Philippe Brudi - Academia.edu (original) (raw)
Papers by Philippe Brudi
Lipids in Health and Disease, Jul 12, 2016
Background: LDL-C, non-HDL-C and ApoB levels are inter-correlated and all predict risk of atheros... more Background: LDL-C, non-HDL-C and ApoB levels are inter-correlated and all predict risk of atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes mellitus (T2DM) and/or high TG. These levels are lowered by extended-release niacin (ERN), and changes in the ratios of these levels may affect ASCVD risk. This analysis examined the effects of extended-release niacin/laropiprant (ERN/LRPT) on the relationships between apoB:LDL-C and apoB:non-HDL-C in patients with T2DM. Methods: T2DM patients (n = 796) had LDL-C ≥1.55 and <2.97 mmol/L and TG <5.65 mmol/L following a 4-week, lipid-modifying run-in (~78 % taking statins). ApoB:LDL-C and apoB:non-HDL-C correlations were assessed after randomized (4:3), double-blind ERN/LRPT or placebo for 12 weeks. Pearson correlation coefficients between apoB:LDL-C and apoB:non-HDL-C were computed and simple linear regression models were fitted for apoB:LDL-C and apoB:non-HDL-C at baseline and Week 12, and the correlations between measured apoB and measured vs predicted values of LDL-C and non-HDL-C were studied. Results: LDL-C and especially non-HDL-C were well correlated with apoB at baseline, and treatment with ERN/LRPT increased these correlations, especially between LDL-C and apoB. Despite the tighter correlations, many patients who achieved non-HDL-C goal, and especially LDL-C goal, remained above apoB goal. There was a trend towards greater increases in these correlations in the higher TG subgroup, non-significant possibly due to the small number of subjects. Conclusions: ERN/LRPT treatment increased association of apoB with LDL-C and non-HDL-C in patients with T2DM. Lowering LDL-C, non-HDL-C and apoB with niacin has the potential to reduce coronary risk in patients with T2DM.
ASEAN heart journal, Sep 13, 2018
Journal of Clinical Lipidology, May 1, 2012
Background/synopsis: Apolipoprotein (apo) B is highly predictive of coronary risk, especially in ... more Background/synopsis: Apolipoprotein (apo) B is highly predictive of coronary risk, especially in patients with high triglycerides (TG). This post hoc analysis evaluated the effects of lipid-lowering therapy on correlations between apoB and low-density lipoprotein cholesterol (apoB:LDL-C) and non-high-density lipoprotein cholesterol (apoB:non-HDL-C) in patients with TG< and !200 mg/dL. Methods: This analysis used data from 3 randomized clinical trials in patients with primary hypercholesterolemia receiving placebo, ezetimibe (EZE), simvastatin (SIMVA) or EZE/SIMVA for 12 weeks. Simple linear regression analyses predicted LDL-C and non-HDL-C levels corresponding to apoB values (80 mg/dL) at baseline and Week 12.
Atherosclerosis, Jul 1, 2015
Se si desidera inviare un libro all'attenzione della Direzione scienti ca per un'eventuale recens... more Se si desidera inviare un libro all'attenzione della Direzione scienti ca per un'eventuale recensione indirizzarlo a:
Journal of Clinical Lipidology, May 1, 2016
The New England Journal of Medicine, Sep 25, 2008
Background Hyperlipidemia has been suggested as a risk factor for stenosis of the aortic valve, b... more Background Hyperlipidemia has been suggested as a risk factor for stenosis of the aortic valve, but lipid-lowering studies have had conflicting results. Methods We conducted a randomized, double-blind trial involving 1873 patients with mild-tomoderate, asymptomatic aortic stenosis. The patients received either 40 mg of simvastatin plus 10 mg of ezetimibe or placebo daily. The primary outcome was a composite of major cardiovascular events, including death from cardiovascular causes, aortic-valve replacement, nonfatal myocardial infarction, hospitalization for unstable angina pectoris, heart failure, coronary-artery bypass grafting, percutaneous coronary intervention, and nonhemorrhagic stroke. Secondary outcomes were events related to aortic-valve stenosis and ischemic cardiovascular events. Results During a median follow-up of 52.2 months, the primary outcome occurred in 333 patients (35.3%) in the simvastatin-ezetimibe group and in 355 patients (38.2%) in the placebo group (hazard ratio in the simvastatin-ezetimibe group, 0.96; 95% confidence interval [CI], 0.83 to 1.12; P = 0.59). Aortic-valve replacement was performed in 267 patients (28.3%) in the simvastatin-ezetimibe group and in 278 patients (29.9%) in the placebo group (hazard ratio, 1.00; 95% CI, 0.84 to 1.18; P = 0.97). Fewer patients had ischemic cardiovascular events in the simvastatin-ezetimibe group (148 patients) than in the placebo group (187 patients) (hazard ratio, 0.78; 95% CI, 0.63 to 0.97; P = 0.02), mainly because of the smaller number of patients who underwent coronary-artery bypass grafting. Cancer occurred more frequently in the simvastatinezetimibe group (105 vs. 70, P = 0.01). Conclusions Simvastatin and ezetimibe did not reduce the composite outcome of combined aorticvalve events and ischemic events in patients with aortic stenosis. Such therapy reduced the incidence of ischemic cardiovascular events but not events related to aortic-valve stenosis. (ClinicalTrials.gov number, NCT00092677.
