Mixed dyslipidemias in primary care patients in France

Laurent Laforest1, Baishali M Ambegaonkar2, Thierry Souchet3, Vasilisa Sazonov2, Eric Van Ganse11Lyon University, Lyon, France; 2Merck and Co Inc, Whitehouse Station, NJ, USA; 3Merck, Sharp & Dohme, Paris, FranceObjective: To determine the prevalence of single and mixed dyslipidemias among patients treated with statins in clinical practice in France.Methods: This is a prospective, observational, cross-sectional, pharmacoepidemiologic study with a total of 2544 consecutive patients treated with a statin for at least 6 months.Main outcome measures: Prevalence of isolated and mixed dyslipidemias of low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), and triglycerides among all patients and among patients at high cardiovascular risk; clinical variables associated with attainment of lipid targets/normal levels in French national guidelines.Results: At least one dyslipidemia was present in 50.8% of all patients and in 71.1% of high-risk patients. Dyslipidemias of LDL-C, HDL-C, and triglycerides were present in 27.7%, 12.4%, and 28.7% of all patients, respectively, and in 51.0%, 18.2%, and 32.5% of high-risk patients, respectively. Among all subjects with any dyslipidemia, 30.9% had mixed dyslipidemias and 69.4% had low HDL-C and/or elevated triglycerides, while 30.6% had isolated elevated LDL-C; corresponding values for high-risk patients were 36.8%, 58.9%, and 41.1%. Age, gender, body mass index and Framingham Risk Score >20% were the factors significantly associated with attainment of normal levels for ≥2 lipid levels.Conclusions: At least one dyslipidemia persisted in half of all patients and two-thirds of high cardiovascular risk patients treated with a statin. Dyslipidemias of HDL-C and/or triglycerides were as prevalent as elevated LDL-C among high cardiovascular risk patients.Keywords: cholesterol, triglycerides, dyslipidemias, prevalence, treatment outcome, Franc

0188: Suboptimal control of low-density lipoprotein cholesterol in French patients after an acute coronary syndrome. Contemporary data from DYSIS IIACS study

AimTo document low-density lipoprotein cholesterol (LDL-C) values during hospitalization of ACS patients with/without lipid-lowering therapy (LLT) at admission, and achievement of the ESC LDL-C target (LDL-C≤70mg/dL) at 4 months following the acute event using data from the French cohort of the DYSIS IIACS study.MethodsDYSIS IIACS was a multicentre prospective observational cohort study (recruitment: Oct 2013 to Oct 2014) conducted in 24 coronary care units in France. Adults hospitalized for an ACS event and who had a lipid panel measured within 24 hours of admission were consecutively enrolled. Eligible patients had to be on LLT for≥3 months or taking no LLT. A telephone follow-up interview was carried out with patients (or their next of kin) 120±15 days after the index event.ResultsOf the 468 patients enrolled, 50.6% had ST-elevation myocardial infarction/left bundle branch block, 40.8% had non-ST-elevation myocardial infarction, and 8.5% had unstable angina. Of the 277 (59.2%) patients on LLT at admission, 25.3% had an LDL-C<70mg/dl (Table). Most patients (96.4%) were on statin therapy at discharge (mean+SD dose calculated in atorvastatin 49±28mg/day). Non-statin LLT was used in 5.6% patients at discharge (61.5% with a cholesterol-absorption inhibitor). At 120 days after admission, 50.9% of ACS patients with follow-up data had achieved the LDL-C target.ConclusionsThese observational data from contemporary French clinical practice in coronary care units indicate suboptimal LDL-C control, with a substantial proportion of very high cardiovascular risk patients presenting with elevated LDL-C despite taking LLT. Four months after the acute event, half of the patients (with data) failed to achieve the target, with a large difference between mean value and target LDL-C.Abstract 0188 – Table: Characteristics of and lipid values in ACS patients: during hospitalization and at 120 daysAll patients (n=468)LLT at admission (n=277)No LLT at admission (n=191)Age (years)65±1267±1261±12***Men80.178.083.2Diabetes type 221.827.413.6**Chronic kidney disease3.84.03.7Lipid variables (within 24 h of admission)LDL-C (mg/dL)110.6±43.493.6±36.4135.3±40.9***LDL<70mg/dL (%)16.925.34.7***Difference between mean and target values (mg/dL)52.1±38.337.0±32.169.3±37.5***Statin at hospital discharge96.497.594.8Lipid variables (120 days after admission)(n=159)(n=86)(n=73)LDL-C (mg/dL)76.1±31.179.7±31.171.9±30.7*LDL-C<70mg/dL50.941.961.6*Difference between mean and target values (mg/dL)29.7±25.828.0±26.532.6±24.7Data are mean±SD or %.*P<0.05**P?0.001**P?0.0001 (LLT vs no LLT

