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W16-P-072 LDL-C goal attainment and cardiovascular hospitalization among CHD patients in Germany
W16
Workshops Treatment of atherosclerosis risk
Methods: Sample had 603 randomly drawn patients from 62 randomly selected general and cardiology practices in Germany. All patients had established CHD, were initiated on LLT between 07/01/1998 and 06/30/1999, had at least one LDL measurement in the preceding year and were treated for for at least two years (or until the patient's death) after LLT initiation. CV event is defined as occurrence of revascularizafion, stable or unstable angina, atherectomy, acute MI, ischemic stroke or endarterectomy.Time to first CV event is analyzed using a piecewise exponential model to account for time-varying hazard rate of CV events. This is done by splitting the total time to event (or the total follow-up time ff the patient did not have an event) into yearly spells and fitting an exponential model. Results: The hazard rate varies with time in this sample of CHD patients (Table 1). It is highest in the 1st year and falls subsequently. CABG at baseline, number of cardiac prescriptions at baseline and high LDL-C level prior to the event all increase the hazard rate (i.e. every 10 mg/dL increase in LDL-C prior to the event increases the hazard rate by 5%). Switch to an intensive statin regimen before the event does not significantly affect the hazard rate. Determinants of hazard rate of CV event (# of patients = 585) Variable Cardiologist CABG at baseline # Baseline prescriptions LDL level prior to CV event High potency statin beforeevent Ttme index Year 1 Year 2 Year 3 Year 4
Hazard rate 0.719 1.528 1.117 1.005 1.022 6.558 3.652 4.329 3.242
p value 0.0870 0.0164 0.0178 0.0(307 0.8839 0.0010 0.0615 0.2006 0.1477 0.2505
# First CV events
101 43 41 21
Conclusion: The hazard rate of CV events changes with time (highest in the first year following an event). Revascularization at baseline, high baseline co-morbidity and high LDL increase the hazard rate of CV events. Therefore, the potential for preventing CV morbidity is the highest in the first year and can be achieved through early aggressive lipid management.
W16-P-072 ] LDL-C GOAL ATTAINMENT AND CARDIOVASCULAR HOSPITALIZATION AMONG C H D PATIENTS IN GERMANY
119
treatment by cardiologists became less significant (p=0.0626) and others remained unchanged in reducing this risk. Conclusion: Early LDL-C goal attainment among CHD patients in clinical practice in Germany provides protection against recurrent CV hospitalizations. This finding is in line with results from recent clinical studies such as the PROVE-IT and the REVERSAL which demonstrated that patients with CHD benefit from LDL-C lowering to levels below current goal levels. /
OF STATINS AND/OR FIBRATES ON IW16-P-073| EFFECTS C-REACTIVE PROTEIN AND LIPID LEVELS IN J
METABOLIC SYNDROME I. Reiber, I. Mez& Internal Medicine, St. Gyiirgy Hospital, SzEkesfehdrvdr,
Hungary Objective: The aim of the study was to investigate the effects of several lipid lowering drugs on the C-reactive protein (CRP) and lipid profiles in patients with metabolic syndrome (MetS). Patients and Methods: The NCEP-ATPIII criteria were used for MetS definition. 115 MetS patients (55 females and 60 males, 574-10 years old, BMI: 32+3 kg/m2) were studied. Forty-one patients were treated with statins, 54 with fibrates and 20 with both of them for 6 months. Total- (TC), high-density lipoprotein- (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), apolipoprotein A and apolipoprotein B and high sensitive (hs) CRP levels were determined at the beginning and the end of the study. Results: The mean baseline hsCRP level (4.44-1.6 mg/1) decreased in average 44% (to 2.3+0.9 mg/l, p< 0.001). There was no significant difference between the three therapy groups. The changing of hsCRP levels was not affected by sex, age and waist circumference. The baseline hsCRP levels correlated significantly with TC and non-HDL-C levels @=0.21 and 0.22, p< 0.05). TC decreased by statins -44%, by fibrates -19% and in combined therapy group -35%. The mean baseline HDL-C (1.254-0.30 mmol/1) increased in statin therapy group +4%, in fibrate group +15% and in statin-fibrate group +9%. Non-HDL-C decreased (from baseline 5.934-1.16 mmol/1) with statins by 41%, with fibrates by 25% and with the combination of them by 42%. Conclusions: The well tolerated and safety statin and/or fibrate therapy has additive, pleiotropic hsCRP decreasing effect 1o better prevention of CHD risk. The hsCRP levels changed independently from TG and HDL-C levels in these groups of patients with metabolic syndrome.
