scholarly journals The importance of highly effective lipid-lowering therapy with atorvastatin in the normalization of the autonomic regulation of heart rate in patients with STEMI

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
Y Barmenkova ◽  
E Dushina ◽  
N Burko ◽  
V Oleinikov
Keyword(s):  
Myocardial Infarction ◽  
Heart Rate ◽  
Troponin I ◽  
Cardiac Activity ◽  
Autonomic Regulation ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Target Values ◽  
Highly Effective

Abstract Purpose To assess the importance of highly effective lipid-lowering therapy with atorvastatin in the normalization of the autonomic regulation of cardiac activity in patients with myocardial infarction with ST segment elevation (STEMI). Methods The study included 130 patients with STEMI aged 51.3±8.9 years, the majority of males (91%). Inclusion criteria: age from 35 to 70 years, STEMI confirmed by ECG and the level of biomarkers (troponin I, CK-MB), the presence of hemodynamically significant stenosis of a culprit artery according to coronary angiography provided that other coronary arteries are occluded no more than 50%, left main coronary artery - not more than 30%. Exclusion criteria: a history of myocardial infarction, CHF III-IV NYHA, bundle branch block, atrial fibrillation, artificial pacemaker. All patients took atorvastatin at a dose of 40–80 mg/day for 48 weeks after STEMI. As part of a further study at the 7th-9th day and 48 weeks after STEMI, 24-hour ECG monitoring was performed with the Astrocard system. The spectral parameters of heart rate variability (HRV) were evaluated: TotP (ms2), ULF (ms2), VLF (ms2), LF (ms2), HF (ms2), LF / HF. By the 48th week of treatment, patients were divided into groups depending on the achievement of the target level of low density lipoproteins (LDL) of less than 1.4 mmol / l or less than 50% of the initial values: 64 people who reached target values of LDL and formed the group of high-effective lipid-lowering therapy “H”, the group of low effective treatment “L” included 66 patients whose LDL did not meet the recommended level. The groups were matched by gender, age, and anthropometric data. Results In the “H” group, by the 48th week, a pronounced power amplification of all spectral components was obtained. The TotP parameter increased from 13021 (95% CI 10967; 15076) ms2 to 20988 (95% CI 17617; 24358) ms2 (p=0.0001); HF - from 164 (95% CI 105; 222) ms2 to 249 (95% CI 178; 321) ms2 (p=0.003). An increase in the low-frequency components of HRV was observed: an increase in ULF from 10695 (95% CI 8985; 12406) ms2 to 20401 (95% CI 15099; 25703) ms2 (p=0.0001), VLF - from 1473 (95% CI 1212; 1734) ms2 to 1734 (95% CI 1478; 1990) ms2 (p=0.01), LF - from 761 (95% CI 573; 949) ms2 to 909 (95% CI 736; 1082) ms2 (p=0.02). Against the background of an increase in all parameters of the frequency spectrum, the sympathovagal balance coefficient LF / HF decreased from 6.6 (95% CI 5.7; 7.6) to 5.2 (95% CI 4.3; 6.1) ( p=0.004). An analysis of the HRV indicators dynamics in the L group revealed an increase in only the total spectrum power - TotP from 12740 (95% CI 10947; 14533) ms2 to 20195 (95% CI 16619; 23770) ms2. Conclusions Highly effective therapy with atorvastatin in STEMI patients helps to normalize the parameters of the autonomic regulation of heart rate in the post-infarction period due to the increased effects of parasympathetic activity. Funding Acknowledgement Type of funding source: None

scholarly journals Main differences between two highly effective lipid-lowering therapies in subclasses of lipoproteins in patients with acute myocardial infarction

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Leticia C. S. Pinto ◽  
Ana P. Q. Mello ◽  
Maria C. O. Izar ◽  
Nagila R. T. Damasceno ◽  
Antonio M. F. Neto ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lipid Profile ◽  
Polyacrylamide Gel Electrophoresis ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Highly Effective ◽  
Ldl Subfractions

