Kian-Keong Poh1,2, Baishali Ambegaonkar3, Carl A Baxter4, Philippe Brudi3, Wacin Buddhari5, Fu-Tien Chiang6, Martin Horack7, Yangsoo Jang8, Brett Johnson9, Dominik Lautsch3, Jps Sawhney10, Ami Vyas11,12, Bryan P Yan13, Anselm K Gitt7,14. 1. 1 Department of Cardiology, National University Heart Centre, Singapore. 2. 2 Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. 3. 3 Merck & Co., Inc., Kenilworth, NJ, USA. 4. 4 MSD Ltd., Hoddesdon, UK. 5. 5 Division of Cardiovascular Medicine, Chulalongkorn University, Thailand. 6. 6 Department of Internal Medicine, National Taiwan University Hospital, Taiwan. 7. 7 Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany. 8. 8 Division of Cardiology, Yonsei University College of Medicine, Korea. 9. 9 Merck Sharp & Dohme (Australia) Pty Ltd., Australia. 10. 10 Department of Cardiology, Sri Ganga Ram Hospital, Rajinder Nagar, India. 11. 11 Department of Epidemiology, Rutgers University, USA. 12. 12 Department of Pharmacy Practice, University of Rhode Island, USA. 13. 13 Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong. 14. 14 Medizinische Klinik B, Klinikum der Stadt Ludwigshafen, Germany.
Abstract
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.
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 syndromepatients, 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.