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Atorvastatin treatment and LDL cholesterol target attainment in patients at very high cardiovascular risk. Clin Res Cardiol 2016; 105:783-90. [PMID: 27120330 PMCID: PMC4989032 DOI: 10.1007/s00392-016-0991-z] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Accepted: 04/19/2016] [Indexed: 10/28/2022]
Abstract
The use of atorvastatin is rapidly increasing among statins since the introduction of generics. However, only limited data are available on its current use and the effectiveness outside of randomised trials. The aim of the study was to assess low-density lipoprotein (LDL-C) levels in ambulatory patients at very high cardiovascular risk on atorvastatin therapy in physician's offices. A total of 2625 high-risk patients on atorvastatin were included into this cross-sectional study by 539 office-based physicians between June and December 2014. 47.0 % of the patients had documented coronary heart disease (CHD), 25.1 % type 2 diabetes mellitus (DM), and 27.9 % CHD plus concomitant DM. The mean age was 66.1 ± 10.8 years, 62.1 % were male. Atorvastatin at the dose of 10, 20, 40 and 80 mg/day was administered in 15.6, 45.7, 33.9, and 4.8 % of the patients, respectively. The treatment duration was 92.6 ± 109.6 weeks. The mean atorvastatin dose at therapy start was 24.8 ± 15.2 mg/day and at time of documentation 27.9 ± 15.8 mg/day. Low-density lipoprotein cholesterol (LDL-C) <70 mg/dL was achieved by 10.5 % of the total cohort (7.5 % in DM, 9.3 % in CHD, and 15.2 % in CHD + DM). In contrast, according to physicians' subjective assessment, 62.7 % of patients (with small differences between groups) had reached their individual LDL-C target. In summary, higher doses of atorvastatin are not frequently used in clinical practice. The LDL-C target level <70 mg/dL as recommended by current guidelines is achieved only in a minority of atorvastatin treated patients at very high cardiovascular risk.
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Danchin N, Lettino M, Zeymer U, Widimsky P, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Lopez Sendón J, Tousek P, Weidinger F, Weston CFM, Zaman A, Andell P, Li J, Jukema JW. Use, patient selection and outcomes of P2Y12 receptor inhibitor treatment in patients with STEMI based on contemporary European registries. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2016; 2:152-67. [PMID: 27533757 DOI: 10.1093/ehjcvp/pvw003] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Accepted: 01/20/2016] [Indexed: 11/13/2022]
Abstract
AIMS Among acute coronary syndromes (ACS), ST-segment elevation myocardial infarction (STEMI) has the most severe early clinical course. We aimed to describe the effectiveness and safety of P2Y12 receptor inhibitors in patients with STEMI based on the data from contemporary European ACS registries. METHODS AND RESULTS Twelve registries provided data in a systematic manner on outcomes in STEMI patients overall, and seven of these also provided data for P2Y12 receptor inhibitor-based dual antiplatelet therapy. The registries were heterogeneous in terms of site, patient, and treatment selection, as well as in definition of endpoints (e.g. bleeding events). All-cause death rates based on the data from 84 299 patients (9612 patients on prasugrel, 11 492 on ticagrelor, and 27 824 on clopidogrel) ranged between 0.49 and 6.68% in-hospital, between 3.07 and 7.95% at 30 days (reported in 6 registries), between 8.15 and 9.13% at 180 days, and between 2.41 and 9.58% at 1 year (5 registries). Major bleeding rates were 0.09-3.55% in-hospital (8 registries), 0.09-1.65% at 30 days, and 1.96% at 1 year (only 1 registry). Fatal/life-threatening bleeding was rare occurring between 0.08 and 0.13% in-hospital (4 registries) and 1.96% at 1 year (1 registry). CONCLUSIONS Real-world evidence from European contemporary registries shows that death, ischaemic events, and bleeding rates are lower than those reported in Phase III studies of P2Y12 inhibitors. Regarding individual P2Y12 inhibitors, patients on prasugrel, and, to a lesser degree, ticagrelor, had fewer ischaemic and bleeding events at all time points than clopidogrel-treated patients. These findings are partly related to the fact that the newer agents are used in younger and less ill patients.
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Affiliation(s)
- Nicolas Danchin
- Department of Cardiology, Hospital Europeen Georges Pompidou, AP-HP, Paris, France Université Paris Descartes, Paris, France
| | - Maddalena Lettino
- Cardiology Unit Humanitas Research Hospital, Rozzano (Milano), Italy
| | - Uwe Zeymer
- Interventional Cardiology, Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Alfredo Bardaji
- Cardiology Service, Hospital Universitari de Tarragona Joan XXIII, IISPV Tarragona, Spain
| | - Jose A Barrabes
- Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Angel Cequier
- Heart Disease Institute Bellvitge University Hospital IDIBELL, University of Barcelona, Barcelona, Spain
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Leonardo De Luca
- Department of Cardiovascular Sciences, Laboratory of Interventional Cardiology European Hospital, Rome, Italy
| | - Jakob Dörler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - David Erlinge
- Department of Cardiology, Lund University, Skåne University Hospital, Lund, Sweden
| | - Paul Erne
- AMIS-Plus Data Center University of Zurich, Zurich, Switzerland
| | - Patrick Goldstein
- Pôle de l'urgence, Service de SAMU du Nord, Centre Hospitalier régional Universitaire de Lille, Lille, France
| | - Sasha M Koul
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Gilles Lemesle
- Cardiac Intensive Care Unit, Interventional Cardiology Hopital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Thomas F Lüscher
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian M Matter
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gilles Montalescot
- Université Paris 06, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Franz Weidinger
- 2nd Department of Medicine with Cardiology and Intensive Care, Hospital Rudolfstiftung, Vienna, Austria
| | | | - Azfar Zaman
- Cardiology Freeman Hospital and Institute of Cellular Medicine, Newcastle Upon Tyne, UK
| | - Pontus Andell
- Department of Cardiology, Skåne University Hospital, Lund, Sweden
| | - Jin Li
- Department of Cardiology, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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