1
|
Qi L, Liu D, Qu Y, Chen B, Meng H, Zhu L, Li L, Wang S, Liu C, Zheng G, Lian Q, Yin G, Lv L, Lu D, Chen X, Xue F, An P, Li H, Deng H, Li L, Qian L, Huo Y. Tafolecimab in Chinese Patients With Hypercholesterolemia (CREDIT-4): A Randomized, Double-Blind, Placebo-Controlled Phase 3 Trial. JACC. ASIA 2023; 3:636-645. [PMID: 37614541 PMCID: PMC10442872 DOI: 10.1016/j.jacasi.2023.04.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 04/05/2023] [Accepted: 04/12/2023] [Indexed: 08/25/2023]
Abstract
Background Tafolecimab is a novel fully human proprotein convertase subtilisin/kexin type 9 (PCSK9) monoclonal antibody, developed for the treatment of hypercholesterolemia. Objectives The purpose of this study was to assess the efficacy and safety of tafolecimab in Chinese patients at high or very high cardiovascular risk with hypercholesterolemia. Methods Patients with diagnoses of heterozygous familial hypercholesterolemia (HeFH) by the Simon Broome criteria or at high or very high cardiovascular risk with nonfamilial hypercholesterolemia, with screening low-density lipoprotein cholesterol (LDL-C) level ≥1.8 mmol/L, were randomized 2:1 to receive tafolecimab or placebo 450 mg every 4 weeks (Q4W) in the 12-week double-blind treatment period. The primary endpoint was the percent change from baseline to week 12 in LDL-C levels. Results A total of 303 patients were enrolled and received at least 1 dose of tafolecimab (n = 205) or placebo (n = 98). The least squares mean percent change in LDL-C level from baseline to week 12 was -68.9% (SE 1.4%) in the tafolecimab group and -5.8% (1.8%) in the placebo group (difference: -63.0%; [95% CI: -66.5% to -59.6%]; P < 0.0001). More patients treated with tafolecimab achieved ≥50% LDL-C reductions, LDL-C <1.8 mmol/L, and LDL-C <1.4 mmol/L at week 12 than did those in the placebo group (all P < 0.0001). Furthermore, tafolecimab markedly reduced non-HDL-C, apolipoprotein B, and lipoprotein(a) levels. During the double-blind treatment period, the most commonly reported adverse events included urinary tract infection (5.9% with tafolecimab vs 4.1% with placebo) and hyperuricemia (3.4% vs 4.1%). Conclusions Tafolecimab was safe and showed robust lipid-lowering efficacy in Chinese patients at high or very high cardiovascular risk with hypercholesterolemia. (A Study of IBI306 in Participants With Hypercholesterolemia; NCT04709536).
Collapse
Affiliation(s)
- Litong Qi
- Department of Cardiology, Peking University First Hospital, Beijing, China
| | - Dexue Liu
- Department of Endocrinology, The First Affiliated Hospital of Nanyang Medical College, Nanyang, China
| | - Yanling Qu
- Department of Cardiology, Yuncheng Central Hospital of Shanxi Province, Yuncheng, China
| | - Beijian Chen
- Department of Cardiology, Heze Municipal Hospital, Heze, China
| | - Haiyan Meng
- Department of Cardiology, Shandong Provincial Third Hospital, Jinan, China
| | - Lei Zhu
- Department of Cardiology, Shandong Provincial Third Hospital, Jinan, China
| | - Lipeng Li
- Department of Cardiology, Luoyang Third People's Hospital, Luoyang, China
| | - Shuqing Wang
- Department of Cardiology, The First Hospital of Qiqihar City, Qiqihar, China
| | - Changyi Liu
- Department of Cardiology, The First Hospital of Qiqihar City, Qiqihar, China
| | - Guanzhong Zheng
- Department of Cardiology, Zibo Municipal Hospital, Zibo, China
| | - Qiufang Lian
- Department of Cardiology, Yan'an University Xianyang Hospital, Xianyang, China
| | - Guotian Yin
- Department of Cardiology, The Third Affiliated Hospital of Xinxiang Medical College, Xinxiang, China
| | - Lingchun Lv
- Department of Cardiology, Lishui Central Hospital, Lishui, China
| | - Di Lu
- Department of Cardiology, China National Petroleum Corporation Central Hospital, Langfang, China
| | - Xiaoshu Chen
- Department of Cardiology, Wenzhou People's Hospital, Wenzhou, China
| | | | - Pei An
- Innovent Biologics, Inc, Suzhou, China
| | - Haoyu Li
- Innovent Biologics, Inc, Suzhou, China
| | - Huan Deng
- Innovent Biologics, Inc, Suzhou, China
| | - Li Li
- Innovent Biologics, Inc, Suzhou, China
| | - Lei Qian
- Innovent Biologics, Inc, Suzhou, China
| | - Yong Huo
- Department of Cardiology, Peking University First Hospital, Beijing, China
| |
Collapse
|
2
|
Pharmacokinetic Interactions and Tolerability of Rosuvastatin and Ezetimibe: A Randomized, Phase 1, Crossover Study in Healthy Chinese Participants. Eur J Drug Metab Pharmacokinet 2023; 48:51-62. [PMID: 36437383 PMCID: PMC9823065 DOI: 10.1007/s13318-022-00798-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVE The combination of rosuvastatin and ezetimibe has promising clinical benefits with a significant safety and tolerability profile. However, there is a lack of clinical data supporting the drug-drug interaction (DDI) in Chinese population. Thus, the aim of this study is to assess the potential pharmacokinetic DDI between rosuvastatin and ezetimibe in a Chinese population. METHODS In this randomized, open-label, phase 1 study, 12 healthy volunteers were randomized to three treatment groups: 10 mg rosuvastatin plus 10 mg ezetimibe, 10 mg rosuvastatin alone, and 10 mg ezetimibe alone under fasting conditions. The plasma concentrations of rosuvastatin and ezetimibe were determined, and the pharmacokinetic parameters were calculated. Primary endpoints were peak plasma concentration (Cmax), area under the curve from zero to last measurement (AUC0-t), and area under the curve from zero to infinity (AUC0-∞) that were log-transformed, and co-administration was compared with monotherapy to evaluate the DDI. RESULTS The geometric mean ratios (GMRs) of rosuvastatin with 90% confidence intervals (CIs) were 0.94 (0.80-1.12) for Cmax, 0.96 (0.85-1.08) for AUC0-t, and 0.96 (0.86-1.07) for AUC0-∞ when administered in combination with ezetimibe versus administered alone. The GMRs of unconjugated ezetimibe and total ezetimibe with 90% CIs were 1.15 (1.00-1.32) and 0.93 (0.80-1.07) for Cmax, 0.96 (0.84-1.10) and 0.95 (0.83-1.08) for AUC0-t, and 1.06 (0.96-1.18) and 0.94 (0.80-1.11) for AUC0-∞, respectively, when administered in combination with rosuvastatin versus administered alone. CONCLUSION Co-administration of rosuvastatin and ezetimibe showed no clinically significant pharmacokinetic interactions in a healthy Chinese population.
