Objective. To quantify the extent of hyperlipidemia and its treatment in patients with stable coronary heart disease (CHD) or an acute coronary syndrome (ACS) in the Philippines.
Methods. The ...Dyslipidemia International Study (DYSIS) II was an observational, multinational study conducted in patients aged ≥18 years with stable CHD or being hospitalized with an ACS. A full lipid profile was evaluated at baseline, and for the ACS cohort, at 4 months after discharge from hospital. Achievement of low-density lipoprotein cholesterol (LDL-C) targets and the use of lipid-lowering therapy (LLT) were assessed.
Results. A total of 232 patients were enrolled from 10 centers in the Philippines, 184 with stable CHD and 48 being hospitalized with an ACS. The mean LDL-C level for the CHD patients was 88.0±40.1 mg/dL, with 33.3% achieving the target of <70 mg/dL recommended for very high-risk patients. For the ACS cohort, the mean LDL-C level was 109.0±48.5 mg/dL, with target attainment of 25.0%. The majority of the CHD cohort was being treated with LLT (97.3%), while 55.3% of the ACS patients were receiving LLT prior to hospitalization, rising to 100.0% at follow-up. There was little use of non-statins.
Conclusions. For these very high-risk patients from the Philippines, LDL-C target attainment was poor. Opportunities for better monitoring and treatment of these subjects are being missed.
Current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) target of<1.8mmol/l for coronary patients and the administration of high potency statin therapy.
Our study documents real ...world lipid target achievement, including distance to target, among patients with stable coronary heart disease (CHD) and patients surviving an acute coronary syndrome (ACS) event in Europe.
DYSIS II is a multicountry, observational cross-sectional chart review conducted in 257 sites throughout Belgium, France, Germany, Greece, Ireland, Italy, and Russia. Two distinct patient cohorts were enrolled: patients surviving an ACS event and patients diagnosed with stable CHD. Full lipid profiles were available within 24 hours of hospital admission for ACS patients and 0-12 months prior to enrollment for CHD patients. Patients were on lipid-lowering therapy (LLT)≥3 months and not participating in clinical trials involving medication. Patient characteristics, risk factors, treatment patterns, and laboratory values were collected. LDL-C target achievement was assessed based on ESC/EAS guidelines.
880 ACS and 2778 CHD patients currently on LLT were enrolled in Europe from 2012 to 2014. Only 23.2% (n=204) ACS and 29.6% (n=821) CHD patients achieved and LDL-C<1.8mmol/l, with median distance to LDLC target in patients not a goal being 0.9mmol/l (IQR 0.4, 1.5) in ACS and 0.6mmol/l (IQR 0.3, 1.1) in CHD patients.
Three out of four coronary patients did not achieve the recommended LDL-C target, even while being treated with LLT, primarily statin monotherapy.
Low potency statin treatment was found in both patient cohorts, despite the high risk of our patient population and the need for more intense LLT (as stressed by our distance to target findings).
Abstract 0186 – Table: Mean Lipid Values and LLTACS Patients N=880CHD Patients N=2778Total cholesterol (mmol/l)4.4±1.24.1±1.0LDL-C (mmol/l)2.6±1.02.3±0.8Triglycerides (mmol/l)1.6±0.91.5±0.8HDL-C (mmol/l)1.1±0.31.2±0.4Non-HDL-C (mmol/l)3.3±1.22.9±0.9Atorvastatin equivalent dose (mg/day)22±1727±20Statin monotherapy87.2%79.8%Statin+ezetimibe6.4%11.6%Statin+other non-statin (fibrates, omega 3 fatty acids)2.4%6.7%Non-statin monotherapy3.8%2.0%
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GEOZS, IJS, IMTLJ, KILJ, KISLJ, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, UILJ, UL, UM, UPCLJ, UPUK, ZAGLJ, ZRSKP
Summary
Low density lipoprotein (LDL-C) levels determine the cardiovascular risk. Previous studies indicated an LDL-C target attainment of around 50 %, but no Austrian wide analysis on results for ...the federal states was available. We therefore sought to detect potential differences.
Design: Open-label, non-interventional, longitudinal study, registered:
www.clinicaltrials.gov
NCT 01381679. In all, 746 statin treated patients not at LDL-C goal received intensified therapy for 12 months. The sample was split into nine subgroups, representing the federal states of Austria.
We detected an east-west gradient for baseline LDL-C. Individual target values were achieved by 37.2 % (range: 26.1–57.7 %). After 12 months, LDL-C < 70 mg/l was achieved by 13.5 % (5.9–38.5 %). Univariate ANCOVA retrieved significant differences within the states (Upper Austria and Salzburg,
p
= 0.001 and
p
= 0.0015, respectively). Furthermore, the capacity of intensified lipid lowering therapy applied in practice was as high as −42 % as compared to previous standard therapy (additional LDL-C reduction after switch from baseline therapy in Vorarlberg).
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Oral medications for chronic conditions often involve a variety of instructions, including time of day/dosing, drug interactions, and food intake restrictions. However, the extent to which patients ...follow these instructions is unclear.
We surveyed patients from the US and Europe (UK, France, Germany, Italy, Spain) who were prescribed sulfonylureas (SU: glimepiride, glipizide, or gliclazide) for diabetes or levothyroxine for hypothyroidism. Patients kept a daily diary for 3-5 days documenting their adherence to three criteria: dosing regimen including time of day, warning labels including drug interactions, and food restrictions.
A total of 421 US and 493 European patients took the study medications; 546 patients took SU and 368 took levothyroxine. Overall, 48% of patients were males; 46% were age 65 years or older. Despite most patients having received instructions on medication requirements (US 71%, EU 75%), most patients reported being only somewhat knowledgeable (US 69%; EU 71%). Adherence, measured by the proportion of the days a participant was adherent to each category out of the observational period (ranging from 3-5 days), varied by type of instruction, with the poorest adherence observed for food restriction requirements (US 34% of the observation days, EU 26%) compared to warning labels (US 77%, EU 67%) and dosing regimen (US 85%, EU 87%).
Patients adhered to dosing and cautionary instructions across the majority of the study period but were largely non-adherent to food intake restrictions. Improved communication and increased emphasis on food intake restrictions is needed when advising patients on their medications.
Comprehensive stroke care is an interdisciplinary challenge. Close collaboration of cardiologists and stroke physicians is
critical to ensure optimum utilisation of short- and long-term care and ...preventive measures in patients with stroke. Risk
factor management is an important strategy that requires cardiologic involvement for primary and secondary stroke
prevention. Treatment of stroke generally is led by stroke physicians, yet cardiologists need to be integrated care
providers in stroke units to address all cardiovascular aspects of acute stroke care, including arrhythmia management,
blood pressure control, elevated levels of cardiac troponins, valvular disease/endocarditis, and the general management
of cardiovascular comorbidities. Despite substantial progress in stroke research and clinical care has been achieved,
relevant gaps in clinical evidence remain and cause uncertainties in best practice for treatment and prevention of stroke.
The Cardiovascular Round Table of the European Society of Cardiology together with the European Society of
Cardiology Council on Stroke in cooperation with the European Stroke Organisation and partners from related scientific
societies, regulatory authorities and industry conveyed a two-day workshop to discuss current and emerging concepts
and apparent gaps in stroke care, including risk factor management, acute diagnostics, treatments and complications, and
operational/logistic issues for health care systems and integrated networks. Joint initiatives of cardiologists and stroke
physicians are needed in research and clinical care to target unresolved interdisciplinary problems and to promote the
best possible outcomes for patients with stroke
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