Publications by authors named "Anselm Gitt"

169 Publications

[COVID-19 pandemic : Effects on clinical care of cardiovascular patients in spring 2020].

Herz 2021 Feb 16. Epub 2021 Feb 16.

Herzzentrum Leipzig, Universität Leipzig, Strümpellstr. 39, 04289, Leipzig, Deutschland.

The coronavirus disease 2019 (COVID-19) pandemic has led to a focus of acute medical care on the treatment of patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and pneumonia with consequences for all other medical specialties. Between March and May 2020 a decline in the number of admissions for elective cardiac procedures as well as for cardiac emergencies was observed. The number of patients hospitalized for acute myocardial infarction decreased, especially those with non-ST elevation myocardial infarction (NSTEMI), while time intervals between symptom onset and admission sometimes increased. In some studies an increase in infarct-related mortality was reported. There are multiple possible reasons for these findings, which include fear of patients to become infected with SARS-CoV‑2 in hospital, misinterpretation of symptoms and focusing of the healthcare system on the pandemic. In addition, SARS-CoV‑2 can lead to a higher proneness to thrombosis and therefore induce more severe courses of myocardial infarction.
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http://dx.doi.org/10.1007/s00059-020-05015-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7884099PMC
February 2021

Lipid-lowering treatment and low-density lipoprotein cholesterol target achievement in patients with type 2 diabetes and acute coronary syndrome.

Arch Cardiovasc Dis 2020 Oct 29;113(10):617-629. Epub 2020 Aug 29.

Stiftung Institut für Herzinfarktforschung, 67063 Ludwigshafen am Rhein, Germany; Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, 67063 Ludwigshafen am Rhein, Germany.

Background: Patients with type 2 diabetes mellitus characteristically display an atherogenic lipid profile with high triglyceride concentrations, low high-density lipoprotein cholesterol (HDL-C) concentrations and low-density lipoprotein cholesterol (LDL-C) concentrations not always elevated. It is unclear if patients with diabetes who present with an acute coronary syndrome (ACS) receive different or more-potent lipid-lowering therapy (LLT).

Aims: To investigate lipid abnormalities in patients with and without type 2 diabetes hospitalised for an ACS, and use of LLT before admission and 4 months after the event.

Methods: Patients were included in the observational DYSIS II study if they were hospitalised for an ACS and had a full lipid profile.

Results: Of 3803 patients, diabetes was documented in 1344 (54.7%). Compared to patients without diabetes, those with diabetes had a lower mean LDL-C (101.2 vs. 112.0mg/dL; 2.6 vs. 2.9mmol/L; P<0.0001), with a greater proportion attaining concentrations<70mg/dL (1.8mmol/L) (23.9% vs. 16.0%; P<0.0001) and<55mg/dL (1.4mmol/L) (11.3% vs. 7.3%; P<0.0001), a higher mean triglyceride concentration (139.0 vs. 121.0mg/dL; 1.6 vs. 1.4mmol/L; P<0.0001) and a lower HDL-C concentration. LLT was more commonly given to patients with diabetes (77.5% vs. 58.8%; P<0.0001); there were no differences in types of therapy prescribed. Four months after hospitalisation, most patients from both groups were being treated with LLT (predominantly statin monotherapy).

Conclusions: Despite the different lipid profiles, the type of LLT prescribed did not vary depending on the presence or absence of type 2 diabetes. There was no difference in LLT in patients with and without diabetes at 4-month follow-up, except for fibrates, which were used in 2% of patients with and 1% of patients without diabetes. Statin monotherapy of intermediate potency was the predominant treatment in both groups.
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http://dx.doi.org/10.1016/j.acvd.2020.05.013DOI Listing
October 2020

Dyslipidemia and Rate of Under-Target Low-Density Lipoprotein-Cholesterol in Patients with Coronary Artery Disease in Korea.

J Lipid Atheroscler 2019 Sep 12;8(2):242-251. Epub 2019 Aug 12.

Division of Cardiology, Department of Internal Medicine, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Objective: The aim of this study was to evaluate under target rates of low-density lipoprotein-cholesterol (LDL-C) in Korean patients with stable coronary artery disease (CAD) or an acute coronary syndrome (ACS) in real world practice.

Methods: Dyslipidemia International Study II was an international observational study of patients with stable CAD or an ACS. Lipid profiles and use of lipid-lowering therapy (LLT) were documented at enrollment, and for the ACS cohort, 4 months follow-up was recommended. Rates of under target LDL-C as per European guidelines, were evaluated, and multivariate regression was performed to identify predictive factors of patients presenting under the target.

Results: A total of 808 patients were enrolled in Korea, 500 with stable CAD and 308 with ACS. Of these, 90.6% and 52.6% were being treated with LLT, respectively. In the stable CAD group, 40.0% were under target LDL-C, while in ACS group, the rate was 23.7%. A higher statin dose was independently associated with under target LDL-C in both groups (OR, 1.03; =0.046 [stable CAD] and OR, 1.05; =0.01 [ACS]). The mean statin dosage (atorvastatin equivalent) was 17 mg/day. In the 79 ACS patients who underwent the follow-up examination, the LDL-C under target rate rose to 59.5%.

Conclusion: Only a minority of patients with stable CAD or ACS were under their target LDL-C level at enrollment. The statin dose was not sufficient in the majority of patients. These results indicate a considerable LLT gap in Korean patients with established CAD.
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http://dx.doi.org/10.12997/jla.2019.8.2.242DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7379120PMC
September 2019

The COVID-19 Registry in Rhineland-Palatinate in the context of international registry activities documenting COVID-19 outcomes.

Herz 2020 Jun;45(4):316-318

Universitätsklinik und Poliklinik für Innere Medizin III, Universitätsklinikum Halle (Saale) der Martin-Luther-Universität Halle-Wittenberg, Ernst-Grube-Str. 40, 06120, Halle (Saale), Germany.

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http://dx.doi.org/10.1007/s00059-020-04928-wDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7181104PMC
June 2020

Comparison of current German and European practice in cardiac resynchronization therapy: lessons from the ESC/EHRA/HFA CRT Survey II.

Clin Res Cardiol 2020 Jul 6;109(7):832-844. Epub 2019 Dec 6.

Department of Cardiology and Intensive Care Medicine, Teutoburger Straße 50, 33604, Bielefeld, Germany.

Introduction: The European CRT Survey II was introduced to offer insights into CRT implantation practice in Europe. We compared the national data from the participating German centres with that of the other European countries with regard to differences in patient selection, implant results, and initial properties.