Abstract Background Large observational studies have shown that small, dense LDL subfractions are related to atherosclerotic cardiovascular disease. This study assessed the effects of two highly effective lipid-lowering therapies in the atherogenic subclasses of lipoproteins in subjects with ST-segment elevation myocardial infarction (STEMI). Methods Patients of both sexes admitted with their first myocardial infarction and submitted to pharmacoinvasive strategy (N = 101) were included and randomized using a central computerized system to receive a daily dose of simvastatin 40 mg plus ezetimibe 10 mg or rosuvastatin 20 mg for 30 days. Intermediate-density lipoprotein (IDL) and low-density lipoprotein (LDL) subfractions were analysed by polyacrylamide gel electrophoresis (Lipoprint System) on the first (D1) and 30th days (D30) of lipid-lowering therapy. Changes in LDL and IDL subfractions between D1 and D30 were compared between the lipid-lowering therapies (Mann-Whitney U test). Results The classic lipid profile was similar in both therapy arms at D1 and D30. At D30, the achievement of lipid goals was comparable between lipid-lowering therapies. Cholesterol content in atherogenic subclasses of LDL (p = 0.043) and IDL (p = 0.047) decreased more efficiently with simvastatin plus ezetimibe than with rosuvastatin. Conclusions Lipid-lowering therapy with simvastatin plus ezetimibe was associated with a better pattern of lipoprotein subfractions than rosuvastatin monotherapy. This finding was noted despite similar effects in the classic lipid profile and may contribute to residual cardiovascular risk. Trial registration ClinicalTrials.gov, NCT02428374, registered on 28/09/2014.

scholarly journals Application of the 2019 ESC/EAS dyslipidaemia guidelines to nationwide data of patients with a recent myocardial infarction: a simulation study

2020 ◽  
Vol 41 (40) ◽  
pp. 3900-3909 ◽  
Author(s):  
Ali Allahyari ◽  
Tomas Jernberg ◽  
Emil Hagström ◽  
Margrét Leosdottir ◽  
Pia Lundman ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
High Intensity ◽  
Low Density Lipoprotein ◽  
Monte Carlo Model ◽  
Density Lipoprotein ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Recent Myocardial Infarction ◽  
Lowering Therapy

Abstract Aims To estimate the proportion of patients with a recent myocardial infarction (MI) who would be eligible for additional lipid-lowering therapy according to the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidaemias, and to simulate the effects of expanded lipid-lowering therapy on attainment of the low-density lipoprotein cholesterol (LDL-C) target as recommended by the guidelines. Methods and results Using the nationwide SWEDEHEART register, we included 25 466 patients who had attended a follow-up visit 6–10 weeks after an MI event, 2013–17. While most patients (86.6%) were receiving high-intensity statins, 82.9% of the patients would be eligible for expanded lipid-lowering therapy, as they had not attained the target of an LDL-C level of <1.4 mmol and a ≥50% LDL-C level reduction. When maximized use of high-intensity statins followed by add-on therapy with ezetimibe was simulated using a Monte Carlo model, the LDL-C target was reached in 19.9% using high-intensity statin monotherapy and in another 28.5% with high-intensity statins and ezetimibe, while 50.7% would still be eligible for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. When use of alirocumab or evolocumab was simulated in those who were eligible for PCSK9 inhibitors, around 90% of all patients attained the LDL-C target. Conclusion  Our study suggests that, even with maximized use of high-intensity statins and ezetimibe, around half of patients with MI would be eligible for treatment with PCSK9 inhibitors according to the 2019 ESC/EAS guidelines. Considering the current cost of PCSK9 inhibitors, the financial implications of the new guidelines may be substantial.

P5015Efficacy of lipid lowering therapy beyond statins to prevent cardiovascular events: A meta-analysis

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
I Dykun ◽  
R Mincu ◽  
M Totzeck ◽  
T Rassaf ◽  
A A Mahabadi
Keyword(s):  
Myocardial Infarction ◽  
Relative Risk ◽  
Statin Therapy ◽  
Risk Reduction ◽  
Cardiovascular Events ◽  
Ldl Cholesterol ◽  
Meta Analysis ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy

