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Özlek B, Başaran Ö. Statin Discontinuation: Global Challenge in Secondary Prevention. Am J Cardiol 2024; 212:40. [PMID: 38040281 DOI: 10.1016/j.amjcard.2023.11.051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 11/21/2023] [Indexed: 12/03/2023]
Affiliation(s)
- Bülent Özlek
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
| | - Özcan Başaran
- Department of Cardiology, Faculty of Medicine, Mugla Sitki Kocman University, Mugla, Turkey
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Kayıkcioglu M, Başaran Ö, Doğan V, Mert KU, Mert GÖ, Özdemir İH, Rencüzoğulları İ, Karadeniz FÖ, Tekinalp M, Aşkın L, Demirelli S, Gencer E, Bekar L, Aktaş M, Resulzade MM, Kalçık M, Aksan G, Cinier G, Akay KH, Pekel N, Utku Şenol, Demir V, İnci S, Derviş E, Özlek B, Özlek E, Çelik O, Çil C, Biteker M. Misperceptions and management of LDL-cholesterol in secondary prevention of patients with familial hypercholesterolemia in cardiology practice: Real-life evidence from the EPHESUS registry. J Clin Lipidol 2023; 17:732-742. [PMID: 38072583 DOI: 10.1016/j.jacl.2023.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 09/11/2023] [Accepted: 09/15/2023] [Indexed: 12/18/2023]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is a common inherited disease, leading to premature atherosclerotic cardiovascular disease (ASCVD) due to elevated low-density lipoprotein cholesterol (LDL-C) levels. Achieving LDL-C goals is extremely important for preventing the complications of this fatal disease. We evaluated the management of FH patients with ASCVD in cardiology practice. METHODS We analyzed patients with ASCVD from the nationwide EPHESUS registry, which was conducted in 40 cardiology outpatient clinics, and compared those with and without FH. RESULTS Of the 1482 consecutively enrolled patients with ASCVD, 618 (41.7%) had FH, among which 455 were categorized as 'Possible FH' and 163 as 'Probable or Definite FH'. Proposed LDL-C goals were not attained in more than 90% of the patients with FH. The proportion of those on statin therapy was 77% for possible and 91% for probable or definite FH, whereas 34.2 % and 59.4% were in use of high-intensity statins, respectively. None of the patients were on PCSK-9 inhibitors, and only 2 used ezetimibe. Adverse media coverage was the most common cause of statin discontinuation (32.5% in 'possible FH' and 45.7% in 'probable/definite FH'). The negative impact of media in the decision to stop lipid lowering therapy (LLT) was increasing with education level. CONCLUSIONS In real life most of the FH patients with ASCVD are undertreated in cardiology practice regarding statin dosing and combined LLT. Drug discontinuation rates are notably high and are mostly media-related, and side effects very rarely cause cessation of LLT. Urgent measures are needed to increase the awareness of FH among healthcare providers and patients and to develop improved treatment strategies aimed at preventing the complications of FH.
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Affiliation(s)
- Meral Kayıkcioglu
- Department of Cardiology (Dr Kayıkcioglu), Ege University Faculty of Medicine, İzmir, Turkey.
| | - Özcan Başaran
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Volkan Doğan
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Kadir Uğur Mert
- Department of Cardiology (Dr Mert), Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Gurbet Özge Mert
- Department of Cardiology (Dr Mert), Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | | | - İbrahim Rencüzoğulları
- Department of Cardiology (Dr Rencüzoğulları), Kafkas University Faculty of Medicine, Kars, Turkey
| | - Fatma Özpamuk Karadeniz
- Department of Cardiology (Dr Karadeniz), Karamanoglu Mehmetbey University Faculty of Medicine, Karaman, Turkey
| | - Mehmet Tekinalp
- Department of Cardiology (Dr Tekinalp), Necip Fazıl State Hospital, Kahramanmaras, Turkey
| | - Lütfü Aşkın
- Department of Cardiology (Dr Aşkın), Dr. Ersin Arslan Education and Research Hospital, Gaziantep, Turkey
| | - Selami Demirelli
- Department of Cardiology (Dr Demirelli), Kayseri City Hospital, Kayseri, Turkey
| | - Erkan Gencer
- Department of Cardiology (Dr Gencer), Şanlıurfa Mehmet Akif İnan Education and Research Hospital, Şanlıurfa, Turkey
