Atherogenic Ratios in Patients with Recurrent Acute Coronary Syndrome and Receiving Statin Therapy: Clinical Usefullness as Cardiovascular Predictors

Patients who have already suffered a vascular event require more and better control of cardiovascular risk factors. Different atherogenic indexes such as TC/HDLc, LDLc/HDLc, apoB/apoA-I, LDLc/apoB and non-HDLc/HDLc have been used to follow-up the patients because of their predictive capacity of the lipid profile. The aim of this study was to evaluate atherogenic ratios as a marker of the lipid residual risk in high-risk patients receiving statin therapy and to know the changes produced by previous lipid-lowering drugs treatment for a previous coronary event. The study including patients admitted to coronary care units of six Spanish tertiary hospitals for Acute Coronary Syndrome (ACS). A total of 633 ACS patients were included; of these, 478 (75.8%) had presented a myocardial infarction and 153 (24.2%) angina. A previous ACS had occurred in 43.1% of cases, and was the first episode in 56.9% of the studied patients. Among patients with known ischemic heart disease, 187 (52.2%) were receiving lipid-lowering drugs, mainlystatins (182 patients, 50.7%). Of those with a first ACS, 59 (21.7%) were on lipid-lowering drugs: 55 (20.1%) statins and 4 (1.7%) fibrates. Patients with recurrent ACS had similar triglyceride and HDLc levels, but significantly lower total cholesterol and LDLc concentrations compared with those presenting the first ACS. Patients with recurrent ACS had significantly lower non-HDLc levels, TC/HDLc and LDLc/HDLc, but higher HDLc/TC and HDLc/LDLc ratios compared with first ACS patients. In patients taking statins the lipid residual vascular risk was related with the persistence of cardiovascular risk factors, and related with lipid profile with dyslipemia no-LDL dependent. So, we can conclude that the correction of lipid profile by statin is not per se sufficient to control cardiovascular risk

Consenso Delphi sobre el manejo de la dislipidemia en pacientes con alteración del metabolismo de la glucosa: estudio Diana. [Delphi consensus on management of dyslipidaemia in patients with impaired glucose metabolism: Diana study].

Objetivos: El objetivo de este estudio fue desarrollar un consenso multidisciplinar mediante el sistema Delphi para establecer recomendaciones clínicas en torno al manejo de la dislipidemia cuando hay una alteración del metabolismo de la glucosa, y la importancia de los factores que se valoran al prescribir y realizar el seguimiento del tratamiento con estatinas. Métodos: El cuestionario formulado por el comité científico incluyó 4 bloques de preguntas alrededor del paciente dislipidémico con alteración del metabolismo de la glucosa, de los que aquí presentaremos los resultados de los 2 primeros: a) manejo de la dislipidemia; y b) factores que se valoran al prescribir y realizar el seguimiento del tratamiento con estatinas. Resultados: Con un porcentaje superior al 90% se consensuó entre los 497 expertos participantes en el estudio que debía realizarse un cribado de dislipidemia a pacientes con diabetes o prediabetes, y/o con enfermedad cardiovascular o con antecedentes familiares y/u obesidad abdominal y/o hipertensos. En presencia de dislipidemia existe un elevado grado de acuerdo en que la estatina es el tratamiento hipolipidemiante de elección, en cambiarla cuando aparecen efectos secundarios, en la elección de dosis y tipo de estatina según la concentración de colesterol LDL basal del paciente y el objetivo a alcanzar, así como la posible interacción con otros fármacos Conclusiones: El cribado de la dislipidemia se realiza principalmente en pacientes con enfermedad cardiovascular o algún factor mayor de riesgo cardiovascular. Al prescribir una estatina los médicos encuestados valoraron fundamentalmente la capacidad de reducción del colesterol LDL y el riesgo de interacciones medicamentosas. OBJECTIVES: The aim of the present study was to develop a multidisciplinary consensus based on the Delphi system to establish clinical recommendations for the management of dyslipidaemia when hyperglycaemia is present, and the relevant factors that should be taken into consideration when prescribing and monitoring treatment with statins. METHODS: The questionnaire developed by the scientific committee included four blocks of questions about dyslipidaemia in patients with impaired glucose metabolism. The results of the first two blocks are presented here: a) management of dyslipidaemia; b) relevant factors that should be taken into consideration when prescribing and monitoring treatment with statins. RESULTS: Among the 497 experts who participated in the study, an agreement of over 90% was attained for recommending screening for dyslipidaemia in patients with diabetes or pre-diabetes and/or cardiovascular disease or a family history and/or abdominal obesity and/or hypertension. There was a high degree of agreement that a statin is the lipid-lowering treatment of choice, and that it should be switched when side effects develop. Also, the choice of statin and dose should be made according to baseline LDL cholesterol levels, the target to achieve, and the possible drug-drug interactions. CONCLUSIONS: The screening of dyslipidaemia is primarily conducted in patients with cardiovascular disease, or any major cardiovascular risk factor. When prescribing a statin, physicians mainly focus on the ability to reduce LDL cholesterol and the risk of drug interactions