Collapse
|
3
|
Yu S, Guo X, Li G, Yang H, Zheng L, Sun Y. Gender discrepancies in predictors for newly onset cardiovascular events and metabolic syndrome in elderly patients from rural China. Front Cardiovasc Med 2022; 9:995128. [PMID: 36505366 PMCID: PMC9726899 DOI: 10.3389/fcvm.2022.995128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2022] [Accepted: 11/01/2022] [Indexed: 11/24/2022] Open
Abstract
Objective The study aimed to estimate the possible predictors of cardiovascular events (CVEs) in elderly patients with metabolic syndrome (MetS) from rural China. Moreover, we also attempted to find the potential risk factors for newly diagnosed MetS. Methods The Northeast China Rural Cardiovascular Health Study (NCRCHS) is a community-based prospective cohort study carried out in rural areas of northeast China. Approximately 1,059 elderly patients with MetS but no cardiovascular diseases and 1,565 elderly patients without MetS at baseline were enrolled in this study. They underwent a physical examination, completed a questionnaire in 2012-2013, and were followed up during 2015-2017. Cox proportional hazard analysis was conducted to assess the possible predictors of newly developed CVEs, and multivariate analysis was used to estimate the risk factors of newly diagnosed MetS. Results The common predictors of newly developed CVEs in both men and women were family history of stroke (HR [hazard ratios] female: 1.696; HR male: 2.504) and soybean consumption (HR female: 0.253; HR male: 0.130). Moreover, minority race (HR: 0.109), systolic blood pressure (SBP) (HR: 1.021), current drinking habits (HR: 2.551), family history of hypertension (HR: 2.297), LDL-C (HR: 1.669), 5,000-20,000 CNY/year annual income (HR: 0.290), and strenuous physical activity (HR: 0.397) were predictors of CVEs only in male elderly patients. For newly diagnosed MetS, body mass index (OR female: 1.212; OR male: 1.207) and fasting blood glucose (OR female: 1.305; OR male: 1.217) were common risk factors in both genders, whereas age (OR:0.958) was a protective factor in men and > 9-h/day sleep duration (OR:0.212) was a protective factor in women. In addition, SBP (OR:1.014) ≥4 times/day, bean consumption (OR:1.955), and uric acid (OR:1.005) increased the risk of MetS in men but not in women. Conclusion Our study identified many effective predictors of CVEs in rural elderly patients with MetS and confirmed the presence of a gender-based discrepancy. Moreover, we also identified additional risk factors, along with the traditional ones, for newly diagnosed MetS in rural elderly patients.
Collapse
Affiliation(s)
- Shasha Yu
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Xiaofan Guo
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - GuangXiao Li
- Department of Clinical Epidemiology, Institute of Cardiovascular Diseases, First Hospital of China Medical University, Shenyang, China
| | - Hongmei Yang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Liqiang Zheng
- Department of Clinical Epidemiology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yingxian Sun
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China,*Correspondence: Yingxian Sun
| |
Collapse
|
4
|
Cheng Y, Dong S, Shen P, Sun Y, Lin H, Zhai S. Achievement of low-density lipoprotein cholesterol targets in Chinese patients with atherosclerotic cardiovascular disease after receiving statins and ezetimibe. Front Cardiovasc Med 2022; 9:988576. [PMID: 36312234 PMCID: PMC9614052 DOI: 10.3389/fcvm.2022.988576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/23/2022] [Indexed: 11/13/2022] Open
Abstract
Background The importance of low-density lipoprotein cholesterol (LDL-C) lowering to reduce atherosclerotic cardiovascular disease (ASCVD) risk is strongly emphasized. If the LDL-C goals are not achieved with statin therapy, combination with ezetimibe is recommended. Studies revealed a substantial gap between obtained LDL-C levels and LDL-C target in ASCVD patients. However, little is known about the achievement of LDL-lowering treatment targets in ASCVD patients receiving ezetimibe in addition to statins. Materials and methods This was a retrospective cohort study based on EHR data from the regional health information system of Yinzhou, an eastern coastal area of China. ASCVD Patients stratified as very high risk, taking both statin and ezetimibe for lipid control, and had at least one lipid test after ezetimibe initiation were included between January 2013 and July 2020. Descriptive statistics were used to summarize the LDL-C values and target value (1.8 mmol/L according to the Chinese guideline, 1.4 mmol/L according to the European guideline) achievements. Multivariable logistic regression was used to explore the influencing factors of target achievement rate. Results A total of 1,727 patients were included. The median follow-up time was 15.0 months. Taking 1.8 mmol/L as the target value, the achievement rates of LDL-C over the first 3 follow up years were 50.6, 31.3, and 30.3%, respectively. Taking 1.4 mmol/L as the target value, the achievement rates were 25.6, 15.5, and 16.5%, respectively. Multivariable analysis suggested that male patients (OR = 1.78, 95%CI: 1.27-2.49), combined use of atorvastatin or rosuvastatin with ezetimibe (vs other statins, OR = 4.64, 95% CI: 1.83-11.76), better medication adherence (OR = 1.03, 95% CI: 1.01-1.04) and smoking cessation (vs smoking, OR = 2.26, 95% CI: 1.27-4.02) were associated with a higher achievement rate, while baseline LDL-C level (OR = 0.48, 95% CI: 0.41-0.56) and treatment course of statin before ezetimibe (OR = 0.93, 95% CI: 0.89-0.98) were negatively associated with achievement rate. Conclusion Long-term follow-up data based on a Chinese regional database shows that in very high-risk ASCVD patients taking ezetimibe in addition to statins, achievement rate of LDL-lowering treatment targets is still low and far from satisfactory in real-world setting. More efforts are needed to achieve optimal LDL-C levels.