0191: Poor achievement of low-density lipoprotein cholesterol targets in French patients with stable coronary heart disease. Contemporary data from DYSIS II CHD study

AimWe sought to determine achievement of lipid targets according to current European guidelines (low-density lipoprotein cholesterol [LDL-C]≤70mg/dL) in patients with stable coronary heart disease (CHD) with or without lipid-lowering therapy (LLT), in the French cohort of the Dyslipidemia International Study IICHD (DYSIS IICHD).MethodsDYSIS IICHD was a multicentre observational cross-sectional study conducted from July 2013 to October 2014 in 27 centres in France. Adults with stable CHD (defined as≥1 of the following:>50% stenosis on coronary angiography or computed tomography, prior percutaneous coronary intervention, prior coronary bypass graft, history of ACS>3 months previously) and a fasting lipid profile done within the previous 12 months were consecutively enrolled. Eligible patients had to be on LLT for≥3 months or taking no LLT.ResultsA total of 436 CHD patients were enrolled. Of the 424 patients (97.2%) on LLT, 91.5% were on statin treatment at the moment of inclusion (mean±SD dose calculated in atorvastatin 27±23mg/day). Non-statin LLT was used in 17.7% patients (79.2% were on a cholesterol-absorption inhibitor). Mean±SD LDL-C was 87.4±30.5mg/dL, 28.4% achieved LDL-C<70mg/dL, and 67.7% had an LDL-C<100mg/dL (Table).Abstract 0191 – Table: Characteristics of lipid values in patients with stable CHDAll patients (n=436)LLT (n=424)No LLT (n=12)Age (years)69±1269±1274±12Men80.079.791.7ACS>3 months previously70.070.066.7Diabetes type 227.027.316.7Chronic kidney disease5.05.20Lipid variablesLDL-C (mg/dL)87.4±30.586.0±29.6135.3±24.5**LDL<70mg/dL28.429.20*Distance to target of<70mg/dL (mg/dL)31.1±24.229.7±23.265.3±24.5**LDL<100mg/dL67.769.38.3**Data are mean±SD or %.*P<0.05**P?0.0001 (LLT vs no LLT)ConclusionsThese observational data from contemporary clinical practice in France indicate suboptimal lipid control, with over two-thirds of high-risk CHD patients failing to achieve the LDL-C target despite taking LLT, and a large difference between mean value and target LDL-C. More-intensive treatment is required to optimize achievement of lipid goals in CHD

Analysis of Episodes of Care in Medicare Beneficiaries Newly Diagnosed with Alzheimer’s Disease

OBJECTIVES: To study transitions between healthcare settings and quantify the cost burdens associated with different combinations of transitions during a 6-month period before initial Alzheimer’s disease (AD) diagnosis so as to investigate how using an episode-of-care approach to payment for specific disease states might apply in AD. DESIGN: A retrospective observational cohort study. SETTING: United States. PARTICIPANTS: A random sample of 8,995 individuals aged 65 to 100 with a diagnosis of AD (International Classification of Diseases, Ninth Revision, Clinical Modification code 331.0) were identified from the Medicare database between January 1, 2011, and June 30, 2014. This analysis identified individuals with AD diagnosed in inpatient (18%), skilled nursing facility (SNF) (1%), hospice (4%), and home and outpatient (77%) settings and analyzed episodes that began in the index setting (defined as the care setting in which the individual was first diagnosed with AD). MEASUREMENTS: Study outcomes included number of transitions between settings, primary discharge diagnoses, and total all-cause healthcare costs during the 6 months after the AD diagnosis. RESULTS: The average numbers of transitions between care settings were 2.8 originating from an inpatient setting, 2.4 from a SNF, 0.3 from a hospice setting and 0.7 from a home or outpatient setting during 6 months post-AD diagnosis. The overall cost burden during the 6 months after AD diagnosis (including costs incurred at the index setting) was high for individuals diagnosed in a nonambulatory setting (mean $41,468). Individuals diagnosed in an ambulatory setting incurred only$12,597 in costs during the same period. CONCLUSION: Episodes of care can be defined and studied in individuals with AD. An episode-of-care approach to payment could encourage providers to use the continuum of care needed for quality medical management in AD more efficiently

Economic Burden, Mortality, and Institutionalization in Patients Newly Diagnosed with Alzheimer’s Disease