S. Raiagopalan, E. Alemao, D. Yin. Outcomes Research Group, Merck &
Co., Inc., Whitehouse Station, NJ, USA Objective: To explore effect of early LDL-C goal attainment on CV hospitalization after initiation of lipid-lowering therapy (LLT) in CHD patients. Method: This retrospective cohort study had a sample of 603 randomly drawn patients from 62 randomly selected general and cardiology practices in Germany. All patients had established CHD, initiated on LLT between 1 July 1998 and 30 June 1999, had at least one LDL measurement in the preceding year and were treated for secondary prevention for at least two yea~ (or until the patient's death) after LLT initiation. CV event is defined as occurrence of revascularization, acute MI, stable or unstable angina, atherectomy, ischemic stroke or endarterectomy. Effect of LDL-C goal attainment within the first 6 months of initiation of LLT on future (after nine months from the index date) CV hospitalization is analyzed using probit model. LDL-C goal attainment was based on ATP III and German guidelines (LDL-C < 100mg/dL). Baseline co-morbidity and age were included by forming Charlson age co-morbidity index. Results: Mean age was 63 years and female patients constituted 32.4%. Prior to LLT, one-third had an AMI, about 36% had a revascularization procedure, a third were diabetic and 77% were hypertensive. Goal attainment any time during the first six months (p=0.0506) and treatment by a cardiologist (p=0.0147) reduced risk of future CV hospitalization. Aggressive statin regimen [defined as an intial dose of simvastatin 40 mg (or equipotent) or a switch to a combination of stalin and fibrates/resins or change to another statin of higher potency or up titration on same statin) during the first six months (p=0.0176) increased the CV hospitalization risk probably because these patients were at high risk to begin with and hence were more aggressively treated (residual confounding by indication). This is supported by baseline Charlson age co-morbidity index which increases the risk (p=0.0196) of hospitalization. When hospitalization due to any event was considered, LDL-C goal attainment was more significant (p=0.0330),
W16-P-074 [ DURATION OF FIRST VISIT TO A LIPID UNIT CAN AFFECT PATIENT'S COMPLIANCE J
D.J. Richter, G. Goumas, D. Athanasias, H. Karabinos, P. Marousis, P. Avgerodimos, A. Papadopoulos, A. Marinakis, P. Toutouzas, E. Voridis.
Cardiac Dept., Euroclinic, Athens, Greece Introduction: Although statins have shown to reduce significantly coronary artery disease in various trials patients compliance is usually poor and dropping significantly after the first six months of treatment. We examined if time spent with the patient by a specjaliTed doctor can improve the outcome. Methods: Euroclinic is a private hospital with all cardiac care facilities and a laxge annual check-up program. After routine annual blood exams all dyslipidemic patients are referred for further counseling in the lipid unit. According to the total cardiac risk score hyperlipidemic patients are assigned either to lifestyle modifcation or drug therapy. Average duration of this first visit in our lipid clinic is 45 minutes. We examined the one year compliance of hyperlipidemic patients to the treatment assigned and an anonymous questionnaire was distributed to patients asking for their comments concerning evaluation of his/her initial counseling. Out of the 3000 annual checkup of 2002, 814 persons were referred to the lipid unit and 478 attended the appointment. Results: About one-third of patients (158) were instructed to lifestyle changes and 320 were assigned to hyperlipidemic drugs. Patients were set LDL goals according to their total risk score and were instructed to titrate statin dose at the lipid unit or at their GP every two months. At the following annual checkup all patients were examined to check compliance to hypolipidemic treatment or to life style changes. Of the 158 patients assigned to lifestyle changes 32 only (20.2%) had a 10% weight loss and/or lipid profile improvement. Patients assigned to drugs had an impressive 90% compliance to treatment. (288 out of 320). In an anonymous questionnaire
75th EAS Congress, 23-26 April 2005, Prague, Czech Republic
0
I 0 "D O3
Workshops Treatment of atherosclerosis risk