Abstract Background Lipid lowering therapy is a key cornerstone in secondary prevention of patients with coronary artery disease. However, only a minority of patients with statin therapy reach LDL thresholds as suggested by the ESC. Ezetimibe and proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors allow for reduction in LDL-cholesterol in addition to statin therapy. Purpose To perform a meta-analysis of existing trials, evaluating how lipid lowering therapy beyond statins impacts cardiovascular outcome. Methods We performed a systematic search using the Pubmed, Cochrane, SCOPUS, and Web of Science databases for studies, evaluating the impact of an intensified lipid lowering therapy via ezetimibe or PCSK-9 inhibitor in addition to statin therapy compared to statin therapy alone. Manuscript and congress presentations, published until 1st of November 2018, were included. We made our search specific and sensitive using Medical Subject Headings terms and free text and considered studies published in English language. Search terms used were “ezetimibe”, “evolocumab”, “alirocumab”, or “bococizumab” and “cardiovascular events”. Results A total of 100,610 patients from 9 randomized controlled trials (IMPROVE-IT, FOURIER, ODYSSEY Outcomes, SIPRE I, SPIRE II, ODYSSEY LONG TERM, OSLER-1 and OSLER-2, HIJ-PROPER) were included. Treatment with ezetimibe or a PCSK-9 inhibitor was associated with a 18% risk reduction in cardiovascular events (OR [95% CI]: 0.82 [0.75–0.89]). Effect sizes were similar for myocardial infarction (0.84 [0.76–0.92]) and even more pronounced for ischemic stroke (0.77 [0.67–0.83]). In contrast, all-cause mortality was not improved by the intensified lipid lowering therapy (0.94 [0.85–1.05]). No relevant heterogeneity and inconsistency between groups was present in all analyses (detailed data not shown). Comparing efficacy of LDL-reduction and relative risk redaction of cardiovascular events, a linear relationship was observed (figure). Figure 1. Correlation of reduction of LDL-cholesterol at one year with relative risk reduction (95% confidence interval) of cardiovascular events in included trials. Conclusion Intensified LDL-lowering therapy with ezetimibe or PCSK-9 inhibitors, in addition to statins, reduces the risk of myocardial infarction and stroke, however, does not impact overall mortality. There is a linear relationship between LDL reduction and cardiovascular risk reduction, confirming the beneficial effects of LDL lowering therapy beyond statins in secondary prevention.

5130Association between degree of LDL-cholesterol decrease after a myocardial infarction and mortality - a nationwide cohort study

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J Schubert ◽  
B Lindahl ◽  
H Melhus ◽  
H Renlund ◽  
M Leosdottir ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Lower Risk ◽  
Ldl Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Index Event ◽  
Risk Of Death ◽  
Lowering Therapy ◽  
Statin Use

Abstract Background In clinical trials, patients with myocardial infarction (MI) and elevated LDL-cholesterol (LDL-C) benefit the most from lipid lowering therapy, and more intensive LDL-C lowering therapy is associated with better prognosis. Purpose To investigate the association between degree of LDL-C lowering and prognosis in MI patients from a large real-world setting. Methods Patients admitted with an MI between 2006 and 2016 and registered in the Swedish MI-registry (SWEDEHEART) were followed until 2018. The difference in LDL-C between the MI hospitalization and a 6–10 week follow-up was measured. In multivariable Cox regression analysis adjusting for clinical risk factors (eg. age, diabetes, prior cardiovascular disease), the association between LDL-C change, mortality and recurrent MI was assessed using restricted cubic splines. Further, the patients were stratified according to quartile decrease in LDL-C from MI hospitalization to the follow-up. Results A total of 44,148 patients (median age: 64) had an LDL-C measured during the MI hospitalization and at follow-up. Of these, 9,905 (22.4%) had ongoing statin treatment prior to admission. The median LDL-C at the MI hospitalization was 2.96 (interquartile range 2.23, 3.74) mmol/L and the median decrease in LDL-C was 1.17 (0.37, 1.86) mmol/L. During a median follow-up of 3.9 years, 3,342 patients died and 3,210 had an MI. Patients with the highest quartile of LDL-C decrease (1.86 mmol/L) from index event to follow-up, had a lower risk of mortality, hazard ratio (HR) 0.59 (95% confidence interval [CI] 0.44–0.80) compared to those with the lowest quartile of LDL-C decrease (0.37 mmol/L) (figure). For MI, the corresponding HR was 0.83 (95% CI 0.68–1.02). Ongoing statin-use prior to admission did not alter the effect of LDL-C decrease and outcome in the analysis. Conclusions In this large nationwide cohort of MI patients, a gradually lower risk of death was observed in patients with larger decrease in LDL-C from index event to follow-up, regardless of statin use prior to admission. The same trend was observed for recurrent MI, although not reaching statistical significance. This confirms previous findings that efforts should be made to lower LDL-C after MI.

scholarly journals The role of soluble fiber intake in patients under highly effective lipid-lowering therapy

2011 ◽  
Vol 10 (1) ◽  
Author(s):  
Silvia C Ramos ◽  
Francisco A Fonseca ◽  
Soraia H Kasmas ◽  
Flávio T Moreira ◽  
Tatiana Helfenstein ◽  
...  
Keyword(s):  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Fiber Intake ◽  
Soluble Fiber ◽  
Lowering Therapy ◽  
Highly Effective

scholarly journals Lipid Clinic is an Efficacious Model of Preventive Medicine

2021 ◽  
Vol 17 (1) ◽  
pp. 4-10
Author(s):  
A. V. Blokhina ◽  
A. I. Ershova ◽  
A. N. Meshkov ◽  
A. S. Limonova ◽  
V. I. Mikhailina ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
Preventive Medicine ◽  
Medical Center ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Medical Care System ◽  
Lipid Clinic ◽  
Lowering Therapy ◽  
Target Values ◽  
Very High

