- Email: [email protected]
Inappropriate intensity statin therapy causing worse lipid profiles in HIV-infected individuals after acute coronary syndrome
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Archives of Cardiovascular Diseases Supplements (2017) 9, 106-112
damage) and LDL-C targets <1.8 mmol/L (<0.70g/L) in T2DM patients with established CVD or with diabetic nephropathy. Methods Analyze of our prospective cohort of diabetic patients followed by the university center of diabetes (CUDC cohort). Our database included 5760 patients between September 2014 and August 2015. Clinical data, diabetes complications status and lipid profile were available for 3539 patients after excluding patients with triglycerides above 4g/l or missing data. Results As a whole, our cohort was at very high risk for CVD: men 57.8%; age 58 y.o. (18-80); BMI 27.5kg/m² (16.42-50.22); obesity 33%; mean diabetes duration 13 years (0-59); HbA1c 7.4% (4.6-14); hypertension 68%; smoking status 16.3%; diabetic nephropathy 39.6%; previous CVD 39%. In T2DM patients without CVD, 61% were under lipid lowering treatments (mainly statins). LDL-C was 1.01g/l (0.2-2.59) and 49% of patients were above the target. In CVD diabetic patients, 91.7% were under lipid lowering treatments (mainly statins). LDL-C was 0.79g/l (0.31-1.9) and 35.8% were above the 0.7g/l target. In patients with diabetic nephropathy, 77.2% were under lipid lowering treatments. LDL-C was 0.89g/l (0.25-2.13) vs 1.01g/l (0.35-2.06) without diabetic nephropathy (p<0.001); 21.8% were above the 0.7g/l target. Conclusion In our CUDC cohort, ESC/EASD LDL-C targets are not achieved in the majority of the T2DM patients despite a multidisciplinary approach. The authors hereby declare no conflict of interest
400 CARDIOSAS: a questionnaire by the “Cercle Coeur et Sommeil” to screen for Sleep Apnea in cardiovascular patients of private practice P. Escourrou* (1), D. Bennegadi (2), F. David (3), P. Delmas (4), AL. El Hallak (5), P. Ghassemi (6), A. Gounaropoulos (7), N. Houdard (8), MP. Houppe-Nousse (9), JP. Labarre (10), B. Mafart (11), M. Pretorian (12), P. Samama (13), Z. Balekji (1), C. Colas Des Francs (1), N. Puisais (1), JM. Davy (14), ET. Cercle Coeur Et Sommeil (15) (1) APHP-Hôpital Antoine Béclère, Médecine du Sommeil, Clamart, France – (2) Clinique les Fauvettes, Chatillon, France – (3) Cabinet, Montigny Les Metz, France – (4) Cabinet, Lisieux, France – (5) Clinique, Evecquemont, France – (6) Cabinet, Mauriac, France – (7) Cabinet, Paris, France – (8) Cabinet, Levallois Perret, France – (9) Cabinet, Thionville, France – (10) Cabinet, Bondigoux, France – (11) Cabinet, Paimpol, France – (12) Cabinet, Roost-Warentain, France – (13) Cabinet, Montauban, France – (14) Service Cardiologie, Montpellier, France – (15) Cabinet, Paris, France *Corresponding author: [email protected] Introduction Sleep apnea syndrome (SAS) is highly prevalent in cardiovascular patients and is usually associated with a worst prognosis. But polygraphy for the diagnosis of SAS cannot apply to all suspected patients due to limited availability and high cost. Purpose To test the faisability of a new questionnaire for screening the SAS in a population of CV patients suspected of SAS in private practice in France. Methods and Results part1 is an autoquestionnaire about nightime and daytime complaints of the patient and partner; part2 is filled in by the cardiologist: comorbidities, treatment and anthropometric data (Body mass index, neck and waist circumference, blood pressure). A respiratory polygraphy was recorded by the cardiologist (equipment used: Cidelec, Nox, Somnolab, Embletta) and sent for central scoring. The patient was asked to document a sleeping agenda on the night of recording. 12 cardiologists prospectively recruited 215 patients (mean age 61 yrs, 66% Males) with hypertension (65%), coronary vascular disease (16%), atrial fibrillation (25%), heart failure (10%) or stroke (15%). 63% had moderate SAS (Apnea-Hypopnea Index >15) and 38% severe SAS (AHI >30/h). Mechanism of apnea were mostly obstructive (95%). Daytime predominant symptoms were: somnolence or fatigue, napping, concentration deficit. Prevalent nightime symptoms were: very short sleep latency, insomnia, snoring, dryness of the mouth, restless sleep. The recordings scored using sleep time evaluated by the sleep agenda lead to higher AHI than when computed by recording time. Conclusions Obstructive SAS is highly prevalent in private practice. A questionnaire to screen for SAS is feasible and polygraphy recordings have an overall good quality. The severity of SAS may be underscored if the AHI is computed by recording time rather than subjective sleeping time.