PubMed, Mar 1, 1995
Silent myocardial ischaemia is the most frequent consequence of coronary artery disease and occur... more Silent myocardial ischaemia is the most frequent consequence of coronary artery disease and occurs in almost 70 per cent to 80 per cent of ischaemic episodes. In some studies, it has some predictive value of cardiovascular events either in stable or unstable angina or after myocardial infarction. In this last case, one year mortality is 30 per cent and 11 per cent respectively with and without silent ischaemia that has been recorded on the 8th day after myocardial infarction. This review has focused on controlled studies in patients with angina and Holter recorded ischaemia. Nitrates are very likely to be active substances on Holter recorded angina but no controlled studies have been performed to really demonstrate it. The efficacy of beta-blocking agents is well established with a 60 per cent reduction in the number of ischaemic events and a 80 per cent reduction in total ischaemic duration. Nifedipine efficacy appears lower than that of beta-blockers with an evaluated mean reduction of 39 per cent for the number of events and of 43 per cent for duration of episodes. Diltiazem induces a 48 per cent reduction of both ischaemic parameters. For drug associations, addition of a calcium antagonist to a beta-blocking agent provides only little benefit. The relationship between anti-ischaemic efficacy and long term prevention of cardiovascular events remains to be established for a given anti-ischaemic therapy.
Atherosclerosis, Jul 1, 2015
Objective: The mechanism of chronic kidney disease on subclinical atherosclerosis is unclear yet.... more Objective: The mechanism of chronic kidney disease on subclinical atherosclerosis is unclear yet. We investigated the association of brachialankle Pulse Wave Velocity (baPWV) and estimated glomerular filtration rate (eGFR) with albuminuria among general Japanese.
Journal of Clinical Lipidology, May 1, 2009
International Journal of Clinical Practice, Feb 11, 2008
Archives of Cardiovascular Diseases Supplements, 2017
Circulation, Sep 27, 2011
Archives of Medical Science, 2019
Introduction: Current European guidelines recommend treatment with lipid-lowering therapy (LLT) t... more Introduction: Current European guidelines recommend treatment with lipid-lowering therapy (LLT) to a low-density lipoprotein cholesterol (LDL-C) target of < 70 mg/dl for patients at very high risk. LDL-C target attainment and use of LLTs in these patients in Greece is not known. Material and methods: The Dyslipidemia International Study (DYSIS) II was a multicenter observational study. The coronary heart disease (CHD) cohort was divided into two groups based on treatment status (on LLT for ≥ 3 months or not on LLT). The acute coronary syndrome (ACS) cohort was evaluated at the time of admission and again 120 ±15 days after admission. Results: In the CHD cohort (n = 499), 457 (91.6%) patients were on LLT. The LDL-C target value was attained by 26.5% of LLT users. Statin monotherapy was used by 77.5% of treated patients, with a mean ± SD atorvastatin dose equivalent of 24 ±16 mg/day. In the ACS cohort (n = 200), 159 (79.5%) patients were on LLT at admission. Mean ± SD LDL-C levels were 108 ±40 mg/dl at admission and 86 ±25 mg/dl at follow-up. LDL-C target value attainment rates were 16.2% at admission and 25.0% at follow-up. At admission, statin monotherapy was used by 86.8% of treated patients. The mean ± SD atorvastatin dose equivalent increased from 20 ±14 mg/day at admission to 29 ±15 mg/day at follow-up. The statin dose was associated with higher odds of LDL-C target value attainment (OR = 1.05, 95% CI: 1.02-1.08). Conclusions: The LDL-C target attainment by very high risk patients in Greece is suboptimal. Increasing the statin dose or combining it with nonstatins may improve target value attainment.
