour after myocardial infarction

et al. 2023

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Aims and Objectives To assess the effects of intensive follow‐up by primary care nurses on cardiovascular disease self‐management and compliance behaviours after myocardial infarction. Background Although cardiovascular disease prevention and cardiac rehabilitation take place in hospital settings, a nurse‐led approach is necessary in primary care during the first few months after a myocardial infarction. Therefore, it is important to assess self‐management of cardiovascular disease and levels of compliance with the prescribed diet, physical activity, and medication. Design The study used a multicentre, quasi‐experimental, pre‐post design without a control group. Methods Patients with acute coronary syndrome from 40 healthcare facilities were included in the study. A total of 212 patients participated in a programme including 11 interventions during the first 12–18 months after myocardial infarction. The following Nursing Outcomes Classification (NOC) outcomes were assessed at baseline and at the end of the intervention: Self‐management: Cardiac Disease (1617) and Compliance Behaviour: Prescribed Diet (1622), Compliance Behaviour: Prescribed Activity (1632), and Compliance Behaviour: Prescribed Medication (1623). Marjory Gordon's functional health patterns and a self‐care notebook were used in each intervention. Pre‐post intervention means were compared using Student's t‐tests for related samples. The results of the study are reported in compliance with the TREND Statement. Results A total of 132 patients completed the intervention. The indicators for each NOC outcome and the variations in scores before and after the intensive follow‐up showed a statistically significant improvement (p‐value = 0.000). Compliance Behaviour: Prescribed Diet (pre = 3.7; post = 4.1); Compliance Behaviour: Prescribed Activity (pre = 3.9; post = 4.3); Compliance Behaviour: Prescribed Medication (pre = 3.9; post = 4.7). Conclusion Intensive, immediate follow‐up after myocardial infarction improves compliance behaviours and self‐management of heart disease. A combined self‐care and family care approach should be encouraged to empower post‐myocardial infarction patients. To facilitate patients' self‐efficacy, the use of health education tools such as a cardiovascular self‐care notebook can also be helpful. Relevance to Clinical Practice This study highlights the benefits of intensive, protocolised, comprehensive patient follow‐up in primary care during the first few months after an acute myocardial infarction (AMI). Primary care nurses train patients in cardiovascular self‐care. Patient or Public Contribution Patients were not involved in either the design or the carrying out of the study. However, at the end of the study, they participated in an evaluation process about the utility of the research study and their satisfaction with it. This process was carried out using an ad hoc survey consisting of 10 questions assessing the nursing care and follow‐up inputs that were received.

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“…AS is a set of processes driven by lipid plaque formation. Hyperlipidemia is considered as the major contributor for the development of atherosclerotic cardiovascular diseases ( Zafeiropoulos et al, 2021 ). Multiple EWASs have explored total cholesterol, low-density lipoprotein cholesterol (LDL-C), and triacylglycerol (TG), which are pro-atherogenic, and high-density lipoprotein cholesterol (HDL-C), which is anti-atherogenic ( Hedman et al, 2017 ).…”

Section: Introductionmentioning

confidence: 99%

DNA Methylation Aberrant in Atherosclerosis

Dai

Chen

2022

Front. Pharmacol.

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Atherosclerosis (AS) is a pathological process involving lipid oxidation, immune system activation, and endothelial dysfunction. The activated immune system could lead to inflammation and oxidative stress. Risk factors like aging and hyperhomocysteinemia also promote the progression of AS. Epigenetic modifications, including DNA methylation, histone modification, and non-coding RNA, are involved in the modulation of genes between the environment and AS formation. DNA methylation is one of the most important epigenetic mechanisms in the pathogenesis of AS. However, the relationship between the progression of AS and DNA methylation is not completely understood. This review will discuss the abnormal changes of DNA methylation in AS, including genome-wide hypermethylation dominating in AS with an increase of age, hypermethylation links with methyl supply and generating hyperhomocysteinemia, and the influence of oxidative stress with the demethylation process by interfering with the hydroxyl-methylation of TET proteins. The review will also summarize the current status of epigenetic treatment, which may provide new direction and potential therapeutic targets for AS.

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Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial

Cited by 8 publications

References 44 publications

Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors: a retrospective cohort study

Associations of statin adherence and lipid targets with adverse outcomes in myocardial infarction survivors: a retrospective cohort study

Intensive nurse‐led follow‐up in primary care to improve self‐management and compliance behaviour after myocardial infarction

DNA Methylation Aberrant in Atherosclerosis

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