Background: Current information is scarce regarding comorbid conditions, treatment, survival, institutionalization, and health care utilization for Alzheimer’s disease (AD) patients. Objectives: Compare all-cause mortality, rate of institutionalization, and economic burden between treated and untreated newly-diagnosed AD patients. Methods: Patients aged 65–100 years with ≥1 primary or ≥2 secondary AD diagnoses (ICD-9-CM:331.0] with continuous medical and pharmacy benefits for ≥12 months pre-index and ≥6 months post-index date (first AD diagnosis date) were identified from Medicare fee-for-service claims 01JAN2011–30JUN2014. Patients with AD treatment claims or AD/ADrelated dementia diagnosis during the pre-index period were excluded. Patients were assigned to treated and untreated cohorts based on AD treatment received post-index date. Total 8,995 newly-diagnosed AD patients were identified; 4,037 (44.8%) were assigned to the treated cohort. Time-to-death and institutionalization were assessed using Cox regression. To compare health care costs and utilizations, 1 : 1 propensity score matching (PSM) was used. Results: Untreated patients were older (83.85 versus 81.44 years; p \u3c 0.0001), with more severe comorbidities (mean Charlson comorbidity index: 3.54 versus 3.22; p \u3c 0.0001). After covariate adjustment, treated patients were less likely to die (hazard ratio[HR] = 0.69; p \u3c 0.0001) and were associated with 20% lower risk of institutionalization (HR = 0.801; p = 0.0003). After PSM, treated AD patients were less likely to have hospice visits (3.25% versus 9.45%; p \u3c 0.0001), and incurred lower annual all-cause costs ($25,828 versus$30,110; p = 0.0162). Conclusion: After controlling for comorbidities, treated AD patients have better survival, lower institutionalization, and sometimes fewer resource utilizations, suggesting that treatment and improved care management could be beneficial for newly-diagnosed AD patients from economic and clinical perspectives

Do Acute Coronary Events Affect Lipid Management and Cholesterol Goal Attainment in Germany?

Objective To document utilization of lipid-lowering therapy, attainment of low-density lipoprotein cholesterol target values, and cardiovascular outcomes in patients hospitalized for acute coronary syndrome in Germany. Methods The Dyslipidemia International Study II was a multicenter, observational study of the prevalence of dyslipidemia and lipid target value attainment in patients surviving any acute coronary syndrome event. Among patients on lipid-lowering therapy for ≥3 months, use of lipid-lowering therapy and lipid profiles were assessed at admission and again at 120 ± 15 days after admission (the follow-up time point). Multivariate logistic regression was used to identify variables predictive of low-density lipoprotein cholesterol target value attainment in patients using lipid-lowering therapy. Results A total of 461 patients hospitalized for acute coronary syndrome were identified, 270 (58.6%) of whom were on lipid-lowering therapy at admission. Among patients on lipid-lowering therapy, 90.7% and 85.9% were receiving statin monotherapy at admission and follow-up, respectively. Mean (SD) lowdensity lipoprotein cholesterol levels in patients on lipid-lowering therapy were 101 (40) mg/dl and 95 (30) mg/dl at admission and follow-up, respectively. In patients with data at both admission and followup (n= 61), low-density lipoprotein cholesterol target value attainment rates were the same (19.7%) at both time points. Smoking was associated with a 77% lower likelihood of attaining the low-density lipoprotein cholesterol target value. Conclusion Hospitalization for an acute event does not greatly alter lipid management in acute coronary syndrome patients in Germany. Both lipid-lowering therapy doses and rates of low-density lipoprotein cholesterol target value attainment remained essentially the same several months after the event

Prevalence Of Potential Familial Hypercholesteremia (Fh) In 54,811 Statin-Treated Patients In Clinical Practice

