DYSLIPIDEMIA

CARDIOLOGY

Prospective evaluation of lipid management following ACS in Saudi Arabia (ACOSYM Study)

Watch the video tackling the critical topic of dyslipidemia management post-acute coronary syndrome. Globally, despite its pivotal role in secondary prevention, the approach remains suboptimal, so we'll dissect Arafah MR et al recent publication, providing a detailed evaluation of lipid management after ACS in Saudi Arabia. Specifically, shining a spotlight on LDL-cholesterol management and delve into the complications of statin use in post-ACS Saudi patients.

Overview of adherence data with LLT highlighting the most recent data with PCSK9i

Watch Prof. Maciej Banach Secretary of EAS, President, International Lipid Expert Panel (ILEP); President, Polish Lipid Association (PoLA); Founder, Lipid and Blood Pressure Meta-analysis Collaboration (LBPMC) Group sharing insights on overview of adherence data with LLT highlighting the most recent data with PCSK9i.

Metabolic Risk Factors and Effect of Alirocumab on CV Events

Accumulation of metabolic risk factors substantially increased risk for Mace in patients with recent ACS. Alirocumab treatment reduced Mace consistently, although absolute risk reduction was more pronounced in patients with multiple metabolic risk factors, including patients without diabetes (Ostadal P, et al. [Lancet Diabetes Endocrinol. 2022]).

Managing the Recurrent ASCVD Risks of Your ACS Patient: A call to Action – GULF Perspective: Part 3

Dyslipidemia management in post-ACS patients has proven to be challenging in various aspects, thus, the observed gaps between clinical practice and guidelines' recommendations accentuate the need for a call-to-action to achieve a comprehensive approach in the management of LDL cholesterol.
Watch the third and last episode of the interview conducted with Professor Mohamed Balgaith, an interventional cardiologist at King Abdulaziz Cardiac Center National Guard Riyadh, discussing the current level of dyslipidemia management in post-ACS patients while introducing possible strategies to facilitate achieving the guidelines recommended for LDL-C targets.

Managing Recurrent ASCVD risk of your ACS Patient: A call to Action – GULF Perspective: Part 2

One-third of ACS patients in Saudi Arabia and Gulf countries have dyslipidemia, according to local registries. Dyslipidemia is commonly observed in patients with acute coronary syndrome. Particularly, low-density lipoprotein cholesterol (LDL-C) is an established risk associated with the development of atherosclerosis.
Watch the second part of the video by Professor Mohamed Balgaith, an interventional cardiologist at the King Abdulaziz Cardiac Center National Guard Riyadh, who highlights the relationship between LDL-C and atherosclerosis as well as provides various insights on how LDL-C reduction could further protect ACS patients.

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.

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