| | - Lütfü Bekar
- Department of Cardiology (Drs Bekar, Kalçık), Hitit University Faculty of Medicine, Çorum, Turkey
| | - Müjdat Aktaş
- Department of Cardiology (Dr Aktaş), Arnavutköy State Hospital, Istanbul, Turkey
| | | | - Macit Kalçık
- Department of Cardiology (Drs Bekar, Kalçık), Hitit University Faculty of Medicine, Çorum, Turkey
| | - Gökhan Aksan
- Department of Cardiology (Dr Aksan), Samsun Education and Research Hospital, Samsun, Turkey
| | - Göksel Cinier
- Department of Cardiology (Dr Cinier), Siyami Ersek Education and Research Hsopital, Istanbul, Turkey
| | - Kadriye Halli Akay
- Department of Cardiology (Dr Akay), Kocaeli State Hospital, Kocaeli, Turkey
| | - Nihat Pekel
- Department of Cardiology (Dr Pekel), Tekden Private Hospital Denizli, Turkey
| | - Utku Şenol
- Department of Cardiology (Dr Utku Şenol), Eskişehir Acıbadem Hospital, Eskişehir, Turkey
| | - Vahit Demir
- Department of Cardiology (Dr Demir), Yozgat City Hospital, Yozgat, Turkey
| | - Sinan İnci
- Department of Cardiology (Dr İnci), Aksaray University Faculty of Medicine, Aksaray
| | - Emir Derviş
- Department of Cardiology (Dr Derviş), Medipol University Faculty of Medicine, Istanbul, Turkey
| | - Bülent Özlek
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology (Drs Başaran, Doğan, Özlek, Özlek, Çelik), Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Cem Çil
- Department of Cardiology (Dr Çil), Medlife Medical Center, Muğla, Turkey
| | - Murat Biteker
- Department of Cardiology (Dr Biteker), Private Fethiye Lokman Hekim Hospital, Mugla, Turkey
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Sonmez A, Demirci I, Haymana C, Tasci I, Ayvalı MO, Ata N, Ezgu FS, Bayram F, Barcin C, Caglayan M, Ülgü MM, Birinci S, Tokgozoglu L, Satman I, Kayikcioglu M. Clinical characteristics of adult and paediatric patients with familial hypercholesterolemia: A real-life cross-sectional study from the Turkish National Database. Atherosclerosis 2023; 375:9-20. [PMID: 37216728 DOI: 10.1016/j.atherosclerosis.2023.04.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 04/22/2023] [Accepted: 04/25/2023] [Indexed: 05/24/2023]
Abstract
BACKGROUND AND AIMS Familial hypercholesterolemia (FH) is the most common cause of premature atherosclerotic cardiovascular disease (ASCVD). Türkiye is among the countries with the highest rate of ASCVD. However, no population-based study has been published so far on the prevalence of FH, demographic and clinical characteristics, burden of ASCVD, treatment compliance, and attainment of low-density lipoprotein cholesterol (LDL-C) targets. METHODS We performed a study using the Turkish Ministry of Health's national electronic health records involving 83,063,515 citizens as of December 2021 dating back 2016. Adults fulfilling the diagnostic criteria of definite or probable FH according to the Dutch Lipid Network Criteria (DLNC), and children and adolescents fulfilling the criteria of probable FH according to the European Atherosclerosis Society (EAS) Consensus Panel report formed the study population (n = 157,790). The primary endpoint was the prevalence of FH. RESULTS Probable or definite FH was detected in 0.63% (1 in 158) of the adults and 0.61% (1 in 164) of the total population. The proportion of adults with LDL-C levels >4.9 mmol/L (190 mg/dL) was 4.56% (1 in 22). The prevalence of FH among children and adolescents was 0.37% (1 in 270). Less than one-third of the children and adolescents, and two-thirds of young adults (aged 18-29) with FH were already diagnosed with dyslipidaemia. The proportion of adults and children and adolescents on lipid-lowering treatment (LLT) was 32.1% and 1.5%, respectively. The overall discontinuation rate of LLT was 65.8% among adults and 77.9% among children and adolescents. Almost no subjects on LLT were found to attain the target LDL-C levels. CONCLUSIONS This nationwide study showed a very high prevalence of FH in Türkiye. Patients with FH are diagnosed late and treated sub-optimally. Whether these findings may explain the high rates of premature ASCVD in Türkiye needs further investigation. These results denote the urgent need for country-wide initiatives for early diagnosis and effective management of FH patients.
