The multicenter HYDRA-ACS registry provided insights into current treatment situation of hyperlipidemia after acute coronary syndrome (ACS) among patients in Germany. The study findings showed that despite receiving lipid-lowering therapy (LLT), only half of very high-risk patients achieved recommended lipid targets (&lt;70 mg/dL) within 12 months post ACS

<h2>Key Takeaway</h2>
<ul>
 <li>The HYDRA-ACS registry investigating the clinical characteristics and current treatment of very high-risk patients with ACS and hyperlipidemia in Germany showed: 
 <ul>
 <li>Two-thirds of the patients received LLT at the time of index event, while all the patients received therapy at 12 months post event 
 <ul>
 <li>Statins were the most commonly prescribed LLT (85.0%), followed by cholesterol resorption inhibitors (32.9%)</li>
 <li>Proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) were prescribed to only 0.7% of patients</li>
 </ul></li>
 <li>Only half (50%) of the patients achieved recommended target level of &lt;70 mg/dL (2016 ESC/EAS dyslipidemia guideline), despite significant decrease in low-density lipoprotein cholesterol (LDL-C) level at 12-month follow-up</li>
 <li>Moderate increase in high-density lipoprotein cholesterol (HDL-C) (45 to 47 mg/dL) and decrease in triglycerides (148 to 119 mg/dL) were observed after 12 months</li>
 </ul></li>
 <li>The study highlighted that an increased adoption of modern treatment approaches, such as PCSK9i, could improve the lipid target achievement in very high-risk patients in the future.</li>
</ul>

<h2>Why This Matters</h2>
<ul>
 <li>Patients with ACS are at high risk of subsequent cardiovascular (CV) events; therefore, long-term treatment of CV risk factors, such as hyperlipidemia, hypertension, or diabetes mellitus, is critical in preventing further progression. 
 <ul>
 <li>However, many patients do not achieve recommended target levels of LDL-C, despite receiving LLT.</li>
 </ul></li>
 <li>Therefore, HYDRA-ACS registry was initiated to provide insights into the current treatment situation for very high-risk patients with ACS and hyperlipidemia in Germany.</li>
</ul>

<h2>Study Design</h2>
<ul>
 <li>HYDRA-ACS study (national, prospective, multicenter, non-interventional registry) was conducted across 24 centers in Germany.</li>
 <li>Inclusion criteria: Adult ACS patients (≥18 years) with (i) LDL-C &gt;155 mg/dL and first-degree relative with premature myocardial infarction (MI)/premature MI; (ii) LDL-C &gt;190 mg/dL without premature MI/without premature MI in first-degree relative</li>
 <li>Study objectives (baseline to 12-month follow-up): (i) lipid target achievement as measured by LDL-C reduction over time and absolute and relative reductions in LDL-C; (ii) absolute and relative change in total cholesterol, HDL-C, and triglycerides; (iii) use of non-drug LLT (lifestyle and nutrition) and percentage of patients using non-drug LLT over time, as well as use of LLT and percentage of patients receiving LLT over time; (iv) drug utilization patterns for secondary prevention and percentage of patients receiving such pharmacotherapy over time; and (v) CV and cerebrovascular events over time, including percentage of patients with complications at baseline, and percentage of patients with non-fatal events since baseline</li>
</ul>

