Calabro Paolo

Calabro, R

Cesaro, A

Concilio, C

Crisci, M

Fimiani, F

Gragnano, F

Natale, F

Pezzullo, E

Russo, MG

Sperlongano, S

English

Archivio Istituzionale della Ricerca - Università degli Studi della Campania "Luigi Vanvitelli"

314 LipidsMethods: Data were pooled from 10 trials according to ALI dose (eight trialsused 75 mg every 2 weeks [Q2W], with potential dose increase to 150 mg Q2Wat Week (W)12 if pre-specified LDL-C goals not achieved at W8 [ALI 75up150mg]; two trials used 150 mg Q2W only) and stratified by baseline LDL-C.Results: At W24, 28% (378 of 1363 patients) had dose increase from ALI 75to 150 mg. Absolute reductions in LDL-C associated with ALI were directly pro-portional to baseline values (Table). For patients with the highest baseline LDL-Cvalues (≥190 mg/dL; ≥4.9 mmol/L), absolute LDL-C reductions at W24 translateto predicted cardiovascular risk reductions (using the CTT model) of 72% (main-tained 75 mg), 71% (75up150 mg) and 74% (150 mg throughout). ALI safetyprofile was similar to comparator (placebo or ezetimibe), except for a higher inci-dence of injection-site reactions with ALI.Conclusions: Substantial absolute reductions in LDL-C, proportional in size tobaseline LDL-C, were observed with both ALI doses.Acknowledgement/Funding: This study was funded by Sanofi and RegeneronPharmaceuticals, Inc.P1513 | BEDSIDEAdherence to PCSK9 inhibitors in high cardiovascular risk patients inreal-world setting: results from a single-center experience andcomparison with statin therapyF. Gragnano, C. Concilio, A. Cesaro, M. Crisci, S. Sperlongano, F. Fimiani,F. Natale, E. Pezzullo, R. Calabro’, M.G. Russo, P. Calabro’. University ofCampania “Luigi Vanvitelli”, Division of Cardiology, Department of Cardio-thoracicand Respiratory Sciences, Naples, ItalyBackground: In real world setting, there is an unmet need in adherence to statintherapy in high risk patients. Contemporary registries report nonadherence in upto 30–40% of subjects, associated with increased cardiovascular risk. PCSK9 in-hibitors have recently proved efficacy in reducing LDL-C level. Considering theirdifferent dosing regimen (biweekly or monthly) and low rate of adverse effects,PCSK9 inhibitors may increase patients’ adherence to lipid-lowering therapy andreduce discontinuation rate, especially in patients with high pill burden. In litera-ture, data on adherence to PCSK9 inhibitors in “real-world setting” have not beenreported.Purpose: To measure level of adherence to PCSK9 inhibitors in high risk “real-world” patients and to compare results with adherence to statin therapy.Methods: We retrospectively analyzed 102 patients (78 male; age >18 years) athigh cardiovascular risk. PCSK9 inhibitors group included 34 patients on PCSK9inhibitors (evolocumab or alirocumab) with biweekly or monthly dose, in combina-tion with statin therapy plus ezetimibe. Statin group included 68 patients on statin,with or without ezetimibe. All patients were stratified in 3 sub-groups: fully adher-ent, partially adherent or nonadherent. Adherence to statin was measured usingpill counts and/or 4-items Morisky scale, considering “fully adherent” patients withadherence ≥80% or a total score of 0, “partially adherent” adherence >40% and<80% or a score of 1 to 2, and “nonadherent” adherence ≤40% or a score of3 to 4. Adherence to PCSK9 inhibitors was measured with pen counts dividing“fully adherent” (≥80%), partially adherent (>40% to <80%) and nonadherent(≤40%) patients. Our endpoints were level of adherence to PCSK9 inhibitors incomparison with statin, and level of adherence to statin in PCSK9 inhibitors groupin comparison with statin group.Results: Clinical characteristics (including age, BMI, sex male) and cardiovascu-lar risk profile were well balanced in the two groups, except for higher prevalenceof dyslipidemia in PCSK9 inhibitors group. All patients had history of myocardialinfarction. Level of adherence to PCSK9 inhibitors was higher than statin (79.4%vs 30.9% “fully adherent”, p=0.75; 11.8% vs 54.4% “partially adherent”; 8.8%vs 14.7% “nonadherent”). In addition, the percentage of patients “fully adherent”to statin resulted higher in PCSK9 group than in statin group (51.8% vs 30.9%;p=0.15).Adherence to PCSK9 inhibitors and statinConclusions: In real-world setting, PCSK9 inhibitors may reveal higher level ofadherence than statin. In addition, the use of PCSK9 inhibitors may also positivelyinfluence patients’ adherence to statin. In our study, non-statistically significantresults were probably due to low number of patients. PCSK9 inhibitors may rep-resent an interesting therapeutic opportunity to overcome nonadherence barriersin selected patients. Further studies with more numerous populations are neededto confirm our findings.P1514 | BEDSIDEPredictive value of the INTERHEART-cholesterol score for long-termprognosis of patients with acute coronary syndromeA. Cordero, R. Lopez-Palop, J. Moreno-Arribas, F. Yepez, F. Ribes, M. Juskova,C. Gunturiz, P. Carrillo, V. Bertomeu-Gonzalez, M. Garcia-Carrilero, A. Marco,A. Sanchez, V. Bertomeu-Martinez. University Hospital of San Juan, Alicante,SpainIntroduction: The INTERHEART study was a case-control study of myocardialinfarction that derived in a specific score to predict the incidence of