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Affiliation(s)
- Alper Sonmez
- Ankara Guven Hospital, Department of Endocrinology and Metabolism, Ankara, Turkiye
| | - Ibrahim Demirci
- University of Health Sciences, Gulhane Training and Research Hospital, Department of Endocrinology and Metabolism, Ankara, Turkiye
| | - Cem Haymana
- University of Health Sciences, Gulhane Faculty of Medicine, Department of Endocrinology and Metabolism, Ankara, Turkiye
| | - Ilker Tasci
- University of Health Sciences, Gulhane Faculty of Medicine, Department of Internal Medicine, Ankara, Turkiye
| | - Mustafa Okan Ayvalı
- General Directorate of the Health Information Systems, Ministry of Health, Ankara, Turkiye
| | - Naim Ata
- Department of Strategy Development, Ministry of Health, Ankara, Turkiye
| | - Fatih Suheyl Ezgu
- Gazi University, Faculty of Medicine, Department of Pediatric Endocrinology, Ankara, Turkiye
| | - Fahri Bayram
- Erciyes University, Faculty of Medicine, Department of Endocrinology and Metabolism, Kayseri, Turkiye
| | - Cem Barcin
- University of Health Sciences, Gulhane Faculty of Medicine, Department of Cardiology, Ankara, Turkiye
| | - Murat Caglayan
- University of Health Sciences, Yildirim Beyazit Training and Research Hospital, Department of Biochemistry, Ankara, Turkiye
| | - Mustafa Mahir Ülgü
- General Directorate of the Health Information Systems, Ministry of Health, Ankara, Turkiye
| | - Suayip Birinci
- Deputy Health Minister, Ministry of Health, Ankara, Turkiye
| | - Lale Tokgozoglu
- Hacettepe University, Faculty of Medicine, Department of Cardiology, Ankara, Turkiye
| | - Ilhan Satman
- Istanbul University, Istanbul Faculty of Medicine, Department of Internal Medicine, Division of Endocrinology and Metabolism, Istanbul, Turkiye
| | - Meral Kayikcioglu
- Ege University Faculty of Medicine, Department of Cardiology, Izmir, Turkiye.
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Cosín-Sales J, Campuzano Ruiz R, Díaz Díaz JL, Escobar Cervantes C, Fernández Olmo MR, Gómez-Doblas JJ, Mostaza JM, Pedro-Botet J, Plana Gil N, Valdivielso P. Impact of physician's perception about LDL cholesterol control in clinical practice when treating patients in Spain. Atherosclerosis 2023; 375:38-44. [PMID: 37245425 DOI: 10.1016/j.atherosclerosis.2023.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 04/26/2023] [Accepted: 04/27/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND AND AIMS We aimed to understand the impact of physicians' perception about LDL-cholesterol (LDLc) control on the management of patients with dyslipidemia in Spain. METHODS We performed a cross-sectional and multicenter study, in which 435 healthcare professionals participated in face-to-face meetings, collecting qualitative and quantitative information related to hypercholesterolemia management. Additionally, aggregated anonymized data of the last 10 patients with hypercholesterolemia attended by each physician were collected. RESULTS A total of 4,010 patients (8%, 13%, 16% and 61% with low, moderate, high, and very high cardiovascular [CV] risk) were included. Physicians' perception was that 62% of their patients attained LDLc goals (66%, 63%, 61% and 56%, for low, moderate, high and very high CV risk, respectively). However, when looking into the data only 31% (vs 62% p<0.01) of patients attained the LDLc goals (47%, 36%, 22% and 25%, respectively). Overall, 33% of patients were taking high intensity statins, 32% statin/ezetimibe, 21% low/moderate intensity statins and 4% PCSK9 inhibitors. These numbers were 38%, 45%, 8% and 6% for very high risk patients and 44%, 21%, 21% and 4% for high CV risk patients. In 32% of patients, a change in lipid lowering therapy was performed after the visit, mainly combining statins/ezetimibe (55%). CONCLUSIONS In Spain, most patients with dyslipidemia do not achieve the recommended LDLc goals because of an insufficient intensification of lipid lowering therapy. On the one hand, this is in part due to physicians misperception on preventive LDLc control and the need for repeated advice to patient, and, on the other, to the lack of patient adherence.
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Affiliation(s)
- Juan Cosín-Sales
- Department of Cardiology, Hospital Arnau de Vilanova, Valencia, Spain.
