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Session Webcast
Introduction
Webcast
Treating primary dyslipidemia in children: what we’ve learned from treating patients with Familial Hypercholesterolemia
Webcast
Lipid lowering therapy in primary and secondary prevention across Europe: are LDL-C goals achieved? Results from the DA VINCI study
Abstract
Background and Aims
Describe lipid lowering therapy (LLT) and achievement of the LDL-C goals recommended in 2016 EAS/ESC dyslipidaemia guidelines.
Methods
Cross-sectional observational study in 18 European countries. Data were collected at a single visit for adults seen in primary or secondary care who consented to participate, with any LLT in the past 12 months and an LDL-C measurement in the past 14 months. FH patients with a prior CV event were ineligible. LLT, most recent LDL-C and clinical/demographic characteristics were abstracted from medical notes. Primary outcome was LDL-C goal attainment ≥ 28 days after starting the most recent LLT (treatment stabilised LLT).
Results
Between Jun ‘17–Nov ’18, 5888 eligible subjects were enrolled. Approximately half (3000 [51%]) were primary prevention (PP). Of 2888 secondary prevention subjects, 2794 met our definition of ASCVD: 22% (622) had coronary disease, 41% (1136) cerebral and 37% (1036) peripheral. 2558 PP and 2039 ASCVD subjects had a treatment stabilised LDL-C; median, 93 and 77 mg/dL, respectively. Among subjects at highest CV risk, 21% of 89 very-high-risk PP and 39% of 2039 ASCVD achieved the recommended LDL-C goal of 70 mg/dL. Among 448 PP and 858 ASCVD subjects receiving high intensity statins, 68% and 46% reached goal, respectively. Among 952 ASCVD subjects receiving moderate intensity statins, 36% achieved goal. Over half (54%) of ASCVD subjects received sub-optimal (low/moderate intensity) statin therapy.
Conclusions
These data highlight a large gap between 2016 ESC/EAS treatment recommendations and European clinical practice across a broad range of patients eligible for LLT.
Webcast
Characteristics of Adults with Heterozygous Familial Hypercholesterolaemia stratified by gender: Preliminary analysis from the EAS FHSC Global Registry on over 36,000 cases of Familial Hypercholesterolaemia
Abstract
Background and Aims
The Familial Hypercholesterolaemia (FH) Studies Collaboration (FHSC) consists of a network of investigators from 69 countries worldwide and houses the largest, only-global FH Registry. We aim to compare the characteristics of men and women with heterozygous FH (HeFH) in the FHSC Registry.
Methods
FHSC comprises regional/national data from multiple cohorts/registries/databases of individuals with a clinical and/or genetic diagnosis of FH. After ensuring data quality, we used smart, bespoke IT routines for automated data cleaning, to allow harmonisation into a merged dataset for analyses. We conducted cross-sectional analyses at registry entry, to compare the baseline characteristics of adults (age ≥18 years) with HeFH stratified by gender.
Results
We included 16,890 (45.8%) men and 19,945 (54.2%) women with HeFH. Proportion of women in the registry was similar across the different WHO world regions, except for the Eastern Mediterranean region, where men accounted for 55.1% of cases. Mean (SD) age at registry entry was 45.2±14.9 and 48.1±16.4 years in men and women, respectively (p<0.0001). 61% men and 58% women were receiving lipid-lowering medication (LLM). Median (IQR) LDL-C (mg/dL) among individuals not taking LLM were: men 206.9 (163.0-255.7), women 213.0 (170.2-264.6), p<0.0003; among those receiving LLM: men 161.6 (122.2-213.0), women 164.7 (125.3-222.4), p<0.0001.
Conclusions
Overall, FH patients are identified late, with women being identified slightly later and presenting slightly higher LDL-C than men. LDL-C remains well above the recommended levels despite LLM at the time of registry entry in both genders. Greater attention is needed on early identification, and intensification of therapy to achieve recommended LDL-levels.
Webcast
Statin-associated muscle symptoms in the PROSISA study: prevalence and risk factors
Abstract
Background and Aims
Statin associated muscle symptoms (SAMS) are one of the main reasons for poor treatment adherence and/or discontinuation, but a definitive diagnosis of SAMS is challenging. The PROSISA study is an observational retrospective study aimed at assessing the prevalence of SAMS in dyslipidaemic patients.
Methods
Demographic/anamnestic data, biochemical levels, and occurrence of SAMS were collected. Adjusted logistic regression was fitted to estimate OR and 95% confidence intervals for association between probability of reporting SAMS and several factors.
Results
This analysis was carried out on 16,717 statin-treated patients (mean±SD age 60.5±12.0 years; 52.1% men). During statin therapy, 9.6% of patients reported SAMS, mainly myalgia (71.9%). Women and physically active subjects were more likely to report SAMS (OR 1.23 [1.10-1.37] and OR 1.35 [1.14-1.60], respectively), while older patients (OR 0.79 [0.70-0.89]), presence of type II diabetes mellitus (OR 0.62 [0.51-0.74]), use of concomitant non-statin lipid-modifying drugs (OR 0.87 [0.76-0.99]), of high-potency statins (OR 0.79 [0.69-0.90]) and of potential interacting drugs (OR 0.63 [0.48-0.84]) were associated with a lower probability of reporting SAMS. Among patients reporting SAMS, 761 underwent dechallenge, with disappearance of muscular symptoms in 87.2% of cases, while overall 908 patients underwent rechallenge (468 with change of statin/dose reduction without interruption of therapy), with reappearance of muscular symptoms in only 248 patients.
Conclusions
The reported prevalence of SAMS was 9.6%, but the percentage of patients in whom intolerance has been confirmed by dechallenge/rechallenge was between 23-28%, emphasizing the need for a better management of SAMS to provide a definitive diagnosis and treatment re-evaluation.