Background and aims: Familial hypercholesterolemia (FH) is a life-threatening disease, characterized by elevated LDL-C levels and a premature, increased risk of coronary heart disease (CHD) that is globally underdiagnosed. The percentage of patients with possible or probable FH in various countries was examined in the Dyslipidemia International Study (DYSIS). Methods: DYSIS is a multinational, cross-sectional observational study of 54,811 adult outpatients treated with statin therapy. The percentages of patients with high levels of LDL-C, and with possible or probable FH, were assessed using the Dutch scoring method for FH across 29 countries, in age subgroups for the analysis population and among diabetes patients. Results: Despite statin therapy, 16.1% (range 4.4-27.6%) of patients had LDL-C > 3.6 mmol/L (140 mg/dL) across countries and the prevalence of possible FH was 15.0% (range 5.5-27.8%) and 1.1% (range 0.0-5.4%) for probable FH. The highest percentages of probable FH occurred in Egypt (5.4%), the Baltic states (4.2%), Russia (3.2%), and Slovenia (3.1%), with the lowest rates in Israel (0.0%), Canada (0.2%), and Sweden (0.3%). Rates of FH were the highest in younger patients (45-54 years) for secondary prevention, regardless of the presence/absence of diabetes. Conclusions: Despite statin therapy, high LDL-C levels and rates of possible and probable FH were observed in some countries. The prevalence of FH was the highest in younger age patients, and > 60% of patients with probable FH displayed CHD. Earlier diagnosis and treatment of patients with FH are needed to reduce CHD risk in these patients. (C) 2016 The Authors. Published by Elsevier Ireland Ltd

Non-professional caregiver burden is associated with the severity of patients' cognitive impairment

<div><p>Background/Objectives</p><p>To analyse the relationship between caregiver burden and severity of patients’ cognitive impairment.</p><p>Design</p><p>Data were drawn from the cross-sectional 2015/2016 Adelphi Real World Dementia Disease-Specific Programme.</p><p>Setting</p><p>This research was multi-national and studied physicians and their consulting patients with cognitive impairment.</p><p>Participants</p><p>1,201 caregivers completed self-assessment forms.</p><p>Measurements</p><p>Validated instruments of caregiver wellbeing and burden (EQ-5D-3L questionnaire, EQ-VAS, Zarit Burden Interview, and Work Productivity and Activity Impairment questionnaire) and number of caregiver hours were analysed by severity of patients’ cognitive impairment, categorised according to the Mini-Mental State Examination. Data were analysed using Spearman’s rank correlation coefficients and ordinary least squares regression models, to compare outcomes between caregivers of patients with prodromal, mild, moderate, and severe dementia.</p><p>Results</p><p>The majority of caregivers were female (69.1%), lived with the patient they cared for (75.8%), and only approximately one third (28.3%) were in part- or full-time employment. There were statistically significant (p<0.001) increases in caregiver time (36.9 versus 108.6 hours per week for prodromal versus severe dementia, respectively) and measures of caregiver burden and health status (EQ-5D-3L, EQ-VAS, and Zarit Burden Interview) and increases in measures of work productivity and activity impairment with increasing severity of patients’ disease.</p><p>Conclusion</p><p>This study of real-world data confirmed an association between increased caregiver burden and severity of patients’ cognitive impairment by analysis of a wide range of validated measures of caregiver burden. These findings suggest that maintaining patients in the earliest stages of their disease for as long as possible may potentially help to protect caregiver wellbeing, although further research is required to confirm this hypothesis.</p></div

Prevalence of Lipid Abnormalities and Cholesterol Target Value Attainment in Patients with Stable and Acute Coronary Heart Disease in the United Arab Emirates

Background: Careful management of lipid abnormalities in patients with coronary heart disease (CHD) or an acute coronary syndrome (ACS) can reduce the risk of recurrent cardiovascular events. The extent of hyperlipidemia in these very high-risk patients in the United Arab Emirates (UAE), along with the treatment strategies employed, is not clear. Methods: The Dyslipidemia International Study II was a multinational observational analysis carried out from 2012 to 2014. Patients were enrolled if they had either stable CHD or an ACS. Patient characteristics, lipid levels, and use of lipid-lowering therapy (LLT) were recorded at enrollment. For the ACS patients, the LLT used during the 4 months\u27 follow-up period was documented, as were any cardiovascular events. Results: A total of 416 patients were recruited from two centers in the UAE, 216 with stable CHD and 200 hospitalized with an ACS. Comorbidities and cardiovascular risk factors were extremely common. A low-density lipoprotein cholesterol level of \u3c70 mg/dl, recommended for patients at very high cardiovascular risk, was attained by 39.3% of the LLT-treated CHD patients and 33.3% of the LLT-treated ACS patients at enrollment. The mean atorvastatin-equivalent daily statin dose was 29 ± 15 mg for the CHD patients, with 13.7% additionally using ezetimibe. For the ACS patients, the daily dosage was 23 ± 13 mg at admission, rising to 39 ± 12 mg by the end of the 4-month follow-up. The use of nonstatin agents was extremely low in this group. Conclusions: Despite LLT being widely used, hyperlipidemia was found to be prevalent in ACS and CHD patients in the UAE. Treatment strategies need to be significantly improved to reduce the rate of cardiovascular events in these very high-risk patients