| | | | - José Luis Díaz Díaz
- Department of Internal Medicine, Hospital Universitario A Coruña, A Coruña, Spain
| | | | | | - Juan José Gómez-Doblas
- Department of Cardiology, Hospital Universitario Virgen de la Victoria-IBIMA CIBERCV, Málaga, Spain
| | | | | | - Núria Plana Gil
- Department of Vascular Medicina and Metabolism, Hospital Universitari Sant Joan de Reus, Tarragona, Spain
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Makhmudova U, Wolf M, Willfeld K, Beier L, Weingärtner O. Different Perspectives of Patients and Physicians on LDL-C Target Achievement in the Treatment of Hypercholesterolemia: Results on Secondary Prevention from the German PROCYON Survey. Adv Ther 2023; 40:460-473. [PMID: 36355313 PMCID: PMC9898401 DOI: 10.1007/s12325-022-02357-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/12/2022] [Indexed: 11/12/2022]
Abstract
AIMS Low-density lipoprotein cholesterol (LDL-C) reduction in hypercholesterolemia patients at very high cardiovascular (CV) risk is essential in preventing future CV events. The objective was to assess the perception on hypercholesterolemia management in secondary prevention in Germany. METHODS PROCYON was a two-part online survey, including a patient questionnaire as well as a physician questionnaire. RESULTS A total of 109 general practitioners, internists, and cardiologists participated. The current ESC/EAS recommendation for high-risk patients is followed by 19.3% of the physicians. The majority (80.7%) reported an LDL-C target failure rate of at least 30%. More than two thirds (71.6%) have stated treating less than half of their patients with the maximum approved statin dose. The survey included 1696 secondary prevention patients. The majority (86.7%) consult their general practitioner for hypercholesterolemia; 54.0% consult a cardiologist (multiple answers allowed). Most patients (87.0%) were receiving lipid-lowering medication. Among these, 800 (54.2%) reported improved LDL-C levels since diagnosis, 569 (38.6%) reported no improvement, and 106 (7.2%) had no information. Of the treated patients with (N' = 800) and without (N' = 569) improvement, 34.3% vs. 37.3% were on their initial drug and dose, 24.8% vs. 23.7% received multiple drug therapy, 48.9% vs. 48.9% reported a dose change, and 16.1% vs. 14.2% had discontinued at least one drug (multiple answers). Disease knowledge was rated as good or very good by 29.8% of patients. CONCLUSION PROCYON demonstrated insufficient ESC/EAS guideline implementation regarding target levels and therapeutic escalation strategies. Furthermore, a lack of specialist involvement and patient education was identified.
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Affiliation(s)
- Umidakhon Makhmudova
- grid.275559.90000 0000 8517 6224Klinik Für Innere Medizin I, Universitätsklinikum Jena, Am Klinikum 1, 07747 Jena, Germany
| | - Michaela Wolf
- Cholesterin & Co E. V.: Patientenorganisation Für Patienten Mit Familiärer Hypercholesterinämie Oder Anderen Schweren Genetischen Fettstoffwechselstörungen (CholCo), Frankfurt/M., Germany
| | - Kathy Willfeld
- grid.467675.10000 0004 0629 4302Novartis Pharma GmbH, Nuremberg, Germany
| | - Lea Beier
- grid.467675.10000 0004 0629 4302Novartis Pharma GmbH, Nuremberg, Germany
| | - Oliver Weingärtner
- Klinik Für Innere Medizin I, Universitätsklinikum Jena, Am Klinikum 1, 07747, Jena, Germany.
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Zhu L, Fang Y, Gao B, Jin X, Zheng J, He Y, Huang J. Effect of an increase in Lp(a) following statin therapy on cardiovascular prognosis in secondary prevention population of coronary artery disease. BMC Cardiovasc Disord 2022; 22:474. [PMID: 36348286 PMCID: PMC9644478 DOI: 10.1186/s12872-022-02932-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/31/2022] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Lipoprotein (a) [Lp(a)] is an independent risk factor for coronary artery disease (CAD). Recent studies have indicated that statins tend to increase Lp(a) levels by 10-20%. However, the association of statin-mediated increases in Lp(a) levels with CAD has not been determined. METHODS: This study included 488 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention (PCI). Lp(a) levels were measured at baseline and 1 month after statin therapy. The study endpoints were major adverse cardiovascular events (MACE). Hazard ratios for the MACE were adjusted for potential confounder using Cox regression. RESULTS After statin therapy, the mean level of Lp(a) increased by 19.3% from baseline. Lp(a) levels increased in 307 patients (62.9%) with a median elevation of 4.1 mg/dL. Patients with an increase in Lp(a) were at higher risk for MACE than those without an increase in Lp(a) (p = 0.044). Subgroup analyses revealed that a mild-to-moderate increase in Lp(a) was not associated with MACE, whereas there was a strong correlation between the highest quartile increase in Lp(a) (≥ 10.1 mg/dL) and MACE (HR = 2.29, 95%CI = 1.36-3.84, p = 0.002). This correlation was independent of baseline Lp(a) levels but not independent of on-statin Lp(a) levels. CONCLUSIONS Severe increases in Lp(a) following statin therapy raise the risk of MACE, but a mild-to-moderate increase in Lp(a) may not affect the cardiovascular prognosis of CAD patients. Even if the baseline Lp(a) levels are low, it is necessary to continue testing for Lp(a) concentration at least once after statin.
