Assessment of Coronary Artery Calcium Scoring for Statin Treatment Strategy according to ACC/AHA Guidelines in Asymptomatic Korean Adults

PURPOSE: The 2013 American College of Cardiology (ACC)/American Heart Association (AHA) cholesterol management guidelines advocate the use of statin treatment for prevention of cardiovascular disease. We aimed to assess the usefulness of coronary artery calcium (CAC) for stratifying potential candidates of statin use among asymptomatic Korean individuals. MATERIALS AND METHODS: A total of 31375 subjects who underwent CAC scoring as part of a general health examination were enrolled in the current study. Statin eligibility was categorized as statin recommended (SR), considered (SC), and not recommended (SN) according to ACC/AHA guidelines. Cox regression analysis was employed to estimate hazard ratios (HR) with 95% confidential intervals (CI) after stratifying the subjects according to CAC scores of 0, 1–100, and >100. Number needed to treat (NNT) to prevent one mortality event during study follow up was calculated for each group. RESULTS: Mean age was 54.4±7.5 years, and 76.3% were male. During a 5-year median follow-up (interquartile range; 3–7), there were 251 (0.8%) deaths from all-causes. A CAC >100 was independently associated with mortality across each statin group after adjusting for cardiac risk factors (e.g., SR: HR, 1.60; 95% CI, 1.07–2.38; SC: HR, 2.98; 95% CI, 1.09–8.13, and SN: HR, 3.14; 95% CI, 1.08–9.17). Notably, patients with CAC >100 displayed a lower NNT in comparison to the absence of CAC or CAC 1–100 in SC and SN groups. CONCLUSION: In Korean asymptomatic individuals, CAC scoring might prove useful for reclassifying patient eligibility for receiving statin therapy based on updated 2013 ACC/AHA guidelines.

Efeito do treinamento físico aeróbio e do uso de estatinas sobre o perfil lipídico de animais com dislipidemia / Effects of physical training and statins therapy in the lipidic profile of animals with dyslipidemia

O objetivo do estudo foi avaliar o efeito do treinamento físico aeróbio (TFA) e a sua associação com estatinas no controle do perfil lipídico em modelo experimental animal com dislipidemia. Este estudo experimental utilizou ratos machos Wistar submetidos a ração comercial e sedentários (GRS), ração comercial e TFA (GRTAF), á dieta hipercolesterolêmica mantidos sedentários (GDHS) e submetidos ao TFA (GDHTFA), à dieta hipercolesterolêmica, sinvastatina, sedentários (GDHSiS) e submetidos ao TFA (GDHSiTFA), à dieta hipercolesterolêmica, fluvastatina, sedentários (GDHFS) e treinados (GDHFTFA).O TFA foi realizado em esteira rolante durante oito semanas. Foi realizado o teste t-teste de Student pareado, com nível de significância para p < 0,05. Notou-se redução significante no nível sérico CT associado ao TFA, exceto em GDHSiTFA, comparado aos sedentários. Observou-se redução nos níveis séricos de HDLc nos grupos GDHFTA (12,1±2,6mg/dL) e GDHS (15,2±2,9mg/dL), comparado aos demais. Houve aumento da fração não-HDLc em GDHSiTFA, GRS e GDHS (76,8±28,4; 71,4±19,9; 62,9±17,3mg/dL, respectivamente), comparado aos demais (GRTFA=52,8±18 mg/dL; GDHTFA=50,4±7,1 mg/dL; GDHSiS=45,4±15,3mg/dL; GDHFTFA-47,1±21mg/dL; GDHFS (52,3±14,8mg/dL). Notou-se, redução nos níveis séricos de triglicérides nos grupos GDHFTFA (53,3±33mg/dL) e GDHSiS (45,1±20,0) e GDHFS (79,3±23,3mg/dL), exceto em GDHSiTFA (89,6±30,4mg/dL), e GRS (108,2±20,6mg/dL). Conclui-se que o TFA associado à fluvastatina parece potencializar o tratamento da dislipidemia considerando a redução de CT se comparado à simvastatina; no entanto, alterações em HDLc foram resistentes mesmo com o uso de TFA e hipolipemiantes. A variação nos níveis de triglicérides e não-HDLc dificulta avaliar a associação entre TFA e hipolipemiantes, exigindo continuidade dos estudos, especialmente do protocolo de treinamento físico.(AU)