Methods: Sample had 603 randomly drawn patients from 62 randomly selected general and cardiology practices in Germany. All patients had established CHD, were initiated on LLT between 07/01/1998 and 06/30/1999, had at least one LDL measurement in the preceding year and were treated for for at least two years (or until the patient's death) after LLT initiation. CV event is defined as occurrence of revascularizafion, stable or unstable angina, atherectomy, acute MI, ischemic stroke or endarterectomy.Time to first CV event is analyzed using a piecewise exponential model to account for time-varying hazard rate of CV events. This is done by splitting the total time to event (or the total follow-up time ff the patient did not have an event) into yearly spells and fitting an exponential model. Results: The hazard rate varies with time in this sample of CHD patients (Table 1). It is highest in the 1st year and falls subsequently. CABG at baseline, number of cardiac prescriptions at baseline and high LDL-C level prior to the event all increase the hazard rate (i.e. every 10 mg/dL increase in LDL-C prior to the event increases the hazard rate by 5%). Switch to an intensive statin regimen before the event does not significantly affect the hazard rate. Determinants of hazard rate of CV event (# of patients = 585) Variable Cardiologist CABG at baseline # Baseline prescriptions LDL level prior to CV event High potency statin beforeevent Ttme index Year 1 Year 2 Year 3 Year 4
Hazard rate 0.719 1.528 1.117 1.005 1.022 6.558 3.652 4.329 3.242
p value 0.0870 0.0164 0.0178 0.0(307 0.8839 0.0010 0.0615 0.2006 0.1477 0.2505
# First CV events
101 43 41 21
Conclusion: The hazard rate of CV events changes with time (highest in the first year following an event). Revascularization at baseline, high baseline co-morbidity and high LDL increase the hazard rate of CV events. Therefore, the potential for preventing CV morbidity is the highest in the first year and can be achieved through early aggressive lipid management.
W16-P-072 ] LDL-C GOAL ATTAINMENT AND CARDIOVASCULAR HOSPITALIZATION AMONG C H D PATIENTS IN GERMANY
119
treatment by cardiologists became less significant (p=0.0626) and others remained unchanged in reducing this risk. Conclusion: Early LDL-C goal attainment among CHD patients in clinical practice in Germany provides protection against recurrent CV hospitalizations. This finding is in line with results from recent clinical studies such as the PROVE-IT and the REVERSAL which demonstrated that patients with CHD benefit from LDL-C lowering to levels below current goal levels. /
OF STATINS AND/OR FIBRATES ON IW16-P-073| EFFECTS C-REACTIVE PROTEIN AND LIPID LEVELS IN J
METABOLIC SYNDROME I. Reiber, I. Mez& Internal Medicine, St. Gyiirgy Hospital, SzEkesfehdrvdr,
Hungary Objective: The aim of the study was to investigate the effects of several lipid lowering drugs on the C-reactive protein (CRP) and lipid profiles in patients with metabolic syndrome (MetS). Patients and Methods: The NCEP-ATPIII criteria were used for MetS definition. 115 MetS patients (55 females and 60 males, 574-10 years old, BMI: 32+3 kg/m2) were studied. Forty-one patients were treated with statins, 54 with fibrates and 20 with both of them for 6 months. Total- (TC), high-density lipoprotein- (HDL-C), low-density lipoprotein-cholesterol (LDL-C), triglycerides (TG), apolipoprotein A and apolipoprotein B and high sensitive (hs) CRP levels were determined at the beginning and the end of the study. Results: The mean baseline hsCRP level (4.44-1.6 mg/1) decreased in average 44% (to 2.3+0.9 mg/l, p< 0.001). There was no significant difference between the three therapy groups. The changing of hsCRP levels was not affected by sex, age and waist circumference. The baseline hsCRP levels correlated significantly with TC and non-HDL-C levels @=0.21 and 0.22, p< 0.05). TC decreased by statins -44%, by fibrates -19% and in combined therapy group -35%. The mean baseline HDL-C (1.254-0.30 mmol/1) increased in statin therapy group +4%, in fibrate group +15% and in statin-fibrate group +9%. Non-HDL-C decreased (from baseline 5.934-1.16 mmol/1) with statins by 41%, with fibrates by 25% and with the combination of them by 42%. Conclusions: The well tolerated and safety statin and/or fibrate therapy has additive, pleiotropic hsCRP decreasing effect 1o better prevention of CHD risk. The hsCRP levels changed independently from TG and HDL-C levels in these groups of patients with metabolic syndrome.