Collapse
Affiliation(s)
- Yinchu Cheng
- Department of Pharmacy, Peking University Third Hospital, Beijing, China,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Shujie Dong
- Department of Pharmacy, Peking University Third Hospital, Beijing, China,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China
| | - Peng Shen
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Yexiang Sun
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China
| | - Hongbo Lin
- Yinzhou District Center for Disease Control and Prevention, Ningbo, China,Hongbo Lin,
| | - Suodi Zhai
- Department of Pharmacy, Peking University Third Hospital, Beijing, China,Institute for Drug Evaluation, Peking University Health Science Center, Beijing, China,*Correspondence: Suodi Zhai,
| |
Collapse
|
5
|
Liao H, Chen Q, Liu L, Zhong S, Xiao C. Utilization of Risk Scores for Coronary Heart Disease Diagnosis in Rural China. Int J Gen Med 2022; 15:2541-2548. [PMID: 35282649 PMCID: PMC8907025 DOI: 10.2147/ijgm.s355573] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 02/17/2022] [Indexed: 11/29/2022] Open
Abstract
Objective The current study was to design a cardiovascular risk score for the diagnosis of coronary heart disease (CHD) in the rural area of China and the sensitivity and specificity of this score would be assessed. Methods A total of 520 patients were enrolled and based on the results from coronary artery angiography, patients were divided into three groups: CHD group (coronary artery ≥50% stenosis), atherosclerosis group (coronary artery <50% stenosis) and normal groups (without stenosis). Between-group differences were evaluated and the sensitivity and specificity of cardiovascular risk score were evaluated. Results Compared to the normal and atherosclerosis groups, patients in the CHD group were older, had higher body mass index, and more likely to be smoking and obese, and had dyslipidemia, hypertension and diabetes, and had higher cardiovascular risk score (4.05 ± 2.15 vs 2.94 ± 1.90 vs 2.54 ± 1.59). Patients in the CHD group were more likely to have cardiovascular risk scores ≥2 (90.2% CHD group vs 74.2% atherosclerosis group vs 76.1% normal group, P < 0.05). The area under the ROC was 0.673, with 95% confidence interval was 0.623–0.722 (P < 0.001), and the sensitivity and specificity were highest when the cardiovascular risk score was 4, indicating that the value of cardiovascular risk score of 4 was a good cutoff point for CHD diagnosis. Conclusion Using cardiovascular risk score can improve CHD diagnosis which may help to reduce health disparities between rural and urban area.
Collapse
Affiliation(s)
- Huocheng Liao
- Department of Cardiology, The Third People’s Hospital of Huizhou and the Affiliated Hospital of Guangzhou Medical University, Huizhou City, Guangdong Province, People’s Republic of China
| | - Qiuyue Chen
- Department of Cardiology, The Third People’s Hospital of Huizhou and the Affiliated Hospital of Guangzhou Medical University, Huizhou City, Guangdong Province, People’s Republic of China
| | - Lin Liu
- Department of Cardiology, The Third People’s Hospital of Huizhou and the Affiliated Hospital of Guangzhou Medical University, Huizhou City, Guangdong Province, People’s Republic of China
| | - Sigan Zhong
- Department of Cardiology, The Third People’s Hospital of Huizhou and the Affiliated Hospital of Guangzhou Medical University, Huizhou City, Guangdong Province, People’s Republic of China
| | - Chun Xiao
- Department of Cardiology, The Third People’s Hospital of Huizhou and the Affiliated Hospital of Guangzhou Medical University, Huizhou City, Guangdong Province, People’s Republic of China
- Correspondence: Chun Xiao, Department of Cardiology, The Third People Hospital of Huizhou, The Affiliated Hospital of Guangzhou Medical University, Huizhou City, Guangdong Province, People’s Republic of China, Email
| |
Collapse
|
6
|
Shi B, Liu X, Dong Q, Yang Y, Cai Z, Wang H, Yin D, Wang H, Dou K, Song W. The Effect of a WeChat-Based Tertiary A-Level Hospital Intervention on Medication Adherence and Risk Factor Control in Patients With Stable Coronary Artery Disease: Multicenter Prospective Study. JMIR Mhealth Uhealth 2021; 9:e32548. [PMID: 34569467 PMCID: PMC8581769 DOI: 10.2196/32548] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Revised: 09/07/2021] [Accepted: 09/26/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In China, ischemic heart disease is the main cause of mortality. Having cardiac rehabilitation and a secondary prevention program in place is a class IA recommendation for individuals with coronary artery disease. WeChat-based interventions seem to be feasible and efficient for the follow-up and management of chronic diseases. OBJECTIVE This study aims to evaluate the effectiveness of a tertiary A-level hospital, WeChat-based telemedicine intervention in comparison with conventional community hospital follow-up on medication adherence and risk factor control in individuals with stable coronary artery disease. METHODS In this multicenter prospective study, 1424 patients with stable coronary artery disease in Beijing, China, were consecutively enrolled between September 2018 and September 2019 from the Fuwai Hospital and 4 community hospitals. At 1-, 3-, 6-, and 12-month follow-up, participants received healthy lifestyle recommendations and medication advice. Subsequently, the control group attended an offline outpatient clinic at 4 separate community hospitals. The intervention group had follow-up visits through WeChat-based telemedicine management. The main end point was medication adherence, which was defined as participant compliance in taking all 4 cardioprotective medications that would improve the patient's outcome (therapies included antiplatelet therapy, β-blockers, statins, and angiotensin-converting-enzyme inhibitors or angiotensin-receptor blockers). Multivariable generalized estimating equations were used to compare the primary and secondary outcomes between the 2 groups and to calculate the relative risk (RR) at 12 months. Propensity score matching and inverse probability of treatment weighting were performed as sensitivity analyses, and propensity scores were calculated using a multivariable logistic regression model. RESULTS At 1 year, 88% (565/642) of patients in the intervention group and 91.8% (518/564) of patients in the control group had successful follow-up data. We matched 257 pairs of patients between the intervention and control groups. There was no obvious advantage in medication adherence with the 4 cardioprotective drugs in the intervention group (172/565, 30.4%, vs 142/518, 27.4%; RR 0.99, 95% CI 0.97-1.02; P=.65). The intervention measures improved smoking cessation (44/565, 7.8%, vs 118/518, 22.8%; RR 0.48, 95% CI 0.44-0.53; P<.001) and alcohol restriction (33/565, 5.8%, vs 91/518, 17.6%; RR 0.47, 95% CI 0.42-0.54; P<.001). CONCLUSIONS The tertiary A-level hospital, WeChat-based intervention did not improve adherence to the 4 cardioprotective medications compared with the traditional method. Tertiary A-level hospital, WeChat-based interventions have a positive effect on improving lifestyle, such as quitting drinking and smoking, in patients with stable coronary artery disease and can be tried as a supplement to community hospital follow-up. TRIAL REGISTRATION ClinicalTrials.gov NCT04795505; https://clinicaltrials.gov/ct2/show/NCT04795505.