Methods And Results: 11,088 patients were enrolled in 288 centres from 42 countries between 2015 and 2017. Of these, 675 (6.1%) were included in 17 centres in Germany. Patients from Germany were older, had more comorbidities and more symptoms of heart failure (HF) than patients from other European countries. There were no differences with regard to HF aetiology and guideline-directed medical treatment was overall well implemented. There was a high use of CRT in patients with atrial fibrillation, even higher in German patients. CRT was most often applied due to HF with wide QRS complex (class I recommendation) but with relatively higher frequency in Germany due to HF with primary indication for an implantable cardioverter-defibrillator (class IIb) or a pacemaker with expected pacing dependency (class I). The overall implant success rate was high with some differences in the implant procedure. The use of remote monitoring was lower in Germany.

Conclusion: This analysis from the European CRT Survey II overall shows good guideline adherence, high implantation success and a low rate of complications in daily practice. There are some regional differences in baseline characteristics, CRT indication, and procedural aspects. The use of remote monitoring in Germany lags behind other European countries.
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http://dx.doi.org/10.1007/s00392-019-01574-zDOI Listing
July 2020

Prevalence of Lipid Abnormalities and Cholesterol Target Value Attainment in Patients with Stable and Acute Coronary Heart Disease in the United Arab Emirates.

Heart Views 2019 Apr-Jun;20(2):37-46

Foundation Institute for Myocardial Infarction Research, Ludwigshafen, Germany.

Background: Careful management of lipid abnormalities in patients with coronary heart disease (CHD) or an acute coronary syndrome (ACS) can reduce the risk of recurrent cardiovascular events. The extent of hyperlipidemia in these very high-risk patients in the United Arab Emirates (UAE), along with the treatment strategies employed, is not clear.

Methods: The Dyslipidemia International Study II was a multinational observational analysis carried out from 2012 to 2014. Patients were enrolled if they had either stable CHD or an ACS. Patient characteristics, lipid levels, and use of lipid-lowering therapy (LLT) were recorded at enrollment. For the ACS patients, the LLT used during the 4 months' follow-up period was documented, as were any cardiovascular events.

Results: A total of 416 patients were recruited from two centers in the UAE, 216 with stable CHD and 200 hospitalized with an ACS. Comorbidities and cardiovascular risk factors were extremely common. A low-density lipoprotein cholesterol level of <70 mg/dl, recommended for patients at very high cardiovascular risk, was attained by 39.3% of the LLT-treated CHD patients and 33.3% of the LLT-treated ACS patients at enrollment. The mean atorvastatin-equivalent daily statin dose was 29 ± 15 mg for the CHD patients, with 13.7% additionally using ezetimibe. For the ACS patients, the daily dosage was 23 ± 13 mg at admission, rising to 39 ± 12 mg by the end of the 4-month follow-up. The use of nonstatin agents was extremely low in this group.

Conclusions: Despite LLT being widely used, hyperlipidemia was found to be prevalent in ACS and CHD patients in the UAE. Treatment strategies need to be significantly improved to reduce the rate of cardiovascular events in these very high-risk patients.
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http://dx.doi.org/10.4103/HEARTVIEWS.HEARTVIEWS_32_18DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6686608PMC
August 2019

Attainment of cholesterol target values in Greece: results from the Dyslipidemia International Study II.

Arch Med Sci 2019 Jul 12;15(4):821-831. Epub 2018 Mar 12.

Department of Internal Medicine, Medical School, University of Ioannina, Ioannina, Greece.

Introduction: Current European guidelines recommend treatment with lipid-lowering therapy (LLT) to a low-density lipoprotein cholesterol (LDL-C) target of < 70 mg/dl for patients at very high risk. LDL-C target attainment and use of LLTs in these patients in Greece is not known.

Material And Methods: The Dyslipidemia International Study (DYSIS) II was a multicenter observational study. The coronary heart disease (CHD) cohort was divided into two groups based on treatment status (on LLT for ≥ 3 months or not on LLT). The acute coronary syndrome (ACS) cohort was evaluated at the time of admission and again 120 ±15 days after admission.

Results: In the CHD cohort ( = 499), 457 (91.6%) patients were on LLT. The LDL-C target value was attained by 26.5% of LLT users. Statin monotherapy was used by 77.5% of treated patients, with a mean ± SD atorvastatin dose equivalent of 24 ±16 mg/day. In the ACS cohort ( = 200), 159 (79.5%) patients were on LLT at admission. Mean ± SD LDL-C levels were 108 ±40 mg/dl at admission and 86 ±25 mg/dl at follow-up. LDL-C target value attainment rates were 16.2% at admission and 25.0% at follow-up. At admission, statin monotherapy was used by 86.8% of treated patients. The mean ± SD atorvastatin dose equivalent increased from 20 ±14 mg/day at admission to 29 ±15 mg/day at follow-up. The statin dose was associated with higher odds of LDL-C target value attainment (OR = 1.05, 95% CI: 1.02-1.08).

Conclusions: The LDL-C target attainment by very high risk patients in Greece is suboptimal. Increasing the statin dose or combining it with non-statins may improve target value attainment.
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http://dx.doi.org/10.5114/aoms.2018.73961DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6657251PMC
July 2019

[Improvement of LDL-C target value achievement through cardiac rehabilitation in patients with acute coronary syndrome: PATIENT-CARE registry].

MMW Fortschr Med 2019 Jul 16;161(Suppl 5):21-24. Epub 2019 Jul 16.

Medizinische Klinik B, Herzzentrum Ludwigshafen und Stiftung IHF - Institut für Herzinfarktforschung, Ludwigshafen/Rhein, Deutschland.

Background: For patients undergoing acute coronary syndrome, participation in cardiac rehabilitation includes, in addition to lifestyle modification, optimal adjustment to secondary preventive medication. As a result, follow-up events can be prevented very effectively.

Method: The PATIENT-CARE registry study examined the treatment of patients during rehabilitation. Of particular interest was whether LDL cholesterol (LDL-C) targets were met.

Results: The rate of treated patients increased in almost all classes of medication. At discharge, 96.7% of patients received statins, 98.5% antithrombotics and 22.3% antidiabetics. LDL-C was significantly reduced during rehabilitation - on average by 21.3 mg/dl (0.55 mmol/l). 41.9% of the patients achieved the LDL-C target value.

Conclusion: The results show that the optimization of secondary drug prevention in the outpatient sector must be continued unconditionally and consistently.
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http://dx.doi.org/10.1007/s15006-019-0742-yDOI Listing
July 2019

Effect of renal insufficiency and diabetes mellitus on in-hospital mortality after acute coronary syndromes treated with primary PCI. Results from the ALKK PCI Registry.

Int J Cardiol 2019 10 25;292:43-49. Epub 2019 Apr 25.

