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GUIDELINES ORIENTED APPROACH TO LIPID (GOAL) MEDICAL PRACTICE ACTIVITY (MPA) TO ACHIEVE LOW DENSITY LIPOPROTEIN CHOLESTEROL (LDL-C) TARGETS
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increased lung weight, an index of pulmonary interstitial alveolar oedema; and (v) prolonged Tau and reduced dp/dt min, markers of dysfunction in the early, energy-dependent phase of diastole. See Table 1. Without affecting blood pressure, empagloflozin significantly (p < 0.05) reduced heart weight, increased haematocrit, lessened lung weight and attenuated the abnormalities in Tau and dp/dt min when compared with untreated DOCA rats. In addition, empagliflozin also increased ejection fraction. CONCLUSION: DOCA salt UNX animals are a model of heart failure with preserved ejection fraction demonstrating evidence of diastolic dysfunction with pulmonary congestion. Empagliflozin therapy improved LV mass and reduced diastolic function, key markers of HFpEF. The role of SGLT2 inhibition as a strategy for treating HFpEF merits further investigation.
Canadian Journal of Cardiology Volume 33 2017 METHODS:
GOAL plans to engage 300 Canadian physicians who will enroll 3000 high CV risk patients with clinical vascular disease such as coronary artery disease (CAD), cerebrovascular disease, abdominal aortic aneurysm, peripheral arterial disease or familial hypercholesterolemia and LDL-C > 2.0 mmol/L despite stable, maximally tolerated statin therapy. Patients will be followed for a total of 3 visits over a period of 6 months. Physicians are asked to manage patients as they see fit but with awareness of the latest Canadian Cardiovascular Society (CCS) Dyslipidemia Guidelines. The program is led by a steering committee supported by the Canadian Heart Research Centre (data collection and physician interactive component) and is ethically approved. RESULTS: As of May 1, 2017, 260 physicians registered to participate and to date 1040 patients were enrolled (mean age 6311 years, 41% female). Co-morbid conditions included: FH 45%, diabetes 39%, CAD 48%, other vascular disease 8%, HT 62%, CKD 8% and current smokers 15%. Systolic blood pressure (BP) was 12915 mmHg, diastolic BP was 7710 mm Hg, and body mass index was 29.96.8 kg/m2. Baseline LDL-C was 3.41.3 , HDL-C 1.30.4, non-HDL-C 4.21.5, and triglycerides 2.11.4 mmol/L. Lipid lowering therapy used at baseline was statin therapy in 75% (with 25% statin intolerant), and 50% ezetimibe. Among statin therapies used, the most frequent were rosuvastatin (39%) and atorvastatin (27%). Physicians indicated their next steps in the lowering of the LDLC to be: addition of ezetimibe in 36%, addition of bile acid sequestrant in 7%, and addition of PCSK9 inhibitor in 39%. CONCLUSION: Among high risk patients with an LDL-C above target despite statin therapy, there is a need for further lipid lowering therapy based on CCS guidelines. Interim assessment of the GOAL study indicates a frequent use of additional lipid lowering therapy which is consistent with greater adherence with CCS guidelines. Amgen Inc.
Boehringer Ingelheim, Eli Lilly and Company Diabetes Alliance.
223 GUIDELINES ORIENTED APPROACH TO LIPID (GOAL) MEDICAL PRACTICE ACTIVITY (MPA) TO ACHIEVE LOW DENSITY LIPOPROTEIN CHOLESTEROL (LDL-C) TARGETS A Langer, S Goodman, M Tan, C Spindler, J Gregoire, J Stone, G Mancini, R Dufour, P Lin, L Leiter Toronto, Ontario BACKGROUND: Lowering of LDL-C < 2.0 mmol/L is a key recommended step in decreasing the risk for cardiovascular (CV) events in high risk patients. Despite widespread use of statin therapy as first line therapy, it is estimated that 40 e 50% of Canadian patients with known CVD do not achieve LDL-C target. GOAL is an investigator initiated study aiming to ascertain the use of second and third line therapy and its impact on LDL-C target achievement in a real world setting.
