These data contribute to our understanding of contemporary trends in the management of patients with HeFH in Canada. Despite a majority of patients receiving LLT, few patients reached high-risk lipid targets. These data highlight important opportunities to improve the care of patients with HeFH.

ST-segment depression is commonly seen in patients with acute coronary syndromes. Most authors have attributed it to transient reductions in coronary blood flow due to nonocclusive thrombus formation on a disrupted atherosclerotic plaque and dynamic focal vasospasm at the site of coronary artery stenosis. However, ST-segment depression was never reproduced in classic animal models of coronary stenosis without the presence of tachycardia. We hypothesized that ST-segment depression occurring during acute coronary syndromes is not entirely explained by changes in epicardial coronary artery resistance and thus evaluated the effect of a slow, progressive epicardial coronary artery occlusion on the ECG and regional myocardial blood flow in anesthetized pigs. Slow, progressive occlusion over 72 min (SD 27) of the left anterior descending coronary artery in 20 anesthetized pigs led to a 90% decrease in coronary blood flow and the development of ST-segment elevation associated with homogeneous and transmural myocardial blood flow reductions, confirmed by microspheres and myocardial contrast echocardiography. ST-segment depression was not observed in any ECG lead before the development of ST-segment elevation. At normal heart rates, progressive epicardial stenosis of a coronary artery results in myocardial ischemia associated with homogeneous, transmural reduction in regional myocardial blood flow and ST-segment elevation, without preceding ST-segment depression. Thus, in coronary syndromes with ST-segment depression and predominant subendocardial ischemia, factors other than mere increases in epicardial coronary resistance must be invoked to explain the heterogeneous parietal distribution of flow and associated ECG changes.

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Objectives: Atopic dermatitis (AD) is an inflammatory, chronic skin disease defined by flare-ups periods. This disorder affects health and quality of life of patients. The follow-up of AD and the prevention of relapses have a great impact on health care, society costs but also on patient's expenditures. The aim of the study is to assess the cost-effectiveness of different emollients prescribed in AD patients. Methods: A Markov simulation model was developed over a 5-year period including data from different sources: (i) randomized clinical trials and literature review for the efficacy of treatments, (ii) resource utilisation and quality of life data, and (iii) unit prices from official prices lists. Three perspectives were considered: NHS/PSS, society which adds productivity losses and patient which includes out-of-pocket expenditures. 4 different emollients were compared (A, B, C, D) with no emollient users. Patients were treated with topical corticosteroid during flare-ups periods. Two outcomes were used to evaluate the cost-effectiveness: QALY and time without flare-ups. Sensitivity analysis were performed. Results: The 5-year costs associated with the different emollients amounts to ₤1,329 and generates 3.55 QALY for emollient A. Patients spend in average 3.89 years without flare-ups periods. Compared to emollient B, emollient A is costlier (D₤42) but more effective (0.08 years, corresponding to a 30-day difference without flare-ups between A and B, or 0.009 QALY). The ICER is ₤515 per year without flare-ups periods and ₤4,672 per QALY. Emollient A is the dominant strategy compared to no treatment (184 more days without flare-ups and ₤268.85 cheaper), emollient B or C. Conclusions: According to the analysis, treatment with preventive emollient was a cost-effective option compared with no treatment in adult AD patients. In this comparative study, emollient A is the most efficient strategy from a willingness to pay of ₤500 with a probability of 47%.

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