International Journal of Cardiology, Aug 1, 2018
Background: Individuals are at increased risk for cardiovascular events following an acute corona... more Background: Individuals are at increased risk for cardiovascular events following an acute coronary syndrome (ACS). Effective management of hyperlipidemia, an associated risk factor, is essential for improving outcomes. We aimed to quantify the extent of hyperlipidemia and its treatment in ACS survivors in Hong Kong and Taiwan. Methods: The multinational, observational Dyslipidemia International Study (DYSIS) II included patients hospitalized for an ACS. Lipid levels and use of lipid-lowering therapy (LLT) were evaluated at baseline and 4 months post-discharge. The proportions of patients attaining the recommended LDL-C target for individuals at very high cardiovascular risk (b70 mg/dL) was assessed and potential predictors of this outcome evaluated. Results: In total, 270 patients were enrolled, 125 (46.3%) of which were being treated with LLT prior to hospitalization. Of these, 28.8% had an LDL-C level b 70 mg/dL, compared to only 6.9% of those not being treated. Statin monotherapy was the most commonly employed LLT, with a mean atorvastatin-equivalent dosage of 14 mg/day. By 4-month follow-up, target attainment had risen to 45.1% for patients treated with LLT at baseline, and 43.3% for those who had not been treated. LLT was being used by 88.4% of patients at follow-up, with a mean atorvastatin dosage of 18 mg/day. Use of statins in combination with ezetimibe/other non-statin was scarce. No predictors of LDL-C target attainment were identified. Conclusions: In patients hospitalized with an ACS, rates of LDL-C target achievement were poor. While LLT was widely employed, statin intensity was low and combination therapy underused, indicating scope for improvement.
European Heart Journal, 2017
Lipids 117 Results: We included 6136 REGARDS participants at mean age 67.6 years, 308 of whom had... more Lipids 117 Results: We included 6136 REGARDS participants at mean age 67.6 years, 308 of whom had low LDL-C (<70 mg/dl) at baseline. Over about 7-year average follow-up, 1,376 (22.4%) participants died, 508 (8.3%)-from a coronary death, and 352 (5.7%)-from a stroke. We found evidence of a non-linear relationship between LDL-C and all-cause mortality, which remained significant after adjustment for all covariates (Figure 1) (p<0.0001; test for nonlinearity p=0.0021). LDL measurements between approximately 70 mg/dl and 200 mg/dl appeared to be protective against all-cause mortality with levels below 70 mg/dl not being associated with decreased mortality risk. Analyzing incident CHD risk fully-adjusted spline plots indicated an approximate doubling of incident CHD risk between baseline LDL-C concentrations of 150 mg/dl and 250 mg/dl (Figure 2). Nonlinearity was not observed in either unadjusted or adjusted data and we noticed marginally significant (p=0.0565 for the unadjusted, and p=0.0691 for the adjusted) association between LDL-C and incident CHD. We did not find any significant associations between LDL-C and incident stroke. Conclusions: We found evidence for a non-linear relationship between LDL and all-cause mortality, which remained significant after adjustment for all covariates. We showed marginally significant association between LDL-C and incident CHD and lack of such association for incident stroke. LDL-C levels lower than 70 mg/dl did not show further benefits in reduction of cardiovascular and mortality risk. As these data are at odds with the results from RCTs further investigation is necessary to explain these discrepancies.
Atherosclerosis, 2015
Objective: The mechanism of chronic kidney disease on subclinical atherosclerosis is unclear yet.... more Objective: The mechanism of chronic kidney disease on subclinical atherosclerosis is unclear yet. We investigated the association of brachialankle Pulse Wave Velocity (baPWV) and estimated glomerular filtration rate (eGFR) with albuminuria among general Japanese.
