Intensive treatment of dyslipidemia in regional outpatient cardiology office

Czech version

Authors: Alexander Klabník
Authors‘ workplace: Kardiologická ambulancia, Námestovo
Published in: AtheroRev 2017; 2(3): 169-174
Category: Reviews

Overview

We presented briefly initial experiences of outpatient cardiologist in the first ever MedPed center in the Orava region. Reduction of low-density lipoprotein cholesterol (LDL) is recognized as the single most effective strategy for reduction of cardiovascular events. Familial hypercholesterolemia is common and under-recognized cause of premature atherosclerosis. It is undertreated worldwide despite urgent need to early, long-term and aggressive treatment. However, in routine clinical practice many patients fail to reach their LDL treatment goal due to low compliance and intolerance or poor therapeutic response. In addition, several patients are intolerant to statins due to side effects. Many physicians do not up-titrate statin doses sufficient to attain LDL targets. Recommended goals are difficult to achieve in the majority of patients with widely available treatments (highest tolerable doses of potent statins with monotherapy alone or in combination with ezetimibe). Promising results of clinical trials with PCSK9 inhibitors opened new therapeutic horizons but they may not be cost-effective at current costs.

Key words:
alirocumab, evolocumab, ezetimibe, familial hypercholesterolemia, high intensity statin

Sources

1. Nordestgaard BG, Chapman MJ, Humphries SE et al. [European Atherosclerosis Society Consensus Panel]. Familial hypercholesterolaemia is underdiagnosed and undertreated in the general population: guidance for clinicians to prevent coronary heart disease. Consensus Statement of the European Atherosclerosis Society. Eur Heart J 2013; 34(45): 3478–3490. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/eht273>.

2. Bell DA, Hooper AJ, Bender R et al. Opportunistic screening for familial hypercholesterolaemia via a community laboratory. Ann Clin Biochem 2012; 49(Pt 6): 534–537. Dostupné z DOI: <http://dx.doi.org/10.1258/acb.2012.012002>.

3. Junyent M, Gilabert R, Daniel Zambón D et al. The use of Achilles tendon sonography to distinguish familial hypercholesterolemia from other genetic dyslipidemias. Arterioscler Thromb Vasc Biol 2005; 25(10): 2203–2208.

4. Wu J, Zhu S, Yao GL et al. Patient factors influencing the prescribing of lipid lowering drugs for primary prevention of cardiovascular disease in UK general practice: a national retrospective cohort study. PLoS ONE 2013; 8(7): e67611. Dostupné z DOI: <http://dx.doi.org/10.1371/journal.pone.0067611>.

5. van Duijn HJ, Belo JN, Blom JW, Velberg ID et al. Revised guidelines for cardiovascular risk management – time to stop medication? A practice-based intervention study. Br J Gen Pract 2011, 61(587): e347–352. Dostupné z DOI: <http://dx.doi.org/10.3399/bjgp11X578025>.

6. LaRosa JC, Grundy SM, Waters DD et al. [Treating to New Targets (TNT) Investigators]. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med 2005; 352(14): 1425–1435.

7. Nissen SE, Tuzcu EM, Schoenhagen P et al. [REVERSAL Investigators]. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. JAMA 2004; 291(9): 1071–1080.

8. Jellinger PS, Handelsman Y, Rosenblit PD et al. American association of clinical endocrinologists and American college endocrinology guidelines for management of dyslipidemia and prevention of cardiovascular disease. Endocrine Practice 2017; 23 (Suppl 2): 1–87. Dostupné z DOI: <http://dx.doi.org/10.4158/EP171764.APPG>.

9. Pearson TA, Laurora I, Chu H et al. The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med 2000; 160(4): 459–467.

10. Hansen WE, Seitz I, Ortner A. Enfluss der Korperlage und der venosen Stauung auf die Blutfettspiegel. Dtch Med Wochenschr 1990, 115(11): 408–411.

11. Piťha J. Jak (s)tvořit spolupracujícího pacienta pro antihypertenzní a hypolipidemickou léčbu. Vnitř Lék 2017; 63(4): 272–276.

12. Jorstad HT, von Birgele C, Alings AMW et al. Effect of a nurse-coordinated prevention programme on cardiovascular risk after an acute coronary syndrome: main results of the RESPONSE randomised trial. Heart 2013, 99(19): 1421–1430. Dostupné z DOI: <http://dx.doi.org/10.1136/heartjnl-2013–303989>.

13. Kostis JB, Dobrzynski JM. The effect of statins on erectile dysfunction: a meta-analysis of randomized trials. J Sex Med 2014; 11(7):1626–1635. Dostupné z DOI: <http://dx.doi.org/10.1111/jsm.12521>.

14. Nielsen SF, Nordestgaard BG. Negative statin-related news stories decrease statin persistence and increase myocardial infarction and cardiovascular mortality: a nationwide prospective cohort study. Eur Heart J 2016; 37(11): 908–916. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehv641>.

