scholarly journals Achieving LDL cholesterol target levels <1.81 mmol/L may provide extra cardiovascular protection in patients at high risk: Exploratory analysis of the Standard Versus Intensive Statin Therapy for Patients with Hypercholesterolaemia and Diabetic Retinopathy study

2019 ◽  
Vol 21 (4) ◽  
pp. 791-800 ◽  
Author(s):  
Hiroshi Itoh ◽  
Issei Komuro ◽  
Masahiro Takeuchi ◽  
Takashi Akasaka ◽  
Hiroyuki Daida ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
High Risk ◽  
Statin Therapy ◽  
Ldl Cholesterol ◽  
Exploratory Analysis ◽  
Cardiovascular Protection ◽  
Intensive Statin Therapy

scholarly journals Diabeteses dyslipidaemia és atherosclerosis

2016 ◽  
Vol 157 (19) ◽  
pp. 746-752 ◽  
Author(s):  
László Márk ◽  
Győző Dani
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
High Risk ◽  
Statin Therapy ◽  
Ldl Cholesterol ◽  
Hdl Cholesterol ◽  
Small Dense Ldl ◽  
Target Values ◽  
Postprandial Triglyceride ◽  
Low Hdl

The incidence and the public health importance of diabetes mellitus are growing continuously. Despite the improvement observed in the latest years, the leading cause of morbidity and mortality of diabetics are cardiovascular diseases. The diagnosis of diabetes mellitus constitutes such a high risk as the known presence of vascular disease. Diabetic dyslipidaemia is characterised by high fasting and postprandial triglyceride levels, low HDL level, and slightly elevated LDL-cholesterol with domination of atherogenic small dense LDL. These are not independent components of the atherogenic dyslipidaemia, but are closely linked to each other. Beside the known harmful effects of low HDL and small dense LDL, recent findings confirmed the atherogenicity of the triglyceride-rich lipoproteins and their remnants. It has been shown that the key of this process is the overproduction and delayed clearance of triglyceride-rich lipoproteins in the liver. In this metabolism the lipoprotein lipase has a determining role; its function is accelerated by ApoA5 and attenuated by ApoC3. The null mutations of the ApoC3 results in a reduced risk of myocardial infarction, the loss-of-function mutation of ApoA5 was associated with a 60% elevation of triglyceride level and 2.2-times increased risk of myocardial infarction. In case of diabetes mellitus, insulin resistance, obesity, metabolic syndrome and chronic kidney disease the non-HDL-cholesterol is a better marker of the risk than the LDL-cholesterol. Its value can be calculated by subtraction of HDL-cholesterol from total cholesterol. Target values of non-HDL-cholesterol can be obtained by adding 0.8 mmol/L to the LDL-cholesterol targets (this means 3.3 mmol/L in high, and 2.6 mmol/L in very high risk patients). The drugs of first choice in the treatment of diabetic dyslipidaemia are statins. Nevertheless, it is known that even if statin therapy is optimal (treated to target), a considerable residual (lipid) risk remains. For its reduction treatment of low HDL-cholesterol and high triglyceride levels is obvious by the administration of fibrates. In addition to statin therapy, fenofibrate can be recommended. Orv. Hetil., 2016, 157(19), 746–752.

JUPITER – Exploring New Frontiers

2009 ◽  
Vol 5 (2) ◽  
pp. 28
Author(s):  
Peter J Lansberg ◽  
Keyword(s):  
Cardiovascular Disease ◽  
Primary Prevention ◽  
High Risk ◽  
Statin Therapy ◽  
Ldl Cholesterol ◽  
Low Density Lipoprotein ◽  
Density Lipoprotein ◽  
High Sensitivity ◽  
Hs Crp ◽  
Current Guidelines

