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Management of dyslipidaemias in specific patient groups


Authors: M. Vaclová;  M. Vráblík;  R. Češka
Authors‘ workplace: III. interní klinika 1. LF UK a VFN v Praze
Published in: Kardiol Rev Int Med 2017, 19(3): 157-160

Overview

This article focuses on different approaches to the management of dyslipidaemia in selected patient groups. These groups are defined by comorbidities (e. g. acute coronary syndrome, elective coronary intervention, systemic inflammatory diseases, chronic kidney disease, diabetes) or by age and gender. In post-ACS patients, individual studies as well as their meta-analyses support routine, early, intensive and long-term use of statin therapy. Highly effective statins (atorvastatin, rosuvastatin) should be used and the therapy should be initiated no later than 4 days after the event. In patients undergoing percutaneous coronary intervention, high-intensity statin therapy has been shown to be beneficial both in statin-naive patients and in statin users who had the dose up titrated prior to the procedure. Statins reduce the risk of periprocedural myocardial infarction as well as complications during the following 30-day period. Statins reduce the activity of systemic inflammatory diseases and the risk of CVD morbidity and mortality in these patients (particularly in primary prevention). On the contrary, statin cessation leads to increased CVD mortality and morbidity. Declining glomerular filtration associates with increasing cardiovascular risk independently on other risk factors. CKD 3 and 4 lead to a 2- and 3-fold increase of CV mortality, respectively. Thus, patients with CKD 3 are classified as high and those with CKD 4 and 5 as very high risk patients. HIV positive patients have an increased CVD risk compared to HIV negative population. Some antiretroviral drugs more than double the risk. Antiretrovirals can accelerate the development of coronary artery disease particularly in young male smokers with dyslipidaemia. Lipid metabolism disorders in post-transplant patients lead to arterial vasculopathy and atherosclerosis progression. Immunosuppressive treatment has a significant negative impact on lipid metabolism. Lipid lowering efficacy in the elderly in secondary prevention differed according to study and the results are often inconsistent.

Keywords:
dyslipidaemia –  acute coronary syndrome –  percutaneous coronary intervention –  autoimmune diseases –  chronic kidney disease –  diabetics –  the elderly


Sources

1. Cífková R, Skodová Z, Bruthans J et al. Longitudinal trends in major cardiovascular risk factors in the Czech population between 1985 and 2007/ 8. Czech MONICA and Czech post-MONICA. Atherosclerosis 2010; 211(2): 676– 681. doi: 10.1016/ j.atherosclerosis.2010.04.007.

2. Catapano L, Graham I, De Backer G et al. 2016 ESC/ EAS Guidelines for the Management of Dyslipidaemias The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European As­sociation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis 2016; 253: 281– 344. doi: 10.1016/ j.atherosclerosis.2016.08.018.

3. Schwartz GG, Ols­son AG, Ezekowitz MD et al. Ef­fects of atorvastatin on early recur­rent ischemic events in acute coronary syndromes: the MIRACL study: a randomized control­led trial. JAMA 2001; 285(13): 1711– 1718.

4. De Lemos JA, Blaz­­ing MA, Wiviott SD et al. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA 2004; 292(11): 1307– 1316.

5. Ray KK, Can­non CP, McCabe CH et al. Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 trial. J Am Coll Cardiol 2005; 46(8): 1405– 1410. doi: 10.1016/ j.jacc.2005.03.077.

6. Robinson JG, Farnier M, Krempf M et al. Ef­ficacy and safety of alirocumab in reduc­­ing lipids and cardiovascular events. N Engl J Med 2015; 372(16): 1489– 1499. doi: 10.1056/ NEJMoa1501031.

7. Sabatine MS, Giugliano RP, Wiviott SD et al. Ef­ficacy and safety of evolocumab in reduc­­ing lipids and cardiovascular events. N Engl J Med 2015; 327(16): 1500– 1509. doi: 10.1056/ NEJMoa1500858.

8. Di Sciascio G, Patti G, Pasceri V et al. Ef­ficacy of atorvastatin reload in patients on chronic statin ther­apy undergo­­ing percutaneous coronary intervention: results of the ARMYDA-RECAPTURE (Atorvastatin for Reduction of Myocardial Damage Dur­­ing Angioplasty) Randomized Trial. J Am Coll Cardiol 2009; 54(6): 558– 565. doi: 10.1016/ j.jacc.2009.05.028.

9. Patti G, Can­non CP, Murphy SA et al. Clinical bene­fit of statin pretreatment in patients undergo­­ing percutaneous coronary intervention: a col­laborative patient-level meta-analysis of 13 randomized studies. Circulation 2001; 123(15): 1622– 1632. doi: 10.1161/ CIRCULATIONAHA.110.002451.

10. Briguori C, Visconti G, Focaccio A et al. Novel ap­proaches for prevent­­ing or limit­­ing events (Naples) II trial: impact of a single high load­­ing dose of atorvastatin on periprocedural myocardial infarction. J Am Coll Cardiol 2009; 54(23): 2157– 2163. doi: 10.1016/ j.jacc.2009.07.005.