Collapse
Affiliation(s)
- Boqun Shi
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Xi Liu
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qiuting Dong
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yuxiu Yang
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhongxing Cai
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Haoyu Wang
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Dong Yin
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongjian Wang
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Kefei Dou
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Weihua Song
- Cardiometabolic Medicine Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| |
Collapse
|
7
|
Gao H, Yang C, Yang J, Wang F. Guideline directed low-density lipoprotein cholesterol goal achievement: A real-world study from a cardiology ward. Eur J Intern Med 2020; 79:124-126. [PMID: 32327317 DOI: 10.1016/j.ejim.2020.04.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 04/04/2020] [Indexed: 11/29/2022]
Affiliation(s)
- Haiyang Gao
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Chenguang Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Jiefu Yang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China
| | - Fang Wang
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Beijing, 100730, China.
| |
Collapse
|
8
|
Yang H, Li N, Zhou Y, Xiao Z, Tian H, Hu M, Li S. Cost-Effectiveness Analysis of Ezetimibe as the Add-on Treatment to Moderate-Dose Rosuvastatin versus High-Dose Rosuvastatin in the Secondary Prevention of Cardiovascular Diseases in China: A Markov Model Analysis. Drug Des Devel Ther 2020; 14:157-165. [PMID: 32021100 PMCID: PMC6969683 DOI: 10.2147/dddt.s213968] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 01/02/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND For patients with inadequate control of cholesterol using moderate-dose statins in the secondary prevention of cardiovascular diseases (CVD), either doubling the dose of statins or adding ezetimibe should be considered. The cost-effectiveness of them is unknown in the Chinese context. The aim of this study is to compare the cost and effectiveness of the two regimens, and estimate the incremental cost-effectiveness ratio (ICER). METHODS A Markov model of five health statuses were used to estimate long-term costs and quality-adjusted life-years (QALYs) of the two treatment regimens from the healthcare perspective. The effectiveness data used to calculate the transition probability was based on a previously published randomized trial. The utility data was gathered from literature and the costs were gathered from the electronic medical record system of West China Hospital in Chinese Yuan (CNY) in 2017 price. One-way sensitivity analysis and probabilistic sensitivity analysis were conducted. RESULTS The ICER for ezetimibe plus moderate-dose rosuvastatin was 47,102.99 CNY per QALY for 20 years simulation, which did not reach the threshold of per capita gross domestic product (GDP) of 59,660 CNY per QALY in 2017 in China. Non-CVD-related mortality and CVD-related mortality contributed most to the ICER. CONCLUSION Adding ezetimibe to the moderate-dose statin in secondary prevention for CVD is cost-effective, compared with the high-dose statin in the Chinese context whose low-density lipoprotein cholesterol (LDL-c) was not inadequately controlled by moderate-dose statin alone.
Collapse
Affiliation(s)
- Han Yang
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
- West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Nan Li
- Department of Informatics, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Youlian Zhou
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
- West China School of Medicine, Sichuan University, Chengdu610041, People’s Republic of China
| | - Zhilan Xiao
- West China School of Medicine, Sichuan University, Chengdu610041, People’s Republic of China
| | - Haoming Tian
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, Chengdu610041, People’s Republic of China
| | - Sheyu Li
- Department of Endocrinology and Metabolism, West China Hospital, Sichuan University, Chengdu610041, People’s Republic of China
| |
Collapse
|
9
|
Wang X, He Y, Wang T, Li C, Ma Z, Zhang H, Ma H, Zhao H. Lipid-Lowering Therapy and Low-Density Lipoprotein Cholesterol (LDL-C) Goal Achievement in High-Cardiovascular-Risk Patients in Fuzhou, China. J Cardiovasc Pharmacol Ther 2020; 25:307-315. [PMID: 31918567 DOI: 10.1177/1074248419899298] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE This study aims to analyze the treatment patterns and goal attainment of low-density lipoprotein cholesterol (LDL-C) among patients with atherosclerotic cardiovascular disease (ASCVD) and diabetes mellitus (DM) in the real-world setting in Fuzhou, China. METHODS Patients aged ≥20 years with a valid LDL-C measurement (index date) in 2016 were selected from National Healthcare Big Data in Fuzhou, China. Patients were stratified into mutually exclusive cardiovascular risk categories: ASCVD (including recent acute coronary syndrome [ACS], chronic coronary heart disease [CHD], stroke, and peripheral arterial disease [PAD]), and DM alone (without ASCVD). Lipid-modifying medication and LDL-C attainment at the index date were assessed. RESULTS A total of 21 989 patients met the inclusion criteria, including 17 320 (78.8%) with ASCVD and 4669 (21.2%) with DM alone; 47.7% of patients received current statin therapy in the overall cohort (53.5% in ASCVD, 26.5% for DM); 20.5% ASCVD population achieved LDL-C target with the highest in patients with recent ACS (33.8%), followed by chronic CHD (21.2%), PAD (20.9%), and ischemic stroke (17.3%); 49.0% of patients with DM achieved LDL-C target. Higher LDL-C attainment was observed in high-intensity statin and a combination of statin and nonstatin groups. Atorvastatin was the most commonly used statin with the highest LDL-C attainment, followed by rosuvastatin. CONCLUSION Compared with previous studies in China, our study found a relatively low statin use and LDL-C target attainment, but higher than similar studies in Europe. Guidelines should be well complied and more prescription of high-intensity statin or statin and nonstatin combination should be advocated.
