Hyporesponse to statin therapy among patients with acute coronary syndrome: prevalence, impact on the development of heart failure in a short-term follow-up

Aim. To study the prevalence of hyporesponse to statin therapy and its impact on the development of heart failure (HF) among patients after acute coronary syndrome (ACS) in a short-term follow-up.Material and methods. This retrospective analysis of outpatient medical records of 400 patients observed at the Omsk Clinical Cardiology Dispensary after ACS was carried out. Optimal medication therapy was prescribed as part of the preferential provision of medicines under the 1H Program, including high-dose atorvastatin therapy (80 mg/day). Low-density lipoprotein cholesterol (LDL-C) was assessed at baseline and 1 and 12 months after therapy. Hyporesponse to statins was defined as the percentage reduction in LDL-C 14; left atrial volume index >34 ml/m2) function.Results. There were 107 patients with hyporesponse (26,8%). Depending on the initial response to therapy, patients were divided into two groups: group 1 (hyporesponse, n=107), group 2 (more pronounced response, n=293). After 1 month, patients in the hyporesponse group had a higher level of LDL-C — 2,4 [2,2; 2,9] mmol/l (Me [25; 75%]) vs 2,0 [1,7; 2,5] mmol/l (p>0,05) in the second group. There was no difference in the prevalence of hospitalizations for recurrent ACS in the compared groups, as well as in the prevalence of new HF cases between groups.Conclusion. The prevalence of hyporesponse to statin therapy was 26,8%, which required correction of lipid-lowering therapy in order to prevent recurrent cardiovascular events. Given the pleiotropic effects of statins that can participate in HF pathogenesis, as well as the inconsistency of current research results, further prospective long-term studies are required

СТАТИНОТЕРАПИЯ ПОСЛЕ ОСТРОГО КОРОНАРНОГО СИНДРОМА: УРОКИ РЕАЛЬНОЙ КЛИНИЧЕСКОЙ ПРАКТИКИ

Aim. To evaluate the effcacy of statin therapy in patients with acute coronary syndrome in real clinical practice and to develop the monitoring of the quality of patients’ management.Methods.  255 patients with acute coronary syndrome who have undergone stenting of the infarct-related coronary artery were included in the study using the continuous sampling method. The follow-up period was 12 months. All the patients received atorvastatin at a dose of 20 mg were included in the «Omsk Segion State Program» (Program) – the control group. The comparison group consisted of 112 patients with acute coronary syndrome who have undergone the stenting of the infarctrelated coronary artery, but who were not included in the Program and were routinely prescribed statins by general practitioners in the outpatient settings. Medical record abstracts and outpatient medical records were analyzed to estimate prescribed statin therapy regimens and clinical and laboratory fndings. The experts analyzed real clinical practice of statin prescription and monitored its effcacy and safety according to the recent guidelines on dyslipidemia. A novel method for improving the quality of statin therapy has been developed and introduced. Statistical analysis was processed using biometric statistical methods.Results. We found that cardiologists (control group) and general practitioners (comparison group) had low adherence to the current guidelines on dyslipidemia. The effcacy and safety of statin therapy regimens and duration were not monitored. Only 9.8% of patients in the control group and 3.6% of the patients in the comparison group achieved the target levels of low-density lipoprotein cholesterol (less than 1.8 mmol/l) within the 12-month follow-up (p = 0.096).Conclusion. Healthcare professionals’ low adherence to the current guidelines on dyslipidemia led to the need to develop the monitoring of the quality of patients’ management within 12 months after acute coronary syndrome.Цель. Провести анализ эффективности статинотерапии больных после острого коронарного синдрома в реальной клинической практике для разработки способа контроля качества ведения пациентов.Материалы и методы. Методом сплошной выборки в исследование включены 255 пациентов, перенесших острый коронарный синдром и стентирование инфаркт-зависимой коронарной артерии, наблюдавшихся у врачей-кардиологов 12 месяцев после события и получавших аторвастатин в дозе от 20 мг в рамках реализации «Государственной программы Омской области "Развитие здравоохранения Омской области"» в части бесплатного лекарственного обеспечения (Программа) – группа контроля. Группу сравнения составили 112 пациентов после острого коронарного синдрома со стентированием инфаркт-зависимой коронарной артерии, не включенных в Программу, получавших статины в рамках назначений врачей-терапевтов в поликлиниках по месту жительства. Проанализированы выписки из историй болезни и медицинские карты амбулаторных больных для оценки данных клинических и лабораторных исследований пациентов, реальной клинической практики статинотерапии. Проведен экспертный анализ реальной клинической практики назначения статинов, контроля их эффективности и безопасности по отношению к актуальным клиническим рекомендациям по дислипидемии. Разработан и внедрен способ улучшения качества терапии статинами. Материал обработан с использованием методов биометрической статистики.Результаты. Выявлена низкая приверженность врачей-кардиологов (группа контроля) и врачей-терапевтов (группа сравнения) к актуальным клиническим рекомендациям по дислипидемии. Не соблюдались объемы и сроки контроля эффективности и безопасности статинотерапии. Отсутствие назначения высоких доз статинов было не обосновано. Это привело к достижению через 12 месяцев наблюдения целевых значений холестерина липопротеидов низкой плотности (менее 1,8 ммоль/л) лишь у 9,8% пациентов в группе контроля и у 3,6% пациентов в группе сравнения (p = 0,096).Заключение. Низкая приверженность врачей к актуальным клиническим рекомендациям по дислипидемии обусловила необходимость разработки способа контроля качества ведения пациентов в течение 12 месяцев после острого коронарного синдрома

