Statins are less effective in common daily practice among patients with hypercholesterolemia: the REALITY-PHARMO study

BACKGROUND: To study the use and effectiveness of lipid-lowering drugs with respect to lowering of cholesterol levels in routine daily practice. METHODS: 20 392 patients for whom lipid levels records were available between January 1991 and December 2001 were included in this retrospective population based cohort study. From this group of patients 1899 patients started treatment during the study period and had at least one baseline cholesterol measurement during the six months prior to the initiation of lipid lowering drugs and at least one cholesterol measurement after initiation. A patient was defined to be 'at goal' if the patient had a total cholesterol less than 5.0 mmol/L. RESULTS: Our results indicate that only 30.2% of all treated patients achieved goal in the first year of treatment. After the introduction of new guidelines in 1998, recommending more aggressive treatment, the goal attainment percentage rose from 22.4% of those patients treated before 1998 to 42.3% for those in whom treatment was initiated after 1998. CONCLUSION: The percentage of patients achieving guideline recommended goal is low in real-life even in patients treated with high dose statins.     

Statins are less effective in common daily practice among patients with hypercholesterolemia: the REALITY-PHARMO study;

SUMMARY

Background: To study the use and effectiveness of lipid-lowering drugs with respect to lowering of cholesterol levels in routine daily practice.

Methods: 20?392 patients for whom lipid levels records were available between January 1991 and December 2001 were included in this retrospective population based cohort study. From this group of patients 1899 patients started treatment during the study period and had at least one baseline cholesterol measurement during the six months prior to the initiation of lipid lowering drugs and at least one cholesterol measurement after initiation. A patient was defined to be ‘at goal’ if the patient had a total cholesterol less than 5.0?mmol/L.

Results: Our results indicate that only 30.2% of all treated patients achieved goal in the first year of treatment. After the introduction of new guidelines in 1998, recommending more aggressive treatment, the goal attainment percentage rose from 22.4% of those patients treated before 1998 to 42.3% for those in whom treatment was initiated after 1998.

Conclusion: The percentage of patients achieving guideline recommended goal is low in real-life even in patients treated with high dose statins.     

Statins and telomere length: risk assessment and management for coronary heart disease

Cornoary heart disease (CHD) is identified as one of the diseases characterised by biological ageing as one of the important risk factors in several epidemiological studies. Premature biological ageing is distinct from chronological ageing and may predispose the individual to myocardial infarction, atherosclerosis and CHD in particular. The mean telomere length serves as a marker for the biological age at the cellular level, with shorter telomeres defining the increased biological age. Telomere length, therefore, correlates with the risk of CHD and atherosclerosis. Statins serve as the drugs of obvious choice based on their well established efficacy and safety profiles for the treatment of CHD and associated atherosclerosis. A present clinical study states that the treatment with a statin is associated with a reduction in the number of clinical events but only in individuals with increased risk based on their telomere length. This suggests a positive relationship of telomere length with the risk of CHD and, therefore, would help clinicians to categorise the patient populations based on their leucocyte telomere length for treatment with statins.     

Statins and telomere length: risk assessment and management for coronary heart disease

Cornoary heart disease (CHD) is identified as one of the diseases characterised by biological ageing as one of the important risk factors in several epidemiological studies. Premature biological ageing is distinct from chronological ageing and may predispose the individual to myocardial infarction, atherosclerosis and CHD in particular. The mean telomere length serves as a marker for the biological age at the cellular level, with shorter telomeres defining the increased biological age. Telomere length, therefore, correlates with the risk of CHD and atherosclerosis. Statins serve as the drugs of obvious choice based on their well established efficacy and safety profiles for the treatment of CHD and associated atherosclerosis. A present clinical study states that the treatment with a statin is associated with a reduction in the number of clinical events but only in individuals with increased risk based on their telomere length. This suggests a positive relationship of telomere length with the risk of CHD and, therefore, would help clinicians to categorise the patient populations based on their leucocyte telomere length for treatment with statins.     

The treatment of coronary heart disease: an update. Part 3: Statins beyond cholesterol lowering

Statins may have additional properties beyond diminishing low-density lipoprotein (LDL) cholesterol levels. These actions could reduce the risk of vascular events. For example, these lipid lowering drugs act on the vascular endothelium, smooth muscle, haemostatic factors and the vessel wall. There are several differences in how statins act on these systems. These observations, in turn, lead to the conclusion that all statins may not be equally effective in terms of vascular disease prevention.     