224 MONITORING THE BURDEN OF HEART DISEASE WITH THE CANADIAN CHRONIC DISEASE SURVEILLANCE SYSTEM C Robitaille, L McRae, J Toews Ottawa, Ontario BACKGROUND:
Heart disease remains the second leading cause of death in Canada despite major declines in heart disease mortality over the last few decades. Heart disease surveillance used to rely on self-reported or hospitalization data. This study explores estimates of incidence, prevalence and all-cause mortality of Canadians with heart disease using population-based data. METHODS: Aggregated administrative health data contributed by the provinces and territories to the Public Health Agency of Canada’s Canadian Chronic Disease Surveillance System (CCDSS) were used to identify ischemic heart disease (IHD) cases, including acute myocardial infarction (AMI), in adults aged 20 years and older from 2000/01 to 2012/13. Those
increased lung weight, an index of pulmonary interstitial alveolar oedema; and (v) prolonged Tau and reduced dp/dt min, markers of dysfunction in the early, energy-dependent phase of diastole. See Table 1. Without affecting blood pressure, empagloflozin significantly (p < 0.05) reduced heart weight, increased haematocrit, lessened lung weight and attenuated the abnormalities in Tau and dp/dt min when compared with untreated DOCA rats. In addition, empagliflozin also increased ejection fraction. CONCLUSION: DOCA salt UNX animals are a model of heart failure with preserved ejection fraction demonstrating evidence of diastolic dysfunction with pulmonary congestion. Empagliflozin therapy improved LV mass and reduced diastolic function, key markers of HFpEF. The role of SGLT2 inhibition as a strategy for treating HFpEF merits further investigation.
Canadian Journal of Cardiology Volume 33 2017 METHODS:
GOAL plans to engage 300 Canadian physicians who will enroll 3000 high CV risk patients with clinical vascular disease such as coronary artery disease (CAD), cerebrovascular disease, abdominal aortic aneurysm, peripheral arterial disease or familial hypercholesterolemia and LDL-C > 2.0 mmol/L despite stable, maximally tolerated statin therapy. Patients will be followed for a total of 3 visits over a period of 6 months. Physicians are asked to manage patients as they see fit but with awareness of the latest Canadian Cardiovascular Society (CCS) Dyslipidemia Guidelines. The program is led by a steering committee supported by the Canadian Heart Research Centre (data collection and physician interactive component) and is ethically approved. RESULTS: As of May 1, 2017, 260 physicians registered to participate and to date 1040 patients were enrolled (mean age 6311 years, 41% female). Co-morbid conditions included: FH 45%, diabetes 39%, CAD 48%, other vascular disease 8%, HT 62%, CKD 8% and current smokers 15%. Systolic blood pressure (BP) was 12915 mmHg, diastolic BP was 7710 mm Hg, and body mass index was 29.96.8 kg/m2. Baseline LDL-C was 3.41.3 , HDL-C 1.30.4, non-HDL-C 4.21.5, and triglycerides 2.11.4 mmol/L. Lipid lowering therapy used at baseline was statin therapy in 75% (with 25% statin intolerant), and 50% ezetimibe. Among statin therapies used, the most frequent were rosuvastatin (39%) and atorvastatin (27%). Physicians indicated their next steps in the lowering of the LDLC to be: addition of ezetimibe in 36%, addition of bile acid sequestrant in 7%, and addition of PCSK9 inhibitor in 39%. CONCLUSION: Among high risk patients with an LDL-C above target despite statin therapy, there is a need for further lipid lowering therapy based on CCS guidelines. Interim assessment of the GOAL study indicates a frequent use of additional lipid lowering therapy which is consistent with greater adherence with CCS guidelines. Amgen Inc.
Boehringer Ingelheim, Eli Lilly and Company Diabetes Alliance.
223 GUIDELINES ORIENTED APPROACH TO LIPID (GOAL) MEDICAL PRACTICE ACTIVITY (MPA) TO ACHIEVE LOW DENSITY LIPOPROTEIN CHOLESTEROL (LDL-C) TARGETS A Langer, S Goodman, M Tan, C Spindler, J Gregoire, J Stone, G Mancini, R Dufour, P Lin, L Leiter Toronto, Ontario BACKGROUND: Lowering of LDL-C < 2.0 mmol/L is a key recommended step in decreasing the risk for cardiovascular (CV) events in high risk patients. Despite widespread use of statin therapy as first line therapy, it is estimated that 40 e 50% of Canadian patients with known CVD do not achieve LDL-C target. GOAL is an investigator initiated study aiming to ascertain the use of second and third line therapy and its impact on LDL-C target achievement in a real world setting.
224 MONITORING THE BURDEN OF HEART DISEASE WITH THE CANADIAN CHRONIC DISEASE SURVEILLANCE SYSTEM C Robitaille, L McRae, J Toews Ottawa, Ontario BACKGROUND:
Heart disease remains the second leading cause of death in Canada despite major declines in heart disease mortality over the last few decades. Heart disease surveillance used to rely on self-reported or hospitalization data. This study explores estimates of incidence, prevalence and all-cause mortality of Canadians with heart disease using population-based data. METHODS: Aggregated administrative health data contributed by the provinces and territories to the Public Health Agency of Canada’s Canadian Chronic Disease Surveillance System (CCDSS) were used to identify ischemic heart disease (IHD) cases, including acute myocardial infarction (AMI), in adults aged 20 years and older from 2000/01 to 2012/13. Those