Herzzentrum Ludwigshafen, Department of Cardiology, Ludwigshafen am Rhein, Germany.

Background: It is known that patients with acute coronary syndromes (ACS) and diabetes mellitus (DM) are at higher risk for in-hospital adverse events. However, we hypothesized that the higher event rate is due to the patients' subgroup with renal failure (RF), a common sequel of DM.

Methods And Results: We used data of the prospective ALKK-PCI registry including all consecutive percutaneous coronary interventions (PCI) for ACS of 48 hospitals between 2008 and 2013. We divided 69,651 patients in four groups according to their history of DM and RF (GFR < 60 ml/min). All-cause, in-hospital mortality of the following four groups: noDM/noRF, DM/noRF, DM/RF, RF/noDM, was: 3.5%, 6.6%, 21.9%, and 14.1% for STEMI and 1.5%, 2.1%, 7.2%, and 5.4% for NSTE-ACS. In a multivariate analysis we looked for independent mortality-predictors. Odds ratios with confidence intervals for the following variables: DM without RF, DM with RF, RF without DM were: 1.62 (1.37-1.90), 3.02 (2.43-3.76), and 2.13 (1.80-2.52) for STEMI and 1.20 (0.99-1.45), 2.72 (2.18-3.88), and 2.08 (1.69-2.56) for NSTE-ACS. We also calculated mortality in four groups (60-90, 45-60, 45-30, <30 ml/min) according to the estimated glomerular filtration rate (eGFR). Mortality rates were: 5.0%, 12.8%, 17.7%, and 31.5% for STEMI and 2.1%, 3.8%, 7.1%, and 12.0% for NSTE-ACS (p for trend <0.0001 for both).

Conclusions: In-hospital death after PCI in patients with ACS and DM is mainly observed in the subgroup with co-existing RF. In a multivariate analysis, DM without RF was a significant mortality-predictor in STEMI, but not in NSTE-ACS. RF, irrespective of co-existent DM, was a stronger predictor than DM alone for both ACS-types (OR > 3) and mortality increased with decreasing eGFR.
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http://dx.doi.org/10.1016/j.ijcard.2019.04.071DOI Listing
October 2019

Low-Density Lipoprotein Cholesterol Target Attainment in Patients Surviving an Acute Coronary Syndrome in Thailand: Results From the Dyslipidaemia International Study (DYSIS) II.

Heart Lung Circ 2020 Mar 28;29(3):405-413. Epub 2019 Mar 28.

Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany; Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany.

Background: Patients suffering an acute coronary syndrome (ACS) are at increased risk for future cardiovascular events. Effective management of hyperlipidaemia in such patients is essential. We aimed to document the use of lipid-lowering therapy (LLT) and low-density lipoprotein cholesterol (LDL-C) target achievement in patients hospitalised with an ACS in Thailand.

Methods: The Dyslipidemia International Study (DYSIS) II was a multinational, observational study that enrolled patients over 18 years of age who were hospitalised with an ACS in 2013-2014 and survived until discharge. Patients were analysed according to whether or not they were treated with LLT prior to hospital admission. A lipid profile was carried forward from blood taken within the first 24 hours after admission, and attainment of the LDL-C target of <70 mg/dL (1.8 mmol/L) for very high-risk subjects was reported. Details of LLTs were collected. Lipid levels, LLT use and cardiovascular events since discharge were collected at a follow-up interview 4 months later.

Results: A total of 320 ACS patients were enrolled from seven sites across Thailand, 188 (58.8%) of whom were being treated with LLT prior to the acute event. The mean LDL-C levels of the LLT and no LLT patients were 106.2 ± 39.4 mg/dL (2.75 ± 1.02 mmol/L) and 139.8 ± 46.6 mg/dL (3.62 ± 1.21), respectively, with 15.4% and 4.5% having an LDL-C level below 70 mg/dL (1.8 mmol/L). Lipid-lowering therapy consisted mainly of statins, with an atorvastatin-equivalent daily dosage of 17 ± 13 mg/day. At the 4-month follow-up, LDL-C target attainment remained low at 26.7% for the initial LLT group and 24.1% for the no LLT group. Although most patients were being treated with LLT at this point, the dosage was still low (28 ± 16 mg/day) and there was little use of combination therapy.

Conclusion: In this cohort of Thai ACS patients, LDL-C levels were highly elevated, placing them at extreme risk of recurrent adverse cardiovascular events. Lipid-lowering therapy was widely used after the ACS; however, treatment was rarely optimised. Huge improvements are required in the management of hyperlipidaemia in Thailand.
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http://dx.doi.org/10.1016/j.hlc.2019.02.193DOI Listing
March 2020

Health-related quality of life and mortality in patients with pulmonary embolism: a prospective cohort study in seven European countries.

Qual Life Res 2019 Aug 4;28(8):2111-2124. Epub 2019 Apr 4.

Ramon y Cajal Hospital IRYCIS and Alcala de Henares University, Madrid, Spain.

Purpose: Little is known about the quality of life following pulmonary embolism (PE). The aim of the study was to assess the 12-month illness burden in terms of health-related quality of life (HrQoL) and mortality, in relation to differences in patient characteristics.

Methods: The PREFER in VTE registry, a prospective, observational study conducted in seven European countries, was used. Within 2 weeks following an acute symptomatic PE, patients were recruited and followed up for 12 months. Associations between patient characteristics and HrQoL (EQ-5D-5L) and mortality were examined using a regression approach.

Results: Among 1399 PE patients, the EQ-5D-5L index score at baseline was 0.712 (SD 0.265), which among survivors gradually improved to 0.835 (0.212) at 12 months. For those patients with and without active cancer, the average index score at baseline was 0.658 (0.275) and 0.717 (0.264), respectively. Age and previous stroke were significant factors for predicting index scores in those with/without active cancer. Bleeding events but not recurrences had a noticeable impact on the HrQoL of patients without active cancer. The 12-month mortality rate post-acute period was 8.1%, ranging from 1.4% in Germany, Switzerland, and Austria to 16.8% in Italy. Mortality differed between patients with active cancer and those without (42.7% vs. 4.7%).

Conclusion: PE is associated with a substantial decrease in HrQoL at baseline which normalizes following treatment. PE is associated with a high mortality rate especially in patients with cancer, with significant country variation. Bleeding events, in particular, impact the burden of PE.
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http://dx.doi.org/10.1007/s11136-019-02175-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6620245PMC
August 2019

Cholesterol goal achievement and lipid-lowering therapy in patients with stable or acute coronary heart disease in Singapore: results from the Dyslipidemia International Study II.

Singapore Med J 2019 Sep 18;60(9):454-462. Epub 2019 Feb 18.

Herzzentrum Ludwigshafen, Cardiology, Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.

