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Candidates for novel lipid-lowering therapies: persistently high on-treatment LDL-C in STEMI and NSTEMI patients
Abstract
171 Biomarkers and risk of atrial fibrillation: a systematic review and meta-analysis R. Pathak 1,∗ , J. Sen 2 , A. Mehta 2 , C. Wong 1 , M. Alasady 1 , D. Lau 1 , W. Abhayaratna 2 , P. Sanders 1 1 Centre for Heart Rhythm Disorders, University of Adelaide, Australia 2 College of Medicine, Biology and Environment, Australian National University and Canberra Hospital, Canberra, Australia
Background: Inflammation and haemodynamic stress are purported to be among the primary causal factors of atrial fibrillation (AF); however, the true impact of these associations with AF remains unclear. Objective: We conducted a systematic review and metaanalysis to evaluate associations between raised biomarkers and AF. Methods: MEDLINE, EMBASE, SCOPUS, and Web of Science were searched for published studies up to May 2014. We used studies that have presented data on the association between raised biomarkers and AF. Summary standardised differences in means (SDM) were obtained using fixed effects models. Results: Of the 472 studies, 10 studies reported various biomarkers that were not used for meta-analysis due to paucity of studies. 16 studies that enrolled a total of 2915 patients were selected for the final analysis (7 for CRP, 4 for IL-6 and 9 for BNP). The SDM of CRP was 0.47 [95% CI: 0.330.60, p <0.001] and IL-6 was 0.56 [95% CI: 0.32-0.80, P <0.001]. There was no evidence of heterogeneity amongst studies for CRP and IL-6 groups (I2 value of 0% for CRP and 21% for IL-6). The SDM of BNP was 0.73 [95% CI: 0.62-0.84] and heterogeneity was present (P <0.001, I2 =85%). Publication bias was not evident for CRP or IL-6 (p =0.4 for CRP; and p=0.1 for IL-6). Conclusions and Relevance: Inflammatory and haemodynamic markers are raised in AF. The underlying mechanisms whereby inflammation and haemodynamic stress may promote the genesis of AF warrant further investigation.
http://dx.doi.org/10.1016/j.hlc.2015.06.172
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172 Candidates for novel lipid-lowering therapies: persistently high on-treatment LDL-C in STEMI and NSTEMI patients N. Hann ∗ , N. Yap, J. Gin, A. Nguyen, H. Adams, A. Wilson St Vincent’s Hospital Melbourne, Australia Introduction: Raised concentrations of LDL cholesterol are one of the key modifiable risk factors for cardiovascular disease. Pharmacological therapy with statins forms the mainstay of treatment for hyperlipidaemia and has proven to be highly effective. Despite this, novel lipid-lowering therapies are being developed which may be able to lower cholesterol levels even further. Purpose: The purpose of this study is to evaluate the proportion of patients on statin therapy presenting with STEMI or NSTEMI who have persistently high LDL-C levels, and therefore who may be candidates for novel lipid-lowering therapies. Methods: Data were collected from patients presenting to the cardiology department of a large metropolitan hospital between 2009 and 2014. The lipid profile of patients on statin therapy presenting with STEMI, NSTEMI or cardiac symptoms without MI was obtained and the proportion with persistently high LDL-C levels (>2.0mmol/L) was calculated. Results: Data from 859 patients on statin therapy were collected, of which 117 presented with either STEMI or NSTEMI. Of these, 77 (65.8%) had LDL-C levels >2.0mmol/L. A further 568 patients presented with cardiac symptoms but not MI, of which 320 (56.3%) had LDL-C levels >2.0mmol/L. The incidence of persistently high LDL-C was thus higher in the STEMI/NSTEMI group (RR 1.168). Conclusion: Our findings suggest a significant proportion of patients presenting with STEMI or NSTEMI have persistently high levels of LDL-C despite statin treatment. Furthermore, a significant proportion of non-MI patients also had high on-treatment LDL-C levels. Patients in both groups may benefit from further reductions in their LDL-C concentrations. http://dx.doi.org/10.1016/j.hlc.2015.06.173