Journal of the American College of Cardiology, 2017
Background: The objective of the second Dyslipidemia International Study (DYSIS II) was to docume... more Background: The objective of the second Dyslipidemia International Study (DYSIS II) was to document use of lipid-lowering therapies (LLTs), LDL-C target value attainment (LDL-C <70 mg/dL) at the time of the acute event and at 4-months follow-up in patients with acute coronary syndrome (ACS). Methods: The ACS cohort of DYSIS II included patients from 18 countries (8 Asian, 5 European, and 5 Middle East). Evaluations were performed at the time of admission, at discharge, and 120 ± 15 days following the date of admission (the follow-up time point). Results: Of the 3,867 patients enrolled, 2,521 were on LLT at admission. Most treated patients received statin monotherapy (89.8% at admission and 86.7% at follow-up). Few patients received combinations of statins with ezetimibe (4.1% at admission, 6.3% at follow-up) or other therapies (3.2% at admission, 3.6% at follow-up). Statin dose was increased during hospitalization for ACS but no further LLTadjustment did take place afterwards. LDL-C <70mg/dl was achieved in 24.8% at admission and in 34.4% at follow-up. Chronic kidney disease (OR 1.52, 95% CI 1.09-2.13), diabetes (OR 1.33, 95% CI 1.08-1.64), and higher atorvastatin doses (OR 1.01, 95% CI 1.004-1.016) were predictors of LDL-C target attainment. Conclusions: DYSIS II ACS showed that in patients with ACS statin dose was increased during hospital stay but no further adaptation of LLT did take place during FU. Only 34.4% of patients achieve the recommended LDL-C target <70mg/dl even 4 months after the ACS event.
Journal of the American College of Cardiology, 2016
Prior studies have documented a gap between guideline recommendations and LDL-C target achievemen... more Prior studies have documented a gap between guideline recommendations and LDL-C target achievement in clinical practice. We identified real world lipid target achievements among stable CHD patients and patients surviving an ACS event. DYSIS II is a multi-country observational study conducted in
Therapie, 1995
L'ischemie myocardique indolore (ou cliniquement silencieuse) est la manifestation la plus fr... more L'ischemie myocardique indolore (ou cliniquement silencieuse) est la manifestation la plus frequente de l'atherosclerose coronaire et represente ainsi 70 a 80 pou'cent des episodes ischemiques. Dans certaines etudes, elle constitue un facteur de mauvais pronostic aussi bien dans l'angor stable ou instable qu'en post-infarctus. Dans cette derniere situation, la mortalite a un an qui est de 11 pour cent en l'absence d'ischemie myocardique indolore passe a 30 pour cent lorsque le Holter realise au huitieme jour du post-infarctus a releve une ischemie silencieuse. La presente revue porte principalement sur l'analyse des etudes controlees evaluant l'ischemie silencieuse au Holter chez des patients souffrant d'un angor stable. Les derives nitres sont tres certainement actifs sur la frequence et la duree des episodes d'ischemie myocardique enregistree au Holter mais aucun essai controle n'a ete realise avec ces agents. Les effets benefiques des β-bloquants sur l'ischemie sont pour leur part parfaitement demontres. La diminution obtenue est de 60 pour cent pou'la frequence et de 80 pour cent pour la duree des episodes. La nifedipine a ete incontestablement l'inhibiteur calcique le plus etudie. Selon la plupart des etudes methodologiquement correctes, elle presente une efficacite qui reste inferieure a celle des β-bloquants puisque la reduction observee est de 39 pour cent pour la frequence et de 43 pour cent pour la duree des episodes. Le diltiazem doue de proprietes chronotropes negatives permet une reduction plus importante estimee a 48 pour cent pour les deux parametres. En ce qui concerne le verapamil, une seule etude de petite taille a ete realisee et il est donc difficile de conclure de maniere definitive meme si les resultats sont prometteurs. concernant les associations therapeutiques, l'adjonction d'un antagoniste calcique a un traitement β-bloquant a fourni des benefices supplementaires variables mais relativement peu convaincants dans l'ensemble
Journal of Clinical Lipidology, 2016
Findings from 52.916 statin treated patients. Results of the Dyslipidemia International Study It ... more Findings from 52.916 statin treated patients. Results of the Dyslipidemia International Study It is unknown whether physicians are influenced by a patients' BMI-independently of other risk factorswhen choosing the type and dose of lipid lowering agents. Purpose: We aimed to identify whether body mass index (BMI) influences the choice of lipid lowering treatment in a large real world cohort of 52.916 statin treated patients.
