Prevalence and Predictors of Out-of-Target LDL Cholesterol 1 to 3 Years After Myocardial Infarction. A Subanalysis From the EYESHOT Post-MI Registry

Silverio, Angelo; Benvenga, Rossella Maria; Piscione, Federico; Gulizia, Michele Massimo; Meessen, Jennifer; Colivicchi, Furio; Nardi, Federico; Baldi, Cesare; Galasso, Gennaro; Vecchione, Carmine; Lenarda, Andrea Di; Gabrielli, Domenico; Luca, Leonardo De

doi:10.1177/1074248420947633

Cited by 9 publications

(7 citation statements)

References 33 publications

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“…Most studies have focused on patients at very high, and high CV risk. Some have looked at recommendations' adherence and guideline patterns in very high-risk patients, such as those who have had a previous MI [14].…”

Section: Discussionmentioning

confidence: 99%

Success in achieving LDL-C target values in a high-risk population in Slovakia: SlovakLipid retrospective study

Toth,

Turek,

Pella

2023

Arch Med Sci

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IntroductionSlovakia belongs among the countries with the highest cardiovascular mortality, nevertheless extensive data on the effectiveness of dyslipidaemia management is lacking. The aim of this study was to assess the implementation of European guidelines in the very high-risk population in Slovakia.Material and methodsWe retrospectively analysed anonymised LDL C values of patients at very high cardiovascular risk gathered between 2017 and 2019 from collaborating laboratory with nationwide reach. CV risk was based on patient’s ICD diagnoses. LDL C target values were based on the 2016ESC/EAS recommendations, as well as current recommendations from 2019. Patients diagnosed with ACS, stroke, or overall very high-risk CVD were selected.ResultsA total of 220 657 LDL-C test results from 72 039 patients were processed. Only 8 9% of patients with ACS attained target LDL-C in a follow-up test each year. 6-9% of patients had LDL-C levels ≥ 4.9 mmol/l. Only 9-10% of patients with stroke achieved target LDL-C levels, and 7-8% had levels ≥ 4.9 mmol/l. In the very high CV risk group, only 7% of patients achieved target levels, and 7-8% had extremely high LDL-C levels ≥ 4.9 mmol/l. With the ESC/EAS2019 recommendations only 2-3% of patients in each group achieved target levels each year.ConclusionsBased on our results, we found that over 90% of patients with very high CVD risk do not achieve target LDL-C levels. This percentage is even higher when implementing the 2019 guidelines. These patients remain at high risk of subsequent CVD events and would benefit significantly from intensified hypolipemic therapy.

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Section: Discussionmentioning

confidence: 99%

Success in achieving LDL-C target values in a high-risk population in Slovakia: SlovakLipid retrospective study

Toth,

Turek,

Pella

2023

Arch Med Sci

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“…Again, this more invasive and aggressive attitude may be related to the greater risk perceived by cardiologists based on the number of comorbidities rather than the number of previous MI episodes. In this regard, prior studies found incomplete prescription of recommended medications to predict re-MI [ 23 , 24 ]. In our series, about one in four patients, regardless of the number of prior MIs, was not prescribed OMT at the time of enrolment.…”

Section: Discussionmentioning

confidence: 99%

Incidence, Characteristics, and Management of Patients with Recurrent Myocardial Infarctions: Insights from the EYESHOT POST-MI