Aim. To characterize patients accessing lipid clinic and assess the efficiency of treatment in a specialized medical center.Material and methods. A retrospective analysis of the surviving medical records of outpatients who visited the lipid clinic of the National Research Center for Therapy and Preventive Medicine (Moscow, Russia) in 2011-2019 (n=675) was carried out. Cardiovascular risk (CVR) and target lipoproteins levels were evaluated in accordance with actual guidelines for the diagnostics and correction of dyslipidemias.Results. The mediana of lipid clinic patients age was 57 [46;65] years. Female persons attend lipid clinic more often (61.5%). 48.5% of patients had low density lipoprotein cholesterol (LDL-c) >4.9 mmol/L, 7.7% had triglycerides level >5.5 mmol/L. Most of the patients were diagnosed with type IIa hyperlipidemia (44,1%) or type IIb (28,0%). Inherited impaired lipid metabolism was diagnosed in 27.7% individuals. 12.7% of the patients had familial hypercholesterolemia, 57.4% – had secondary causes of impaired lipid metabolism. More than half of the patients (52.4%) had low or moderate CVR, 28.1% had a very high CVR. High or very high CVR individuals revisited the lipid clinic more often than people with lower risk (68.2% vs. 35.4%). Revisiting patients (25.4%) reached LDL-c targets more often (33.3% of very high CVR patients; 45.5% of moderate-risk people) than in ordinary outpatient practice. High-intensity statin therapy was recommended for 32% of patients, and combined lipid-lowering therapy – for 14.8%. Among very high CVR individuals, combined lipid-lowering therapy was prescribed for 38.5%. Given the lipid-lowering therapy prescribed in the lipid clinic, LDL-с<1.8 mmol/L and<1.5 mmol/L will be achieved at 40.7% and 32.9% of patients with very high СVR.Conclusion. Lipid clinic is an important part of the medical care system for long-term follow-up of patients with impaired lipid metabolism, and it is more efficient in achieving target values of lipids and correcting risk factors in comparison with the primary medical service.

scholarly journals Intensification of lipid-lowering therapy in patients with severe lipid metabolism disorders in specialized lipid control centers. Possibilities of using evolocumab

2020 ◽  
Vol 4 (7) ◽  
pp. 437-444
Author(s):  
O.L. Barbarash ◽  
◽  
V.V. Kashtalap ◽  
N.V. Fedorova ◽  
D.Yu. Sedykh ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
Current Data ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Control Center ◽  
Lowering Therapy ◽  
Lipid Metabolism Disorders ◽  
Target Values ◽  
Lipid Control

The article presents current data on the prevalence of dyslipidemia worldwide and in the Russian Federation as the main cardiovascular risk factor of developing diseases associated with atherosclerosis. The article identifies the problems of low-level detection of dyslipidemia in the population and insufficient efficacy of lipid-lowering therapy to achieve the lipid profile target values depending on the established risk. It also presents the possibilities of modern lipid-lowering therapy with the use of innovative drugs — PCSK9 inhibitors and the use of evolocumab in accordance with evidence-based medicine. Adding that, the article shows the experience of two lipid control centers (in Kemerovo and Surgut) with the postulation of the need to expand the lipid control center chain to improve methods for providing medical care to patients with severe forms of dyslipidemia. The possibilities of intensifying lipid-lowering therapy in real clinical practice are outlined on the example of patients undergoing treatment in the lipid control center of Kemerovo. Evolocumab has been shown to be highly effective: reduction of atherogenic cholesterol fractions by 67% from the baseline and high safety of such therapy.KEYWORDS: lipid metabolism disorders, statins, lipid-lowering therapy, familial hypercholesterolemia, PCSK9 inhibitors, evolocumab.FOR CITATION: Barbarash O.L., Kashtalap V.V., Fedorova N.V. et al. Intensification of lipid-lowering therapy in patients with severe lipid metabolism disorders in specialized lipid control centers. Possibilities of using evolocumab. Russian Medical Inquiry. 2020;4(7):437–444. DOI: 10.32364/2587-6821-2020-4-7-437-444.

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