Comparing High Intensity with Low Intensity Statins in Achieving Optimal LDL Goals Among Coronary Artery Disease Patients in Suburban Population in South India (original) (raw)
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Therapeutics and Clinical Risk Management, 2015
Background: Elevated low-density lipoprotein cholesterol (LDL-C) is associated with an increased risk of coronary artery disease. Current guidelines recommend an LDL-C target of 70 mg/dL (1.8 mmol/L) for acute coronary syndrome (ACS) patients, and the first-line treatment to lower lipids is statin therapy. Despite current guidelines and the efficacious lipid-lowering agents available, about half of patients at very high risk, including ACS patients, fail to achieve their LDL-C goal. This study assessed LDL-C goal attainment according to use of high and low potency statins in routine practice in Thailand. Methods: A retrospective cohort study was performed by retrieving data from medical records and the electronic hospital database for a tertiary care hospital in Thailand between 2009 and 2011. Included were ACS patients treated with statins at baseline and with follow-up of LDL-C levels. Patients were divided into high or low potency statin users, and the proportion reaching the LDL-C goal of 70 mg/dL was determined. A Cox proportional hazard model was applied to determine the relationship between statin potency and LDL-C goal attainment. Propensity score adjustment was used to control for confounding by indication. Results: Of 396 ACS patients (60% males, mean age 64.3±11.6 years), 229 (58%) were treated with high potency statins and 167 (42%) with low potency statins. A quarter reached their target LDL-C goal (25% for patients on high potency statins and 23% on low potency statins). High potency statins were not associated with increased LDL-C goal attainment (adjusted hazards ratio 1.22, 95% confidence interval 0.79-1.88; P=0.363). Conclusion: There was no significant effect of high potency statins on LDL-C goal attainment. Moreover, this study showed low LDL-C goal attainment for patients on either low or high potency statins. The reasons for the low LDL-C goal attainment rate warrants further investigation.
Circulation Journal, 2010
Once many epidemiological studies had proven an increase in coronary deaths and cardiac events associated with elevated levels of low-density lipoprotein-cholesterol (LDL-C), 1,2 the next clinical question became whether lowering LDL-C by drugs or diet would result in a reduction in cardiac events. This assessment was facilitated by the development of potent cholesterol-lowering drugs such as the 3-hydroxy-3-methylglutaryl coenzyme A (HMG-CoA) reductase inhibitors (statins). In particular, statin therapy was proposed as a strategy to improve clinical outcomes and accordingly, large clinical trials using statin were started. By 2000, there had been many reports of the results of such large-scale clinical trials 3-8 and there was abundant evidence of the significant beneficial effects of lipid-lowering treatment using statin in reducing mortality and cardiovascular morbidity in patients with CAD as shown in Table 1. Interestingly, all the long-term clinical trials demonstrated that the beneficial effects of statin treatment were sustained and cumulative compared with placebo group as shown in Table 1. In the meta-analysis performed by The opinions expressed in this article are not necessarily those of the editors or of the Japanese Circulation Society.
Atherosclerosis, 2002
We compared the effects of five different statins (atorvastatin, simvastatin, pravastatin, lovastatin, and fluvastatin) on the lipid, lipoprotein, and apolipoprotein (apo) A-I-containing high-density lipoprotein (HDL) subpopulation profiles of 86 coronary heart disease (CHD) patients. Patients with established CHD, and low density lipoprotein (LDL) cholesterol (C)>130 mg/dl, and triglyceride (TG)<400 mg/dl, were treated with atorvastatin 20, 40, and 80 mg/day and one of the other four statins at 20, 40, and when available 80 mg/day in increasing doses (4 weeks of each dose) in a randomized crossover fashion. There was an 8-week placebo controlled washout period between different drug treatments. All five statins on each dose resulted in significant reductions in total- and LDL-C compared to placebo treatment. There were also decreases in plasma TG and increases in HDL-C and apoA-I concentrations, but not all treatments changed these parameters significantly. Each statin except fluvastatin improved the HDL subpopulation profile by increasing the concentrations of the large, cholesterol-rich, LpA-I alpha-1 and prealpha-1 HDL subpopulations. CHD patients have significantly lower concentration of the large, LpA-I alpha-1 HDL particles compared to controls. Our data indicate that statins which are the most effective in lowering LDL-C and TG are also the most effective agents in modifying the HDL subpopulation profile in CHD patients towards the patterns found in healthy individuals. The order of efficacy of statins in increasing alpha-1 HDL subpopulation was: atorvastatin, simvastatin, pravastatin, lovastatin and fluvastatin.