Luca

Colivicchi

Gabrielli

et al. 2022

Journal of Interventional Cardiology

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Background. It is unknown whether patients who survived two or multiple episodes of myocardial infarction (MI) present different clinical characteristics and management than patients at their first MI. Methods. The EYESHOT post-MI was a prospective, observational, nationwide study aimed to evaluate the management of patients presenting to cardiologists 1 to 3 years from the last MI event. In 3 months of enrolment, 165 Italian cardiology centers included 1633 consecutive post-MI patients. In the present analysis, we stratified the study cohort according to the number of prior MI episodes (i.e., 1, 2 or ≥3). Results. Among the 1618 patients enrolled with complete data on MI history, 1335 (82.5%) were at their first MI episode, 209 (12.9%) had a history of 2 MIs, and the remaining 74 (4.6%) had ≥ 3 prior MIs. Patients with a history of multiple MIs were increasingly older and presented a significantly higher rate of risk factors compared to those at their first MI. During the year prior to enrolment, patients with 2 or ≥3 MI episodes more frequently underwent coronary angiography compared to the other group ( p < 0.0001 ). In addition, several lifesaving and antianginal drugs were more frequently prescribed in patients presenting with a history of multiple MIs compared to those at their first MI. Conclusions. Our data suggest that patients with multiple MIs managed by cardiologists in routine clinical practice present an incremental clinical risk, more frequently undergo coronary angiography, and are more intensively managed with pharmacological therapies compared to patients at their first MI episode.

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“…Landmark trials showed that LDL-c-lowering agents, such as statins and ezetimibe, significantly reduced the incidence of adverse ischemic events in patients with CAD [ 37 , 38 ]. However, several studies on lipid-lowering therapies showed a persistent residual risk of ischemic events despite an aggressive LDL-C control [ 37 , 39 , 40 ]. The issue of “residual cholesterol risk” has been partially addressed with the introduction of proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors that dramatically reduce LDL-c levels when added to statin therapy, showing a significant reduction in cardiovascular events in patients with CAD [ 41 , 42 ].…”

Section: Introductionmentioning

confidence: 99%

Secondary Cardiovascular Prevention after Acute Coronary Syndrome: Emerging Risk Factors and Novel Therapeutic Targets

Silverio

Cancro

Esposito

et al. 2023

JCM

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The control of cardiovascular risk factors, the promotion of a healthy lifestyle, and antithrombotic therapy are the cornerstones of secondary prevention after acute coronary syndrome (ACS). However, many patients have recurrent ischemic events despite the optimal control of traditional modifiable risk factors and the use of tailored pharmacological therapy, including new-generation antiplatelet and lipid-lowering agents. This evidence emphasizes the importance of identifying novel risk factors and targets to optimize secondary preventive strategies. Lipoprotein(a) (Lp(a)) has emerged as an independent predictor of adverse events after ACS. New molecules such as anti-PCSK9 monoclonal antibodies, small interfering RNAs, and antisense oligonucleotides can reduce plasma Lp(a) levels and are associated with a long-term outcome benefit after the index event. The inflammatory stimulus and the inflammasome, pivotal elements in the development and progression of atherosclerosis, have been widely investigated in patients with coronary artery disease. More recently, randomized clinical trials including post-ACS patients treated with colchicine and monoclonal antibodies targeting cytokines yielded promising results in the reduction in major cardiovascular events after an ACS. Gut dysbiosis has also raised great interest for its potential pathophysiological role in cardiovascular disease. This evidence, albeit preliminary and needing confirmation by larger population-based studies, suggests the possibility of targeting the gut microbiome in particularly high-risk populations. The risk of recurrent ischemic events after ACS is related to the complex interaction between intrinsic predisposing factors and environmental triggers. The identification of novel risk factors and targets is fundamental to customizing patient clinical management with a precision medicine perspective.

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Prevalence and Predictors of Out-of-Target LDL Cholesterol 1 to 3 Years After Myocardial Infarction. A Subanalysis From the EYESHOT Post-MI Registry

Cited by 9 publications

References 33 publications

Success in achieving LDL-C target values in a high-risk population in Slovakia: SlovakLipid retrospective study

Success in achieving LDL-C target values in a high-risk population in Slovakia: SlovakLipid retrospective study

Incidence, Characteristics, and Management of Patients with Recurrent Myocardial Infarctions: Insights from the EYESHOT POST-MI

Secondary Cardiovascular Prevention after Acute Coronary Syndrome: Emerging Risk Factors and Novel Therapeutic Targets

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