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Affiliation(s)
- Lijun Zhu
- Department of Cardiology, Ningbo Municipal Medical Center LiHuili Hospital, Zhejiang, China
| | - Yangliang Fang
- Department of Cardiology, Ningbo Municipal Medical Center LiHuili Hospital, Zhejiang, China
| | - Beibei Gao
- grid.13402.340000 0004 1759 700XDepartment of Cardiology, The Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Xiangbo Jin
- grid.13402.340000 0004 1759 700XDepartment of Cardiology, The Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Jiamin Zheng
- grid.13402.340000 0004 1759 700XDepartment of Cardiology, The Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Ying He
- grid.13402.340000 0004 1759 700XDepartment of Cardiology, The Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
| | - Jinyu Huang
- grid.13402.340000 0004 1759 700XDepartment of Cardiology, The Affiliated Hangzhou First People’s Hospital, Zhejiang University School of Medicine, Zhejiang, China
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Şimşek B, Çınar T, Tanık VO, İnan D, Avcı İİ, Zeren G, Tekkeşin AI, Karabay CY, Gungor B, Tokgozoglu L. In-hospital statin initiation characteristics and one-year statin adherence rates in patients hospitalised for acute coronary syndrome. Acta Cardiol 2021; 76:852-858. [PMID: 32677872 DOI: 10.1080/00015385.2020.1794162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION In the present study, we aimed to evaluate compliance to lipid lowering guidelines regarding statin prescription on discharge and statin adherence rates during a follow-up period of one year in patients hospitalised with a diagnosis of acute coronary syndrome (ACS). METHODS In-hospital records of 3506 ACS patients, of which 771 had experienced an ST-elevation myocardial infarction (STEMI) and 2735 had experienced a non-STEMI, were collected. We calculated medication possession ratios (MPRs) for each subject. We designated patients with ≥9 statin refills/year (MPR ≥ 0.75) as the statin-adherent group and patients with <9 statin refills/year (MPR < 0.75) as the statin-non-adherent group. RESULTS During a 12-month follow-up period, 234 patients in the STEMI group (30.3%) and 391 patients in the non-STEMI group (14.3%) had 12 refills of statin. Thus, only 17.8% of the total study population had complete adherence to statin therapy with an MPR of 1. When patients with ≥9 statin prescriptions were categorised as the statin-adherent group, only 1575 patients (44.9%) were found to be adherent to statin treatment. In multivariate analysis, patients with a non-STEMI diagnosis and high intensity statin treatment had higher rates of non-adherence (OR:1.685, 95%CI:1.412-2.012, p < .01 and OR:1.344, 95% CI: 1.147-1.574, p < .01, respectively). Patients with prior statin treatment had lower rates of non-adherence(OR:0.437, 95%CI: 0.346-0.553, p < .01). CONCLUSION The present study shows that compliance with guidelines regarding statin initiation during hospitalisation and statin adherence rates during a one-year follow-up period are low for patients treated for ACS. Considering the overwhelming clinical benefits of high-intensity statins in patients with ACS, every effort should be made to increase the rate of optimal use of statins in secondary prevention.
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Affiliation(s)
- Barış Şimşek
- Department of Cardiology, Health Science University, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Tufan Çınar
- Department of Cardiology, Health Science University, Sultan Abdülhamid Han Training and Research Hospital, Istanbul, Turkey
| | - Veysel Ozan Tanık
- Department of Cardiology, Ankara Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Duygu İnan
- Department of Cardiology, Health Science University, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - İlhan İlker Avcı
- Department of Cardiology, Health Science University, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Gönül Zeren
- Department of Cardiology, Health Science University, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Ilker Tekkeşin
- Department of Cardiology, Health Science University, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Can Yucel Karabay
- Department of Cardiology, Health Science University, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Baris Gungor
- Department of Cardiology, Health Science University, Dr. Siyami Ersek Training and Research Hospital, Istanbul, Turkey
| | - Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Medical Faculty, Ankara, Turkey
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Mert KU, Başaran Ö, Mert GÖ, Doğan V, Rencüzoğulları İ, Özlek B, Cinier G, Şenol U, Çelik O, Özlek E, Özdemir İH, Karadeniz FÖ, Bekar L, Aktaş M, Resulzade MM, Kalçık M, Aksan G, Akay K, Pekel N, Biteker M, Kayıkçıoğlu M. Management of LDL-cholesterol levels in patients with Diabetes Mellitus in Cardiology Practice: Real-life evidence of Under-treatment from the EPHESUS registry. Eur J Clin Invest 2021; 51:e13528. [PMID: 33630348 DOI: 10.1111/eci.13528] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 02/19/2021] [Accepted: 02/23/2021] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND AIMS Effective treatment of high low-density lipoprotein cholesterol (LDL-C) levels has been shown to improve cardiovascular outcomes of patients with diabetes mellitus (DM). Herein, we aimed to provide insight to the real-life management of patients with DM in terms of LDL-C goal attainment and adherence to lipid management recommendations. Our