Резолюция совещания экспертов Сибирского федерального округа «Эмпаглифлозин и сердечная недостаточность» по результатам исследования EMPEROR-Reduced

The results of the international multicenter study EMPEROR-Reduced have been discussed on October 31, 2020, at the online expert meeting. Considering the positive cardiovascular and renal effects of empagliflozin, the experts have supported the use of empagliflozin in the clinical practice to treat patients with chronic heart failure.На состоявшемся 31 октября 2020 г. онлайн-совещании экспертов рассмотрены итоги международного многоцентрового исследования EMPEROR-Reduced. С учетом выявленных сердечно-сосудистых и почечных эффектов эмпаглифлозина приняты предложения и рекомендации по широкому внедрению результатов исследования в клиническую практику лечения больных хронической сердечной недостаточностью

Резолюция онлайн-совещания экспертов Сибирского, Дальневосточного и Южного федеральных округов по результатам исследования EMPEROR-Reduced «Подходы к терапии сердечной недостаточности со сниженной фракцией выброса: от исследования EMPA-REG Outcome к EMPEROR-Reduced»

At the online meeting of experts held on April 24, 2021, the results of the international multicenter trial EMPEROR-Reduced were considered. Taking into account the beneficial cardiovascular and renal outcomes in patients with chronic heart failure and reduced left ventricular ejection fraction (<40%), and improvement in patient survival rates, a number of proposals and recommendations for widespread implementation of the trial results into practice of treating patients with chronic heart failure were adopted.На состоявшемся 24 апреля 2021 г. онлайн-совещании экспертов рассмотрены итоги международного многоцентрового исследования EMPEROR-Reduced. Принимая во внимание убедительные сердечно-сосудистые и почечные эффекты эмпаглифлозина у пациентов с хронической сердечной недостаточностью и сниженной фракцией выброса левого желудочка (<40%), а также доказанное улучшение выживаемости больных при приеме этого препарата приняты предложения и рекомендации по широкому внедрению результатов исследования в клиническую практику лечения больных хронической сердечной недостаточностью

CLINICAL AND COST EFFECTIVENESS OF PREVENTIVE COUNSELING OF YOUNG PATIENTS WITH ARTERIAL HYPERTENSION IN PRIMARY HEALTH CARE

Aim. To study clinical and cost effectiveness of training of young patients with arterial hypertension (HT) in the health school in comparison with individual counseling.Material and methods. Hypertensive outpatients (n=114) at the age of 18-27 years were included into the study. Patients were randomized into 2 groups: “Health school” and "Typical practice". “Health school” patients received special training course “School health for patients with HT." Patients of the "Typical practice" had individual consultation. Clinical and cost analysis was performed in 6, 12 and 36 months of the follow-up.Results. The total cardiovascular risk in patients of “Health school” and "Typical practice" groups after 12 months decreased from 15.85Ѓ}3.47% to 7.22Ѓ}2.59% and from 15.60Ѓ}3.34% to 11.29Ѓ}4.14%, respectively, after 36 months to 10.77Ѓ}3.18% and to 11.40Ѓ}3.93%, respectively. Cost of 1% reduction in the total cardiovascular risk was 3425.1 and 190.4 rubles per one patient in “Health school” and "Typical practice" groups, respectively.Conclusion. The more time after the training course passes, the more its clinical and cost effectiveness reduces. This requires a follow-up care and repeated preventive counseling of these patients.</p

Antihypertensive Efficacy of Fixed Combination of Amlodipine and Ramipril in Patients with Arterial Hypertension and Very High Cardiovascular Risk

Aim. To evaluate the antihypertensive efficacy and tolerability of a fixed combination of amlodipine and ramipril in hypertensive patients with very high cardiovascular risk. Material and methods. A retrospective cohort study of real clinical practice of prescribing antihypertensive drugs according to 255 medical records of outpatient hypertensive patients with a history of acute coronary syndrome (ACS) and coronary artery stenting was performed in the first part. An open observational study was performed in the second part. 69 people older than 18 years with a history of ACS and coronary artery stenting, without reaching the target blood pressure (BP) level while using free combinations of antihypertensive drugs and with indications for a fixed combination of ramipril and amlodipine were included into the study. Analysis of self-monitoring of BP, office BP, daily BP monitoring (ABPM) and patients’ adherence to treatment (Morisky-Green test) initially, after 4 and after 12 weeks of taking the fixed combination of ramipril and amlodipine was performed to assess the clinical efficacy of the studied drug. Results. It was found that 42.0% of patients did not follow the recommendations for regular intake of antihypertensive drugs. So, hypertension of all patients regarded as false-refractory, which was the basis for the prescription of the fixed combination of ramipril and amlodipine in accordance with clinical guidelines for the diagnosis and treatment of hypertension. After 4 weeks of therapy, there was significant decrease in office BP with the achievement and preservation of the target level by the 12th week, normalization to the 12th week of day and night BP variability in 54.9% of patients. 78.0% of patients followed medical recommendations for regular administration of antihypertensive drugs, none of the patients had adverse events. Conclusion. The use of fixed combinations of drugs, in particular, amlodipine and ramipril as a part of multicomponent therapy in hypertensive patients with very high cardiovascular risk, led to the achievement of target BP by the 4th week of therapy and stable preservation of antihypertensive effect in 12 weeks of treatment as well as gradual normalization of day and night BP variability in more than half of patients. Fixed combination of ramipril and amlodipine allowed to improve adherence of patients to cardiovascular diseases