The DYSlipidemia International Study (DYSIS)-Egypt: A report on the prevalence of lipid abnormalities in Egyptian patients on chronic statin treatment

Introduction and objectives: Cardiovascular disease and its associated comorbidities, including diabetes mellitus, obesity and dyslipidemia, represent a significant socioeconomic burden, particularly in low- to middle-income countries. Pharmacological intervention with statins, which reduce low-density lipoprotein–cholesterol levels, has been demonstrated to reduce cardiovascular risk. This study assessed the prevalence of lipid abnormalities as well as risk factors for dyslipidemia in Egyptian patients on chronic statin treatment. Methods: DYSIS is a cross-sectional, observational, multinational study. Key eligibility criteria were age of at least 45 years and stable statin treatment for at least three months. In the Egyptian DYSIS cohort, a total of 1466 patients, 920 men and 532 women, were enrolled in 24 different centers. Patient characteristics and lipid measurements were documented, and multivariate regression modeling was used to assess factors associated with dyslipidemia. Results: Most patients (85%) were defined as being at very-high risk of cardiovascular disease. Gender-specific differences included higher rates of tobacco smoking and metabolic syndrome in men and women, respectively. Goal LDL–C levels were not achieved by 67.2% of the population, rising to 72% in both high- and very-high risk patients. Factors independently associated with LDL–C levels not being at goal included diabetes mellitus, ischemic heart disease, and high blood pressure. Conclusions: Despite chronic statin treatment, two-thirds of patients in the DYSIS-Egypt study had elevated LDL–C levels. A dual strategy, comprising modification of lifestyle factors together with novel treatment options, appears to be necessary to combat the rise in cardiovascular-related morbidity and mortality

Plasma Granzyme B in ST Elevation Myocardial Infarction versus Non-ST Elevation Acute Coronary Syndrome: Comparisons with IL-18 and Fractalkine

Objective. The proapoptotic protein, granzyme B (GZB), was identified as a contributor to the atherosclerotic plaque instability and recently as inflammatory activator. We studied the release kinetics of GZB and other markers of inflammation such as high sensitivity C reactive protein (hsCRP), interleukin 18 (IL-18), and fractalkine (FKN) in the early phase after acute cardiac events in different ACS subgroups. Methods. Thirty-six nondiabetic patients with ACS were compared to 12 control subjects. According to ACS diagnosis, the patients were classified into 22 patients with ST elevation myocardial infarction (STEMI) and 14 patients with non-ST elevation myocardial infarction or unstable angina (NSTEMI/UA). Blood samples were taken on day 1 (day of onset) and day 3 to measure hsCRP, IL-18, FKN, and GZB by ELISA. Results. Patients with ACS showed significantly higher GZB, IL-18, and FKN levels than the controls. STEMI group showed significantly higher GZB levels than NSTEMI/UA group. On day 3, FKN levels displayed a significant decrease, while GZB levels were significantly increased. IL-18 levels were more or less constant. GZB levels were positively correlated with IL-18 (, ) and FKN (, ). Conclusions. Unlike IL-18 and FKN, plasma GZB may be a marker of ACS disease severity

Prevalence of lipid abnormalities and cholesterol target value attainment in Egyptian patients presenting with an acute coronary syndrome

Background: Effective management of hyperlipidemia is of utmost importance for prevention of recurring cardiovascular events after an acute coronary syndrome (ACS). Indeed, guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level of <70 mg/dL for such patients. The Dyslipidemia International Study II (DYSIS II) – Egypt was initiated in order to quantify the prevalence and extent of hyperlipidemia in patients presenting with an ACS in Egypt. Methods: In this prospective, observational study, we documented patients presenting with an ACS at either of two participating centers in Egypt between November 2013 and September 2014. Individuals were included if they were over 18 years of age, had a full lipid profile available (recorded within 24 h of admission), and had either been taking lipid-lowering therapy (LLT) for ≥3 months at time of enrollment or had not taken LLT. Data regarding lipid levels and LLT were recorded on admission to hospital and at follow-up 4 months later. Results: Of the 199 patients hospitalized for an ACS that were enrolled, 147 were on LLT at admission. Mean LDL-C at admission was 127.1 mg/dL, and was not significantly different between users and non-users of LLT. Only 4.0% of patients had an LDL-C level of <70 mg/dL, with the median distance to this target being 61.0 mg/dL. For the patients with LDL-C information available at both admission and follow-up, LDL-C target attainment rose from 2.8% to 5.6%. Most of the LLT-treated patients received statin monotherapy (98.6% at admission and 97.3% at follow-up), with the mean daily statin dose (normalized to atorvastatin) increasing from admission (30 mg/day) to follow-up (42 mg/day). Conclusions: DYSIS II revealed alarming LDL-C goal attainment, with none of the patients with follow-up information available reaching the target of LDL-C <70 mg/dL, either at hospital admission or 4 months after their ACS event. Improvements in guideline adherence are urgently needed for reducing the burden of cardiovascular disease in Egypt. Strategies include the effective use of statins at high doses, or combination with other agents recommended by guidelines. Keywords: Hyperlipidemia, Cholesterol, Statins, Acute coronary syndrome, Myocardial infarctio

2015 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation

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Cohort profile. the ESC-EORP chronic ischemic cardiovascular disease long-term (CICD LT) registry

The European Society of cardiology (ESC) EURObservational Research Programme (EORP) Chronic Ischemic Cardiovascular Disease registry Long Term (CICD) aims to study the clinical profile, treatment modalities and outcomes of patients diagnosed with CICD in a contemporary environment in order to assess whether these patients at high cardiovascular risk are treated according to ESC guidelines on prevention or on stable coronary disease and to determine mid and long term outcomes and their determinants in this population