objective was also to reveal the reasons of poor LDL-C goal attainment by assessing the perceptions of both physicians and patients. METHODS We compared the diabetic and non-diabetic patients from the database of a nationwide registry conducted in cardiology outpatient clinics with regard to the demographic characteristics, educational status, comorbidities, medications, laboratory parameters and LDL-C goal attainment. Also, both the patients and attending physicians were surveyed to analyse perceptions and awareness of hypercholesterolemia. RESULTS Of the 1868 consecutively enrolled patients, 873 (47%) had DM. Proportion of patients on statins was significantly lower in patients with DM (67.8% vs 55.3%; P < .001). The proportion of patients who attained LDL-C targets were lower among the diabetic patients (17.8% vs 15%; P = .06). The most common causes of the discontinuation of statin therapy were negative media coverage about statins (32.1%), and recommendations of physicians to stop the lipid lowering therapy (29.6%). Analysis of the physician survey revealed that the physicians could determine the off-target patients accurately (negative predictive value 98.4%) while the positive predictive value (48.8%) was low. The reasons for not attaining the LDL-C goals in diabetic patients were not prescription of statins (38%) and inadequate (eg low-dose, non-adherent) statin (28.3%) dosages. CONCLUSIONS In real-life clinical cardiology practice, diabetic patients are far below the recommended LDL-C treatment goals. High-intensity statin treatment in diabetic population is still avoided because of the concerns about polypharmacy and drug interactions. Also, the inertia of physicians and even cardiologists is probably a major cause of refraining of prescription of optimal statin dosages.
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Affiliation(s)
- Kadir Uğur Mert
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Özcan Başaran
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Gurbet Özge Mert
- Department of Cardiology, Eskişehir Osmangazi University Faculty of Medicine, Eskişehir, Turkey
| | - Volkan Doğan
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | | | - Bülent Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Göksel Cinier
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Turkey
| | - Utku Şenol
- Department of Cardiology, Eskisehir Acıbadem Hospital, Eskişehir, Turkey
| | - Oğuzhan Çelik
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Eda Özlek
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | | | | | - Lütfü Bekar
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Müjdat Aktaş
- Department of Cardiology, Kocaeli University Faculty of Medicine Regional Training and Research Hospital, Kocaeli, Turkey
| | | | - Macit Kalçık
- Department of Cardiology, Hitit University Faculty of Medicine, Çorum, Turkey
| | - Gökhan Aksan
- Department of Cardiology, Sisli Hamidiye Etfal Research and Training Hospital, İstanbul, Turkey
| | - Kadriye Akay
- Department of Cardiology, Kocaeli State Hospital, Kocaeli, Turkey
| | - Nihat Pekel
- Department of Cardiology, Tekden Private Hospital, Denizli, Turkey
| | - Murat Biteker
- Department of Cardiology, Muğla Sıtkı Koçman University Faculty of Medicine, Muğla, Turkey
| | - Meral Kayıkçıoğlu
- Department of Cardiology, Ege University Faculty of Medicine, İzmir, Turkey
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9
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Tokgozoglu L, Kayikcioglu M, Ekinci B. The landscape of preventive cardiology in Turkey: Challenges and successes. Am J Prev Cardiol 2021; 6:100184. [PMID: 34327504 PMCID: PMC8315400 DOI: 10.1016/j.ajpc.2021.100184] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Revised: 03/24/2021] [Accepted: 04/04/2021] [Indexed: 12/20/2022] Open
Abstract
Turkey, like many countries, is facing a growing burden of non-communicable disease (NCD)s and is among the countries with high cardiovascular mortality in Europe. Moreover, Turkey currently has the highest rate of premature cardiovascular disease (CVD) in Europe. During the last decades, Turkey made fundamental reforms in the health system to improve the treatment of risk factors to prevent CVD. The most outstanding success was in the area of tobacco control (13.4% decrease in smoking prevalence) and decreasing the salt consumption of the population (from 18 to 9.9 g/day) leading to a significant decrease in CVD mortality from 45% to 36.8% of all deaths. However, obesity and diabetes are increasing rapidly as a result of urbanization, low physical activity and unhealthy eating and the new generation is starting to take up smoking. The increase in cardiometabolic risk factors and aging of the population are expected to increase the number of CVD deaths. All CVD risk factors except smoking are significantly more prevalent in women. In addition, rare disease is a country specific problem with a significant contribution to the high rates of premature CVD in Turkey. Despite major improvements in management in acute coronary syndromes, sustained achievement in guideline recommended goals is suboptimal. In patients with a previous cardiovascular event smoking rate is 25.5%, 80.9% of these patients are overweight (BMI ≥25 kg/m2), 30% obese (BMI ≥30 kg/m2), and LDL‐cholesterol targets of 70 mg/dL are attained in only 18%. Herein, we scrutinize the achievements and challenges of Turkey in establishing a ‘National Heart Health Policy’ aiming to decrease the burden of CVD and its risk factors.