Collapse
Affiliation(s)
- Xing Wang
- NHC Key Laboratory of Reproduction Regulation (Shanghai Institute of Planned Parenthood Research), Public Health School, Fudan University, Shanghai, China.,Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Yan He
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Tao Wang
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Chunming Li
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Zihui Ma
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Heng Zhang
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| | - Handong Ma
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China.,Department of Computer Science, Shanghai Jiao Tong University, Shanghai, China
| | - Hongxin Zhao
- Shanghai Synyi Medical Technology Co, Ltd, Shanghai, China
| |
Collapse
|
10
|
Wang Y, Nichol MB, Yan BP, Wu J, Tomlinson B, Lee VW. Descriptive analysis of real-world medication use pattern of statins and antiplatelet agents among patients with acute coronary syndrome in Hong Kong and the USA. BMJ Open 2019; 9:e024937. [PMID: 31315855 PMCID: PMC6661883 DOI: 10.1136/bmjopen-2018-024937] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2018] [Revised: 05/31/2019] [Accepted: 06/10/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES The objective was to explore the differences in medication use pattern of lipid-lowering drug (LLD) and antiplatelet agents among post-percutaneous coronary intervention patients with acute coronary syndrome aged <65 in Hong Kong (HK) and the USA. DESIGN Retrospective study. SETTING This study used deidentified claims data from Clinformatics Data Mart database (OptumInsight, Eden Prairie, Minnesota, USA) and electronic health records from HK Hospital Authority Clinical Data Analysis and Reporting System database. PARTICIPANTS We used 1 year prescription records of LLDs and antiplatelet agents among 1013 USA patients and 270 HK Chinese patients in 2011-2013. PRIMARY AND SECONDARY OUTCOME MEASURES Continuity was investigated on the assumption that one defined daily dose represented 1 day treatment. Medication possession ratio method was used to evaluate the adherence. Multivariate-adjusted logistic regressions were constructed to compare the good continuity and adherence levels in the merged database with the cutoffs set at 80%, and Cox proportional hazard models were built using the time to discontinuation as the dependent variable, to assess the persistence level. RESULTS HK Chinese patients were less adherent (67.41% vs 84.60%, adjusted odds ratio (AOR) for Americans over Chinese=2.23 (95% CI=1.60 to 3.12), p<0.001) to antiplatelet agents compared with American patients but better adherent to statins (90.00% vs 78.18%, AOR=0.37 (0.23 to 0.58), p<0.001). The discontinuation with statins was more common in American patients (13.33% vs 34.25%, adjusted hazard ratio (AHR)=2.95 (2.05 to 4.24), p<0.001). Low-to-moderate potency statins and clopidogrel were favoured by our HK local physicians, while American patients received higher doses of statins and prasugrel. CONCLUSIONS We seemed to find HK physicians tended to prescribe cheaper and lower doses of statins and antiplatelet agents when compared with the privately insured patients in the USA, though the adherence and persistence levels of HK patients with statins were relatively good.
Collapse
Affiliation(s)
- Yun Wang
- Peninsula Clinical School, Monash University, Clayton, Victoria, Australia
| | - Michael B Nichol
- University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA
| | - Bryan Py Yan
- Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Joanne Wu
- University of Southern California Sol Price School of Public Policy, Los Angeles, California, USA
| | - Brian Tomlinson
- Department of Medicine & Therapeutics Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
- Prince of Wales Hospital, Hospital Authority, Hong Kong, China
| | - Vivian Wy Lee
- School of Pharmacy, The Chinese University of Hong Kong, Hong Kong, China
| |
Collapse
|
11
|
Liu H, Dong A, Wang H. Long-term benefits of high-intensity atorvastatin therapy in Chinese acute coronary syndrome patients undergoing percutaneous coronary intervention: A retrospective study. Medicine (Baltimore) 2018; 97:e12687. [PMID: 30334951 PMCID: PMC6211933 DOI: 10.1097/md.0000000000012687] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
There is lack of long-term data on high-intensity statin therapy of Chinese acute coronary syndrome (ACS) patients scheduled to undergo percutaneous coronary intervention (PCI). In this retrospective study, we compared the long-term efficacy and safety of high-intensity and conventional atorvastatin therapy in reducing low-density lipoprotein cholesterol (LDL-C) and plaque size, and improving cardiac function of ACS patients who underwent PCI.We retrospectively analyzed the clinical records of 120 consecutive ACS patients who underwent PCI at our hospital. Group I received a loading dose of atorvastatin (80 mg/day) prior to PCI, followed by a maintenance dose of 40 mg/day for 3 months post-PCI. Group II received a regular dose of atorvastatin (20 mg/day) from the date of admission until 1 year post-PCI. The composite primary efficacy end point was the mean percent change in calculated LDL-C from baseline to week 48 in both groups and percentage of patients achieving the LDL-C target of ≤1.81 mmol/L.Group I had significantly higher mean baseline LDL-C than group II. Moreover, 8.3% of group I patients had an LDL-C ≤1.81 mmol/L versus 43.3% for group II. At week 24, 75.0% and 90.0% of group I and II patients, respectively, achieved the LDL-C target. At week 48, 85.0% and 96.7% of group I and II patients, respectively, achieved the LDL-C target. Additionally, the mean percent changes at week 4 from baseline in LDL-C were -33.6% ± 20.0% for group I versus -12.8% ± 19.6% for group II, and -47.0% ± 25.5% at week 48 for group I versus -36.4% ± 20.2% for group II. Meanwhile, significant reduction in plaque size and marked improvement in cardiac function were seen in patients receiving high-intensity atorvastatin therapy.Compared to conventional therapy, high-intensity statin therapy is more effective in reducing LDL-C and improving cardiac function of ACS patients, with a general benign safety profile over a period of 48 weeks. Our findings support the use of high-intensity statin therapy for Chinese ACS patients to improve the proportion of patients attaining the LDL-C target and reduction in plaque size and improvement cardiac function.
Collapse
Affiliation(s)
- Hui Liu
- Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University
| | - Aiqiao Dong
- Youth Road Community Health Service Center, Lianhu District, Xi’an, Shaanxi, China
| | - Haiyan Wang
- Department of Cardiology, Tangdu Hospital, the Fourth Military Medical University
| |
Collapse
|
12
|
Fu S, Yao Y, Luan F, Zhao Y. Prevalence of metabolic syndrome risk factors and their relationships with renal function in Chinese centenarians. Sci Rep 2018; 8:9863. [PMID: 29959374 PMCID: PMC6026211 DOI: 10.1038/s41598-018-28316-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 06/19/2018] [Indexed: 01/16/2023] Open
Abstract
As the first time, this study was to investigate the prevalence of metabolic syndrome (MetS) risk factors and explore their relationships with renal function in Chinese centenarians. China Hainan Centenarian Cohort Study was performed in 18 cities and counties of Hainan Province. Home interview, physical examination and blood analysis were performed in 874 centenarians following standard procedures. Prevalence of MetS was 15.6% (136 centenarians). There were 229 centenarians with abdominal obesity (26.2%), 645 centenarians (73.8%) with hypertension, 349 centenarians with dyslipidemia (39.9%) and 92 centenarians with diabetes mellitus (10.5%). In multivariate linear regression, age, smoking, waist circumstance (WC), systolic blood pressure (SBP) and triglyceride levels were inversely and diastolic blood pressure (DBP) levels were positively associated with glomerular filtration rate levels (P < 0.05 for all). This study reported low prevalence of MetS risk factors and demonstrated that age, smoking, abdominal obesity (WC), hypertension (SBP and DBP) and triglyceride levels were independently associated with renal function in Chinese centenarians. This study provided reliable data about Chinese centenarians, analyzed significant relationships between Mets risk factors and renal function, and explained possible reason (low prevalence of MetS and its risk factors) and mechanism (interrelationship of age, Mets risk factors with renal function) of longevity.
