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Application of the ...
Application of the 2019 ESC/EAS dyslipidaemia guidelines to nationwide data of patients with a recent myocardial infarction : a simulation study
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- Allahyari, Ali (författare)
- Karolinska Institutet
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- Jernberg, Tomas (författare)
- Karolinska Institutet
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- Hagström, Emil (författare)
- Uppsala University,Uppsala universitet,Uppsala kliniska forskningscentrum (UCR),Kardiologi,Uppsala University Hospital
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- Leosdottir, Margret (författare)
- Lund University,Lunds universitet,Internmedicin - epidemiologi,Forskargrupper vid Lunds universitet,Internal Medicine - Epidemiology,Lund University Research Groups,Skåne University Hospital
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- Lundman, Pia (författare)
- Karolinska Institutet
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- Ueda, Peter (författare)
- Karolinska Institutet,Karolinska Institute
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(creator_code:org_t)
- 2020-02-18
- 2020
- Engelska.
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Ingår i: European Heart Journal. - : Oxford University Press (OUP). - 0195-668X .- 1522-9645. ; 41:40, s. 3900-3909
- Relaterad länk:
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https://doi.org/10.1...
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https://doi.org/10.1...
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Abstract
Ämnesord
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- AIMS: To estimate the proportion of patients with a recent myocardial infarction (MI) who would be eligible for additional lipid-lowering therapy according to the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidaemias, and to simulate the effects of expanded lipid-lowering therapy on attainment of the low-density lipoprotein cholesterol (LDL-C) target as recommended by the guidelines.METHODS AND RESULTS: Using the nationwide SWEDEHEART register, we included 25 466 patients who had attended a follow-up visit 6-10 weeks after an MI event, 2013-17. While most patients (86.6%) were receiving high-intensity statins, 82.9% of the patients would be eligible for expanded lipid-lowering therapy, as they had not attained the target of an LDL-C level of <1.4 mmol and a ≥50% LDL-C level reduction. When maximized use of high-intensity statins followed by add-on therapy with ezetimibe was simulated using a Monte Carlo model, the LDL-C target was reached in 19.9% using high-intensity statin monotherapy and in another 28.5% with high-intensity statins and ezetimibe, while 50.7% would still be eligible for proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. When use of alirocumab or evolocumab was simulated in those who were eligible for PCSK9 inhibitors, around 90% of all patients attained the LDL-C target.CONCLUSION : Our study suggests that, even with maximized use of high-intensity statins and ezetimibe, around half of patients with MI would be eligible for treatment with PCSK9 inhibitors according to the 2019 ESC/EAS guidelines. Considering the current cost of PCSK9 inhibitors, the financial implications of the new guidelines may be substantial.
Ämnesord
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kardiologi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)
Nyckelord
- ESC/EAS guidelines
- Ezetimibe
- LDL cholesterol target
- PCSK9 inhibitors
- Statins
- Treatment goals
- ESC/EAS guidelines
- Ezetimibe
- LDL cholesterol target
- PCSK9 inhibitors
- Statins
- Treatment goals
Publikations- och innehållstyp
- ref (ämneskategori)
- art (ämneskategori)
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