Lipids in Health and Disease, Jul 12, 2016
Background: LDL-C, non-HDL-C and ApoB levels are inter-correlated and all predict risk of atheros... more Background: LDL-C, non-HDL-C and ApoB levels are inter-correlated and all predict risk of atherosclerotic cardiovascular disease (ASCVD) in patients with type 2 diabetes mellitus (T2DM) and/or high TG. These levels are lowered by extended-release niacin (ERN), and changes in the ratios of these levels may affect ASCVD risk. This analysis examined the effects of extended-release niacin/laropiprant (ERN/LRPT) on the relationships between apoB:LDL-C and apoB:non-HDL-C in patients with T2DM. Methods: T2DM patients (n = 796) had LDL-C ≥1.55 and <2.97 mmol/L and TG <5.65 mmol/L following a 4-week, lipid-modifying run-in (~78 % taking statins). ApoB:LDL-C and apoB:non-HDL-C correlations were assessed after randomized (4:3), double-blind ERN/LRPT or placebo for 12 weeks. Pearson correlation coefficients between apoB:LDL-C and apoB:non-HDL-C were computed and simple linear regression models were fitted for apoB:LDL-C and apoB:non-HDL-C at baseline and Week 12, and the correlations between measured apoB and measured vs predicted values of LDL-C and non-HDL-C were studied. Results: LDL-C and especially non-HDL-C were well correlated with apoB at baseline, and treatment with ERN/LRPT increased these correlations, especially between LDL-C and apoB. Despite the tighter correlations, many patients who achieved non-HDL-C goal, and especially LDL-C goal, remained above apoB goal. There was a trend towards greater increases in these correlations in the higher TG subgroup, non-significant possibly due to the small number of subjects. Conclusions: ERN/LRPT treatment increased association of apoB with LDL-C and non-HDL-C in patients with T2DM. Lowering LDL-C, non-HDL-C and apoB with niacin has the potential to reduce coronary risk in patients with T2DM.
ASEAN heart journal, Sep 13, 2018
Journal of Clinical Lipidology, May 1, 2012
Background/synopsis: Apolipoprotein (apo) B is highly predictive of coronary risk, especially in ... more Background/synopsis: Apolipoprotein (apo) B is highly predictive of coronary risk, especially in patients with high triglycerides (TG). This post hoc analysis evaluated the effects of lipid-lowering therapy on correlations between apoB and low-density lipoprotein cholesterol (apoB:LDL-C) and non-high-density lipoprotein cholesterol (apoB:non-HDL-C) in patients with TG< and !200 mg/dL. Methods: This analysis used data from 3 randomized clinical trials in patients with primary hypercholesterolemia receiving placebo, ezetimibe (EZE), simvastatin (SIMVA) or EZE/SIMVA for 12 weeks. Simple linear regression analyses predicted LDL-C and non-HDL-C levels corresponding to apoB values (80 mg/dL) at baseline and Week 12.
Atherosclerosis, Jul 1, 2015
Se si desidera inviare un libro all'attenzione della Direzione scienti ca per un'eventuale recens... more Se si desidera inviare un libro all'attenzione della Direzione scienti ca per un'eventuale recensione indirizzarlo a:
Journal of Clinical Lipidology, May 1, 2016
The New England Journal of Medicine, Sep 25, 2008
Background Hyperlipidemia has been suggested as a risk factor for stenosis of the aortic valve, b... more Background Hyperlipidemia has been suggested as a risk factor for stenosis of the aortic valve, but lipid-lowering studies have had conflicting results. Methods We conducted a randomized, double-blind trial involving 1873 patients with mild-tomoderate, asymptomatic aortic stenosis. The patients received either 40 mg of simvastatin plus 10 mg of ezetimibe or placebo daily. The primary outcome was a composite of major cardiovascular events, including death from cardiovascular causes, aortic-valve replacement, nonfatal myocardial infarction, hospitalization for unstable angina pectoris, heart failure, coronary-artery bypass grafting, percutaneous coronary intervention, and nonhemorrhagic stroke. Secondary outcomes were events related to aortic-valve stenosis and ischemic cardiovascular events. Results During a median follow-up of 52.2 months, the primary outcome occurred in 333 patients (35.3%) in the simvastatin-ezetimibe group and in 355 patients (38.2%) in the placebo group (hazard ratio in the simvastatin-ezetimibe group, 0.96; 95% confidence interval [CI], 0.83 to 1.12; P = 0.59). Aortic-valve replacement was performed in 267 patients (28.3%) in the simvastatin-ezetimibe group and in 278 patients (29.9%) in the placebo group (hazard ratio, 1.00; 95% CI, 0.84 to 1.18; P = 0.97). Fewer patients had ischemic cardiovascular events in the simvastatin-ezetimibe group (148 patients) than in the placebo group (187 patients) (hazard ratio, 0.78; 95% CI, 0.63 to 0.97; P = 0.02), mainly because of the smaller number of patients who underwent coronary-artery bypass grafting. Cancer occurred more frequently in the simvastatinezetimibe group (105 vs. 70, P = 0.01). Conclusions Simvastatin and ezetimibe did not reduce the composite outcome of combined aorticvalve events and ischemic events in patients with aortic stenosis. Such therapy reduced the incidence of ischemic cardiovascular events but not events related to aortic-valve stenosis. (ClinicalTrials.gov number, NCT00092677.