Collapse
Affiliation(s)
- Shihui Fu
- Department of Geriatric Cardiology, Chinese People's Liberation Army General Hospital, Beijing, China.,Department of Cardiology and Hainan Branch, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Yao Yao
- Institute of Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China.,Beijing Key Laboratory of Aging and Geriatrics, Chinese People's Liberation Army General Hospital, Beijing, China
| | - Fuxin Luan
- Central Laboratory, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, China.
| | - Yali Zhao
- Central Laboratory, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, China.
| |
Collapse
|
13
|
Dai W, Long J, Cheng Y, Chen Y, Zhao S. Elevated plasma lipoprotein(a) levels were associated with increased risk of cardiovascular events in Chinese patients with stable coronary artery disease. Sci Rep 2018; 8:7726. [PMID: 29769559 PMCID: PMC5955944 DOI: 10.1038/s41598-018-25835-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 04/27/2018] [Indexed: 12/13/2022] Open
Abstract
Recent studies have suggested that lipoprotein(a) [Lp(a)] is associated with cardiovascular disease (CVD). However, the contribution of Lp(a) to residual risk of CVD has not been determined in Chinese populations. We conducted a prospective study to evaluate the association between Lp(a) and the risk of major adverse cardiovascular events (MACEs) in patients with stable coronary artery disease (CAD) who received optimal medication treatment (OMT). The study enrolled 1602 patients with stable CAD from 5 hospitals in China. The baseline clinical characteristics and follow-up MACE data for the patients were recorded. Coronary lesion severity was assessed by the Gensini scoring system. All-cause death, non-fatal myocardial infarction, non-fatal stroke and unplanned coronary revascularization were considered MACEs. We found that plasma Lp(a) levels were positively associated with coronary lesion severity at baseline (p < 0.001). During a mean follow-up period of 39.6 months, 166 (10.4%) patients suffered MACEs. There were significant differences in the adjusted event-free survival rates among the Lp(a) quartile subgroups (p = 0.034). The hazard ratio for MACEs was 1.291 (95% confidence interval: 1.091-1.527, p = 0.003) per standardized deviation in the log-transformed Lp(a) level after adjustment for traditional cardiovascular risk factors. Therefore, Lp(a) was an independent predictor of MACEs in Chinese patients with stable CAD who received OMT.
Collapse
Affiliation(s)
- Wen Dai
- Department of Cardiology, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011, China
| | - Junke Long
- Department of Cardiology, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011, China
| | - Ying Cheng
- Department of Endocrinology, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011, China
| | - Yaqin Chen
- Department of Cardiology, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011, China
| | - Shuiping Zhao
- Department of Cardiology, The Second Xiangya Hospital, Central South University, No. 139, Middle Renmin Road, Changsha, 410011, China.
| |
Collapse
|
14
|
Zhao W, Zheng XL, Jiang ZN, Liao XB, Zhao SP. Risk factors associated with atherogenic dyslipidemia in the presence of optimal statin therapy. Int J Cardiol 2017; 248:355-360. [DOI: 10.1016/j.ijcard.2017.06.105] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2016] [Revised: 06/08/2017] [Accepted: 06/26/2017] [Indexed: 11/26/2022]
|
15
|
Zhang W, Ji F, Yu X, Wang X. Factors associated with unattained LDL-cholesterol goals in Chinese patients with acute coronary syndrome one year after percutaneous coronary intervention. Medicine (Baltimore) 2017; 96:e5469. [PMID: 28072688 PMCID: PMC5228648 DOI: 10.1097/md.0000000000005469] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Reducing low-density lipoprotein cholesterol (LDL-C) to target ≤1.81 mmol/L is a common therapeutic goal after acute coronary syndrome (ACS). This study aimed to examine the factors associated with reaching or not this LDL-C target after 1 year of optimal statin therapy postpercutaneous coronary intervention (PCI). This was a retrospective study of 633 consecutive prospectively enrolled patients with ACS treated between January 2011 and December 2012 at the Beijing Hospital (China). All patients were treated with PCI and statins for 1 year. A multivariate analysis was carried out to identify the factors associated with reaching the LDL-C target of ≤1.81 mmol/L. The rate of unreached LDL-C goal after 1 year was 48%. Compared with those who achieved their LDL-C goal, patients not achieving their LDL-C goal showed a higher proportion of females (37.9% vs 28.7%, P < 0.001), higher LDL-C levels at admission (2.82 ± 0.75 vs 2.08 ± 0.70 mmol/L, P < 0.001), lower proportion of patients with a history of PCI (17.6% vs 24.8%, P = 0.03), and younger age (66.7 ± 10.6 vs 68.9 ± 10.1 years, P = 0.009). A multivariate analysis showed that lower LDL-C levels on admission were predictive of LDL-C goal achievement (odds ratio [OR] = 4.81; 95% confidence interval [CI]: 3.46-6.70; P < 0.001), together with older age (OR: 0.98; 95% CI: 0.96-0.997; P = 0.026), and male gender (OR: 0.64; 95% CI: 0.42-0.98; P = 0.040). Higher LDL-C levels at admission, younger age, and female gender were independently associated with not reaching the LDL-C target after 1 year of optimal statin therapy after PCI.
