DYSLIPIDEMIA

CARDIOLOGY

Managing the Recurrent ASCVD Risks of Your ACS Patient: Gulf Perspective (Part 1)

Atherosclerosis cardiovascular disease (ASCVD) is now a leading cause of death internationally and locally. It’s a risk for patients who have acute coronary syndrome, which is a medical emergency that requires immediate attention. Professor Mohamed Balgaith, an interventional cardiologist at King Abdulaziz Cardiac Center National Guard Riyadh, highlights the effect of atherosclerosis, cardiovascular disease burden, and the risks of recurring ischemic events post-Acute Coronary Syndrome, watch the video to learn more.

<h2>The Medenox Study: Prophylaxis in medical patients with Enoxaparin</h2>
<h3>Objective</h3>
Evaluating the efficacy and safety of enoxaparin for the prophylaxis of venous thromboembolism (VTE) in acute medical patients.¹

<h2>Study design: Screening¹</h2>
Phase III double-blind, placebo-controlled, multi-center trial
Patients were primarily hospitalized for acute heart failure (New York Heart Association [NYHA] Class III/IV) or acute respiratory failure. Subjects with at least one predefined VTE risk factor plus 1 of the following medical conditions were also enrolled:
<ul>
 <li>Acute Rheumatic Disorders</li>
 <li>Acute Infection (without septic shock)</li>
 <li>Active episodes of inflammatory bowel</li>
</ul>

The primary endpoint:¹&nbsp;The development of VTE (deep vein thrombosis [DVT], pulmonary embolism [PE], or both) between days 1 and 14.
The secondary endpoint:&nbsp;The occurrence of VTE between days 1 and 110.

<h2>Baseline characteristics¹</h2>
<ul>
 <li>Baseline characteristics were similar between the enoxaparin and placebo groups.</li>
 <li>The mean number of risk factors per patient was 2.1 in the placebo group, 2.0 in the enoxaparin 20 mg group, and 2.1 in the enoxaparin 40 mg group.</li>
 <li>Median treatment duration was 7 days and did not differ significantly between the groups</li>
</ul>

<h2>Results: Efficacy¹</h2>
The intent-to-treat analysis demonstrated a statistically significant reduction in the rate of VTE between days 1-14 in the enoxaparin 40 mg group compared to placebo, while enoxaparin 20 mg showed comparable results to placebo.

<h2>Results: Safety¹</h2>
No significant difference in the rate of adverse events (AEs) was noted between placebo and either enoxaparin group with the exception of local injection site reactions.

The investigators concluded that enoxaparin 40 mg SC daily was effective and safe in reducing the risk of VTE in acutely-ill hospitalized medical patients.1

<h2>Post-hoc analysis of Medenox study*²</h2>
The relative risk reductions (RRR) for VTE in the enoxaparin 40 mg group compared to placebo in the&nbsp;disease subgroups and in the pre-defined risk factor subgroups.
<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <th style="background-color: rgb(244, 242, 246);">
 Disease State</th>
 <th style="background-color: rgb(244, 242, 246);">
 Medenox study (n)</th>
 <th style="background-color: rgb(244, 242, 246);">
 Placebo 
 (% of VTE)</th>
 <th style="background-color: rgb(244, 242, 246);">
 Enoxaparin 40 mg 
 (% of VTE)</th>
 <th style="background-color: rgb(244, 242, 246);">
 Relative Risk 
 (confidence interval)</th>
 <th style="background-color: rgb(244, 242, 246);">P&nbsp;value</th>
 </tr>
 <tr>
 <td>Heart failure</td>
 <td>290</td>
 <td>14.6%(14/96)</td>
 <td>4.0% (4/99)</td>
 <td>0.29 (0.10-0.84)</td>
 <td>0.02</td>
 </tr>
 <tr>
 <td>Class III</td>
 <td>217</td>
 <td>12.3%(9/73)</td>
 <td>5.1% (4/78)</td>
 <td>0.42 (0.13-1.29)</td>
 <td>0.2</td>
 </tr>
 <tr>
 <td>Class IV</td>
 <td>73</td>
 <td>21.7%(5/23)</td>
 <td>0% (0/21)</td>
 <td>-</td>
 <td>0.05</td>
 </tr>
 <tr>
 <td>Respiratory disease</td>
 <td>457</td>
 <td>13.1%(20/153)</td>
 <td>3.3% (5/153)</td>
 <td>0.25 (0.10-0.65)</td>
 <td>0.003</td>
 </tr>
 <tr>
 <td>Infectious disease</td>
 <td>463</td>
 <td>15.5%(24/155)</td>
 <td>6.3%(10/159)</td>
 <td>0.41 (0.20-0.82)</td>
 <td>0.01</td>
 </tr>
 <tr>
 <td>Infectious and respiratory disease</td>
 <td>239</td>
 <td>16.5%(13/79)</td>
 <td>4.6% (4/88)</td>
 <td>0.28 (0.09-0.81)</td>
 <td>0.02</td>
 </tr>
 <tr>
 <td>Rheumatic disease</td>
 <td>78</td>
 <td>20.7%(6/29)</td>
 <td>10.0%(2/20)</td>
 <td>0.48 (0.11-2.16)</td>
 <td>0.4</td>
 </tr>
 <tr>
 <td>Inflammatory Bowel disease</td>
 <td>5</td>
 <td>0% (0/1)</td>
 <td>0% (0/3)</td>
 <td>-</td>
 <td>-</td>
 </tr>
 </tbody>
</table>