11. Gandhi S, Mosleh W, Abdel-Qadir H et al. Statins and contrast induced acute kidney injury with coronary angiogramy. Am J Med 2014; 127(10): 987– 1000. doi: 10.1016/ j.amjmed.2014.05.011.

12. Goldberg RJ, Urowitz MB, Ibanez D et al. Risk factors for development of coronary artery dis­ease in women with systemic lupus erythematosus. J Rheumatol 2009; 36(11): 2454– 2461. doi: 10.3899/ jrheum.090011.

13. Ogdie A, Yu Y, Haynes K et al. Risk of major cardiovascular events in patients with psoriatic arthritis, psoriasis and rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis 2015; 74(2): 326– 332. doi: 10.1136/ an­nrheumdis-2014-205675.

14. Peters MJ, Sym­mons DP, McCarey D et al. EULAR evidence-based recom­mendations for cardiovascular risk management in patients with rheumatoid arthritis and other forms of inflam­matory arthritis. Ann Rheum Dis 2010; 69(2): 325– 331. doi: 10.1136/ ard.2009.113696.

15. De Vera MA, Choi H, Abrahamowicz H et al. Statin discontinuation and risk of acute myocardial infarction in patients with rheumatoid arthritis: a population-based cohort study. Ann Rheum Dis 2011; 70(6): 1020– 1024. doi: 10.1136/ ard.2010.142455.

16. Bar­ry R, James MT. Guidelines for clas­sification of acute kidney dis­eases and disorders. Nephron 2015; 131(4): 221– 226. doi: 10.1159/ 000441425.

17. Gansevoort RT, Cor­rea-Rotter R, Hem­melgarn BRet al. Chronic kidney dis­ease and cardiovascular risk: epidemiology, mechanisms, and preventiv. Lancet 2013; 382(9889): 339– 352. doi: 10.1016/ S0140-6736(13)60595-4.

18. Matsushita K, van der Velde M, Astor BC et al. As­sociation of estimated glomerular filtration rate and albuminuria with al­l-cause and cardiovascular mortality in general population cohorts: a col­laborative meta-analysis. Lancet 2010; 375(9731): 2073– 2081. doi: 10.1016/ S0140-6736(10)60674-5.

19. Palmer SC, Navaneethan SD, Craig JC et al. HMG CoA reductase inhibitors (statins) for people with chronic kidney dis­ease not requir­­ing dialysis. Cochrane Database Syst Rev 2014; 5: CD007784. doi: 10.1002/ 14651858.CD007784.pub2.

20. Souhrn údajů o přípravku. Rosuvastatin Mylan 10 mg. Dostupné na: http:/ / www.sukl.cz/ download/ spc/ SPC34067.pdf

21. Riddler SA, Smit E, Cole SR et al. Impact of HIV infection and HAART on serum lipids in men. JAMA 2003; 289: 2978– 2982. doi: 10.1001/ jama.289.22.2978.

22. Hemkens LG, Bucher HC. HIV infection and cardiovascular dinase. Eur Heart J 2014; 35: 1373– 1381.

23. Islam FM, Wu J, Jans­son J et al. Relative risk of cardiovascular dis­ease among people liv­­ing with HIV: a systematic review and meta-analysis. HIV Med 2012; 13(8): 453– 468. doi: 10.1111/ j.1468-1293. 2012.00996.x.

24. Bavinger C, Bendavid E, Niehaus K et al. Risk of cardiovascular dis­ease from antiretroviral ther­apy for HIV: a systematic review. PLoS One 2013; 8(3): e59551. doi: 10.1371/ journal.pone.0059551.

25. Kobashigawa JA, Katznelson S, Laks H et al. Ef­fect of pravastatin on outcomes after cardiac transplant­ation. N Engl J Med 1995; 333(10): 621– 627. doi: 10.1056/ NEJM199509073331003.

26. Navaneethan SD, Perkovic V, Johnson DW et al. HMG CoA reductase inhibitors (statins) for kidney transplant recipients. Cochrane Database Syst Rev 2009; 2: CD005019. doi: 10.1002/ 14651858.CD005019.pub3.

27. Rosengren A. Better treatment and improved prognosis in elderly patients with AMI: but do reg­isters tell the whole truth? Eur Heart J 2012; 33(5): 562– 563. doi: 10.1093/ eurheartj/ ehr364.

28. Lloyd-Jones DM, Leip EP, Larson MG et al. Prediction of lifetime risk for cardiovascular dis­ease by risk factor burden at 50 years of age. Circulation 2006; 113(6): 791– 798. doi: 10.1161/ CIRCULATION­AHA.105.54 8206.

29. Ber­ry JD, Dyer A, Cai X et al. Lifetime risks of cardiovascular dinase. N Engl J Med 2012; 366(4): 321– 329. doi: 10.1056/ NEJMoa1012848.

30. Glynn RJ, Koenig W, Nordestgaard BG et al. Rosuvastatin for primary prevention in older persons with elevated C-reactive protein and low to average low-density lipoprotein cholesterol levels: exploratory analysis of a random­ized trial. Ann Intern Med 2010; 152(8): 488– 496. W174. doi: 10.7326/ 0003-4819-152-8-201004200-00005.

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