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REFLECTIONS dae mia
Dyslipidaemia Global Newsletter #3 Dyslipi
CLINICAL PEARLS FROM THE FACULTY Dyslipi
difficult to achieve with up-titration of statin monotherapy. The aim ead
combination of a moderate-dose statin with ezetimibe might
be considered earlier in the treatment approach instead of WATCH
doubling the statin dose for patients, especially in patients PROF. FARNIER DISCUSS HIS
at high risk of adverse effects or statin intolerance with high- THOUGHTS ON MODERATE-
intensity statin therapy. INTENSITY STATIN COMBINATION
THERAPY VS. HIGH-INTENSITY
While the addition of ezetimibe (combination therapy) was STATIN MONOTHERAPY IN CLINICAL
evaluated in two large, randomized trials (the IMPROVE-IT PRACTICE.
trial and the HIJ-PROPER trial), those studies focused on CLICK HERE
the additive effect of ezetimibe on same-dose statin, not in FOR THE LINK TO FULL ARTICLE
comparison to a different statin intensity. This is the first long-
term study to compare moderate-dose statin with ezetimibe
combination therapy to higher-dose statin monotherapy.
The results showed that cumulative LDL-C during young
adulthood and middle age were associated with the risk
of incident CHD, independent of midlife LDL-C level. No
association was found between LDL-C variables and
ischaemic stroke or HF. These findings suggest that past levels
of LDL-C may inform strategies for primary prevention of CHD
and that maintaining optimal LDL-C levels at an earlier age
may reduce the lifetime risk of developing atherosclerotic CVD.
Intensity of and adherence to lipid-lowering therapy as predictors of major
adverse cardiovascular outcomes in patients with coronary heart disease.
Mazhar F, et al. J Am Heart Assoc. 2022 Jul 19;11(14):e025813.
Both adherence and treatment intensity can alter the ~60% of the patients were on high-intensity treatment, which is
effectiveness of lipid-lowering therapy (LLT) in routine clinical a greater proportion than reported in other healthcare systems,
practice, especially in patients with coronary heart disease but still far from optimal. Adherence was found to be highest
which require targeted risk management strategies. This during the first year of treatment and decreased progressively
observational study evaluated the association of LLT intensity over time. Reasons for the progressive decline are not well-
and adherence in adults who suffered a myocardial infarction known but may be attributed to patient-related factors such as
or had coronary revascularization between 2012 and 2018 age, socioeconomic factors, drug intolerance, adverse effects,
and initiated LLT in Stockholm, Sweden. A combined measure or comorbidities.
of adherence and treatment intensity was used with a roll-
out design to minimize the immortal-time bias of evaluating Each 10% increment in adherence was associated with a 6%
treatment adherence within fixed periods. reduction in risk of MACE (HR, 0.94 [95% CI, 0.93–0.96]).
Poor adherence (PDC <80%) and discontinuation of LLT were
In the study of 20,490 eligible patients who had initiated or associated with higher risks of MACE (HR, 1.23 [95% CI,
continued statin and/or ezetimibe treatment post-hospitalization, 1.12–1.34] and HR, 1.66 [95% CI, 1.23–2.22], respectively).
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