PubMed, Mar 1, 1995
Silent myocardial ischaemia is the most frequent consequence of coronary artery disease and occur... more Silent myocardial ischaemia is the most frequent consequence of coronary artery disease and occurs in almost 70 per cent to 80 per cent of ischaemic episodes. In some studies, it has some predictive value of cardiovascular events either in stable or unstable angina or after myocardial infarction. In this last case, one year mortality is 30 per cent and 11 per cent respectively with and without silent ischaemia that has been recorded on the 8th day after myocardial infarction. This review has focused on controlled studies in patients with angina and Holter recorded ischaemia. Nitrates are very likely to be active substances on Holter recorded angina but no controlled studies have been performed to really demonstrate it. The efficacy of beta-blocking agents is well established with a 60 per cent reduction in the number of ischaemic events and a 80 per cent reduction in total ischaemic duration. Nifedipine efficacy appears lower than that of beta-blockers with an evaluated mean reduction of 39 per cent for the number of events and of 43 per cent for duration of episodes. Diltiazem induces a 48 per cent reduction of both ischaemic parameters. For drug associations, addition of a calcium antagonist to a beta-blocking agent provides only little benefit. The relationship between anti-ischaemic efficacy and long term prevention of cardiovascular events remains to be established for a given anti-ischaemic therapy.
Atherosclerosis, Jul 1, 2015
Objective: The mechanism of chronic kidney disease on subclinical atherosclerosis is unclear yet.... more Objective: The mechanism of chronic kidney disease on subclinical atherosclerosis is unclear yet. We investigated the association of brachialankle Pulse Wave Velocity (baPWV) and estimated glomerular filtration rate (eGFR) with albuminuria among general Japanese.
Journal of Clinical Lipidology, May 1, 2009
International Journal of Clinical Practice, Feb 11, 2008
Archives of Cardiovascular Diseases Supplements, 2017
Circulation, Sep 27, 2011
Archives of Medical Science, 2019
Introduction: Current European guidelines recommend treatment with lipid-lowering therapy (LLT) t... more Introduction: Current European guidelines recommend treatment with lipid-lowering therapy (LLT) to a low-density lipoprotein cholesterol (LDL-C) target of < 70 mg/dl for patients at very high risk. LDL-C target attainment and use of LLTs in these patients in Greece is not known. Material and methods: The Dyslipidemia International Study (DYSIS) II was a multicenter observational study. The coronary heart disease (CHD) cohort was divided into two groups based on treatment status (on LLT for ≥ 3 months or not on LLT). The acute coronary syndrome (ACS) cohort was evaluated at the time of admission and again 120 ±15 days after admission. Results: In the CHD cohort (n = 499), 457 (91.6%) patients were on LLT. The LDL-C target value was attained by 26.5% of LLT users. Statin monotherapy was used by 77.5% of treated patients, with a mean ± SD atorvastatin dose equivalent of 24 ±16 mg/day. In the ACS cohort (n = 200), 159 (79.5%) patients were on LLT at admission. Mean ± SD LDL-C levels were 108 ±40 mg/dl at admission and 86 ±25 mg/dl at follow-up. LDL-C target value attainment rates were 16.2% at admission and 25.0% at follow-up. At admission, statin monotherapy was used by 86.8% of treated patients. The mean ± SD atorvastatin dose equivalent increased from 20 ±14 mg/day at admission to 29 ±15 mg/day at follow-up. The statin dose was associated with higher odds of LDL-C target value attainment (OR = 1.05, 95% CI: 1.02-1.08). Conclusions: The LDL-C target attainment by very high risk patients in Greece is suboptimal. Increasing the statin dose or combining it with nonstatins may improve target value attainment.