Statin therapy, LDL cholesterol, C-reactive protein, and coronary artery disease
… England Journal of …, 2005
Recent trials have demonstrated better outcomes with intensive than with moderate statin treatment. Intensive treatment produced greater reductions in both low-density lipoprotein (LDL) cholesterol and C-reactive protein (CRP), suggesting a relationship between these two biomarkers and disease progression.
Lipids, 2012
Despite the established efficacy of statin therapy, the risk of cardiovascular events remains high in many patients. We examined high-density lipoprotein (HDL) subclass distribution profiles among statin-treated coronary heart disease (CHD) patients undergoing percutaneous coronary intervention (PCI). Plasma HDL subclasses were measured in 85 patients with established CHD and quantified by two-dimensional gel electrophoresis and immunoblotting. In CHD patients with statin treatment, the mean value of total cholesterol (TC) reached the desirable level and the triacylglycerol level (TAG) was borderline high. Moreover, low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), apolipopro-teinA-I, and apolipoproteinB-100 levels in these patients resembled those in normolipidemic healthy subjects. The HDL subclass did not show a normal distribution and was characterized by the lower large-sized HDL 2b contents and higher contents of small-sized preb 1-HDL in CHD patients, compared to those in normolipidemic control subjects. Multiple stepwise regression analysis revealed that the severity of coronary stenosis, determined by the Gensini Score, was significantly and independently predicted by HDL 2b and HDL 3b. Statin therapy was effective in modifying plasma lipids levels, but not adequate as a monotherapy to normalize the HDL subclass distribution phenotype of patients with CHD undergoing PCI. The HDL subclass distribution may aid in risk stratification, especially in patients with CHD and therapeutic LDL-C and HDL-C levels. Keywords Coronary heart disease Á High-density lipoprotein subclasses Á Statins therapy Á Quantitative coronary angiography Á Two-dimensional gel electrophoresis-immunodetection Abbreviations HDL High density lipoprotein CHD Coronary heart disease PCI Percutaneous coronary intervention QCA Quantitative coronary angiography TC Total cholesterol TAG Triacylglycerol LDL-C Low density lipoprotein cholesterol HDL-C High density lipoprotein cholesterol ApoA-I ApolipoproteinA-I ApoB-100 ApolipoproteinB-100 AMI Acute myocardial infarction Li Tian and Yucheng Chen contributed equally to this study.
JAMA Internal Medicine, 2016
International guidelines recommend treatment with statins for patients with preexisting ischemic heart disease to prevent additional cardiovascular events but differ regarding target levels of low-density lipoprotein cholesterol (LDL-C). Trial data on this question are inconclusive and observational data are lacking. OBJECTIVE To assess the relationship between levels of LDL-C achieved with statin treatment and cardiovascular events in adherent patients with preexisting ischemic heart disease. DESIGN, SETTING, AND PARTICIPANTS Population-based observational cohort study from 2009 to 2013 using data from a health care organization in Israel covering more than 4.3 million members. Included patients had ischemic heart disease, were aged 30 to 84 years, were treated with statins, and were at least 80% adherent to treatment or, in a sensitivity analysis, at least 50% adherent. Patients with active cancer or metabolic abnormalities were excluded. EXPOSURES Index LDL-C was defined as the first achieved serum LDL-C measure after at least 1 year of statin treatment, grouped as low (Յ70.0 mg/dL), moderate (70.1-100.0 mg/dL), or high (100.1-130.0 mg/dL). MAIN OUTCOMES AND MEASURES Major adverse cardiac events included acute myocardial infarction, unstable angina, stroke, angioplasty, bypass surgery, or all-cause mortality. The hazard ratio of adverse outcomes was estimated using 2 Cox proportional hazards models with low vs moderate and moderate vs high LDL-C, adjusted for confounders and further tested using propensity score matching analysis. RESULTS The cohort with at least 80% adherence included 31 619 patients, for whom the mean (SD) age was 67.3 (9.8) years. Of this population, 27% were female and 29% had low, 53% moderate, and 18% high LDL-C when taking statin treatment. Overall, there were 9035 patients who had an adverse outcome during a mean 1.6 years of follow-up (6.7 per 1000 persons per year). The adjusted incidence of adverse outcomes was not different between low and moderate LDL-C (hazard ratio [HR], 1.02; 95% CI, 0.97-1.07; P = .54), but it was lower with moderate vs high LDL-C (HR, 0.89; 95% CI, 0.84-0.94; P < .001). Among 54 884 patients with at least 50% statin adherence, the adjusted HR was 1.06 (95% CI, 1.02-1.10; P = .001) in the low vs moderate groups and 0.87 (95% CI, 0.84-0.91; P = .001) in the moderate vs high groups. CONCLUSIONS AND RELEVANCE Patients with LDL-C levels of 70 to 100 mg/dL taking statins had lower risk of adverse cardiac outcomes compared with those with LDL-C levels between 100 and 130 mg/dL, but no additional benefit was gained by achieving LDL-C of 70 mg/dL or less. These population-based data do not support treatment guidelines recommending very low target LDL-C levels for all patients with preexisting heart disease.