<h2>Key Results</h2>
<ul>
 <li>A total of 391 ACS patients were enrolled: After exclusion of 38 patients, baseline analysis set (BAS)*&nbsp;comprised of 353 patients and 140 patients were included in the full analysis set (FAS)*.</li>
</ul>
Key baseline characteristics in BAS and FAS group:
<table border="1" cellpadding="1" cellspacing="1" style="height:100%;width:100%;">
 <tbody>
 <tr>
 <td colspan="2" rowspan="1">&nbsp;</td>
 <td style="text-align: center;">BAS (n= 353)</td>
 <td style="text-align: center;">FAS (n = 140)</td>
 </tr>
 <tr>
 <td colspan="2" rowspan="1">Age, years (mean ± SD)</td>
 <td style="text-align: center;">57.3 ± 11.4</td>
 <td style="text-align: center;">59.6 ± 11.3</td>
 </tr>
 <tr>
 <td colspan="2" rowspan="1">Males, %</td>
 <td style="text-align: center;">73.4</td>
 <td style="text-align: center;">66.4</td>
 </tr>
 <tr>
 <td colspan="2" rowspan="1">BMI, kg/m2&nbsp;(mean ± SD)</td>
 <td style="text-align: center;">32.9</td>
 <td style="text-align: center;">25.7</td>
 </tr>
 <tr>
 <td colspan="1" rowspan="3">Cardiovascular history,%</td>
 <td style="text-align: center;">Coronary heart disease</td>
 <td style="text-align: center;">32.9</td>
 <td style="text-align: center;">25.7</td>
 </tr>
 <tr>
 <td style="text-align: center;">Percutaneous intervention</td>
 <td style="text-align: center;">25.5</td>
 <td style="text-align: center;">20.7</td>
 </tr>
 <tr>
 <td style="text-align: center;">Acute coronary syndrome</td>
 <td style="text-align: center;">23.0</td>
 <td style="text-align: center;">19.3</td>
 </tr>
 <tr>
 <td colspan="1" rowspan="3">Comorbidities, %</td>
 <td style="text-align: center;">Arterial hypertension</td>
 <td style="text-align: center;">68.6</td>
 <td style="text-align: center;">70.7</td>
 </tr>
 <tr>
 <td style="text-align: center;">Diabetes</td>
 <td style="text-align: center;">17.3</td>
 <td style="text-align: center;">12.1</td>
 </tr>
 <tr>
 <td style="text-align: center;">Heart failure</td>
 <td style="text-align: center;">16.7</td>
 <td style="text-align: center;">19.3</td>
 </tr>
 </tbody>
</table>
BAS, Baseline analysis set; BMI, Body mass index; FAS, Full analysis set; SD, Standard deviation
Cross-sectional analysis (BAS):
<ul>
 <li>Most common LLT: Statins (40.0%), cholesterol resorption inhibitors (9.4%)</li>
 <li>Lifestyle and nutrition: 46.2% of patients had no physical exercise, while only 15.0% exercised &gt;3 times/week. 73.9% consumed fruits and vegetables at least 3 times/week, while 69.7% ate fish (&lt;2 times/week). 47.9% of patients consumed alcohol (&lt;2 drinks/day) and 45.6% were smokers</li>
 <li>Frequently used CV pharmacotherapies: Antihypertensives (angiotensin-converting enzyme inhibitors [ACEi; 32.9%] and beta-blockers [23.8%]), platelet aggregation inhibitors (37.7%), and antidiabetic agents (10.5%)</li>
 <li>Lipid profile levels: 
 <ul>
 <li>Median LDL-C: 166 mg/dL; most patients (65.2%) had a level of &gt;150 mg/dL, with only 5.1% having a level of &lt;70 mg/dL</li>
 <li>Median total cholesterol: 235 mg/dL, of which 31.6% had a level &gt;260 mg/dL</li>
 <li>Median HDL-C: 43 mg/dL; majority of patients (65.2%) had a level of &lt;45 mg/dL (men) or &lt;55 mg/dL (women)</li>
 <li>Median triglycerides: 162 mg/dL; 45.8% had a level of &gt;172 mg/dL</li>
 </ul></li>
</ul>
Longitudinal analysis (FAS):
<ul>
 <li>Use of LLT (12 months vs baseline): 
 <ul>
 <li>Proportion of patients receiving statins (85.0% vs. 36.5%, P = 0.0002) and cholesterol resorption inhibitors (32.9% vs. 8.6%, P = 0.0003) notably increased</li>
 <li>Statin use peaked post-index event, but slightly declined by 12 months, while the use of cholesterol resorption inhibitor steadily increased from baseline after index event to 12-month follow-up</li>
 <li>Only 0.7% of patients were prescribed PCSK9i at 12 months after ACS o Use of combination therapy increased</li>
 </ul></li>
 <li>Lifestyle and nutrition: Proportion of patients engaging in no physical exercise decreased from 40.0% (baseline) to 24.0% at 12 months (P &lt;0.0001); consumption of fruit and vegetables (P = 0.0222) and fish (P = 0.0162) increased, while alcohol decreased (P = 0.0019)</li>
 <li>CV pharmacotherapies: Increase in the proportion of patients (12 months vs baseline) receiving antihypertensives (mostly beta-blockers [64.3% vs 23.6%], diuretics [58.6% vs 17.9%], angiotensin II receptor blockers [30.0% vs 16.4%], and ACEi [42.1% vs 29.3%], P2Y12 antagonists (35.7% vs 9.3%), and other platelet aggregation inhibitors (77.9% vs 26.4%)</li>
 <li>Lipid profile levels: 
 <ul>