acute coronarysyndromes (ACS) in contrast to other scores that predict coronary heart diseaseincidence or mortality; one of its variations was mainly based on lipid values,the so-called INTERHEART-cholesterol (IHc) score. We assessed the predicticevalue of the IHc score in patients admitted with ACS for hospital and long-termmortality as well as recurrent cardiovascular events.Methods: Prospective and observational study of all consecutive patients admit-ted in a single centre. The IHc score was assessed according to the original pub-lication: age (males >55 or females >65: 2 points), LDL-c (<77 mg/dl: 0, 77–116mg/dl: 1, 116–151 mg/dl:2, >151 mg/dl: 5), HDL-c (<40 mg/dl:2), Smoking (for-mer: 2, current 1–5 cig/d: 2, current 6–10 cig/d: 4, current 11–20 cig/d: 7, current>20 cig/d: 11), diabetes (yes: 7) and hypertension (yes: 6). Patients were dividedin tertiles according to the score obtained. Mortality multivariate analyses wereperformed by Cox regression and results are presented as hazard ratio (HR). Re-current major cardiovascular events (MACE), including ACS, heart failure, strokeand major bleeding, rate was assessed by negative binomial regression and re-sults are presented as incidence rate ratio (IRR).Results: We included 1729 patients, mean age 68.4 (12.9) years, 83.0% males,33.8% STEMI and mean GRACE score 142.0 (42.8). Mean IHc score was 12.6(5.5) and patients and the patients with IHc score ≥17 were included in the thirdtertile. An increasing pattern in the prevalence of risk factors was noted in eachIHc score tertile and the GRACE score was higher in patients within the thirdtertile as compared to the rest (145.4±2.0 vs. 140.5±1.2; p=0.03); in contrast, adecreasing pattern was noted as the IHc score increased: 37.2%; 32.1%; 29.9%(p=0.02). Hospital mortality was 3.9% and it has higher in each IHc score tertile:2.7%; 3.5%; 6.1% (p=0.01). Post-discharge median follow-up was 34.1 months(IQ range 28–33). All-cause mortality was 16.1% and it was increasingly higher ineach IHc score (10.4%; 16.8%; 23.2; p<0.01), as happened also for cardiovascu-lar mortality (7.1%; 11.5%; 16.7; p<0.01) or recurrent ACS (12.9%; 13.4%; 21.0;p<0.01). Multivariate analysis identified the third tertile of the IHc as indepen-dently associated with higher all-cause mortality (HR: 1.56 95% CI 1.00–2.42;p=0.048), cardiovascular mortality (HR: 1.69 95% CI 0.98–2.91; p=0.058) and(IRR: 1.52 95% CI 1.29–1.80; p<0.01).Conclusions: The third tertile of the IHC score (≥17) identified patients withhigher cardiovascular and all-cause mortality risk as well as higher incidence ofrecurrent MACEs.P1515 | BEDSIDERate of cholesterol goal attainment in patients with coronary heartdisease: Results from the Dyslipidemia International Study IIA.K. Gitt1, D. Lautsch2, M. Horack3, P.H. Brudi4, K.K. Poh5, G. De Ferrari6,J. Ferrieres7 on behalf of DYSIS-Study Group. 1Herzzentrum Ludwigshafen, Car-diology and Stiftung Institut f. Herzinfarktforschung Ludwigshafen, Ludwigshafen,Germany; 2MSD, Vienna, Austria; 3Institut f. Herzinfarktforschung Ludwigshafen,Ludwigshafen am Rhein, Germany; 4Merck & Co, Inc., Kenilworth, United Statesof America; 5National University of Singapore, Singapore, Singapore; 6Universityof Pavia, Pavia, Italy; 7Toulouse Rangueil University Hospital (CHU), Toulouse,FranceBackground: Current guidelines for the management of dyslipidemia confirmedthe LDL-C-target of <70mg/dl in very high risk patients. The objective of the sec-ond Dyslipidemia International Study (DYSIS II) was to document LDL-C goalattainment among patients with coronary heart disease (CHD) or acute coronarysyndrome (ACS).Methods: The CHD cohort of DYSIS II included patients from 17 countries ofAsia, Europe, and the Middle East aged ≥18 and with a complete fasting lipidprofile. Patients were classified as treated (on lipid-lowering therapy [LLT] for ≥3months) or untreated (not on LLT). Lipid profiles were assessed in all patients,and LDL-C goal (<70 mg/dL) attainment and kind of LLTs in treated patients wasdocumented. Multivariable logistic regression was performed to identify variablespredictive of LDL-C target attainment.Results: We identified 6,794 patients with CHD, of whom 6,370 (93.8%) wereon LLT. Mean LDL-C concentrations were significantly different between treatedand untreated patients (86 mg/dL versus 117 mg/dL; P<0.001). The LDL-C targetwas attained by 30.6% of treated patients. Statin monotherapy was the most com-monly used LLT (82.3% of treated patients), with atorvastatin the most frequentlyused statin (52.5% of statin users). The mean atorvastatin dose equivalent was25±18 mg/day. The atorvastatin dose equivalent was predictive of slightly higherDownloaded from https://academic.oup.com/eurheartj/article/38/suppl_1/ehx502.P1513/4088655 by BIBLIOTECA CENTRALIZZATA S. ANDREA DELLE DAME user on 08 June 2021

Adherence to PCSK9 inhibitors in high cardiovascular risk patients in real-world setting: results from a single-center experience and comparison with statin therapy

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Adherence to PCSK9 inhibitors in high cardiovascular risk patients in real-world setting: results from a single-center experience and comparison with statin therapy

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