Baris Gencer1, Reto Auer2, David Nanchen2, Lorenz Räber3, Roland Klingenberg4, David Carballo1, Manuel Blum5, Pierre Vogt6, Sebastian Carballo1, Philippe Meyer1, Christian M Matter4, Stephan Windecker3, Thomas F Lüscher4, François Mach1, Nicolas Rodondi7. 1. Division of Cardiology, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland. 2. Department of Ambulatory and Community Medicine, University of Lausanne, Lausanne, Switzerland. 3. Department of Cardiology, University Hospital Bern, Bern, Switzerland. 4. Department of Cardiology, University Heart Center, Zürich, Switzerland. 5. Department of General Internal Medicine, University of Bern, Bern, Switzerland. 6. Department of Cardiology, Lausanne University Hospital, Lausanne, Switzerland. 7. Department of General Internal Medicine, University of Bern, Bern, Switzerland. Electronic address: Nicolas.Rodondi@insel.ch.
Abstract
BACKGROUND: 2013 AHA/ACC guidelines on the treatment of cholesterol advised to tailor high-intensity statin after ACS, while previous ATP-III recommended titration of statin to reach low-density lipoprotein cholesterol (LDL-C) targets. We simulated the impact of this change of paradigm on the achievement of recommended targets. METHODS: Among a prospective cohort study of consecutive patients hospitalized for ACS from 2009 to 2012 at four Swiss university hospitals, we analyzed 1602 patients who survived one year after recruitment. Targets based on the previous guidelines approach was defined as (1) achievement of LDL-C target < 1.8 mmol/l, (2) reduction of LDL-C ≥ 50% or (3) intensification of statin in patients who did not reach LDL-C targets. Targets based on the 2013 AHA/ACC guidelines approach was defined as the maximization of statin therapy at high-intensity in patients aged ≤75 years and moderate- or high-intensity statin in patients >75 years. RESULTS: 1578 (99%) patients were prescribed statin at discharge, with 1120 (70%) at high-intensity. 1507 patients (94%) reported taking statin at one year, with 909 (57%) at high-intensity. Among 482 patients discharged with sub-maximal statin, intensification of statin was only observed in 109 patients (23%). 773 (47%) patients reached the previous LDL-C targets, while 1014 (63%) reached the 2013 AHA/ACC guidelines targetsone year after ACS (p value < 0.001). CONCLUSION: The application of the new 2013 AHA/ACC guidelines criteria would substantially increase the proportion of patients achieving recommended lipid targets one year after ACS. Clinical trial number, NCT01075868.
BACKGROUND: 2013 AHA/ACC guidelines on the treatment of cholesterol advised to tailor high-intensity statin after ACS, while previous ATP-III recommended titration of statin to reach low-density lipoprotein cholesterol (LDL-C) targets. We simulated the impact of this change of paradigm on the achievement of recommended targets. METHODS: Among a prospective cohort study of consecutive patients hospitalized for ACS from 2009 to 2012 at four Swiss university hospitals, we analyzed 1602 patients who survived one year after recruitment. Targets based on the previous guidelines approach was defined as (1) achievement of LDL-C target < 1.8 mmol/l, (2) reduction of LDL-C ≥ 50% or (3) intensification of statin in patients who did not reach LDL-C targets. Targets based on the 2013 AHA/ACC guidelines approach was defined as the maximization of statin therapy at high-intensity in patients aged ≤75 years and moderate- or high-intensity statin in patients >75 years. RESULTS: 1578 (99%) patients were prescribed statin at discharge, with 1120 (70%) at high-intensity. 1507 patients (94%) reported taking statin at one year, with 909 (57%) at high-intensity. Among 482 patients discharged with sub-maximal statin, intensification of statin was only observed in 109 patients (23%). 773 (47%) patients reached the previous LDL-C targets, while 1014 (63%) reached the 2013 AHA/ACC guidelines targetsone year after ACS (p value < 0.001). CONCLUSION: The application of the new 2013 AHA/ACC guidelines criteria would substantially increase the proportion of patients achieving recommended lipid targets one year after ACS. Clinical trial number, NCT01075868.
Authors: Marie-Eva Laurencet; François Girardin; Fabio Rigamonti; Anne Bevand; Philippe Meyer; David Carballo; Marco Roffi; Stéphane Noble; François Mach; Baris Gencer Journal: PLoS One Date: 2016-08-23 Impact factor: 3.240
Authors: Baris Gencer; Konstantinos C Koskinas; Lorenz Räber; Alexios Karagiannis; David Nanchen; Reto Auer; David Carballo; Sebastian Carballo; Roland Klingenberg; Dik Heg; Christian M Matter; Thomas F Lüscher; Nicolas Rodondi; François Mach; Stephan Windecker Journal: J Am Heart Assoc Date: 2017-11-09 Impact factor: 5.501
Authors: David Carballo; Nicolas Rodondi; Reto Auer; Sebastian Carballo; David Nanchen; Lorenz Räber; Roland Klingenberg; Pierre-Frédéric Keller; Dik Heg; Peter Jüni; Olivier Muller; Christian M Matter; Thomas F Lüscher; Stephan Windecker; Francois Mach; Baris Gencer Journal: PLoS One Date: 2019-02-21 Impact factor: 3.240
Authors: Baris Gencer; Nicolas Rodondi; Reto Auer; David Nanchen; Lorenz Räber; Roland Klingenberg; Mark Pletscher; Peter Jüni; Stephan Windecker; Christian M Matter; Thomas F Lüscher; François Mach; Thomas V Perneger; François R Girardin Journal: Open Heart Date: 2016-05-23
Authors: Iryna Dykun; Daniela Wiefhoff; Matthias Totzeck; Fadi Al-Rashid; R Alexander Jánosi; Tienush Rassaf; Amir A Mahabadi Journal: Int J Cardiol Heart Vasc Date: 2018-12-28