 <li>Median LDL-C: Significantly decreased at 12-month follow-up visit vs baseline, with increase in proportion of patients having levels &lt;70 or &lt;55 mg/dL.</li>
 <li>A moderate increase in median HDL-C and decrease in median triglyceride level were seen post 12 months</li>
 </ul></li>
</ul>
<table border="1" cellpadding="10" cellspacing="10" style="height:100%;width:100%;">
 <tbody>
 <tr>
 <td colspan="1" rowspan="1">&nbsp;</td>
 <td colspan="2" rowspan="1" style="text-align: center;">BAS (n = 353)</td>
 <td colspan="1" rowspan="1" style="text-align: center;">FAS (n = 140)</td>
 <td style="text-align: center;">P&nbsp;value</td>
 </tr>
 <tr>
 <td>&nbsp;</td>
 <td style="text-align: center;">Baseline (cross-sectional analysis)</td>
 <td style="text-align: center;">Baseline (Longitudinal analysis)</td>
 <td colspan="1" rowspan="1" style="text-align: center;">12 months</td>
 <td style="text-align: center;">(12 months vs baseline)</td>
 </tr>
 <tr>
 <td style="text-align: center;">LDL-C, mg/dL, median (IQR)</td>
 <td style="text-align: center;">166 (128, 198)</td>
 <td style="text-align: center;">166 (129, 196)</td>
 <td colspan="1" rowspan="1" style="text-align: center;">87 (70, 106)</td>
 <td style="text-align: center;">&lt;0.0001</td>
 </tr>
 <tr>
 <td style="text-align: center;">&gt;150 mg/dL, %</td>
 <td style="text-align: center;">65.2</td>
 <td style="text-align: center;">63.6</td>
 <td colspan="1" rowspan="1" style="text-align: center;">7.1</td>
 <td style="text-align: center;">&lt;0.0001</td>
 </tr>
 <tr>
 <td style="text-align: center;">&gt;100 mg/dL, %</td>
 <td style="text-align: center;">86.9</td>
 <td style="text-align: center;">87.1</td>
 <td colspan="1" rowspan="1" style="text-align: center;">27.9</td>
 <td style="text-align: center;">&lt;0.0001</td>
 </tr>
 <tr>
 <td style="text-align: center;">&lt;70 mg/dL, % (2016 ESC/EAS dyslipidemia guideline)</td>
 <td style="text-align: center;">5.1</td>
 <td style="text-align: center;">5.7</td>
 <td colspan="1" rowspan="1" style="text-align: center;">50.0</td>
 <td style="text-align: center;">&lt;0.0001</td>
 </tr>
 <tr>
 <td style="text-align: center;">&lt;55 mg/dL, % (2019 ESC/EAS guideline)</td>
 <td style="text-align: center;">0.9</td>
 <td style="text-align: center;">1.4</td>
 <td colspan="1" rowspan="1" style="text-align: center;">6.4</td>
 <td style="text-align: center;">0.0310</td>
 </tr>
 <tr>
 <td style="text-align: center;">Total cholesterol, mg/dL, median (IQR)</td>
 <td style="text-align: center;">235 (194, 271)</td>
 <td style="text-align: center;">228 (200, 265)</td>
 <td colspan="1" rowspan="1" style="text-align: center;">152 (135, 173)</td>
 <td style="text-align: center;">&lt;0.0001</td>
 </tr>
 <tr>
 <td style="text-align: center;">&gt;260 mg/dL, %</td>
 <td style="text-align: center;">31.6</td>
 <td style="text-align: center;">26.9</td>
 <td colspan="1" rowspan="1" style="text-align: center;">0.8</td>
 <td style="text-align: center;">&lt;0.0001</td>
 </tr>
 <tr>
 <td style="text-align: center;">HDL-C, mg/dL, median (IQR)</td>
 <td style="text-align: center;">43 (36, 51)</td>
 <td style="text-align: center;">45 (39, 55)</td>
 <td colspan="1" rowspan="1" style="text-align: center;">47 (39, 56)</td>
 <td style="text-align: center;">0.0235</td>
 </tr>
 <tr>
 <td style="text-align: center;">m&nbsp;&lt;45 /&nbsp;f&nbsp;&lt;55, mg/dL, %</td>
 <td style="text-align: center;">62.5</td>
 <td style="text-align: center;">58.3</td>
 <td colspan="1" rowspan="1" style="text-align: center;">53.7</td>
 <td style="text-align: center;">0.1172</td>
 </tr>
 <tr>
 <td style="text-align: center;">Triglycerides, mg/dL, median (IQR)</td>
 <td style="text-align: center;">162 (111, 234)</td>
 <td style="text-align: center;">148 (103, 196)</td>
 <td colspan="1" rowspan="1" style="text-align: center;">119 (90, 179)</td>
 <td style="text-align: center;">0.0080</td>
 </tr>
 <tr>
 <td style="text-align: center;">&gt;172 mg/dL, %</td>
 <td style="text-align: center;">45.8</td>
 <td style="text-align: center;">38.4</td>
 <td colspan="1" rowspan="1" style="text-align: center;">28.0</td>
 <td style="text-align: center;">0.0196</td>
 </tr>
 </tbody>
</table>
BAS, baseline analysis set; FAS, full analysis set; HDL, high-density lipoprotein; IQR, interquartile range; LDL, low-density lipoprotein
Outcomes assessed in FAS during 12-month follow-up:
<ul>
 <li>Percutaneous coronary intervention (PCI; 25.9%), cardiac catheterization without PCI (12.9%), and MI (2.4%)</li>
 <li>Stroke and transient ischemic attack (0.0%)</li>
 <li>Overall, 38.8% of patients required hospitalization due to an event and 68.2% of patients received rehabilitation therapy</li>
 <li>No deaths were reported</li>
</ul>