International Journal of Cardiology, Aug 1, 2018
Background: Individuals are at increased risk for cardiovascular events following an acute corona... more Background: Individuals are at increased risk for cardiovascular events following an acute coronary syndrome (ACS). Effective management of hyperlipidemia, an associated risk factor, is essential for improving outcomes. We aimed to quantify the extent of hyperlipidemia and its treatment in ACS survivors in Hong Kong and Taiwan. Methods: The multinational, observational Dyslipidemia International Study (DYSIS) II included patients hospitalized for an ACS. Lipid levels and use of lipid-lowering therapy (LLT) were evaluated at baseline and 4 months post-discharge. The proportions of patients attaining the recommended LDL-C target for individuals at very high cardiovascular risk (b70 mg/dL) was assessed and potential predictors of this outcome evaluated. Results: In total, 270 patients were enrolled, 125 (46.3%) of which were being treated with LLT prior to hospitalization. Of these, 28.8% had an LDL-C level b 70 mg/dL, compared to only 6.9% of those not being treated. Statin monotherapy was the most commonly employed LLT, with a mean atorvastatin-equivalent dosage of 14 mg/day. By 4-month follow-up, target attainment had risen to 45.1% for patients treated with LLT at baseline, and 43.3% for those who had not been treated. LLT was being used by 88.4% of patients at follow-up, with a mean atorvastatin dosage of 18 mg/day. Use of statins in combination with ezetimibe/other non-statin was scarce. No predictors of LDL-C target attainment were identified. Conclusions: In patients hospitalized with an ACS, rates of LDL-C target achievement were poor. While LLT was widely employed, statin intensity was low and combination therapy underused, indicating scope for improvement.
European Heart Journal, 2017
Lipids 117 Results: We included 6136 REGARDS participants at mean age 67.6 years, 308 of whom had... more Lipids 117 Results: We included 6136 REGARDS participants at mean age 67.6 years, 308 of whom had low LDL-C (<70 mg/dl) at baseline. Over about 7-year average follow-up, 1,376 (22.4%) participants died, 508 (8.3%)-from a coronary death, and 352 (5.7%)-from a stroke. We found evidence of a non-linear relationship between LDL-C and all-cause mortality, which remained significant after adjustment for all covariates (Figure 1) (p<0.0001; test for nonlinearity p=0.0021). LDL measurements between approximately 70 mg/dl and 200 mg/dl appeared to be protective against all-cause mortality with levels below 70 mg/dl not being associated with decreased mortality risk. Analyzing incident CHD risk fully-adjusted spline plots indicated an approximate doubling of incident CHD risk between baseline LDL-C concentrations of 150 mg/dl and 250 mg/dl (Figure 2). Nonlinearity was not observed in either unadjusted or adjusted data and we noticed marginally significant (p=0.0565 for the unadjusted, and p=0.0691 for the adjusted) association between LDL-C and incident CHD. We did not find any significant associations between LDL-C and incident stroke. Conclusions: We found evidence for a non-linear relationship between LDL and all-cause mortality, which remained significant after adjustment for all covariates. We showed marginally significant association between LDL-C and incident CHD and lack of such association for incident stroke. LDL-C levels lower than 70 mg/dl did not show further benefits in reduction of cardiovascular and mortality risk. As these data are at odds with the results from RCTs further investigation is necessary to explain these discrepancies.
Atherosclerosis, 2015
Objective: The mechanism of chronic kidney disease on subclinical atherosclerosis is unclear yet.... more Objective: The mechanism of chronic kidney disease on subclinical atherosclerosis is unclear yet. We investigated the association of brachialankle Pulse Wave Velocity (baPWV) and estimated glomerular filtration rate (eGFR) with albuminuria among general Japanese.
