1
|
Ogawa H, Sekiguchi H, Jujo K, Kawada-Watanabe E, Arashi H, Yamaguchi J, Hagiwara N. Impact of comprehensive management on clinical outcomes in hypertensive patients with coronary artery disease: HIJ-CREATE sub-study. Eur Heart J 2020. [DOI: 10.1093/ehjci/ehaa946.2796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
There are limited data on the effects of blood pressure (BP) control and lipid lowering in secondary prevention of coronary artery disease (CAD) patients. We report a secondary analysis of the effects of BP control and lipid management in participants of the HIJ-CREATE, a prospective randomized trial.
Methods
HIJ-CREATE was a multicenter, prospective, randomized, controlled trial that compared the effects of candesartan-based therapy with those of non-ARB-based standard therapy on major adverse cardiac events (MACE; a composite of cardiovascular death, non-fatal myocardial infarction, unstable angina, heart failure, stroke, and other cardiovascular events requiring hospitalization) in 2,049 hypertensive patients with angiographically documented CAD. In both groups, titration of antihypertensive agents was performed to reach the target BP of <130/85 mmHg. The primary endpoint was the time to first MACE. Incidence of endpoint events in addition to biochemistry tests and office BP was determined during the scheduled 6, 12, 24, 36, 48, and 60-month visits. Achieved systolic BP and LDL-Cholesterol (LDL-C) level were defined as the mean values of these measurements in patients who did not develop MACEs and as the mean values of them prior to MACEs in those who developed MACEs during follow-up.
Results
During a median follow-up of 4.2 years (follow-up rate of 99.6%), the primary outcome occurred in 304 patients (30.3%). Among HIJ-CREATE participants, 905 (44.2%) were prescribed statins on enrollment. Kaplan–Meier curves for the primary outcome revealed that there was no relationship between statin therapy and MACEs in hypertensive patients with CAD. The original HIJ-CREATE population was divided into 9 groups based on equal tertiles based on mean achieved BP and LDL-C during follow-up. For the analysis of subgroups, estimates of relative risk and the associated 95% CIs were generated with a Cox proportional-hazards model (Figure 1). The relation between LDL cholesterol level and hazard ratios for MACEs was nonlinear, with a significant increase of MACEs only in the patients with inadequate controlled LDL-C level even in the patients with tightly controlled BP.
Conclusions
The results of the post-hoc analysis of the HIJ-CREATE suggest that clinicians should pay careful attention to conduct comprehensive management of lipid lowering even in the contemporary BP lowering for the secondary prevention in hypertensive patients with CAD.
Figure 1
Funding Acknowledgement
Type of funding source: None
Collapse
Affiliation(s)
- H Ogawa
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Sekiguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Jujo
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - E Kawada-Watanabe
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Arashi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - J Yamaguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| |
Collapse
|
2
|
Nakawaza M, Arashi H, Nomura H, Kawada-Watanabe E, Ogiso M, Sekiguchi H, Yamaguchi J, Ogawa H, Hagiwara N. P824The clinical impact of polyunsaturated fatty acid on clinical outcomes in acute coronary syndrome with dyslipidemia: HIJ-PROPER sub-analysis. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Polyunsaturated fatty acids, especially omega-3 and -6 series, are key essential nutrients that play an important role in humans to maintain cell membranes and function. A recent randomized trial reported that adding eicosapentaenoic acid (EPA) to statins was beneficial to cardiovascular disease patients who had a residual risk factor. Further, several studies have reported that the low baseline value for EPA to arachidonic acid (AA) ratio is related to worse clinical outcome and plaque vulnerability in coronary artery disease patients. However, effects of baseline EPA/AA ratio on clinical outcomes in ACS patients have not been thoroughly evaluated.
Objectives
This study aimed to examine the impact of baseline eicosapentaenoic acid to arachidonic acid (EPA/AA) ratio on clinical outcomes of acute coronary syndrome (ACS) patients and how lipid-lowering therapy affects serum EPA/AA levels in these patients.
Methods
This is a sub-analysis of HIJ-PROPER assessing the effect of aggressive low-density lipoprotein cholesterol (LDL-C)-lowering treatment with pitavastatin+ezetimibe in 1,734 ACS patients with dyslipidemia. Patients were divided into two groups based on EPA/AA level on admission (cut-off: 0.34 μg/mL; median of baseline EPA/AA level) and clinical outcomes were examined.
Results
Percent reduction of LDL-C from baseline to follow-up and mean LDL-C level during follow-up were similar regardless of baseline EPA/AA ratio. In the low EPA/AA group, the Kaplan–Meier estimate for the primary endpoint at 3 years was 27.2% in the pitavastatin+ezetimibe group, compared with 36.6% in the pitavastatin-monotherapy group [hazard ratio (HR), 0.69; 95% confidence interval (CI), 0.52–0.93; P=0.015). However, in the high EPA/AA group, there was no significant reduction in the primary endpoint by pitavastatin+ezetimibe therapy (HR, 0.92; 95% CI, 0.70–1.20; P=0.52).
Conclusions
Aggressive lipid-lowering therapy with ezetimibe had a positive effect on clinical outcomes in the low EPA/AA group of ACS patients with dyslipidemia, but not in the high EPA/AA group. This effect was independent of LDL-C reduction and suggests that EPA/AA measurement on admission in ACS patients contributes to a “personalized” lipid-lowering approach.