The objective of this study was to evaluate the effect of physical training (TFA) and its association with statins in the control of the lipidic profile in an experimental model for dislipidemic animals. To achieve that, male Wistar rats were submitted to commercial ration diet and sedentaries (GRS), commercial ration diet and TFA (GRTFA), hypercholesterolemic diet and sedentaries (GDHS), hypercholesterolemic diet and TFA (GDHTFA), hypercholesterolemic diet, simvastatin and sedentaries (GDHSiS), hypercholesterolemic diet, simvastatin and TFA (GDHSiTFA), hypercholesterolemic diet, fluvastatin and sedentaries (GDHFS) and hypercholesterolemic diet, fluvastatin and TFA (GDHFTFA). TFA was performed using treadmill during eight weeks. The paired t Student test was performed and the level of significance considered in the comparative statistics was p<0.05. Total cholesterol level (CT) in rats subjected to TFA was lower than in sedentary rats, except in GDHSiTFA. There was a reduction in HDLc level in GDHTFA (12.1±2.6mg/dL) and GDHS (15.2±2.9mg/dL), comparing to the other groups. Increased non-HDL fraction was observed in GDHSiTFA, GRS and GDHS (76.8±28.4; 71.4±19.9; 62.9±17.3mg/dL, respectively) when compared to the others (GRTFA=52.8±18 mg/dL; GDHTFA =50.4±7.1 mg/dL; GDHSiS=45.4±15.3mg/dL; GDHFTFA-47.1±21mg/dL; GDHFS (52.3±14.8mg/dL). There was an reduction in triglycerides levels in GDHFTFA (53.3±33mg/dL), GDHSiS (45.1±20.0) and GDHFS (79.3±23.3mg/dL), except in GDHSiTFA (89.6±30.4mg/dL) and GRS (108.2±20.6mg/dL). In conclusion, dyslipidemia treatment seems to be improved by TFA associated to fluvastatine, considering the reduction of CT, compared to simvastatin. However, HDLc changes are resistant even with TFA and lipid-lowering therapy. Changes in triglycerides levels and non-HDLc make it difficult to evaluate the association between TFA and lipid-lowering therapy. Further studies are necessary to elucidate this, especially the physical training protocol.(AU)

Clinical Significance of On-Treatment Triglyceride Level in Patients Treated by Percutaneous Coronary Intervention for Non-ST-Segment Elevation Acute Coronary Syndrome

BACKGROUND/AIMS: The use of statins in patients with acute coronary syndrome (ACS) has increased, and reduced levels of low-density lipoprotein cholesterol (LDL-C) lead to lower coronary event rates. We studied the effect of lipid levels during statin treatment on prognosis in patients with ACS and percutaneous coronary intervention (PCI). METHODS: Between January 2005 and May 2007, 325 ACS patients who underwent PCI and received statins were evaluated. We measured serum lipid levels at baseline and 4 weeks. The relationships between on-treatment levels of triglyceride (TG) and LDL-C and one-year major adverse cardiac events (MACE) were assessed. RESULTS: At 4 weeks, the mean LDL-C level was 72.5+/-23.8 mg/dL and the mean TG was 123.2+/-62.8 mg/dL. MACE occurred in 41 cases (12.6%). Baseline serum lipid levels were similar between the patients with and those without MACE. However, the patients with MACE showed significantly higher TG level at 4 weeks (149.6+/-81.4 vs. 119.3+/-58.9 mg/dL, p=0.026) than those without. High on-treatment TG level (> or =150 mg/dL) were associated with increased adverse events compared to lower TG level in a univariate analysis (hazard ratio [HR], 3.3; p or =150 mg/dL) was associated with a higher risk of MACE. This finding supports the concept that achieving low TG levels may be an important therapeutic parameter in statin-treated patients following ACS and PCI.