Journal of the American College of Cardiology, 2017
Background: The objective of the second Dyslipidemia International Study (DYSIS II) was to docume... more Background: The objective of the second Dyslipidemia International Study (DYSIS II) was to document use of lipid-lowering therapies (LLTs), LDL-C target value attainment (LDL-C <70 mg/dL) at the time of the acute event and at 4-months follow-up in patients with acute coronary syndrome (ACS). Methods: The ACS cohort of DYSIS II included patients from 18 countries (8 Asian, 5 European, and 5 Middle East). Evaluations were performed at the time of admission, at discharge, and 120 ± 15 days following the date of admission (the follow-up time point). Results: Of the 3,867 patients enrolled, 2,521 were on LLT at admission. Most treated patients received statin monotherapy (89.8% at admission and 86.7% at follow-up). Few patients received combinations of statins with ezetimibe (4.1% at admission, 6.3% at follow-up) or other therapies (3.2% at admission, 3.6% at follow-up). Statin dose was increased during hospitalization for ACS but no further LLTadjustment did take place afterwards. LDL-C <70mg/dl was achieved in 24.8% at admission and in 34.4% at follow-up. Chronic kidney disease (OR 1.52, 95% CI 1.09-2.13), diabetes (OR 1.33, 95% CI 1.08-1.64), and higher atorvastatin doses (OR 1.01, 95% CI 1.004-1.016) were predictors of LDL-C target attainment. Conclusions: DYSIS II ACS showed that in patients with ACS statin dose was increased during hospital stay but no further adaptation of LLT did take place during FU. Only 34.4% of patients achieve the recommended LDL-C target <70mg/dl even 4 months after the ACS event.
Journal of the American College of Cardiology, 2016
Prior studies have documented a gap between guideline recommendations and LDL-C target achievemen... more Prior studies have documented a gap between guideline recommendations and LDL-C target achievement in clinical practice. We identified real world lipid target achievements among stable CHD patients and patients surviving an ACS event. DYSIS II is a multi-country observational study conducted in
Therapie, 1995
L'ischemie myocardique indolore (ou cliniquement silencieuse) est la manifestation la plus fr... more L'ischemie myocardique indolore (ou cliniquement silencieuse) est la manifestation la plus frequente de l'atherosclerose coronaire et represente ainsi 70 a 80 pou'cent des episodes ischemiques. Dans certaines etudes, elle constitue un facteur de mauvais pronostic aussi bien dans l'angor stable ou instable qu'en post-infarctus. Dans cette derniere situation, la mortalite a un an qui est de 11 pour cent en l'absence d'ischemie myocardique indolore passe a 30 pour cent lorsque le Holter realise au huitieme jour du post-infarctus a releve une ischemie silencieuse. La presente revue porte principalement sur l'analyse des etudes controlees evaluant l'ischemie silencieuse au Holter chez des patients souffrant d'un angor stable. Les derives nitres sont tres certainement actifs sur la frequence et la duree des episodes d'ischemie myocardique enregistree au Holter mais aucun essai controle n'a ete realise avec ces agents. Les effets benefiques des β-bloquants sur l'ischemie sont pour leur part parfaitement demontres. La diminution obtenue est de 60 pour cent pou'la frequence et de 80 pour cent pour la duree des episodes. La nifedipine a ete incontestablement l'inhibiteur calcique le plus etudie. Selon la plupart des etudes methodologiquement correctes, elle presente une efficacite qui reste inferieure a celle des β-bloquants puisque la reduction observee est de 39 pour cent pour la frequence et de 43 pour cent pour la duree des episodes. Le diltiazem doue de proprietes chronotropes negatives permet une reduction plus importante estimee a 48 pour cent pour les deux parametres. En ce qui concerne le verapamil, une seule etude de petite taille a ete realisee et il est donc difficile de conclure de maniere definitive meme si les resultats sont prometteurs. concernant les associations therapeutiques, l'adjonction d'un antagoniste calcique a un traitement β-bloquant a fourni des benefices supplementaires variables mais relativement peu convaincants dans l'ensemble
Journal of Clinical Lipidology, 2016
Findings from 52.916 statin treated patients. Results of the Dyslipidemia International Study It ... more Findings from 52.916 statin treated patients. Results of the Dyslipidemia International Study It is unknown whether physicians are influenced by a patients' BMI-independently of other risk factorswhen choosing the type and dose of lipid lowering agents. Purpose: We aimed to identify whether body mass index (BMI) influences the choice of lipid lowering treatment in a large real world cohort of 52.916 statin treated patients.