Collapse
|
16
|
Al-Zakwani I, Al Mahmeed W, Shehab A, Arafah M, Al-Hinai AT, Al Tamimi O, Al Awadhi M, Al Herz S, Al Anazi F, Al Nemer K, Metwally O, Alkhadra A, Fakhry M, Elghetany H, Medani AR, Yusufali AH, Al Jassim O, Al Hallaq O, Baslaib FOAS, Amin H, Al-Waili K, Al-Hashmi K, Santos RD, Al-Rasadi K. Impact of metabolic syndrome on lipid target achievements in the Arabian Gulf: findings from the CEPHEUS study. Diabetol Metab Syndr 2016; 8:49. [PMID: 27468314 PMCID: PMC4962507 DOI: 10.1186/s13098-016-0160-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Accepted: 07/10/2016] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The aim of this study was to determine the impact of metabolic syndrome (MetS) on lipid target achievements in the Arabian Gulf. METHODS The centralized pan-middle east survey on the undertreatment of hypercholesterolemia (CEPHEUS) included 4171 high and very high atherosclerotic cardiovascular disease (ASCVD) risk patients from six Arabian Gulf countries. Analyses were performed using univariate statistics. RESULTS The overall mean age was 57 ± 11 years, 41 % were females and 71 % had MetS. MetS patients were less likely to attain their HDL-C (34 vs. 79 %; P < 0.001), LDL-C (27 vs. 37 %; P < 0.001), non HDL-C (35 vs. 55 %; P < 0.001) and Apo B (35 vs. 54 %; P < 0.001) compared to those without MetS. Within the MetS cohort, those with very high ASCVD risk were less likely to attain their lipid targets compared to those with high ASCVD risk [HDL-C (32 vs. 41 %; P < 0.001), LDL-C (24 vs. 43 %; P < 0.001), non HDL-C (32 vs. 51 %; P < 0.001) and Apo B (33 vs. 40 %; P = 0.001)]. In those with MetS and very high ASCVD risk status, females were less likely to attain their HDL-C (27 vs. 36 %; P < 0.001), LDL-C (19 vs. 27 %; P < 0.001) and Apo B (30 vs. 35 %; P = 0.009) compared to males. CONCLUSIONS MetS was associated with low lipid therapeutic targets. Women and those with very high ASCVD risk were also less likely to attain their lipid targets in the Arabian Gulf.
Collapse
Affiliation(s)
- Ibrahim Al-Zakwani
- Department of Pharmacology & Clinical Pharmacy, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
- Gulf Health Research, Muscat, Oman
| | - Wael Al Mahmeed
- Heart and Vascular Institute-Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | | | - Mohamed Arafah
- King Saud University Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | | | | | - Shorook Al Herz
- King Fahad National Guard Hospital, Riyadh, Kingdom of Saudi Arabia
| | | | - Khalid Al Nemer
- School of Medicine, Al-Imam Mohammad Ibn Saud Islamic University (IMSIU), Riyadh, Kingdom of Saudi Arabia
| | - Othman Metwally
- King Fahad General Hospital, Jeddah, Kingdom of Saudi Arabia
| | - Akram Alkhadra
- King Fahad Hospital of the University, Khobar, Kingdom of Saudi Arabia
| | - Mohammed Fakhry
- King Fahad Hospital of the University, Khobar, Kingdom of Saudi Arabia
| | | | | | | | | | | | | | | | - Khalid Al-Waili
- Department of Biochemistry, Sultan Qaboos University Hospital, P.O. Box 38, Al-Khod, 123 Muscat, Oman
| | - Khamis Al-Hashmi
- Department of Physiology, College of Medicine & Health Sciences, Sultan Qaboos University, Muscat, Oman
| | - Raul D. Santos
- Lipid Clinic Heart Institute (InCor), University of Sao Paulo Medical School Hospital, Sao Paulo, Brazil
| | - Khalid Al-Rasadi
- Department of Biochemistry, Sultan Qaboos University Hospital, P.O. Box 38, Al-Khod, 123 Muscat, Oman
| |
Collapse
|
17
|
Wang CJ, Wang YL, Li ZX, Wang YJ. The Management of LDL Cholesterol and Predictors of Goal Achievement in Stroke Patients in China: A Cross-Sectional Study. CNS Neurosci Ther 2016; 22:577-83. [PMID: 27297687 DOI: 10.1111/cns.12543] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/01/2016] [Accepted: 03/02/2016] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE To assess the management of low-density lipoprotein cholesterol (LDL-C) in patients suffering from ischemic stroke within 6-12 months and explore the predictors of the achievement of LDL-C target. METHODS This study was a nation-wide, multicenter, cross-sectional study conducted from July 2013 to August 2013 in mainland China. Patients who had an ischemic stroke within 6-12 months and were more than 18 year old were consecutively included into this study. All data referred to personal information, medical history, medication and results from laboratory tests were collected by face-to-face questionnaires, physical examination and blood tests. The predictors for the achievement of LDL-C target (<1.8 mmol/L or <70 mg/dL) were analyzed by the multivariate analysis. RESULTS A total of 3956 cases from 56 centers who suffered from ischemic stroke within 6-12 months were finally included into this study. The average serum level of LDL-C in all patients was 2.42 ± 0.91 mmol/L with a median of 2.30 mmol/L and the total LDL-C goal achievement rate was 27.4% (95% CI: 26.0%-28.8%). Lipid-lowering therapy (odds ratio [OR] = 3.54, 95% CI: 2.879-4.388) was the most significant predictor for LDL-C target achievement and female (OR = 0.64, 95% CI: 0.526-0.777), current smoking (OR = 0.714, 95% CI: 0.571-0.892), and the history of dyslipidemia (OR = 0.577, 95% CI: 0.497-0.668) were other three important negative factors for the LDL-C goal achievement. CONCLUSION Although lipid modulation is recommended as an important intervention for stroke patients in the international guidelines, the goal achievement of LDL-C is still very low in this population in mainland China. The modifiable predictors including the use of lipid-lowering medication and smoking cessation should be improved in secondary prevention of stroke.