Introduction: Dyslipidaemia is a major risk factor for coronary heart disease (CHD). There is a lack of data on the extent of lipid abnormalities and lipid-lowering therapy (LLT) in Singapore.

Methods: The Dyslipidemia International Study (DYSIS) II was a multinational observational study of patients with stable CHD and hospitalised patients with an acute coronary syndrome (ACS). A full lipid profile and use of LLT were documented at baseline, and for the ACS cohort, at four months post-hospitalisation.

Results: 325 patients were recruited from four sites in Singapore; 199 had stable CHD and 126 were hospitalised with an ACS. At baseline, 96.5% of the CHD cohort and 66.4% of the ACS cohort were being treated with LLT. In both cohorts, low-density lipoprotein cholesterol (LDL-C) levels were lower for the treated than the non-treated patients; accordingly, a higher proportion of patients met the LDL-C goal of < 70 mg/dL (CHD: 28.1% vs. 0%, p = 0.10; ACS: 20.2% vs. 0%, p < 0.01). By the four-month follow-up, a higher proportion of the ACS patients that were originally not treated with LLT had met the LDL-C goal (from 0% to 54.5%), correlating with the increased use of medication. However, there was negligible improvement in the patients who were treated prior to the ACS.

Conclusion: Dyslipidaemia is a significant concern in Singapore, with few patients with stable or acute CHD meeting the recommended European Society of Cardiology/European Atherosclerosis Society goal. LLT was widely used but not optimised, indicating considerable scope for improved management of these very-high-risk patients.
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http://dx.doi.org/10.11622/smedj.2019021DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7911083PMC
September 2019

Incidence and outcome of peri-procedural cardiogenic shock: results from the international Euro Heart Survey PCI registry.

Eur Heart J Acute Cardiovasc Care 2020 Mar 8;9(2):120-127. Epub 2019 Jan 8.

Department of Cardiology, Justus-Liebig University of Giessen, Germany.

Background: There is a large body of literature on acute myocardial infarction complicated by cardiogenic shock. However, very little is known about patients who are initially haemodynamically stable and develop cardiogenic shock during percutaneous coronary intervention.

Methods: A total of 47,407 consecutive patients were prospectively enrolled in the PCI Registry of the Euro Heart Survey Programme. We analysed interventions with peri-procedural complications that were classified as 'shock induced by procedure' on the case report form. Clinical and procedural characteristics as well as hospital outcomes of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention were evaluated. Patients with haemodynamic instability at presentation prior to intervention were excluded.

Results: A total of 68 patients (0.2%) developed cardiogenic shock as a complication of percutaneous coronary intervention. The majority of cases comprised acute coronary syndrome (60.3%) with complex lesions (93.1%). Most patients had multi-vessel disease (82.1%) and an ejection fraction less than 40% (58.1%). In the multivariate analysis, left main disease (odds ratio (OR) 9.51), ST-segment elevation myocardial infarction (OR 5.31) and multi-vessel disease without left main involvement (OR 3.32) were the strongest independent predictors of peri-procedural cardiogenic shock. Among these patients procedural success was low (66.1%) and in-hospital mortality was very high (39.7%).

Conclusions: In this real-world registry the rate of haemodynamically stable patients who developed cardiogenic shock during percutaneous coronary intervention was very low. Patients at a priori high risk were more likely to be affected by this complication. The in-hospital mortality rate of these patients was very high.
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http://dx.doi.org/10.1177/2048872618822460DOI Listing
March 2020

Comparison of quality of life measurements: EQ-5D-5L versus disease/treatment-specific measures in pulmonary embolism and deep vein thrombosis.

Qual Life Res 2019 May 3;28(5):1155-1177. Epub 2019 Jan 3.

University of Sheffield, Sheffield, UK.

Introduction: There is a lack of performance comparisons of the generic quality of life tool EQ-5D-5L against disease- and treatment-specific measures in venous thromboembolism (VTE). The aim of this study was to compare EQ-5D-5L against the pulmonary embolism (PE)-specific PEmb-QoL and the deep vein thrombosis (DVT)-specific VEINES-QOL/Sym, and PACT-Q2 (treatment-specific) questionnaires in five language settings.

Methods: PREFER in VTE was a non-interventional disease registry conducted between 2013 and 2014 in primary and secondary care across seven European countries with five languages, including English, French, German, Italian and Spanish. Consecutive patients with acute PE/DVT were enrolled and followed over 12 months. Only patients who completed all three questionnaires at baseline were included in the study sample. The psychometric properties examined included acceptability (missing, ceiling and floor effects), validity (convergent and known-groups validity), and responsiveness. Known groups validity and responsiveness were assessed using both effect size (Cohen's d) and relative efficiency (F-statistic). All analyses were conducted in each language version and the total sample across all languages.

Results: A total of 1054 PE and 1537 DVT patients were included. 14% of PE and 10% of DVT patients had the maximum EQ-5D-5L index score. EQ-5D-5L was low to moderately correlated with other measures (r < 0.5). EQ-5D-5L was associated with larger effect size/relative efficiency in most of known group comparisons in both VTE groups. Similar results were observed for responsiveness. EQ-5D-5L performed relatively better in French, Italian and Spanish language versions.

Conclusion: Overall EQ-5D-5L is comparable to PEmb-QoL, VEINES-QOL/Sym and PACT-Q2 in terms of acceptability, validity and responsiveness in both PE and DVT populations in English, French, German, Italian and Spanish language version. Nevertheless, it should be noted that each measure is designed to capture different aspects of health-related quality of life.
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http://dx.doi.org/10.1007/s11136-018-2081-3DOI Listing
May 2019

Improvement of low-density lipoprotein cholesterol target achievement rates through cardiac rehabilitation for patients after ST elevation myocardial infarction or non-ST elevation myocardial infarction in Germany: Results of the PATIENT CARE registry.

Eur J Prev Cardiol 2019 02 3;26(3):249-258. Epub 2018 Dec 3.

2 Medizinische Klinik B, Herzzentrum Ludwigshafen, Germany.

Aims: The PATIENT CARE registry aimed to document clinical characteristics of patients during cardiac rehabilitation after myocardial infarction, including the current pharmacological treatment, risk factor modification and achievement of treatment targets for low-density lipoprotein cholesterol (LDL-C).

Methods: Multicentre, prospective non-interventional study at 20 cardiac rehabilitation in-patient centres across Germany.