<h2>Key Limitations</h2>
<ul>
 <li>Severe loss to follow-up of patients during the study period</li>
 <li>Differences in patient characteristics between those with and without follow-up, such as higher proportions of male patients, those with diabetes, and coronary heart disease might have impacted the outcomes data, requiring cautious interpretation of rates.</li>
</ul>
*BAS included eligible patients with documented entries in the first eCRF section (used for cross-sectional data analysis). FAS comprised all BAS patients with LDL-C and LLT documentation at index event and 12-month follow-up (used for longitudinal data analysis); Note: Conversion factor – to get from mg/dL to mmol/L for total cholesterol, HDL, and LDL: multiply by 0.02586 and for triglycerides: multiply by 0.01129
Please refer source publication&nbsp;<a href="https://link.springer.com/article/10.1007/s00392-022-02108-w">Gitt AK, et al for</a>&nbsp;additional details.

Reference

Hypercholesterolemia Treatment Patterns and Lipid Target in ACS Patients: HYDRA-ACS Registry

DYSLIPIDEMIA

CARDIOLOGY

EAS guidance regarding combining Lipid-modifying therapy

Watch the video and learn on how to integrate recommendations by European Atherosclerosis Society (EAS) Task Force on combining lipid-modifying therapy into routine practice and have positive impact on Atherosclerotic Cardiovascular Disease (ASCVD) trajectory and burden in high- and very-high-risk patients.