© Elsevier Masson SAS. All rights reserved.
Supported by “Societé Française de Recherche et Médecine du Sommeil” and promoted by “commission registres de la Société Française de Cardiologie” The authors hereby declare no conflict of interest
595 Inappropriate intensity statin therapy causing worse lipid profiles in HIV-infected individuals after acute coronary syndrome F. Boccara* (1), J. Miantezila-Basilua (2), M. Mary-Krause (2), S. Lang (1), E. Teiger (3), C. Funck-Brentano (4), PM. Girard (5), D. Costagliola (2), A. Cohen (1), M. Guiguet ? (2) (1) APHP-Hôpital Saint-Antoine, Cardiologie, Paris, France – (2) Pierre Louis Institute of Epidemiology and Public Health, Inserm UMR_S 1136, Paris, France – (3) APHP-CHU Henri Mondor, Inserm-U955, Créteil, France – (4) Université Pierre et Marie Curie, Faculty of Medicine, Pharmacology and UMR ICAN 1166, Paris, France – (5) APHP-Hôpital SaintAntoine, Infectious and tropical diseases, Paris, France *Corresponding author: [email protected] Background HIV-infected individuals are at higher risk of acute coronary syndrome (ACS) as compared to the general population. Studies about lipid interventions in secondary prevention in HIV-infected individuals are missing. Methods A prospective multicenter nested case-control study enrolled 282 patients on statin 1 month after a first ACS (95 HIV-infected individuals, 187 HIV-uninfected). Data on fasting lipids (total cholesterol [TC], lowdensity lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], non – HDL-C, triglycerides, TC: HDL-C ratio) were collected over 3 years. The evolution of lipid concentrations was analyzed using mixedeffects models. Achievement of NCEP-ATP III lipid goals was assessed. Results Participants’ mean age was 49.0 years (94% men). Baseline lipids were similar in the two groups. At month 6 after the ACS, a borderline decrease in LDLc in the HIV-infected group was observed (p=0.06) while a significant decrease was found in the HIV-uninfected group (p<0.0001). The slope of variation from month 6 to 36 indicated a decrease in LDL-C in the HIV-infected group (p<0.0001) and no change in the HIV-uninfected group (p=0.59). Similar trends were observed for TC and non – HDL-C. The HIV-infected group less frequently achieved LDL-C goal (<100 mg/dl) in the first 6 months (42.6% vs. 67.7%, p=0.0002). HIV-infected participants were treated with high-intensity statins less frequently then the HIV-uninfected controls (15% vs 45%). Conclusions HIV-infected individuals after ACS exhibited a worse lipid profile than HIV-uninfected controls particularly during the first 6 months with less potent statins used. Appropriate statin intensity should be prescribed in HIVinfected individuals with awareness of potential lethal drug-drug interaction. The authors hereby declare no conflict of interest
129 Score of adherence to European cardiovascular prevention guidelines is an independent determinant of cardiovascular and all-cause mortality in the general population E. Bérard (1)(2), V. Bongard (1)(2), D. Arveiler (3)(4), J. Dallongeville (5), A. Wagner (3), P. Amouyel (5), B. Haas (3), D. Cottel (5), JB. Ruidavets (1)(2), J. Ferrières* (6)- (2) (1) CHU Toulouse, Epidémiologie, USMR, Toulouse, France – (2) Université Paul Sabatier, Epidemiology, Inserm UMR1027, Toulouse, France – (3) Université Strasbourg, Epidemiology and public health, EA 3430, FMTS, Strasbourg, France – (4) CHU Strasbourg, Santé publique, Strasbourg, France – (5) Pasteur Institute, Epidemiology and Public Health, Inserm UMR744, Lille, France – (6) CHU Toulouse, Rangueil, Cardiologie B, Fédération de Cardiologie, Toulouse, France *Corresponding author: [email protected] Background Guidelines on cardiovascular (CV) disease prevention promote healthy lifestyle behaviours and CV risk factor control in order to reduce CV risk. Purpose We assessed the impact of baseline adherence to “European Guidelines on cardiovascular disease prevention in clinical practice (version
Archives of Cardiovascular Diseases Supplements (2017) 9, 106-112