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Affiliation(s)
- Lale Tokgozoglu
- Department of Cardiology, Hacettepe University Medical Faculty, Ankara, Turkey
| | - Meral Kayikcioglu
- Department of Cardiology, Ege University Medical Faculty, Izmir, Turkey
| | - Banu Ekinci
- Department of Chronic Disease and Elderly Health, Ministry of Health, Ankara, Turkey
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10
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Froylan D MS, Esteban JG, Carlos PR, Aida X MU, Ma Rocío MA, Horacio OA, Juan G JR. Prevalence of poor lipid control in patients with premature coronary artery disease. Nutr Metab Cardiovasc Dis 2020; 30:1697-1705. [PMID: 32571615 DOI: 10.1016/j.numecd.2020.04.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/22/2020] [Accepted: 04/29/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND AIMS Lipid goals have become more stringent in high risk patients. However, no studies have analyzed lipid control defined as the composite achievement of goals in low-density lipoprotein cholesterol (LDL-C), non-high-density lipoprotein cholesterol (Non-HDL-C) and apolipoproteinB-100 (ApoB-100), in patients with premature coronary artery disease (CAD). We aimed to analyze lipid control rates, and the associated factors with its poor achievement in patients with premature CAD. METHODS AND RESULTS The study included 1196 patients with CAD diagnosed before 55 and 65 years old in men and women, respectively. The American Heart Association/American College of Cardiology (non-strict) and the American Association of Clinical Endocrinologists (strict) criteria were used to analyze lipid control rates. Sociodemographic, dietary-healthy and clinical characteristics of the patients were collected. Participants were 54 ± 8 years old, 19.7% were women, and median CAD evolution was 2.4 years. Non-strict and strict lipid control was achieved in 23.0% and 8.9% of the patients, respectively. Moreover, 46.5% and 62.8% of the patients did not achieve any lipid goal using both criteria. Sociodemographic data were not different among patients who achieved or not lipid control. Treatment adherence<85%, prescription of low- and moderate-intensity statins, and obesity were consistently associated with poor lipid control. CONCLUSIONS Lipid control is suboptimal in patients with premature CAD. Low lipid-lowering treatment adherence, low prescription of high-intensity statins, and obesity were independently associated with poor lipid control. Novel preventive programs and more aggressive pharmacological intervention should be implemented in order to reduce the burden of premature CAD.
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Affiliation(s)
- Martínez-Sánchez Froylan D
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Jorge-Galarza Esteban
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Posadas-Romero Carlos
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Medina-Urrutia Aida X
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Martínez-Alvarado Ma Rocío
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
| | - Osorio-Alonso Horacio
- Department of Cardio-Renal Physiopathology, Instituto Nacional de Cardiología Ignacio Chávez, Mexico.
| | - Juárez-Rojas Juan G
- Department of Endocrinology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1, Sección XVI, C.P. 14080, Tlalpan, Mexico City, Mexico.
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11
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Gomez-Barrado JJ, Gomez-Turegano P, Ortiz-Cortes C, Vega-Fernandez J, Gomez-Turegano M, Garciperez de Vargas FJ, Lezcano Gort LE, Kounka Z, Roque Rodriguez B, Chipayo Gonzales D, Perez-Espejo P, Fernandez-Chamorro AI, Beltran Moreno M, Romero Castro MJ, Mogollon Jimenez MV, Marcos Gomez G, Porras Ramos Y. Low-Density Lipoprotein Cholesterol Targets in Patients With Coronary Heart Disease in Extremadura (Spain): LYNX Registry. Cardiol Res 2020; 11:311-318. [PMID: 32849966 PMCID: PMC7430891 DOI: 10.14740/cr1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/11/2020] [Indexed: 11/13/2022] Open
Abstract
Background Low-density lipoprotein cholesterol (LDL-C) contributes decisively to the development of cardiovascular disease (CVD). In the LYNX registry we determined the rate of achievement of the target value of LDL-C, the use of lipid-lowering therapy (LLT) and the predictive factors of not reaching the target in patients with stable coronary heart disease (CHD). Methods LYNX included consecutive patients with stable CHD treated at the University Hospital of Caceres, Extremadura (Spain) from September 2016 to September 2018, and those who must have an LDL-C target below 70 mg/dL according to the European Society of Cardiology (ESC) 2016 guidelines. The variables independently associated with the breach of the LDL-C objective were evaluated by multivariable logistic regression. Results A total of 674 patients with stable CHD were included. The average LDL-C levels were 68.3 ± 24.5 mg/dL, with 56.7% showing a level below 70 mg/dL. LLT was used by 96.7% of patients, 71.7% were treated with high-powered statins and 30.1% with ezetimibe. The risk of not reaching the target value of LDL-C was higher in women, in active smokers, and in those who had multivessel CHD or had atrial fibrillation. Patients with diabetes mellitus, those who took potent statins or co-administration treatment with ezetimibe were more likely to reach the target level of LDL-C. Conclusions The treatment of dyslipidemia in patients with chronic CHD remains suboptimal; however, an increasing number of very high-risk patients achieve the LDL-C objective, although there is still enormous potential to improve cardiovascular outcome through the use of more intensive LLT.