Five-year update on ESC/EAS guidelines for detection, prevention, and treatment of individuals at risk of a first myocardial infarction*
When compared with 2016 and 2019 ESC/EAS (European Society of Cardiology/ European Atherosclerosis Society) guidelines, the 2021 ESC guidelines improved detection and treatment of men and women who are at risk for a first ST-segment elevated myocardial infraction (STEMI).

<h2>Key Takeaway</h2>
This study aimed to evaluate whether 2021 ESC guidelines vs 2016 and 2019 guidelines improved eligibility of individuals for primary prevention statin therapy before their first STEMI, and for intensive lipid-lowering treatments in secondary prevention and found that:
<ul>
 <li>2019 ESC guidelines helped in improved identification of individuals (mostly women) who are at risk of myocardial infraction (MI), but failed to assign direct statin therapy to 60% of them</li>
 <li>With 2021 ESC guidelines, a significant improvement was noticed in detection of individuals before they have a first MI, with 1/3rd of individuals considered as very-high-risk individuals, and 2/3rd of individuals directly eligible for primary preventive statin therapy 
 <ul>
 <li>The improvement was predominantly noticed in women with previously underestimated cardiovascular (CV) risk</li>
 <li>Despite updating SCORE (systematic coronary risk estimation) to SCORE2, 2021 ESC guidelines have still failed to identify 1/3rd of individuals who are at risk of developing MI</li>
 </ul></li>
 <li>Immediate initiation of PCSK9i (proprotein convertase subtilisin/kexin type 9 inhibitor) after first STEMI could be the next important step to reduce CV death or events and enable an effective and rapid reduction in LDL-C levels</li>
</ul>

<h2>Why This Matter</h2>
<ul>
 <li>The ESC has provided three consecutive guidelines (2016–2021) aiming to prevent CV disease (CVD), with 2019 edition providing updated recommendations on the detection and treatment of individuals at risk in primary and secondary prevention, and 2021 release implemented the use of SCORE2. 
 <ul>
 <li>However, few studies demonstrated limitations in ESC guidelines to detect and recommend primary prevention statins in patients at risk of CVD.</li>
 <li>The real-life effect of the stepwise approach in patients after a first STEMI is unknown.</li>
 </ul></li>
</ul>

<h2>Study Design</h2>
<ul>
 <li>e-PARIS register (Prospective registry of all individuals admitted for a STEMI at the university hospital of Pitié- Salpêtrière) was screened and included patients admitted for a first STEMI between January 2000 and October 2018, with no prior history of CVD and, with available cholesterol samples at the time of admission.</li>
 <li>First objective: To compare 2016, 2019 and 2021 ESC guidelines efficiency to detect and treat men and women, who will develop a first STEMI</li>
 <li>Second objective: Proportion of men and women with hospital follow-ups and eligible for an intensive LLT (lipid lowering therapy) with PCSK9i and ezetimibe based on real-life LDL-C levels</li>
</ul>