Results: A total of 1408 patients post myocardial infarction were analysed. Patients' mean age was 62 ± 11 years and 27.0% were women. ST elevation myocardial infarction ( n = 657; 48.7%), and non-ST elevation myocardial infarction ( n = 617; 45.8%) were equally balanced causes for hospitalization, while previous coronary artery bypass grafting was reported in n = 134 patients (9.9%). On average, cardiac rehabilitation began 19 ± 10 days after the index event and lasted for 22 ± 4 days. At discharge, 96.7% of patients received statins, 13.0% another lipid-lowering medication in addition to a statin, 98.5% antithrombotic drugs and 22.3% antidiabetic medication. The rate of patients with LDL-C on target according to the European Society of Cardiology/European Atherosclerosis Society dyslipidaemia guidelines 2011 (<70 mg/dl (1.8 mmol/l) or at least 50% reduction of baseline value) was increased from 21.4% at admission to cardiac rehabilitation to 41.9% at discharge after cardiac rehabilitation. Most patients (95.2%) completed the cardiac rehabilitation and 88% returned to their former work at full time.

Conclusion: During cardiac rehabilitation, the modifiable cardiovascular risk factors, in particular the LDL-C, were substantially improved in patients after myocardial infarction. The great majority were able to return to work. However, less than 50% reached the LDL-C guideline targets during short-term cardiac rehabilitation.
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http://dx.doi.org/10.1177/2047487318817082DOI Listing
February 2019

Frequency and predictors of cholesterol target attainment in patients with stable coronary heart disease in Belgium: results from the Dyslipidemia International Study II (DYSIS II ).

Acta Clin Belg 2019 Dec 25;74(6):399-404. Epub 2018 Oct 25.

Herzzentrum Ludwigshafen, Germany and Institut für Herzinfarktforschung Ludwigshafen , Ludwigshafen , Germany.

: To document the frequency and predictors of low-density lipoprotein cholesterol (LDL-C) target value attainment among patients with coronary heart disease (CHD) in Belgium. : The second Dyslipidemia International Study (DYSIS II) was an observational study of the prevalence of dyslipidemias and lipid target value attainment. Patients in this analysis were aged ≥ 18, had documented CHD, and had a full lipid profile. Use of lipid-lowering therapy (LLT), lipid profile, and LDL-C target value attainment (< 70 mg/dL) were assessed cross-sectionally at the enrollment visit. The distribution of LLTs was assessed among treated patients. Multivariate logistic regression was used to identify variables predictive of LDL-C target value attainment in treated patients. : We identified 409 patients with CHD in Belgium, 387 (94.6%) of whom were on LLT at the time of the lipid profile. Among treated patients, the rate of LDL-C target value attainment was 40.6%, and statin monotherapy was the most commonly used LLT (79.3%). Among users of statin monotherapy or combination therapy, simvastatin was the most commonly used treatment (41.6% of patients). Diabetes was associated with higher odds of LDL-C target value attainment (OR 2.29, 95% CI 1.33-3.93), and female gender was associated with lower odds (OR 0.48, 95% CI 0.24-0.97). : Rates of LDL-C target value attainment are low in patients with CHD in Belgium. Intensifying statin therapy or combining it with non-statins is essential in Belgian patients for optimal LDL-C reduction.
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http://dx.doi.org/10.1080/17843286.2018.1539203DOI Listing
December 2019

Predictors of LDL-cholesterol target value attainment differ in acute and chronic coronary heart disease patients: Results from DYSIS II Europe.

Eur J Prev Cardiol 2018 12 18;25(18):1966-1976. Epub 2018 Oct 18.

6 Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.

Background: Patients with coronary heart disease (CHD) and survivors of acute coronary syndrome (ACS) are at very high risk for adverse cardiovascular events. Lowering low-density lipoprotein cholesterol (LDL-C) can reduce the risk, with effective lipid-lowering therapy (LLT) readily available; however, dyslipidemia remains prevalent throughout Europe.

Design: The observational Dyslipidemia International Study II (DYSIS II) aimed to identify unmet treatment needs in adult ACS and CHD patients. Data for the seven participating European countries are presented herein.

Methods: The study was carried out from December 2012 to November 2014. Use of LLT and attainment of European-guideline-recommended LDL-C targets were assessed. For ACS patients, changes in lipid levels and LLT were evaluated 4 months post-hospitalization.

Results: Of the 4344 patients enrolled, 2946 were attending a physician visit for the assessment of stable CHD, while 1398 had been hospitalized for an ACS event. In both patient sets, mean LDL-C levels were high (89.5 and 112.5 mg/dl, respectively) and <70 mg/dl target attainment extremely poor. The mean daily statin dosage (normalized to atorvastatin potency) was 27 ± 20 mg for CHD and 22 ± 17 mg for ACS patients. Treatment was intensified slightly for ACS subjects after hospitalization, with the dosage reaching 35 ± 24 mg/day. LDL-C target attainment was higher by the end of the 4-month follow up (30.9% and 41.5% for patients on LLT and without LLT at baseline, respectively; p < 0.05).

Conclusion: Elevated blood cholesterol levels are highly prevalent across Europe, with low numbers of coronary patients reaching their recommended LDL-C target. While use of LLT is widespread, there is significant scope for intensifying treatment.
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http://dx.doi.org/10.1177/2047487318806359DOI Listing
December 2018

The impact of co-morbidity on the disease burden of VTE.

J Thromb Thrombolysis 2018 Nov;46(4):507-515

University of Perugia, Perugia, Italy.

Venous thromboembolism (VTE) is often accompanied by co-morbidities, which complicate and confound data interpretation concerning VTE-related mortality, costs and quality of life. We aimed to assess the contribution of co-morbidities to the burden of VTE. The PREFER in VTE registry, across seven European countries, documented and followed acute VTE patients over 12 months. Patients with co-morbidities were grouped in major co-morbidity groups: cancer, cardiovascular (CV) comorbidity (other than VTE), CV risks, venous, renal, liver, respiratory, bone and joint diseases, and lower extremity paralysis. Mortality rates and health-related quality of life (HrQoL) utility values grouped per co-morbidity were compared to the UK general population. Regression analyses were performed to determine the impact of co-morbidities on mortality and HrQoL. VTE were analyzed together and separately as pulmonary embolism (PE) and deep vein thrombosis (DVT). In total, 3455 patients were included, 40.5% with PE and 59.5% with DVT. 13% and 16% of the PE and DVT patients had no co-morbidities and had a 12-month mortality rate of 1.8% and 1.7%, respectively. Frequency and severity of co-morbidities increased mortality rates up to 30%. The EQ-5D-5L index in patients without co-morbidities were 0.826 and 0.838 for PE and DVT. These scores decreased to 0.638 and 0.555 in the presence of co-morbidities. Co-morbidities in VTE patients are common. VTE had an impact on mortality and HrQoL, and additional impact of co-morbidities was seen. Awareness of the presence of co-morbidities is important when making VTE-related treatment decisions. The presence of co-morbidities in PE and DVT patients is common and their frequency and severity in VTE patients have a substantial impact on mortality rates and HrQoL. When adjusting for co-morbidities, the impact of VTE on mortality as well as health-related quality of life remains present. Assessing patients without consideration of co-morbidities might lead to misinterpretations of the disease burden of PE and DVT.
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http://dx.doi.org/10.1007/s11239-018-1732-0DOI Listing
November 2018

Low-density lipoprotein cholesterol target attainment in patients with stable or acute coronary heart disease in the Asia-Pacific region: results from the Dyslipidemia International Study II.