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Affiliation(s)
- Jose Javier Gomez-Barrado
- San Pedro de Alcantara University Hospital, Caceres, Extremadura, Spain.,Department of Biomedical Sciences, University of Extremadura, Extremadura, Spain
| | | | | | | | | | | | | | - Zineb Kounka
- San Pedro de Alcantara University Hospital, Caceres, Extremadura, Spain
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12
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Silverio A, Benvenga RM, Piscione F, Gulizia MM, Meessen JMTA, Colivicchi F, Nardi F, Baldi C, Galasso G, Vecchione C, Di Lenarda A, Gabrielli D, De Luca L. Prevalence and Predictors of Out-of-Target LDL Cholesterol 1 to 3 Years After Myocardial Infarction. A Subanalysis From the EYESHOT Post-MI Registry. J Cardiovasc Pharmacol Ther 2020; 26:149-157. [PMID: 32757779 DOI: 10.1177/1074248420947633] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
BACKGROUND There is an incomplete understanding of the prevalence and predictors of attainment of low-density lipoprotein cholesterol (LDL-C) goal after myocardial infarction (MI). AIM To evaluate the prevalence of achievement of LDL-C goal of 70 mg/dL, to identify the baseline features associated with suboptimal lipid control, and to assess the use of LDL-C-lowering drug therapies (LLT) beyond the first year after MI. METHODS The EYESHOT Post-MI was a prospective, cross-sectional, Italian registry, which enrolled patients presenting to cardiologist 1 to 3 years after MI. In this retrospective post-hoc analysis, patients were categorized in 2 groups according to the achievement or not of the LDL-C goal of 70 mg/dL. Univariable and multivariable logistic regression analyses were performed to identify the baseline features associate with LDL-C≥70 mg/dL. RESULTS The study population included 903 patients (mean age 65.5 ± 11.5 years). Among them, LDL-C was ≥70 mg/dL in 474 (52.5%). Male sex (P = 0.031), hypertension (P = 0.024), prior percutaneous coronary intervention (P = 0.016) and high education level (P = 0.008) were higher in the LDL-C <70 group. At multivariable analysis, low education level was an independent predictor of LDL-C≥70 mg/dL (OR:1.582; 95%CI, 1.156-2.165; P = 0.004). Conversely, hypertension increased the probability to achieve the LDL-C goal (OR:0.650; 95%CI, 0.443-0.954; P = 0.028). Among off-target patients, LLT was not modified in the majority of cases (67.3%), intensified in 85 (18.6%), and actually reduced in 63 patients (13.8%). CONCLUSIONS In patients presenting to cardiologists 1 to 3 years from the last MI event, LDL-C is not under control in a large proportion of patients, particularly in those with a low education level or without hypertension. LLT is underused in this very-high-risk setting.
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Affiliation(s)
- Angelo Silverio
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Rossella Maria Benvenga
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Federico Piscione
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Michele M Gulizia
- Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy.,Fondazione per il Tuo cuore-HCF onlus, Florence, Italy
| | - Jennifer M T A Meessen
- Department of Cardiovascular Medicine, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy
| | | | - Federico Nardi
- Division of Cardiology, 18526Santo Spirito Hospital, Casale Monferrato, Alessandria, Italy
| | - Cesare Baldi
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Gennaro Galasso
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
| | - Carmine Vecchione
- Division of Cardiology, University Hospital S. Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.,Vascular Pathophysiology Unit, IRCCS Neuromed, Pozzilli, Isernia, Italy
| | - Andrea Di Lenarda
- Division of Cardiology, Azienda Sanitaria Universitaria Integrata di Trieste, Italy
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13
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Wierzbicki AS. Treating lipids in secondary prevention in a developing country: Lies, damn lies and the internet. Int J Clin Pract 2019; 73:1-3. [PMID: 31168908 DOI: 10.1111/ijcp.13381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Anthony S Wierzbicki
- Department of Metabolic Medicine/Chemical Pathology, Guy's & St Thomas' Hospitals, London, UK
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