Over the last two decades statins have become indispensable for managing patients at high risk of cardiovascular disease. Since their introduction in the late 1980s, their role has expanded from drugs to be used in secondary prevention to standard treatment in primary prevention for individuals at high risk of cardiovascular disease. Targets for low-density lipoprotein (LDL) cholesterol, as well as LDL levels at which statin therapy should be started, have gradually gone down. The JUPITER study succeeded in expanding the limits of earlier interventions and aimed for lower plasma LDL cholesterol levels, as well as including high-sensitivity C-reactive protein (hs-CRP) as a biomarker for risk and target for treatment. The investigators included patients who, according to current guidelines, would not qualify for statin therapy. Patients with elevated levels of hs-CRP (>2mg/dl) and low LDL cholesterol (<130mg/dl) were treated with rosuvastatin 20mg or placebo. The trial was terminated after 1.9 years because of unexpected early benefits, whereby the relative risk of developing atherothrombotic complications was reduced by 44%. The implications of this trial are far-reaching, not only because of the public health consequences of treating a larger number of individuals with aggressive statin therapy than current guidelines dictate; it also forces us to re-evaluate current cardiovascular risk calculating tools. The provocative results of this important primary prevention trial have generated new questions on how to intervene earlier in the development of atherosclerosis in patients at risk of cardiovascular disease.

scholarly journals Intensive Treat-to-Target Statin Therapy in High-Risk Japanese Patients With Hypercholesterolemia and Diabetic Retinopathy: Report of a Randomized Study

Diabetes Care ◽  
2018 ◽  
pp. dc172224 ◽  
Author(s):  
Hiroshi Itoh ◽  
Issei Komuro ◽  
Masahiro Takeuchi ◽  
Takashi Akasaka ◽  
Hiroyuki Daida ◽  
...  
Keyword(s):  
Diabetic Retinopathy ◽  
High Risk ◽  
Statin Therapy ◽  
Randomized Study ◽  
Japanese Patients ◽  
Treat To Target

P5327Are we being able to meet current guidelines LDL-cholesterol goals in very high risk patients? How many of them could benefit of PSCK9 inhibition by the FOURIER/ODYSSEY and NICE criteria?

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T El Andere ◽  
J A T Soto ◽  
I S Moreira ◽  
M N Wamser ◽  
H C Freitas ◽  
...  
Keyword(s):  
Cardiovascular Risk ◽  
High Risk ◽  
Statin Therapy ◽  
Ldl Cholesterol ◽  
Target Range ◽  
Pcsk9 Inhibitors ◽  
High Risk Patients ◽  
Risk Patients ◽  
Pcsk9 Inhibition ◽  
Very High

Abstract Background/Introduction With increasing evidence of LDL-cholesterol (LDL-c) lowering and a subsequent reduction in cardiovascular events, guidelines of different parts of the world aim for lower LDL-c goals by risk stratification. Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibition has been able to reduce up to 60% LDL-c levels, with further reduction in cardiovascular outcomes. Purpose Our aim was to evaluate the proportion of very high risk patients in a tertiary cardiology center that met LDL-c goal of less than 50mg/dL proposed by the Brazilian Society of Cardiology (BSC) guidelines. Furthermore, we assessed the number of patients that were receiving adequate statin intensity therapy and could benefit from PCSK9 inhibition by the FOURIER/ODYSSEY and by the National Institute for Health and Care Excellence (NICE) criteria. Methods We screened 2180 consecutive patients from March, 2018 to February, 2019 for cardiovascular risk factors, cholesterol and glycemic levels, and current medical therapy at use. Patients were stratified by level of risk, and compliance to recommended statin therapy was evaluated. We then analyzed how many of the very high risk patients, that were in use of high intensity statin therapy, met the inclusion LDL-c levels of the FOURIER/ODYSSEY trials (≥70mg/dL) and the NICE recommendations (≥140mg/dL) for the introduction of PCSK9 inhibitors. Results Of the 2180 patients enrolled to our study, 1225 (56.2%) patients were at very high cardiovascular risk level. Of these patients, 136 (11.1%) met LDL-c BSC guideline levels. Using the LDL-c target of 70mg/dL, an additional 320 (26.1%) patients were below target range. When analyzing statin therapy at use, 913 (74,5%) were receiving adequate statin therapy. Of the very high risk patients in adequate statin treatment, 617 (65.9%) by the FOURIER/ODYSSEY criteria and 88 (9.4%) patients by the NICE criteria would benefit from PCSK9 inhibitors. Conclusions With lower LDL-c goals, achievement of optimal LDL-c levels is now a challenge for current clinical practice. Even though many patients are receiving adequate guideline-based statin therapy, difficulty remains in achieving optimal treatment, especially in the higher risk stratum. These patients would benefit from PCSK9 inhibition, being the NICE criteria, a more cost-effective strategy, still applicable in a substantial portion of our patients.

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