Collapse
Affiliation(s)
- Chun-Juan Wang
- Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yi-Long Wang
- Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Zi-Xiao Li
- Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| | - Yong-Jun Wang
- Tiantan Clinical Trial and Research Center for Stroke, Department of Neurology, Beijing Tiantan Hospital, Capital Medical University, Beijing, China.,China National Clinical Research Center for Neurological Diseases, Beijing, China.,Center of Stroke, Beijing Institute for Brain Disorders, Beijing, China.,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China
| |
Collapse
|
18
|
Du R, Zhao XQ, Cai J, Cui B, Wu HM, Ye P. Changes in carotid plaque tissue composition in subjects who continued and discontinued statin therapy. J Clin Lipidol 2016; 10:587-93. [DOI: 10.1016/j.jacl.2016.01.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 01/13/2016] [Indexed: 12/13/2022]
|
19
|
Pan L, Yang Z, Wu Y, Yin RX, Liao Y, Wang J, Gao B, Zhang L. The prevalence, awareness, treatment and control of dyslipidemia among adults in China. Atherosclerosis 2016; 248:2-9. [PMID: 26978581 DOI: 10.1016/j.atherosclerosis.2016.02.006] [Citation(s) in RCA: 238] [Impact Index Per Article: 29.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 01/17/2016] [Accepted: 02/02/2016] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To analyze the prevalence, awareness, treatment, control and epidemiological characteristics of dyslipidemia in Chinese adults. METHODS In this cross-sectional study, we adopted a multi-stage, stratified sampling method to obtain representative samples of the general population aged >18 years from different urban and rural regions in China. All subjects completed a lifestyle and medical history questionnaire and were examined for risk factors. Dyslipidemia was defined according to criteria of the 2007 Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. Continuous variables were compared using variance analysis. Multivariate logistic regression analysis was performed to explore the risk factors of dyslipidemia. RESULTS The prevalence of dyslipidemia was 34.0% overall, and 35.1%, and 26.3% in urban and rural areas, respectively. The prevalence of dyslipidemia was significantly higher in men than women (41.9% vs 32.5%; P < 0.001). Rates of awareness, treatment, and control were 31.0%, 19.5%, and 8.9%, respectively. Increasing age (OR = 1.012; 95% CI:1.010, 1.014), male sex (OR = 1.411; 95% CI:1.318, 1.510), obesity (OR = 1.424; 95% CI:1.345, 1.507), cardiovascular disease (OR = 1.343; 95% CI:1.125, 1.603), diabetes (OR = 1.955; 95% CI:1.751, 2.182), hypertension (OR = 1.481; 95% CI:1.391, 1.577) and hyperuricemia (OR = 2.223; 95% CI:2.060, 2.399) were independent risk factors of dyslipidemia. CONCLUSION The prevalence of dyslipidemia among Chinese adults was high but awareness, treatment, and control of dyslipidemia were low. Urban high income earners and rural medium income earners show higher prevalence. Low income earners in urban and rural population have the worst awareness treatment, and control rate. There is an increased need for closely monitoring and controlling high risk factors in the populations including postmenopausal women, unhealthy lifestyle peoples and patients with chronic non-communicable diseases.
Collapse
Affiliation(s)
- Ling Pan
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, China; Guangxi Medical University Institute of Urinology, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Zhenhua Yang
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, China; Guangxi Medical University Institute of Urinology, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Yue Wu
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, China; Guangxi Medical University Institute of Urinology, Nanning, 530021, Guangxi Zhuang Autonomous Region, China
| | - Rui-Xing Yin
- Cardiology Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, China
| | - Yunhua Liao
- Renal Division, Department of Medicine, First Affiliated Hospital of Guangxi Medical University, China; Guangxi Medical University Institute of Urinology, Nanning, 530021, Guangxi Zhuang Autonomous Region, China.
| | - Jinwei Wang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Peking University Health Science Center, Beijing, China
| | - Bixia Gao
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Peking University Health Science Center, Beijing, China
| | - Luxia Zhang
- Renal Division, Department of Medicine, Peking University First Hospital, Beijing, China; Peking University Institute of Nephrology, Peking University Health Science Center, Beijing, China
| |
Collapse
|
20
|
Liu X, Tao L, Cao K, Wang Z, Chen D, Guo J, Zhu H, Yang X, Wang Y, Wang J, Wang C, Liu L, Guo X. Association of high-density lipoprotein with development of metabolic syndrome components: a five-year follow-up in adults. BMC Public Health 2015; 15:412. [PMID: 25896058 PMCID: PMC4409998 DOI: 10.1186/s12889-015-1747-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 02/25/2015] [Indexed: 12/14/2022] Open
Abstract
Background High-density lipoprotein (HDL) is associated with the incidence of metabolic syndrome (MetS). It is unclear whether subjects with different HDL levels develop different components of MetS over time. Our study aimed to determine what MetS components tend to emerge and change relative to different levels of HDL. Methods During the period 2007 to 2012, 4,905 adults in Tongren and Xiaotangshan Hospitals in Beijing were included with no MetS, self-reported type 2 diabetes, or cardiovascular disease at baseline. An association rule was used to determine the changes of MetS components over time. Results The incidence of MetS at follow-up was 3.40% for men and 1.50% for women in the high-normal HDL group; 6.65% and 4.55%, respectively, in the normal HDL group; and 11.05% and 6.45%, respectively, in the low HDL group. The most common transition was from healthy to healthy in normal-high or normal HDL groups (47.2% to 63.8%), whereas 11.7% to 39.9% of subjects with low HDL returned to healthy status or stayed unchanged in the low HDL group. The most common new-onset components were elevated blood pressure (9.2 to 10.0%), elevated high-density lipoprotein (5.5 to 11.0%), and raised fasting glucose (5.4 to 5.5%) in the groups with normal-high or normal HDL. Conclusions The incidence of MetS increased in parallel with the decrease in HDL. Adults with a low HDL level were more susceptible to developing MetS over time. Low HDL seemed to be a pre-existing phase of MetS and may be a crucial status for MetS prevention.
Collapse
Affiliation(s)
- Xiangtong Liu
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Lixin Tao
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Kai Cao
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Zhaoping Wang
- Physical Examination Department, Beijing Tongren Hospital Affiliated to Capital Medical University, No.1 Dongjiao Minxiang, Dongcheng District, Beijing, 100730, China.
| | - Dongning Chen
- Physical Examination Department, Beijing Tongren Hospital Affiliated to Capital Medical University, No.1 Dongjiao Minxiang, Dongcheng District, Beijing, 100730, China.
| | - Jin Guo
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Huiping Zhu
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Xinghua Yang
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Youxin Wang
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Jingjing Wang
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Chao Wang
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Long Liu
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| | - Xiuhua Guo
- School of Public Health, Capital Medical University, No. 10 Xitoutiao, You'anmen Wai, Fengtai District, Beijing, 100069, China. .,Beijing Municipal Key Laboratory of Clinical Epidemiology, Beijing, 100069, China.
| |
Collapse
|
21
|
Achieving optimal lipid goals in the metabolic syndrome: A global health problem. Atherosclerosis 2014; 237:191-3. [DOI: 10.1016/j.atherosclerosis.2014.07.039] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 07/05/2014] [Indexed: 11/21/2022]
|