<table border="1" cellpadding="1" cellspacing="1" style="width:100%;">
 <tbody>
 <tr>
 <th scope="col" style="background-color: rgb(244, 242, 246);">Pre-defined risk factor</th>
 <th scope="col" style="background-color: rgb(244, 242, 246);">Relative Risk (confidence interval)</th>
 <th scope="col" style="background-color: rgb(244, 242, 246);">P&nbsp;value</th>
 </tr>
 <tr>
 <td>Chronic heart failure</td>
 <td>0.26 (0.08-0.92)</td>
 <td>0.04</td>
 </tr>
 <tr>
 <td>Chronic respiratory disease</td>
 <td>0.26 (0.10-0.68)</td>
 <td>0.005</td>
 </tr>
 <tr>
 <td>Age</td>
 <td>0.22 (0.09-0.51)</td>
 <td>0.0001</td>
 </tr>
 <tr>
 <td>Immobility</td>
 <td>0.44 (0.22-0.88)</td>
 <td>0.02</td>
 </tr>
 <tr>
 <td>Previous VTE</td>
 <td>0.49 (0.15-1.68)</td>
 <td>0.4</td>
 </tr>
 <tr>
 <td>Cancer</td>
 <td>0.50 (0.14-1.72)</td>
 <td>0.4</td>
 </tr>
 <tr>
 <td>Obesity</td>
 <td>0.49 (0.18-1.36)</td>
 <td>0.3</td>
 </tr>
 </tbody>
</table>
A subgroup analysis of the Medenox study was conducted to determine the patient characteristics of medical patient populations that benefit from prophylaxis with enoxaparin 40 mg compared to placebo in the prevention of VTE. RR was calculated from the 40 mg group data for each of the major disease groups and for eight risk factors that had been recorded in the Medenox study²
The authors concluded that enoxaparin was significantly superior to placebo in the prevention of VTE in patients hospitalized with heart failure (NYHA class III or IV), acute respiratory failure, and acute infectious diseases. Overall, the benefits of enoxaparin extended to a range of acutely ill medical patients.²

Abbreviations

References

VTE prophylaxis in medically ill patients

THROMBOSIS

Lipid management in patients with ACS/ASCVD

Watch Prof. J. Wouter Jukema, Professor of cardiology, chairman of “Leiden Vascular Medicine” at Leiden University Medical Center (LUMC) in the Netherlands, and co-chairman of the Dutch Atherosclerosis Society sharing insights on lipid management in patients with ACS/ASCVD.

Improving Lipid Management for Patients Post-ACS

Watch Prof. Pasquale Perrone-Filardi from Department of Clinical Medicine, Cardiovascular and Immunology Sciences, Federico II University, Naples sharing insights on improving lipid management for patients post-ACS.

Identifying and treating patients with high Lipidaemia risk post-ACS

Watch Prof. Pasquale Perrone-Filardi from Department of Clinical Medicine, Cardiovascular and Immunology Sciences, Federico II University, Naples sharing insights on Identifying and treating patients with high lipidaemia risk post-ACS.

Atherosclerosis: Identifying risks and improving outcomes

Watch Stephen Nicholls, Professor at Monash Medicine Health, Head of Victorian Heart Hospital, Melbourne, Australia sharing insights on the various atherosclerotic risk factors, and which one is the main culprit driving the development of atherosclerosis burden? And why? and as well discussing what is the clinical outcome of plaque formation in atherosclerosis?

Act Now for Your ACS Patients: Treat Aggressively, Combine and Start Early

Watch Professor Kausik Ray, Cardiologist and Professor of Public Health, Imperial College London, presenting the ACS and how to manage patients in alignment to the 2019 ESC/EAS guidelines using combination therapy, starting the changes immediately and aggressively in alignment with the recent aggressive LDL goals and recent studies outcomes that recommends early use of combination therapy to achieve target goals.

Act Now for Your ACS Patients: Summary

Watch Professor Kausik Ray, Cardiologist and Professor of Public Health, Imperial College London, summarizing the 3 chapters of the ESC/EAS 2019 guidelines and how to adopt them into the clinical practice easing the identification of patients with very high CV risk, especially post ACS.

Act Now for Your ACS Patients: Patient Identification

Watch Professor Kausik Ray, a Cardiologist and Professor of Public Health, Imperial College London, present the 2019 ESC/EAS guidelines, showing how to adapt recent strategies into the medical practice especially for the very high risk CV patients. Professor Kausik Ray provides various insights into how to identify the patient of a very high CV risk, bridging the gap between LDL target goals and actual levels through adopting more aggressive approaches.

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