15. Thomas M, Mann J. Increased thrombotic vascular events after change of statin. Lancet 1998; 352(9143): 1830–1831.

16. McGowan MP. There is no evidence for an increase in acute coronary syndromes after short-term abrupt discontinuation in stable cardiac patients. Circulation 2004; 110(16): 2333–2335.

17. Ford I, Murray H, McCowan C et al. Long-term safety and efficacy of lowering low-density lipoprotein cholesterol with statin therapy: 20-year follow-up of West of Scotland Coronary Prevention Study. Circulation 2016; 133(11): 1073–1080. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.115.019014>.

18. Becker DJ, Gordon RY, Morris PB et al. Simvastatin vs therapeutic lifestyle changes and supplements: randomized primary prevention trial. Mayo Clin Proc 2008; 83(7): 758–764. <http://dx.doi.org/10.4065/83.7.758>.

19. Murín J, Pernický M, Wawruch M. Intolerancia statínov. Cardiology Lett 2015; 24(6): 451–457.

20. Preiss D, Seshasai SR, Welsh P et al. Risk of incident diabetes with intensive-dose compared with moderate-dose statin therapy: a meta-analysis. JAMA 2011; 305(24): 2556–2564. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2011.860>.

21. Waters DD, Ho JE, DeMicco DA et al. Predictors of new-onset diabetes in patients treated with atorvastatin: results from 3 large randomized clinical trials. J Am Coll Cardiol 2011; 57(14): 1535–1545. Dostupné z DOI: <http://dx.doi.org/10.1016/j.jacc.2010.10.047>.

22. Rašlová K, Tkáč I, Fábryová Ľ. Racionálna liečba dyslipoproteinémií. Metodický list Ústrednej komisie racionálnej farmakoterapie a liekovej politiky MZ SR č. 36, Marec 2005; 9(1): 1–8. Dostupné z WWW: <https://zona.fmed.uniba.sk/uploads/media/Liecba_dyslipoproteinemii.pdf>.

23. Aguiar C, Alegria E, Bonadonna RC et al. A review of the evidence on reducing macrovascular risk in patients with atherogenic dyslipidaemia: a report from an expert consensus meeting on the role of fenofibrate-statin combination therapy. Atheroscler Suppl 2015; 19: 1–12. Dostupné z DOI: <http://dx.doi.org/10.1016/S1567–5688(15)30001–5>.

24. Kastelein JJ, Akdim F, Stroes ES et al. [ENHANCE investigators]. Simvastatin with or without ezetimibe in familial hypercholesterolemia. N Engl J Med 2008; 358(14): 1431–1443. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa0800742>. Erratum in N Engl J Med 2008; 358(18): 1977.

25. Cannon CP, Blazing MA, Giugliano RP et al. [IMPROVE-IT investigators]. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015; 372(25): 2387–2397. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1410489>.

26. Ridker PM, Revkin J, Amarenco P et al. [SPIRE cardiovascular outcome investigators]. Cardiovascular efficacy and safety of bococizumab in high-risk Patients. N Engl J Med 2017; 376(16):1527–1539. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1701488>.

27. Sabatine MS, Giugliano RP, Keech AC et al. [FOURIER steering committee and investigators]. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med 2017; 376(18): 1713–1722.10.1056/NEJMoa1615664

28. Kazi DS, Penko J, Coxson PG et al. Updated cost-effectiveness analysis of PCSK9 inhibitors based on the results of the FOURIER trial. JAMA 2017; 318(8): 748–750. Dostupné z DOI: <http://dx.doi.org/10.1001/jama.2017.9924>.

29. Fonarow GC, Keech AC, Pedersen TR et al. Cost-effectiveness of evolocumab therapy for reducing cardiovascular events in patients with atherosclerotic cardiovascular disease. JAMA Cardiol 2017; August 23. Dostupné z DOI: <http://dx.doi.org/10.1001/jamacardio.2017.2762>.

30. Virani SS, Akeroyd JM, Nambi V et al. Estimation of eligibility for proprotein convertase subtilisin/kexin type 9 inhibitors and associated costs based on the FOURIER trial (Further cardiovascular OUtcomes Research with PCSK9 Inhibition in subjects with Elevated Risk): insights from the department of Veterans Affairs. Circulation 2017; 135(25): 2572–2574. Dostupné z DOI: <http://dx.doi.org/10.1161/CIRCULATIONAHA.117.028503>.

31. Cannon CP, Khan I, Klimchak AC et al. Simulation of Lipid-Lowering Therapy Intensification in a Population with Atherosclerotic Cardiovascular Disease. JAMA Cardiol 2017; 2(9): 959–966. Dostupné z DOI: <http://dx.doi.org/10.1001/jamacardio.2017.2289>.

Labels

Angiology Diabetology Internal medicine Cardiology General practitioner for adults

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Article was published in

Athero Review

2017 Issue 3