Eur J Prev Cardiol 2018 12 10;25(18):1950-1963. Epub 2018 Sep 10.

7 Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.

Background: As mortality due to cardiovascular disease increases throughout the world, accurate data on risk factors such as hyperlipidemia are required. This is lacking in the Asia-Pacific region.

Design: The observational Dyslipidemia International Study (DYSIS) II was established to quantify the extent of hyperlipidemia in adults with acute and stable coronary heart disease globally.

Methods: Patients with stable coronary heart disease or hospitalised with an acute coronary syndrome were enrolled across nine Asia-Pacific countries from July 2013 to October 2014. Lipid-lowering therapy and low-density lipoprotein cholesterol target attainment (<70 mg/dL) were assessed. The acute coronary syndrome cohort was followed up 4 months post-discharge.

Results: Of the 4592 patients enrolled, 2794 had stable coronary heart disease and 1798 were admitted with an acute coronary syndrome. In the coronary heart disease cohort, the mean low-density lipoprotein cholesterol level was 86.9 mg/dL, with 91.7% using lipid-lowering therapy and 31% achieving low-density lipoprotein cholesterol of less than 70 mg/dL. In the acute coronary syndrome cohort at admission, the corresponding values were 103.2 mg/dL, 63.4% and 23.0%, respectively. Target attainment was significantly higher in lipid-lowering therapy-treated than non-treated patients in each cohort (32.6% vs. 12.9% and 31.1% vs. 9.0%, respectively). Mean atorvastatin-equivalent dosages were low (20 ± 15 and 22 ± 18 mg/day, respectively), with little use of non-statin adjuvants (13.0% and 6.8%, respectively). Low-density lipoprotein cholesterol target attainment had improved by follow-up for the acute coronary syndrome patients, but remained low (41.7%).

Conclusions: Many patients in Asia at very high risk of recurrent cardiovascular events had a low-density lipoprotein cholesterol level above the recommended target. Although lipid-lowering therapy was common, it was not used to its full potential.
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http://dx.doi.org/10.1177/2047487318798927DOI Listing
December 2018

Prevalence of lipid abnormalities and cholesterol target value attainment in Egyptian patients presenting with an acute coronary syndrome.

Egypt Heart J 2018 Sep 22;70(3):129-134. Epub 2018 Aug 22.

Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.

Background: Effective management of hyperlipidemia is of utmost importance for prevention of recurring cardiovascular events after an acute coronary syndrome (ACS). Indeed, guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL for such patients. The Dyslipidemia International Study II (DYSIS II) - Egypt was initiated in order to quantify the prevalence and extent of hyperlipidemia in patients presenting with an ACS in Egypt.

Methods: In this prospective, observational study, we documented patients presenting with an ACS at either of two participating centers in Egypt between November 2013 and September 2014. Individuals were included if they were over 18 years of age, had a full lipid profile available (recorded within 24 h of admission), and had either been taking lipid-lowering therapy (LLT) for ≥3 months at time of enrollment or had not taken LLT. Data regarding lipid levels and LLT were recorded on admission to hospital and at follow-up 4 months later.

Results: Of the 199 patients hospitalized for an ACS that were enrolled, 147 were on LLT at admission. Mean LDL-C at admission was 127.1 mg/dL, and was not significantly different between users and non-users of LLT. Only 4.0% of patients had an LDL-C level of <70 mg/dL, with the median distance to this target being 61.0 mg/dL. For the patients with LDL-C information available at both admission and follow-up, LDL-C target attainment rose from 2.8% to 5.6%. Most of the LLT-treated patients received statin monotherapy (98.6% at admission and 97.3% at follow-up), with the mean daily statin dose (normalized to atorvastatin) increasing from admission (30 mg/day) to follow-up (42 mg/day).

Conclusions: DYSIS II revealed alarming LDL-C goal attainment, with none of the patients with follow-up information available reaching the target of LDL-C <70 mg/dL, either at hospital admission or 4 months after their ACS event. Improvements in guideline adherence are urgently needed for reducing the burden of cardiovascular disease in Egypt. Strategies include the effective use of statins at high doses, or combination with other agents recommended by guidelines.
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http://dx.doi.org/10.1016/j.ehj.2018.05.001DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6123296PMC
September 2018

Do acute coronary events affect lipid management and cholesterol goal attainment in Germany? : Results from the Dyslipidemia International study II.

Wien Klin Wochenschr 2018 Dec 3;130(23-24):707-715. Epub 2018 Sep 3.

Merck & Co., Inc., Kenilworth, NJ, USA.

Objective: To document utilization of lipid-lowering therapy, attainment of low-density lipoprotein cholesterol target values, and cardiovascular outcomes in patients hospitalized for acute coronary syndrome in Germany.

Methods: The Dyslipidemia International Study II was a multicenter, observational study of the prevalence of dyslipidemia and lipid target value attainment in patients surviving any acute coronary syndrome event. Among patients on lipid-lowering therapy for ≥3 months, use of lipid-lowering therapy and lipid profiles were assessed at admission and again at 120 ± 15 days after admission (the follow-up time point). Multivariate logistic regression was used to identify variables predictive of low-density lipoprotein cholesterol target value attainment in patients using lipid-lowering therapy.

Results: A total of 461 patients hospitalized for acute coronary syndrome were identified, 270 (58.6%) of whom were on lipid-lowering therapy at admission. Among patients on lipid-lowering therapy, 90.7% and 85.9% were receiving statin monotherapy at admission and follow-up, respectively. Mean (SD) low-density lipoprotein cholesterol levels in patients on lipid-lowering therapy were 101 (40) mg/dl and 95 (30) mg/dl at admission and follow-up, respectively. In patients with data at both admission and follow-up (n = 61), low-density lipoprotein cholesterol target value attainment rates were the same (19.7%) at both time points. Smoking was associated with a 77% lower likelihood of attaining the low-density lipoprotein cholesterol target value.

