BACKGROUND Guidelines recommend nonstatin lipid-lowering agents in patients at very high risk for major adverse cardiovascular events (MACE) if low-density lipoprotein cholesterol (LDL-C) remains ≥70 mg/dL on maximum tolerated statin treatment. It is uncertain if this approach benefits patients with LDL-C near 70 mg/dL. Lipoprotein(a) levels may influence residual risk. OBJECTIVES In a post hoc analysis of the ODYSSEY Outcomes (Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab) trial, the authors evaluated the benefit of adding the proprotein subtilisin/kexin type 9 inhibitor alirocumab to optimized statin treatment in patients with LDL-C levels near 70 mg/dL. Effects were evaluated according to concurrent lipoprotein(a) levels. METHODS ODYSSEY Outcomes compared alirocumab with placebo in 18,924 patients with recent acute coronary syndromes receiving optimized statin treatment. In 4,351 patients (23.0%), screening or randomization LDL-C was <70 mg/dL (median 69.4 mg/dL; interquartile range: 64.3–74.0 mg/dL); in 14,573 patients (77.0%), both determinations were ≥70 mg/dL (median 94.0 mg/dL; interquartile range: 83.2–111.0 mg/dL). RESULTS In the lower LDL-C subgroup, MACE rates were 4.2 and 3.1 per 100 patient-years among placebo-treated patients with baseline lipoprotein(a) greater than or less than or equal to the median (13.7 mg/dL). Corresponding adjusted treatment hazard ratios were 0.68 (95% confidence interval [Cl]: 0.52–0.90) and 1.11 (95% Cl: 0.83–1.49), with treatment-lipoprotein(a) interaction on MACE ( P interaction = 0.017). In the higher LDL-C subgroup, MACE rates were 4.7 and 3.8 per 100 patient-years among placebo-treated patients with lipoprotein(a) >13.7 mg/dL or ≤13.7 mg/dL; corresponding adjusted treatment hazard ratios were 0.82 (95% Cl: 0.72–0.92) and 0.89 (95% Cl: 0.75–1.06), with P interaction = 0.43. CONCLUSIONS In patients with recent acute coronary syndromes and LDL-C near 70 mg/dL on optimized statin therapy, proprotein subtilisin/kexin type 9 inhibition provides incremental clinical benefit only when lipoprotein(a) concentration is at least mildly elevated. (ODYSSEY Outcomes: Evaluation of Cardiovascular Outcomes After an Acute Coronary Syndrome During Treatment With Alirocumab; NCT01663402 )

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RBCCV 44205-93 BARBOSA, G. v .; SOUZA, B. F.; REY, N. A.; WENDER , O. C.; PIMENTEL FILHO, P.; VIEIRA, S. R. R. ; WOLMEISTER, H. ; MANFROI, W. C.; WESTPHALEN, P. P. -Substituição isolada da valva aórtica em pacientes com função ventricular deprimida. Rev. Bras. Cir. Cardiovasc., 4(3): 195-201, 1989. RESUMO: Para avaliar o valor prognóstico da fração de ejeção do ventrículo esquerdo, entre 210 pacientes com lesões da valva aórtica operados, consecutivamente, entre maio de 1981 e outubro de 1988 e que receberam as próteses Omniscience e Meditronic-Hall , foram selecionados 112 e divididos, de acordo com a fração de ejeção do ventrículo esquerdo, em dois grupos : o G1 = FE > 40%, ficou com 52 pacientes com médias de idade 39 ± 12 anos, FE = 58 ± 10% e classe funcional (NYHA) = 2,8; o GE = FE ;;;; 40% ficou com 60 pacientes com médias de idade 48 ± 17 anos, FE = 27 ±13% e (NYHA) = 3,6. Nas cirurgias, foram utilizados hipotermia e hemodiluição moderadas, oxigenador de bolhas, infusão cardioplégica SI. Thomas. As médias dos tempos de circulação extracorpórea e parada cardíaca foram : no G1 = 82 ± 18 e 49 ± 7 minutos, e 96 ± 11 e 55 ± 6 minutos, no Grupo 2; o tamanho das próteses foi 25,2 ± 1,8 milímetros. No Grupo 1, a mortalidade imediata foi 3,8% no G1

Background: Low-density lipoprotein cholesterol (LDL-C) is a risk factor and even cause of atherosclerosis. High dose statins early in all Acute Coronary Syndrome (ACS) patients are now recommended. . Mean serum LDL-C vary relatively little over the early days of ACS and lipid therapy generally is not considered a priority during ACS . Initiation of statin is strongly associated with their use after discharge Purpose: To evaluate our data on lipids after ACS and compare with current standards of therapy. Methods: 100 patients were analyzed during 6 months in 2016 in a step-down unit with ACS -unstable angina (UA), myocardial infarction with ST elevation (STEMI) and without ST elevation (NonSTEMI). Data regarded age, gender, type of ACS, coronary angiogram , medical therapy, lipid levels. Symmetric variables are described by mean and standard deviation(sd) and asymetric by the median and interquartile range. Categorical variables are described by frequencies and percentages . 95% confidence intervals for percentages are presented for main results. Results: 56 men, 44 women, mean ages 64 years old (sd 12.5); 36 with diabetes; 42 UA, 35 NonSTEMI and 23 STEMI. Coronary angiograms in 98 patients, 4 without lesions . Medical therapy with aspirin in 100, clopidogrel 92,beta blockers 96, ACE inhibitors 63, angiotensin receptor blockers 12, calcium channel blockers 7, diuretics 20 , nitrates 9. Previous statin use in 32 and statin use during hospital stay and discharge in 99. The range of TC was 90 to 291 mg/dL (mean: 167,1; sd 40.8), LDL-C: 39 to 194mg/dL (mean 98.0; sd: 34.1); HDL-C from 20 to 68 mg/dL (mean :34.8; sd: 99.2); Triglycerides from 55 to 615 mg/dl ( median 151.5; interquartile range : 114.5 to 197.0) . Patients with LDL-C ≤ 70 mg/dL : 25% ( CI 95% : 16.9- 34.7); HDL-C ≥40 : 24% (CI 95% : 16.0 - 33.6). Lipid levels were measured in only 12 patients at arrival (CI 95% : 6.4 - 20.0), in 70 during hospital stay (CI 95% : 60.0 - 78.8); in 30 patients no measure at all (CI95% : 21.2 - 40.0). Conclusion: Knowledge of serum lipid levels early after ACS is very relevant and should facilitate initiation of lipid lowering therapy. There is still a large gap between current recommendations and clinical practice concerning lipids in ACS, as shown with our data.