<h2>Key Results</h2>
<ul>
 <li>In total 2,757 patients were admitted for first STEMI (648 women [23.5%]). Risk modifiers are more frequent in women than men (especially chronic inflammatory diseases). 
 <ul>
 <li>Median LDL-C at the time of admission for acute MI: Women: 115 mg/dL (IQR [Interquartile range]: 92–151); Men: 121 mg/dl (IQR: 92–151), P = 0.52</li>
 </ul></li>
 <li>Estimation of CV risk in primary prevention:
 <ul>
 <li>Patients considered as very-high-risk (in %): ECS 2019 guidelines (based on clinical factors and SCORE): 17.2%; 2021 guidelines (based on clinical factors and SCORE2): 40.9%</li>
 </ul></li>
 <li>Eligibility for primary prevention intervention in men and women:
 <ul>
 <li>More in 2021 vs 2019 vs 2016 guidelines: 61.8% vs 38.6% vs 24% (P &gt;0.001)</li>
 <li>There was increase in detection of risk (P&nbsp;&lt;0.001) from 2016 to 2021 guidelines, both in men (62.3% vs 35.0% vs 24.9%) and women (60.2% vs 50.7% vs 19.3%).</li>
 </ul></li>
 <li>Guideline-based intensive LLT after a first STEMI according to real-life LDL-C (n = 975):
 <ul>
 <li>After patients were followed up to 33 months after MI, 27% achieved required LDL-C levels of &lt;55 mg/dL and 39% &lt;70 mg/dL.</li>
 <li>Following ECS stepwise approach was used: Among 73% of patients out of LDL-C objective levels, 61.7% patients were eligible to an increase of their statin dosage, 26.2% patients were eligible to add ezetimibe and 12.1% were eligible for PCSK9i therapy</li>
 </ul></li>
 <li>Guideline-based intensive LLT after a first STEMI according to expected LDL-C (n = 2757 patients) [using ESC estimations of LDL-C reduction at discharge]:
 <ul>
 <li>Using 2019/2021 guidelines: Even under full dose and adherence to statins, 38.7% of patients would have LDL-C levels of ≤55 mg/dL; 16.8% of patients would still require ezetimibe; and 44.5% would have LDL-C levels of &gt; 55 mg/dL under statins and ezetimibe and would be eligible for PCSK9i therapy</li>
 <li>Using 2016 guidelines: 14.3% eligible for ezetimibe; 22.5% for PCSK9i for LDL-C levels &lt;70 mg/dL</li>
 </ul></li>
 <li>Control of other cardiovascular risk factors and outcomes:&nbsp;Persistent active smoking was frequent, (men = 35%; women = 14%); HbA1c (glycated hemoglobin) &gt;6.5% in 47% men and 68% women; rate of composite of ACS, stroke or death = 5.1 per 1000 patient-years</li>
</ul>

<h2>Limitations</h2>
<ul>
 <li>Real life follow-up LDL-C was incomplete.</li>
 <li>Risk modifiers (coronary artery calcium score, carotid plaques, computerized tomography, coronary angiography) were not collected to determine eligibility for statins.</li>
 <li>Patients with Non-ST segment elevated myocardial infraction (NSTEMI) were not analyzed in the study.</li>
 <li>Individual patient response to treatments and compliance were not taken into consideration.</li>
 <li>LDL-C levels were taken within the hour of administration for STEMI.</li>
 <li>Data on statin tolerance in secondary prevention was not collected to decide whether an increase in the dosage was permitted.</li>
</ul>

Dyslipidemia performance of 2016 2019 and 2021 ESC Dyslipidemia guidelines

The need is clear: the healthcare community must do more to prevent devastating cardiovascular events in high and very high-risk patients that cause personal, societal and economic trauma.

black

Reducing risk in very high-risk ASCVD patients requires a&nbsp;HOLISTIC APPROACH&nbsp;and control of all modifiable risk factors, including elevated low-density lipoprotein cholesterol (LDL-C)5.
Over 4 million deaths were attributed to elevated LDL-C in 20196,12. That's eight deaths per minute, and many of those could be prevented.

According to the&nbsp;2019 ESC/EAS Guidelines for the management of dyslipidaemia&nbsp;and the&nbsp;2023 ESC Guidelines for the management of CVD in patients with diabetes, all ASCVD patients without exceptions are classified as very high-risk and, as such, have very strict LDL-C targets:
&lt;55 mg/dL (&lt;1.4 mmol/L) AND ≥ 50% LDL-C reduction vs. baseline5,11.

Yet,&nbsp;less than one third&nbsp;of ASCVD patients had their LDL-C levels within target range, according to the multinational observational SANTORINI study7. The reasons behind that are numerous, with one of them certainly being&nbsp;underuse of lipid-lowering treatment (LLT), most notably - combined LLT in general and PCSK9 inhibitors in particular7.