Conclusion: Hospitalization for an acute event does not greatly alter lipid management in acute coronary syndrome patients in Germany. Both lipid-lowering therapy doses and rates of low-density lipoprotein cholesterol target value attainment remained essentially the same several months after the event.
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http://dx.doi.org/10.1007/s00508-018-1375-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6290720PMC
December 2018

Prevalence of lipid abnormalities and cholesterol target value attainment in patients with stable coronary heart disease or an acute coronary syndrome in Saudi Arabia.

Saudi Med J 2018 Jul;39(7):697-704

Al Hada Armed Forces Hospital, Al Hada Taif, Kingdom of Saudi Arabia. E-mail.

Objectives: To provide an overview of the extent of hyperlipidemia in very high-risk patients, and how lipid-lowering therapy (LLT) is used in a real-world setting. Methods: In this multicenter observational study, data were collected from LLT-treated patients with stable CHD or an ACS in Saudi Arabia between 2013 and 2014. Individuals were included if they were greater than 18 years and had a full lipid profile available, recorded either prior to the baseline physician visit (CHD patients) or within 24-hours of admission to hospital (ACS patients).  Results: A total of 737 patients were included in the study, 597 with stable CHD and 140 with ACS. Few patients in either group had an LDL-C level of greater than 70 mg/dl, which is advocated for very high-risk patients (24.3% and 11.4%, respectively). The median distances to this value were 19.0 mg/dl (CHD) and 25.0 mg/dl (ACS). Low doses of statins were being utilized (31 and 24 mg/day for CHD and ACS, respectively), with only minimal intensification for the ACS patients after hospital admission (41 mg/day at follow-up). Conclusions: Achievement of recommended LDL-C levels was poor for patients with stable CHD or an ACS. Statin intensity was low, indicating huge scope for intensifying the treatment of these very high-risk patients.
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http://dx.doi.org/10.15537/smj.2018.7.22146DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6146262PMC
July 2018

Use of guideline-recommended management in established coronary heart disease in the observational DYSIS II study.

Int J Cardiol 2018 Nov 6;270:21-27. Epub 2018 Jun 6.

Herzzentrum Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Germany.

Background: Guidelines recommend lifestyle modification and medications to control risk factors in coronary heart disease (CHD). Using data from the observational DYSIS II study, we sought to evaluate the use of guideline-recommended treatments at discharge for acute coronary syndromes (ACS) or in the chronic phase for CHD, and participation in rehabilitation/secondary prevention programs.

Methods And Results: Between 2013 and 2014, 10,661 patients (3867 with ACS, 6794 with stable CHD) were enrolled in 332 primary and secondary care centers in 18 countries (Asia, Europe, Middle East). Patients with incident ACS were younger and more likely to be smokers than patients with recurrent ACS or stable CHD (both p < 0.0001). Sedentary lifestyle was common (44.4% of ACS patients; 44.2% of stable CHD patients); 22.8% of ACS patients and 24.3% of stable CHD patients were obese. Prevalence of low high-density lipoprotein cholesterol (<40 mg/dL in men/50 mg/dL in women) was 46.9% in chronic CHD and 55.0% in ACS. Rates of secondary prevention medications were lower among CHD versus ACS (all p < 0.0001): antiplatelet 94.3% vs 98.0%, beta-blocker 72.0% vs 80.0%, lipid-lowering therapy 94.7 vs 97.5%, and angiotensin-converting enzyme inhibitors/angiotensin-receptor blockers 69.4% vs 73.7%, respectively. Attendance at cardiac rehabilitation (16.8% of patients with a first ACS, 10.8% with recurrent ACS) or a secondary prevention program (3.7% of ACS and 11.7% of stable CHD patients) was infrequent.

Conclusions: The high prevalence of risk factors in all CHD patients and reduced rates of secondary prevention medications in stable CHD offer areas for improvement.

Translational Aspects: The findings of DYSIS II may reinforce the importance of adopting a healthy lifestyle and prescribing (by clinicians) and adhering (by patients) to evidence-based medications in the management of CHD, not only during the short term but also over the longer term after a cardiac ischemic event. The results may help to increase the proportion of ACS patients who are referred to cardiac rehabilitation centres.
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http://dx.doi.org/10.1016/j.ijcard.2018.06.008DOI Listing
November 2018

Available oral lipid-lowering agents could bring most high-risk patients to target: an estimate based on the Dyslipidemia International Study II-Italy.

J Cardiovasc Med (Hagerstown) 2018 Sep;19(9):485-490

Azienda Ospedaliera Universitaria Ospedali Riuniti di Foggia, Foggia, Italy.

Aims: The analysis evaluated the contemporary percentage of patients with established coronary heart disease (CHD) reaching the European guidelines recommended LDL-cholesterol (LDL-C) levels of less than 70 mg/dl and the threshold required for proprotein convertase subtlisin/kexin type 9 reimbursement in Italy (100 mg/dl). It also assessed how these percentages would change in case of diffuse use of ezetimibe.

Methods: The Dyslipidemia International Study II enrolled CHD patients aged at least 18 either on lipid-lowering therapy (LLT) for at least 3 months or not on LLT at the time of the lipid profile. Distribution of LLTs and LDL-C target attainment were assessed. Multivariate logistic regression evaluated predictors of LDL-C target attainment. A 24% LDL-C lowering was modeled in patients not taking ezetimibe to assess its potential effects.

Results: Among 676 Italian CHD patients enrolled, LDL-C concentrations were lower among the 631 patients (93.3%) who were on LLT (82 versus 118 mg/dl; P < 0.001). The LDL-C target was attained by 35.4% of patients. Statin dose (median atorvastatin dose 40 mg/day) was the sole significant predictor of LDL-C target attainment. The simple addition of ezetimibe in the model reduced the percentage of patients more than 70 and 100 mg/dl from 64.6 to 37.9% and from 25.1 to 11.8%, respectively.

Conclusion: Despite treatment in more than 90%, only one-third of Italian stable CHD patients attained the recommended LDL-C target. Statin dose was the sole predictor of the target achievement. The addition of ezetimibe would almost double patients at target and halve the potential candidates for reimbursement of more expensive agents such as proprotein convertase subtlisin/kexin type 9 inhibitors.
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http://dx.doi.org/10.2459/JCM.0000000000000680DOI Listing
September 2018

Contemporary data on treatment practices for low-density lipoprotein cholesterol in 6794 patients with stable coronary heart disease across the world.

Data Brief 2018 Jun 1;18:1937-1940. Epub 2018 May 1.

Merck&Co, Inc., Kenilworth, NJ, USA.