171 Biomarkers and risk of atrial fibrillation: a systematic review and meta-analysis R. Pathak 1,∗ , J. Sen 2 , A. Mehta 2 , C. Wong 1 , M. Alasady 1 , D. Lau 1 , W. Abhayaratna 2 , P. Sanders 1 1 Centre for Heart Rhythm Disorders, University of Adelaide, Australia 2 College of Medicine, Biology and Environment, Australian National University and Canberra Hospital, Canberra, Australia
Background: Inflammation and haemodynamic stress are purported to be among the primary causal factors of atrial fibrillation (AF); however, the true impact of these associations with AF remains unclear. Objective: We conducted a systematic review and metaanalysis to evaluate associations between raised biomarkers and AF. Methods: MEDLINE, EMBASE, SCOPUS, and Web of Science were searched for published studies up to May 2014. We used studies that have presented data on the association between raised biomarkers and AF. Summary standardised differences in means (SDM) were obtained using fixed effects models. Results: Of the 472 studies, 10 studies reported various biomarkers that were not used for meta-analysis due to paucity of studies. 16 studies that enrolled a total of 2915 patients were selected for the final analysis (7 for CRP, 4 for IL-6 and 9 for BNP). The SDM of CRP was 0.47 [95% CI: 0.330.60, p <0.001] and IL-6 was 0.56 [95% CI: 0.32-0.80, P <0.001]. There was no evidence of heterogeneity amongst studies for CRP and IL-6 groups (I2 value of 0% for CRP and 21% for IL-6). The SDM of BNP was 0.73 [95% CI: 0.62-0.84] and heterogeneity was present (P <0.001, I2 =85%). Publication bias was not evident for CRP or IL-6 (p =0.4 for CRP; and p=0.1 for IL-6). Conclusions and Relevance: Inflammatory and haemodynamic markers are raised in AF. The underlying mechanisms whereby inflammation and haemodynamic stress may promote the genesis of AF warrant further investigation.
http://dx.doi.org/10.1016/j.hlc.2015.06.172
S185
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172 Candidates for novel lipid-lowering therapies: persistently high on-treatment LDL-C in STEMI and NSTEMI patients N. Hann ∗ , N. Yap, J. Gin, A. Nguyen, H. Adams, A. Wilson St Vincent’s Hospital Melbourne, Australia Introduction: Raised concentrations of LDL cholesterol are one of the key modifiable risk factors for cardiovascular disease. Pharmacological therapy with statins forms the mainstay of treatment for hyperlipidaemia and has proven to be highly effective. Despite this, novel lipid-lowering therapies are being developed which may be able to lower cholesterol levels even further. Purpose: The purpose of this study is to evaluate the proportion of patients on statin therapy presenting with STEMI or NSTEMI who have persistently high LDL-C levels, and therefore who may be candidates for novel lipid-lowering therapies. Methods: Data were collected from patients presenting to the cardiology department of a large metropolitan hospital between 2009 and 2014. The lipid profile of patients on statin therapy presenting with STEMI, NSTEMI or cardiac symptoms without MI was obtained and the proportion with persistently high LDL-C levels (>2.0mmol/L) was calculated. Results: Data from 859 patients on statin therapy were collected, of which 117 presented with either STEMI or NSTEMI. Of these, 77 (65.8%) had LDL-C levels >2.0mmol/L. A further 568 patients presented with cardiac symptoms but not MI, of which 320 (56.3%) had LDL-C levels >2.0mmol/L. The incidence of persistently high LDL-C was thus higher in the STEMI/NSTEMI group (RR 1.168). Conclusion: Our findings suggest a significant proportion of patients presenting with STEMI or NSTEMI have persistently high levels of LDL-C despite statin treatment. Furthermore, a significant proportion of non-MI patients also had high on-treatment LDL-C levels. Patients in both groups may benefit from further reductions in their LDL-C concentrations. http://dx.doi.org/10.1016/j.hlc.2015.06.173