<h3>Meet Susan, 65</h3>
T2DM:&nbsp;from age 50 /&nbsp;LDL-C:&nbsp;2.9 mmol/L (112 mg/dL) /&nbsp;BP: 130/80 mmHg /&nbsp;HbA1c:&nbsp;7.0% /&nbsp;TGs:&nbsp;165 mg/dL /&nbsp;BMI:&nbsp;29 kg/m2
Complains of transient chest pain and shortness of breath while climbing stairs
Current medications: 
 Rosuvastatin 40 mg / ezetimibe 10 mg / telmisartan 80 mg / insulin glargine 300 units/mL / metformin 2000 mg / acetysalicylic acid 100 mg
Patients with combined T2DM and CAD have a 28% higher risk of CV events* compared to those without T2DM8
*cardiovascular death, myocardial infarction or stroke

<h3>Meet Eric, 62</h3>
Smoker / LDL-C:&nbsp;2.9 mmol/L (112 mg/dL) /&nbsp;BP:&nbsp;140/80 mmHg /&nbsp;HbA1c:&nbsp;5.0% /&nbsp;TGs:&nbsp;140 mg/dL /&nbsp;BMI:&nbsp;27 kg/m2
Complained of progressive persistent anginal symptoms, 12 months ago - CTA was performed, 55% obstruction of left anterior descending artery was found, subsequently - severe stenosis was confirmed during a cardiac catheterization, and elective PCI was performed
Current medications: 
 Rosuvastatin 40 mg / ezetimibe 10 mg / acetysalicylic acid 100 mg / clopidogrel 75 mg
Coronary artery disease (ischemic heart disease) is the leading cause of mortality worldwide, accounting for 16% of all deaths in 20199

<h3>Meet John, 60</h3>
Long-term smoker / LDL-C:&nbsp;2.5 mmol/L (98 mg/dL) /&nbsp;BP:&nbsp;130/80 mmHg /&nbsp;T2DM:&nbsp;since age 48 /&nbsp;HbA1c:&nbsp;7.5% /&nbsp;TGs:&nbsp;167 mg/dL /&nbsp;BMI:&nbsp;28 kg/m2
Complains of moderate pain in calves on exertion, which is relieved by rest
Current medications: 
 Atorvastatin 80 mg / ezetimibe 10 mg / insulin glargine 300 units/mL / metformin 2000 mg / acetysalicylic acid 100 mg / rivaroxaban 5 mg
Patients with combined T2DM and PAD have a nearly 8x higher risk of CV events compared to those without either condition10

Time to Act Early. Time to Prevent The Event.

<h3>Mission of the healthcare community: to help ASCVD patients avoid the trauma of a 1st event through effective LDL-C control and CV risk reduction</h3>

Abbreviations

References

According to the World Health Organization, an estimated 17.9 million people died from CVDs in 2019, representing 32% of all global deaths1. Of these deaths, 85% were due to myocardial infarction or stroke1.
 A CV event is a highly traumatic experience for patients and their families2. It takes a heavy emotional toll, brings widespread disability and significantly impedes quality of life3,4.

Cardiovascular diseases (CVDs) are the leading cause of death globally¹

RESPIRATORY-SYNCYTIAL-VIRUS

VACCINES

2024 RSV International Congress ECMMID


<h3>Decoding RSV unveiling truths and myths in infant burden</h3>
Dr. Janak Patel 
 Director of Department of Infection Control &amp; Healthcare Epidemiology at UTMB, Texas, USA ECCMID congress, April 2024

2024 RSV International Congress - ESPID

<h3>Beyfortus, an innovative immunization for RSV disease prevention in infants</h3>
Dr Jason Terk, Senior Consultant - Vice-Chair for Primary Care, Cook Children's Physician Network, Texas, USA

ASTHMA

RESPIRATORY

Why is it important to measure FEV1 in patients with asthma?

Dupixent Asthma KOL Expert Series Video - Lung Function.

What's possible when their Child's Asthma is under control?

When the symptoms are not under control, the airways can become inflamed making breathing difficult. Whilst Asthma cannot be cured, the symptoms can be controlled enabling people with Asthma to live full lives.

What gives you confidence that Dupixent improves patients’ quality of life?

Dupixent Asthma KOL Expert Series Video - Quality of Life.

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