S. Raiagopalan, E. Alemao, D. Yin. Outcomes Research Group, Merck &
Co., Inc., Whitehouse Station, NJ, USA Objective: To explore effect of early LDL-C goal attainment on CV hospitalization after initiation of lipid-lowering therapy (LLT) in CHD patients. Method: This retrospective cohort study had a sample of 603 randomly drawn patients from 62 randomly selected general and cardiology practices in Germany. All patients had established CHD, initiated on LLT between 1 July 1998 and 30 June 1999, had at least one LDL measurement in the preceding year and were treated for secondary prevention for at least two yea~ (or until the patient's death) after LLT initiation. CV event is defined as occurrence of revascularization, acute MI, stable or unstable angina, atherectomy, ischemic stroke or endarterectomy. Effect of LDL-C goal attainment within the first 6 months of initiation of LLT on future (after nine months from the index date) CV hospitalization is analyzed using probit model. LDL-C goal attainment was based on ATP III and German guidelines (LDL-C < 100mg/dL). Baseline co-morbidity and age were included by forming Charlson age co-morbidity index. Results: Mean age was 63 years and female patients constituted 32.4%. Prior to LLT, one-third had an AMI, about 36% had a revascularization procedure, a third were diabetic and 77% were hypertensive. Goal attainment any time during the first six months (p=0.0506) and treatment by a cardiologist (p=0.0147) reduced risk of future CV hospitalization. Aggressive statin regimen [defined as an intial dose of simvastatin 40 mg (or equipotent) or a switch to a combination of stalin and fibrates/resins or change to another statin of higher potency or up titration on same statin) during the first six months (p=0.0176) increased the CV hospitalization risk probably because these patients were at high risk to begin with and hence were more aggressively treated (residual confounding by indication). This is supported by baseline Charlson age co-morbidity index which increases the risk (p=0.0196) of hospitalization. When hospitalization due to any event was considered, LDL-C goal attainment was more significant (p=0.0330),
W16-P-074 [ DURATION OF FIRST VISIT TO A LIPID UNIT CAN AFFECT PATIENT'S COMPLIANCE J
D.J. Richter, G. Goumas, D. Athanasias, H. Karabinos, P. Marousis, P. Avgerodimos, A. Papadopoulos, A. Marinakis, P. Toutouzas, E. Voridis.
Cardiac Dept., Euroclinic, Athens, Greece Introduction: Although statins have shown to reduce significantly coronary artery disease in various trials patients compliance is usually poor and dropping significantly after the first six months of treatment. We examined if time spent with the patient by a specjaliTed doctor can improve the outcome. Methods: Euroclinic is a private hospital with all cardiac care facilities and a laxge annual check-up program. After routine annual blood exams all dyslipidemic patients are referred for further counseling in the lipid unit. According to the total cardiac risk score hyperlipidemic patients are assigned either to lifestyle modifcation or drug therapy. Average duration of this first visit in our lipid clinic is 45 minutes. We examined the one year compliance of hyperlipidemic patients to the treatment assigned and an anonymous questionnaire was distributed to patients asking for their comments concerning evaluation of his/her initial counseling. Out of the 3000 annual checkup of 2002, 814 persons were referred to the lipid unit and 478 attended the appointment. Results: About one-third of patients (158) were instructed to lifestyle changes and 320 were assigned to hyperlipidemic drugs. Patients were set LDL goals according to their total risk score and were instructed to titrate statin dose at the lipid unit or at their GP every two months. At the following annual checkup all patients were examined to check compliance to hypolipidemic treatment or to life style changes. Of the 158 patients assigned to lifestyle changes 32 only (20.2%) had a 10% weight loss and/or lipid profile improvement. Patients assigned to drugs had an impressive 90% compliance to treatment. (288 out of 320). In an anonymous questionnaire
75th EAS Congress, 23-26 April 2005, Prague, Czech Republic
0
I 0 "D O3