Clinical Cardiology, 2011
Background: A low level of high-density lipoprotein cholesterol (HDL-C) is a strong predictor for cardiovascular disease morbidity and mortality at all low-density lipoprotein cholesterol (LDL-C) concentrations. Hypothesis: We evaluated this association in routine clinical practice among statin-treated coronary heart disease patients who achieved LDL-C target levels. This association also exists in routine clinical practice. Methods: A retrospective dynamic cohort included all male coronary heart disease patients of the Sharon-Shomron district, Clalit Health Services, Israel, with LDL-C levels <100 mg/dL and who were receiving statins (≥6 purchases/y) from January 1998 to June 2008. Data were collected on demographic variables; coexistence of hypertension, diabetes mellitus, and peripheral vascular diseases; details of revascularization procedures; and lipid levels. The outcome variable was revascularization procedure, by either percutaneous intervention or coronary artery bypass graft. Results: The study group of 909 male patients was stratified into quintiles, based on mean HDL-C levels: Q1 (n = 179): ≤ 26.4 mg/dL; Q2 (n = 190): 26.4-≤ 30.0 mg/dL; Q3 (n = 191): >30.0-≤ 34.0 mg/dL; Q4 (n = 186): >34.0-≤ 41.0 mg/dL; Q5 (n = 163): >41.0 mg/dL. During the study period, 307 (33.8%) of the cohort required ≥1 revascularization procedure. Those in the highest quintile underwent significantly fewer procedures (40.8% for Q1 vs 16.6% for Q5, P < 0.001). This significant effect of the highest HDL-C quintile was not influenced by any variable. Conclusions: The protective effect of high HDL-C levels, regardless of other risk factors, in preventing revascularization procedures was confirmed in the routine clinical practice among statin-treated CHD patients who reached LDL-C level <100 mg/dL. Possible additional benefits of using agents to raise HDL-C levels should be investigated.
International journal of biomedical research, 2015
Aim: To determine the status of dyslipidemia management with statins in In-patients with known Coronary Artery Disease (CAD) confirmed by angiographic findings. Methods: This study has been conducted in a corporate cardiac centre at Visakhapatnam, Andhra Pradesh. This study is a retrospective analysis of data collected from the electronic medical records in terms of age, sex, CAD status, associated risk factors, statin usage, and lipid parameters. Results: Among a sample of 92 known CAD in-patients, 81.5% achieved LDL-C goal of <100 mg/dl as recommended by Third Report of the National Cholesterol Education Program (NCEP) Adult Treatment Panel III [ATP III] for CAD and CAD risk equivalents. Success rates among males and females are 79.7% and 85% respectively. 78.2% of 69 patients on Atorvastatin, 85% of 20 patients on Rosuvastatin and 100% of 3 patients on Simvastatin achieved LDL-C goal. If the target LDL-C level is kept at <70 mg/dl as defined as optional goal for very high r...
Statins and LDL-C in Secondary Prevention—So Much Progress, So Far to Go
JAMA Network Open
Elevated circulating concentrations of low-density lipoproteins have been definitively demonstrated to be a cause of atherosclerotic cardiovascular disease (ASCVD). Increasing recognition is given to the importance of reducing lifetime exposure to low-density lipoprotein cholesterol (LDL-C) 1 according to the rule of "the lower the better," but also "the earlier the better" and "the longer the better." Statin therapy reduces the risk of cardiovascular events by approximately a quarter for each reduction in low-density lipoprotein level of 38.6 mg/dL (1 mmol), and long-term LDL-C reduction + Related article Author affiliations and article information are listed at the end of this article.