A Comparison of Statin Treatment Algorithms Based on the ACC/AHA and Philippine Guidelines for Primary Prevention of Dyslipidemia in Statin-Naive Filipino Patients.

Objectives: This cross-sectional study evaluates the degree of agreement between the 2018 American College of Cardiology/American Heart Association (ACC/AHA2018) and 2020 Philippine Guideline (PG2020) treatment algorithms for the primary prevention of dyslipidemia among Filipinos. Methodology: This review included 159 charts of statin-naive Filipinos who are 45-79 years old. Using risk profile and lipid measurements, statin treatment recommendation was determined through the PG2020 algorithm and ACC/AHA-ASCVD Risk Estimator Plus web application. The degree of agreement was measured by Cohen's kappa statistic with the two algorithms as independent raters. Results: A total of 159 patients were included in the final analysis. There was a slight agreement with a kappa coefficient of 0.209 or 4.4% (95% CI 0.078-0.340, p=0.003). Statin treatment was recommended in 69 out of 159 patients (43.4%) by the PG2020 overlapping with ACC/AHA2018 in 56 cases (81.2%). On the other hand, 109 cases (68.6%) were recommended for statin treatment by ACC/AHA2018 overlapping with PG2020 in only 51.4%. Conclusions: The low degree of agreement between the two treatment algorithms highlights the key demographic and ethnic variations in dyslipidemia management necessitating outcome-based studies to translate these differences. Overestimation of ASCVD risk calculation in the ACC/AHA2018 and consideration of important, unique risk factors among Filipinos favors the applicability of the Philippine guideline.

Anthracycline-Induced Cardiotoxicity in Breast Cancer Patients: A Five-Year Retrospective Study in 10 Centers.

Background: Cardiotoxicity as a result of anthracycline chemotherapy has been linked to increased morbidity and mortality in breast cancer patients. There is a need for early detection through risk factor identification. To date, no large multicenter study has been conducted to describe the incidence, risk factors and clinical and demographic profiles of breast cancer patients with anthracycline-induced cardiotoxicity (AIC) in the Philippines. Methods: This was a nationwide multicenter retrospective cohort study among adult breast cancer patients who underwent anthracycline chemotherapy from 2015 to 2020 in 10 sites in the Philippines. Baseline characteristics and possible risk factors for AIC were retrieved from medical records and cancer registries. AIC was defined as a reduction of left ventricular ejection fraction (LVEF) by > 10% from baseline to a value of < 53% or the development of overt left ventricular systolic dysfunction or heart failure (HF). Odds ratios from logistic regression were computed to determine risk factors associated with AIC using STATA-15.0 software. Results: Out of 341 patients included, 33 had AIC, accounting for an incidence of 9.68%. Nine patients (2.6%) had clinical HF. AIC patients had a mean age of 53.91 ± 10.84 years. Breast cancer AIC patients were significantly older and had lower body mass index (BMI) than those without AIC. AIC patients had significantly more comorbidities, especially hypertension and atrial fibrillation. Multivariate analysis showed that patients with any preexisting comorbidity are approximately 12.37 times as likely to have AIC, while those with concurrent chemotherapy are 0.07 times or 93% less likely to have AIC. Conclusion: Among adult breast cancer patients undergoing anthracycline chemotherapy, we determined a high incidence of cardiotoxicity at 9.68%. Having preexisting comorbidities gave patients 12 times increased odds of developing anthracycline cardiotoxicity. The presence of concurrent non-anthracycline chemotherapy showed an inverse association with the development of AIC which we attribute largely to patient selection in a retrospective study. The significantly higher propensity for AIC development in patients with preexisting comorbidities may warrant closer monitoring and control of patient comorbidities such as hypertension among patients undergoing anthracycline chemotherapy.

Lower extremity peripheral artery disease: a basic approach.

Peripheral artery disease of the lower limbs is a chronically progressive disorder characterised by the presence of occlusive lesions in the medium and large arteries that result in symptoms secondary to insufficient blood flow to the lower extremities. It is both a manifestation of systemic atherosclerosis and a marker of increased cardiovascular morbidity and mortality. Because of its highly heterogenous clinical picture, a detailed history and physical assessment, a high degree of suspicion for peripheral artery disease and the use of the ankle-brachial pressure index is essential to identify patients with peripheral artery disease. This will allow early administration of basic pharmacotherapy and lifestyle changes to reduce cardiovascular events, minimise claudication symptoms and enable optimal revascularisation to prevent loss of limb function.