DYSIS II CHD was a longitudinal, observational study in 6794 patients from 18 countries. They were attending an outpatient physician appointment for coronary heart disease (CHD). 6370 patients (93.8%) were on active lipid lowering therapy (LLT). The mean atorvastatin dose equivalent was 25 mg per day and 10.5% received ezetimibe in combination with a statin. The mean low-density lipoprotein cholesterol (LDL-C) level was 88 mg/dL, with 29.4% of patients displaying a level below the 70 mg/dL target for very high-risk subjects.

Conclusion: While more than 90% of patients with CHD were on lipid lowering drugs, only three out of ten patients achieved their LDL-C target value.
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http://dx.doi.org/10.1016/j.dib.2018.04.092DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5998213PMC
June 2018

Body mass index impacts the choice of lipid-lowering treatment with no correlation to blood cholesterol - Findings from 52 916 patients in the Dyslipidemia International Study (DYSIS).

Diabetes Obes Metab 2018 11 10;20(11):2670-2674. Epub 2018 Jul 10.

CGH Medical Center, Sterling, Illinois.

A high body mass index (BMI) is associated with increased cardiovascular risk. We sought to identify whether BMI influences the choice of lipid-lowering treatment in a large, real-world cohort of 52 916 patients treated with statins. The Dyslipidemia International Study (DYSIS) is a cross-sectional, observational, multicentre study in statin-treated patients ≥45 years of age from 30 countries; 1.1% were underweight (BMI < 18.5 kg/m ), 33.1% had normal weight (BMI 18.5-24.9 kg/m ), 41.5% were overweight (BMI 25-29.9 kg/m ), 17.1% had class I obesity (BMI 30.0-34.9 kg/m ), 5.0% had class II obesity (BMI 35-39.9 kg/m ), and 2.1% had class III obesity (≥40 kg/m ). BMI correlated with high-density lipoprotein cholesterol (HDL-C) and triglycerides (Spearman's ρ: -0.147 and 0.170, respectively; P < 0.0001 for both); however, there was no correlation with low-density lipoprotein cholesterol (LDL-C; ρ: 0.003; P = 0.51). Statin intensity increased with increasing BMI (ρ: 0.13; P < 0.001), an association that held after adjustment for comorbidities (OR: 2.4; 95% CI: 2.0-3.0) on BMI ≥ 30 kg/m for atorvastatin equivalent ≥40 mg/d.
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http://dx.doi.org/10.1111/dom.13415DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6220851PMC
November 2018

Low-density lipoprotein cholesterol target achievement in patients surviving an acute coronary syndrome in Hong Kong and Taiwan - findings from the Dyslipidemia International Study II.

Int J Cardiol 2018 08;265:1-5

Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany.

Background: Individuals are at increased risk for cardiovascular events following an acute coronary syndrome (ACS). Effective management of hyperlipidemia, an associated risk factor, is essential for improving outcomes. We aimed to quantify the extent of hyperlipidemia and its treatment in ACS survivors in Hong Kong and Taiwan.

Methods: The multinational, observational Dyslipidemia International Study (DYSIS) II included patients hospitalized for an ACS. Lipid levels and use of lipid-lowering therapy (LLT) were evaluated at baseline and 4 months post-discharge. The proportions of patients attaining the recommended LDL-C target for individuals at very high cardiovascular risk (<70 mg/dL) was assessed and potential predictors of this outcome evaluated.

Results: In total, 270 patients were enrolled, 125 (46.3%) of which were being treated with LLT prior to hospitalization. Of these, 28.8% had an LDL-C level < 70 mg/dL, compared to only 6.9% of those not being treated. Statin monotherapy was the most commonly employed LLT, with a mean atorvastatin-equivalent dosage of 14 mg/day. By 4-month follow-up, target attainment had risen to 45.1% for patients treated with LLT at baseline, and 43.3% for those who had not been treated. LLT was being used by 88.4% of patients at follow-up, with a mean atorvastatin dosage of 18 mg/day. Use of statins in combination with ezetimibe/other non-statin was scarce. No predictors of LDL-C target attainment were identified.

Conclusions: In patients hospitalized with an ACS, rates of LDL-C target achievement were poor. While LLT was widely employed, statin intensity was low and combination therapy underused, indicating scope for improvement.
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http://dx.doi.org/10.1016/j.ijcard.2018.01.099DOI Listing
August 2018

Hitting Hard and Early: A Novel Paradigm for Lipid Lowering in Primary Prevention.

Cardiology 2018;140(1):68-70. Epub 2018 Jun 6.

Cardiology, Herzzentrum Ludwigshafen, Ludwigshafen, Germany.

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http://dx.doi.org/10.1159/000488972DOI Listing
September 2019

How does the TRS 2°P score relate to real-world patients?

Eur Heart J Cardiovasc Pharmacother 2018 04;4(2):72-74

Stiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany.

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http://dx.doi.org/10.1093/ehjcvp/pvy004DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5939887PMC
April 2018

CRT Survey II: a European Society of Cardiology survey of cardiac resynchronisation therapy in 11 088 patients-who is doing what to whom and how?

Eur J Heart Fail 2018 06 19;20(6):1039-1051. Epub 2018 Feb 19.

Heart and Vessels Theme, Karolinska University Hospital, Stockholm, and Karolinska Institutet, Stockholm, Sweden.

Background: Cardiac resynchronisation therapy (CRT) reduces morbidity and mortality in appropriately selected patients with heart failure and is strongly recommended for such patients by guidelines. A European Society of Cardiology (ESC) CRT survey conducted in 2008-2009 showed considerable variation in guideline adherence and large individual, national and regional differences in patient selection, implantation practice and follow-up. Accordingly, two ESC associations, the European Heart Rhythm Association and the Heart Failure Association, designed a second prospective survey to describe contemporary clinical practice regarding CRT.

Methods And Results: A survey of the clinical practice of CRT-P and CRT-D implantation was conducted from October 2015 to December 2016 in 42 ESC member countries. Implanting centres provided information about their hospital and CRT service and were asked to complete a web-based case report form collecting information on patient characteristics, investigations, implantation procedures and complications during the index hospitalisation. The 11 088 patients enrolled represented 11% of the total number of expected implantations in participating countries during the survey period; 32% of patients were aged ≥75 years, 28% of procedures were upgrades from a permanent pacemaker or implantable cardioverter-defibrillator and 30% were CRT-P rather than CRT-D. Most patients (88%) had a QRS duration ≥130 ms, 73% had left bundle branch block and 26% were in atrial fibrillation at the time of implantation. Large geographical variations in clinical practice were observed.

Conclusion: CRT Survey II provides a valuable source of information on contemporary clinical practice with respect to CRT implantation in a large sample of ESC member states. The survey permits assessment of guideline adherence and demonstrates variations in patient selection, management, implantation procedure and follow-up strategy.
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http://dx.doi.org/10.1002/ejhf.1142DOI Listing
June 2018