damage) and LDL-C targets <1.8 mmol/L (<0.70g/L) in T2DM patients with established CVD or with diabetic nephropathy. Methods Analyze of our prospective cohort of diabetic patients followed by the university center of diabetes (CUDC cohort). Our database included 5760 patients between September 2014 and August 2015. Clinical data, diabetes complications status and lipid profile were available for 3539 patients after excluding patients with triglycerides above 4g/l or missing data. Results As a whole, our cohort was at very high risk for CVD: men 57.8%; age 58 y.o. (18-80); BMI 27.5kg/m² (16.42-50.22); obesity 33%; mean diabetes duration 13 years (0-59); HbA1c 7.4% (4.6-14); hypertension 68%; smoking status 16.3%; diabetic nephropathy 39.6%; previous CVD 39%. In T2DM patients without CVD, 61% were under lipid lowering treatments (mainly statins). LDL-C was 1.01g/l (0.2-2.59) and 49% of patients were above the target. In CVD diabetic patients, 91.7% were under lipid lowering treatments (mainly statins). LDL-C was 0.79g/l (0.31-1.9) and 35.8% were above the 0.7g/l target. In patients with diabetic nephropathy, 77.2% were under lipid lowering treatments. LDL-C was 0.89g/l (0.25-2.13) vs 1.01g/l (0.35-2.06) without diabetic nephropathy (p<0.001); 21.8% were above the 0.7g/l target. Conclusion In our CUDC cohort, ESC/EASD LDL-C targets are not achieved in the majority of the T2DM patients despite a multidisciplinary approach. The authors hereby declare no conflict of interest
400 CARDIOSAS: a questionnaire by the “Cercle Coeur et Sommeil” to screen for Sleep Apnea in cardiovascular patients of private practice P. Escourrou* (1), D. Bennegadi (2), F. David (3), P. Delmas (4), AL. El Hallak (5), P. Ghassemi (6), A. Gounaropoulos (7), N. Houdard (8), MP. Houppe-Nousse (9), JP. Labarre (10), B. Mafart (11), M. Pretorian (12), P. Samama (13), Z. Balekji (1), C. Colas Des Francs (1), N. Puisais (1), JM. Davy (14), ET. Cercle Coeur Et Sommeil (15) (1) APHP-Hôpital Antoine Béclère, Médecine du Sommeil, Clamart, France – (2) Clinique les Fauvettes, Chatillon, France – (3) Cabinet, Montigny Les Metz, France – (4) Cabinet, Lisieux, France – (5) Clinique, Evecquemont, France – (6) Cabinet, Mauriac, France – (7) Cabinet, Paris, France – (8) Cabinet, Levallois Perret, France – (9) Cabinet, Thionville, France – (10) Cabinet, Bondigoux, France – (11) Cabinet, Paimpol, France – (12) Cabinet, Roost-Warentain, France – (13) Cabinet, Montauban, France – (14) Service Cardiologie, Montpellier, France – (15) Cabinet, Paris, France *Corresponding author: [email protected] Introduction Sleep apnea syndrome (SAS) is highly prevalent in cardiovascular patients and is usually associated with a worst prognosis. But polygraphy for the diagnosis of SAS cannot apply to all suspected patients due to limited availability and high cost. Purpose To test the faisability of a new questionnaire for screening the SAS in a population of CV patients suspected of SAS in private practice in France. Methods and Results part1 is an autoquestionnaire about nightime and daytime complaints of the patient and partner; part2 is filled in by the cardiologist: comorbidities, treatment and anthropometric data (Body mass index, neck and waist circumference, blood pressure). A respiratory polygraphy was recorded by the cardiologist (equipment used: Cidelec, Nox, Somnolab, Embletta) and sent for central scoring. The patient was asked to document a sleeping agenda on the night of recording. 12 cardiologists prospectively recruited 215 patients (mean age 61 yrs, 66% Males) with hypertension (65%), coronary vascular disease (16%), atrial fibrillation (25%), heart failure (10%) or stroke (15%). 63% had moderate SAS (Apnea-Hypopnea Index >15) and 38% severe SAS (AHI >30/h). Mechanism of apnea were mostly obstructive (95%). Daytime predominant symptoms were: somnolence or fatigue, napping, concentration deficit. Prevalent nightime symptoms were: very short sleep latency, insomnia, snoring, dryness of the mouth, restless sleep. The recordings scored using sleep time evaluated by the sleep agenda lead to higher AHI than when computed by recording time. Conclusions Obstructive SAS is highly prevalent in private practice. A questionnaire to screen for SAS is feasible and polygraphy recordings have an overall good quality. The severity of SAS may be underscored if the AHI is computed by recording time rather than subjective sleeping time.