小于6个月婴儿先天性心脏病531例外科治疗

目的总结笔者所在医院小于6个月婴儿先天性心脏病手术治疗经验。方法 2005年1月—2014年12月,笔者所在医院共施行小于6个月婴儿先天性心脏病手术531例;其中男268例,女263例;年龄22 d至6个月,平均(4.0±2.2)个月;体重2.1~8.0 kg,平均(4.7±2.4)kg。病种包括室间隔缺损(VSD)352例、房间隔缺损(ASD)23例、肺动脉瓣狭窄(PS)4例、动脉导管未闭(PDA)20例、法洛四联症(TOF)18例、右心室双出口(DORV)5例、完全肺静脉异位引流(TAPVC)7例、完全性房室通道(CAVCD)5例、部分性房室通道(PAVCD)4例、肺动脉闭锁(PA)2例、VSD+ASD 48例、VSD+PDA 17例、VSD+ASD+PDA 6例、二尖瓣关闭不全(MR)+VSD 7例、ASD+PS 5例、ASD+PDA 5例、主动脉缩窄(Co A)+VSD 3例。结果手术死亡15例(2.83%)。术后发生低心排血量综合征24例,肺部感染19例,右肺不张4例,右侧气胸1例,喉头水肿9例,细菌性心内膜炎1例,切口液化5例,Ⅲ度房室传导阻滞1例,二次开胸止血4例。术后6~12个月门诊随访462例(87.2%),发现VSD残余漏6例,右下肺不张2例,二尖瓣中度关闭不全2例,三尖瓣重度关闭不全1例。结论开展小婴儿先天性心脏病手术,应结合自身的技术设备条件选择病种,把握好手术时机和手术指征,重视围手术期处理,可取得满意的临床效果。     

中年人血清尿酸水平与冠心病的关系

目的探索年龄小于50岁患者的血尿酸与冠心病的关系。方法收集近3年间经冠脉造影证实为冠心病患者与非冠心病患者的临床资料,包括性别、年龄、血尿酸、血糖、血脂、体重指数、冠脉造影结果等,分析两组之间血尿酸水平;多元回归方法分析血尿酸与冠心病的关系。结果冠心病组血尿酸水平明显高于非冠心病组（P=0．003）。冠心病双支和多支病变的患者血尿酸水平均高于明显单支病变（P〈0．05;P〈0．01）。多元组步回归分析证实在调整了其他危险因素外,血尿酸与冠心病病变严重程度密切相关（P=0．005）。结论血尿酸升高是50岁以下冠心病患者的独立危险因素。     

他汀类药物预防肾功能不全患者冠状动脉介入治疗术后对比剂肾病的研究

目的 探讨短期、大剂量他汀类药物对合并肾功能不全的冠心病患者择期冠状动脉介入治疗( PCI)术后对比剂肾病(CIN)的预防作用.方法 选择行择期PCI的冠心病合并肾功能不全患者41例,将其随机分为研究组(n=21)和对照组(n=20).分别于入院时开始口服阿托伐他汀80 mg/d或20 mg/d,连续使用3d.PCI术前,PCI术后第1、2、3d检测所有患者血清肌酐( SCr).CIN定义为:使用对比剂后3d内SCr较基础水平升高≥25％,或绝对值升高≥0.5 mg/dl.结果 对照组与研究组不同时间点间SCr比较差异均无显著性(P＞0.05).所有患者中,共有2例发生CIN( 4.88％),对照组和研究组各有1例发生CIN,二者发生率比较差异无显著性(P＞ 0.05 ).对照组SCr峰值为227.6 μmol/L,研究组SCr峰值为232.4 μmol/L,二者比较差异无显著性(P＞0.05).结论 在标准水化治疗的基础上,短期、大剂量他汀类药物并不能降低合并肾功能不全的择期PCI患者术后CIN的发生率.     

Prevention of coronary heart disease with aspirin and clopidogrel: efficacy, safety, costs and cost-effectiveness

Atherothrombotic coronary artery disease is the single most common cause of death worldwide and a growing public health problem. Platelets play a central role in the pathogenesis of atherothrombosis and are therefore commonly targeted by one or more antiplatelet drugs as part of primary and secondary atherothrombosis prevention strategies. Aspirin reduces the risk of serious vascular events (myocardial infarction, stroke or cardiovascular death) by approximately 20% in a broad range of high-risk patients and remains the first-line antiplatelet drug because of its relative safety, low cost and cost-effectiveness. Compared with aspirin alone, clopidogrel reduces the risk of serious vascular events by approximately 10% and the combination of aspirin and clopidogrel reduces the risk by approximately 20% in patients with non-ST-segment elevation acute coronary syndrome. Clopidogrel has a similar safety profile to aspirin but clopidogrel tablets are substantially more expensive. However, the incremental cost-effectiveness ratio of clopidogrel compared with aspirin is favourable, particularly in high-risk patients and is intermediate compared with a range of other effective therapeutic strategies for the treatment of coronary heart disease. Clopidogrel should be considered as a replacement for aspirin in patients who are allergic to aspirin, cannot tolerate aspirin, have experienced a recurrent atherothrombotic vascular event whilst taking aspirin and are at very high absolute risk of a serious vascular event (e.g., > 20%/year). The combination of clopidogrel and aspirin should be considered in patients with non-ST-segment elevation acute coronary syndrome or undergoing percutaneous coronary intervention.