Collapse
Affiliation(s)
- M Nakawaza
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Arashi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Nomura
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - E Kawada-Watanabe
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - M Ogiso
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Sekiguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - J Yamaguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Ogawa
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| |
Collapse
|
3
|
Ogido M, Nomura H, Nakawaza M, Kawada-Watanabe E, Sekiguchi H, Arashi H, Yamaguchi J, Ogawa H, Hagiwara N. P830Differences in the usefulness of aggressive lipid-lowering therapy among single-vessel and multi-vessel coronary artery disease patients: HIJ-PROPER sub-study. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz747.0429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [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] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Acute coronary syndrome (ACS) patients with multi-vessel disease (MVD) are at high risk of recurrent cardiovascular events. Previous study, examining stable atherosclerotic cardiac disease, reported that aggressive lipid-lowering therapy was more beneficial in MVD patients than in single-vessel disease (SVD) patients. However, no report has investigated the effects of aggressive lipid-lowering treatment according to the number of diseased coronary arteries in ACS patients.
Purpose
The purpose of the present study was to elucidate the efficacy of aggressive lipid-lowering therapy in ACS patients with MVD and SVD in modern early invasive strategy era.
Methods
The study population was derived from the HIJ-PROPER study, in which, ACS patients with dyslipidemia were randomized to pitavastatin + ezetimibe therapy (targeting LDL-C less than 70mg/dl) or pitavastatin-monotherapy (targeting LDL-C less than 90mg/dl). In the present study, the treatment efficacy was compared between patients with MVD and SVD. The primary end point was a composite of major advanced cardiovascular events (MACEs), including all-cause death, non-fatal myocardial infarction, non-fatal stroke, and ischemia driven revascularization.
Results
We identified 1702 eligible patients (mean age, 65.6 years; male, 75.6%); 869 patients (51.1%) had MVD and 833 (48.9%) patients had SVD. The rate of acute revascularization was 96.2%. The incidence of MACEs was significantly higher in MVD group compared to SVD group (43.7% vs 25.9%, hazard ratio 1.95, 95% confidence interval 1.65–2.31, p<0.001). In MVD group, there was no significant difference in MACEs between pitavastatin + ezetimibe therapy and pitavastatin-monotherapy group. (43.5% vs. 43.9%, 1.0, 0.82–1.23; p=0.95). However, in SVD group, pitavastatin + ezetimibe therapy showed significantly fewer MACEs than pitavastatin-monotherapy (34.6% vs. 47.4%, 0.72, 0.55–0.94, p=0.02). (Figure)
Conclusion
This study showed that ACS patients with SVD enjoyed significantly greater benefits from pitavastatin + ezetimibe therapy compared with pitavastatin monotherapy, whereas the patients with MVD did not. High rate of revascularization in acute phase of ACS might affect the efficacy of aggressive lipid-lowering therapy and our results in the present study suggest different treatment approach would be necessary in ACS patients with MVD in modern early invasive strategy era.
Collapse
Affiliation(s)
- M Ogido
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Nomura
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - M Nakawaza
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - E Kawada-Watanabe
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Sekiguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Arashi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - J Yamaguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Ogawa
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| |
Collapse
|
4
|
Sekiguchi H, Yoshimura A, Fukushima T, Suzuki K, Ogiso M, Kawada-Watanabe E, Arashi H, Yamaguchi J, Ogawa H, Hagiwara N. P6242Simple risk score for predicting secondary cardiovascular events in ACS patients undergoing contemporary aggressive lipid-lowering management for dyslipidaemia: a sub-analysis of the HIJ-PROPER study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy566.p6242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Sekiguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - A Yoshimura
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - T Fukushima
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Suzuki
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - M Ogiso
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - E Kawada-Watanabe
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Arashi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - J Yamaguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Ogawa
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | | |
Collapse
|
5
|
Sekiguchi H, Yoshimura A, Fukushima T, Suzuki K, Ogiso M, Kawada-Watanabe E, Arashi H, Yamaguchi J, Ogawa H, Hagiwara N. P2531Comparison of risk factors for cardiovascular outcomes between patients with and without diabetes: results from the HIJ-PROPER Study. Eur Heart J 2018. [DOI: 10.1093/eurheartj/ehy565.p2531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- H Sekiguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - A Yoshimura
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - T Fukushima
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - K Suzuki
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - M Ogiso
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - E Kawada-Watanabe
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Arashi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - J Yamaguchi
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - H Ogawa
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | - N Hagiwara
- Tokyo Women's Medical University, Department of Cardiology, Tokyo, Japan
| | | |
Collapse
|
6
|
Kanbayashi K, Yamaguchi J, Fujii S, Kawada-Watanabe E, Arashi H, Sekiguchi H, Ogawa H, Hagiwara N. P1119The impact of serum sitosterol level on clinical outcomes in acute coronary syndrome patients with dyslipidemia: a subanalysis of HIJ PROPER. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx502.p1119] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- K. Kanbayashi
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - J. Yamaguchi
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - S. Fujii
- Cardiovascular Center of Sendai, Sendai, Japan
| | | | - H. Arashi
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - H. Sekiguchi
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - H. Ogawa
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | - N. Hagiwara
- Tokyo Women's Medical University, Cardiology, Tokyo, Japan
| | | |
Collapse
|