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

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

Budget Impact of Oral Semaglutide Intensification versus Sitagliptin among US Patients with Type 2 Diabetes Mellitus Uncontrolled with Metformin.

BACKGROUND: Oral semaglutide was approved in 2019 for blood glucose control in patients with type 2 diabetes mellitus (T2DM) and was the first oral glucagon-like peptide 1 receptor agonist (GLP-1 RA). T2DM is associated with substantial healthcare expenditures in the US, so the cost of a new intervention should be weighed against clinical benefits. OBJECTIVE: This study evaluated the budget impact of a treatment pathway with oral semaglutide 14 mg daily versus oral sitagliptin 100 mg daily among patients not achieving target glycated hemoglobin (HbA1c) level despite treatment with metformin. METHODS: This study used the validated IQVIA™ CORE Diabetes Model to simulate the treatment impact of oral semaglutide 14 mg and sitagliptin 100 mg over a 5-year time horizon from a US healthcare sector (payer) perspective. Trial data (PIONEER 3) informed cohort characteristics and treatment effects, and literature sources informed event costs. Population and market share data were from the literature and data on file. The analysis evaluated the estimated budget impact of oral semaglutide 14 mg use for patients currently using sitagliptin 100 mg considering both direct medical and treatment costs to understand the impact on total cost of care, given underlying treatment performance and impact on avoidable events. RESULTS: In a hypothetical plan of 1 million lives, an estimated 1993 patients were treated with sitagliptin 100 mg in the target population. Following these patients over 5 years, the incremental direct medical and treatment costs of a patient using oral semaglutide 14 mg versus sitagliptin 100 mg was $US16,562, a 70.7$US3,300,143 (7.1%) over 5 years for every 10% of market share that oral semaglutide 14 mg takes away from sitagliptin 100 mg. Univariate and scenario analyses with alternate inputs and assumptions demonstrated consistent results. CONCLUSIONS: Use of oral semaglutide 14 mg in patients currently receiving sitagliptin 100 mg substantially increases the budget impact for patients with T2DM whose blood glucose level is not controlled with metformin over a 5-year time horizon for US healthcare payers

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

Cost Effectiveness of Vericiguat for the Treatment of Chronic Heart Failure with Reduced Ejection Fraction Following a Worsening Heart Failure Event from a US Medicare Perspective.

OBJECTIVE: Given the high economic burden of disease among adult patients with chronic heart failure with reduced ejection fraction (HFrEF) following a worsening heart failure event in the US, this study aimed to estimate the cost effectiveness of vericiguat plus prior standard-of-care therapies (PSoCT) versus PSoCT alone from a US Medicare perspective. METHODS: A four-state Markov model (alive prior to heart failure hospitalization, alive during heart failure hospitalization, alive post-heart failure hospitalization, and death) was developed to predict clinical and economic outcomes, based on the results of the VICTORIA trial, in which patients with chronic HFrEF following a worsening heart failure were randomized to placebo or vericiguat, in addition to PSoCT, which consisted of β-blockers, renin-angiotensin-aldosterone inhibitors, mineralocorticoid receptor antagonists, and the angiotensin receptor-neprilysin inhibitor sacubitril/valsartan. Risks of heart failure hospitalization and cardiovascular mortality were based on multivariable regression models derived from VICTORIA data. Utilities were derived from VICTORIA EQ-5D data and the literature. Costs included drug acquisition, heart failure hospitalization, routine care, and terminal care. Primary outcomes included heart failure hospitalization, cardiovascular mortality, life-years, quality-adjusted life-years (QALYs), and incremental costs per QALY gained over a 30-year lifetime horizon, discounted at 3.0% annually. RESULTS: For the VICTORIA overall intent-to-treat population, compared with PSoCT, vericiguat plus PSoCT resulted in 19 fewer heart failure hospitalizations and 13 fewer cardiovascular deaths per 1000 patients, as well as 0.28 QALY gained per patient at an incremental cost of $23,322, leading to$82,448 per QALY gained. CONCLUSIONS: Based on the results of VICTORIA, patients treated with vericiguat had lower rates of heart failure hospitalization and cardiovascular death. The addition of vericiguat to PSoCT was estimated to increase QALYs and to be cost effective at a willingness-to-pay threshold of $100,000 per QALY gained

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

Use of guideline-recommended management in established coronary heart disease in the observational DYSIS II study

Abstract Background Guidelines recommend lifestyle modification and medications to control risk factors in coronary heart disease (CHD). Using data from the observational DYSIS II study, we sought to evaluate the use of guideline-recommended treatments at discharge for acute coronary syndromes or in the chronic phase for CHD, and participation in rehabilitation/secondary prevention programs. Methods and results Between 2013 and 2014, 10,661 patients (3867 with ACS, 6794 with stable CHD) were enrolled in 332 primary and secondary care centers in 18 countries (Asia-Pacific, Europe, Middle East/Africa). Patients with incident ACS were younger and more likely to be smokers than patients with recurrent ACS or stable CHD (both p  Conclusions The high prevalence of risk factors in all CHD patients and reduced rates of secondary prevention medications in stable CHD offer areas for improvement. Translational aspects The findings of DYSIS II may reinforce the importance of adopting a healthy lifestyle and prescribing (by clinicians) and adhering (by patients) to evidence-based medications in the management of coronary heart disease, not only during the short-term but also over the longer term after a cardiac ischemic event. The results may help to increase the proportion of ACS patients who are referred to cardiac rehabilitation centres

Numeričko i eksperimentalno modeliranje nosivih elemenata teške metalurške opreme

Carrying structures of heavy metallurgical equipments are during their operation often exposed to extreme loading. The short-term overloading of the structure results to high stresses in locations of their concentrations. By repeating of these phenomena is decreased the life-time of the structure and eventually this leads to local failures in their carrying elements. In the paper are on examples described advantages of using numerical and experimental methods of mechanical system modelling that is exploited for identification of overloading in carrying elements of metallurgical equipments or for detection of damage causes.Nosivi elementi teške metalurške opreme tijekom eksploatacije često su izloženi ekstremnim opterećenjima. Njihova kratkotrajna preopterećenja izazivaju visoka naprezanja na mjestima koncentracije. Ponavljanje ove pojave izaziva skraćenje životnog vijeka konstrukcije i moguća lokalna oštećenja nosivih elemenata. U ovom članku, na dva primjera su prikazane prednosti primjene numeričkih i eksperimentalnih metoda modeliranja mehaničkog sustava u otkrivanju preopterećenja ili uzroka oštećenja nosivih elemenata metalurške opreme