© Elsevier Masson SAS. All rights reserved.
Supported by “Societé Française de Recherche et Médecine du Sommeil” and promoted by “commission registres de la Société Française de Cardiologie” The authors hereby declare no conflict of interest
595 Inappropriate intensity statin therapy causing worse lipid profiles in HIV-infected individuals after acute coronary syndrome F. Boccara* (1), J. Miantezila-Basilua (2), M. Mary-Krause (2), S. Lang (1), E. Teiger (3), C. Funck-Brentano (4), PM. Girard (5), D. Costagliola (2), A. Cohen (1), M. Guiguet ? (2) (1) APHP-Hôpital Saint-Antoine, Cardiologie, Paris, France – (2) Pierre Louis Institute of Epidemiology and Public Health, Inserm UMR_S 1136, Paris, France – (3) APHP-CHU Henri Mondor, Inserm-U955, Créteil, France – (4) Université Pierre et Marie Curie, Faculty of Medicine, Pharmacology and UMR ICAN 1166, Paris, France – (5) APHP-Hôpital SaintAntoine, Infectious and tropical diseases, Paris, France *Corresponding author: [email protected] Background HIV-infected individuals are at higher risk of acute coronary syndrome (ACS) as compared to the general population. Studies about lipid interventions in secondary prevention in HIV-infected individuals are missing. Methods A prospective multicenter nested case-control study enrolled 282 patients on statin 1 month after a first ACS (95 HIV-infected individuals, 187 HIV-uninfected). Data on fasting lipids (total cholesterol [TC], lowdensity lipoprotein cholesterol [LDL-C], high-density lipoprotein cholesterol [HDL-C], non – HDL-C, triglycerides, TC: HDL-C ratio) were collected over 3 years. The evolution of lipid concentrations was analyzed using mixedeffects models. Achievement of NCEP-ATP III lipid goals was assessed. Results Participants’ mean age was 49.0 years (94% men). Baseline lipids were similar in the two groups. At month 6 after the ACS, a borderline decrease in LDLc in the HIV-infected group was observed (p=0.06) while a significant decrease was found in the HIV-uninfected group (p<0.0001). The slope of variation from month 6 to 36 indicated a decrease in LDL-C in the HIV-infected group (p<0.0001) and no change in the HIV-uninfected group (p=0.59). Similar trends were observed for TC and non – HDL-C. The HIV-infected group less frequently achieved LDL-C goal (<100 mg/dl) in the first 6 months (42.6% vs. 67.7%, p=0.0002). HIV-infected participants were treated with high-intensity statins less frequently then the HIV-uninfected controls (15% vs 45%). Conclusions HIV-infected individuals after ACS exhibited a worse lipid profile than HIV-uninfected controls particularly during the first 6 months with less potent statins used. Appropriate statin intensity should be prescribed in HIVinfected individuals with awareness of potential lethal drug-drug interaction. The authors hereby declare no conflict of interest
129 Score of adherence to European cardiovascular prevention guidelines is an independent determinant of cardiovascular and all-cause mortality in the general population E. Bérard (1)(2), V. Bongard (1)(2), D. Arveiler (3)(4), J. Dallongeville (5), A. Wagner (3), P. Amouyel (5), B. Haas (3), D. Cottel (5), JB. Ruidavets (1)(2), J. Ferrières* (6)- (2) (1) CHU Toulouse, Epidémiologie, USMR, Toulouse, France – (2) Université Paul Sabatier, Epidemiology, Inserm UMR1027, Toulouse, France – (3) Université Strasbourg, Epidemiology and public health, EA 3430, FMTS, Strasbourg, France – (4) CHU Strasbourg, Santé publique, Strasbourg, France – (5) Pasteur Institute, Epidemiology and Public Health, Inserm UMR744, Lille, France – (6) CHU Toulouse, Rangueil, Cardiologie B, Fédération de Cardiologie, Toulouse, France *Corresponding author: [email protected] Background Guidelines on cardiovascular (CV) disease prevention promote healthy lifestyle behaviours and CV risk factor control in order to reduce CV risk. Purpose We assessed the impact of baseline adherence to “European Guidelines on cardiovascular disease prevention in clinical practice (version