Sex Differences in Low-Density Lipoprotein Cholesterol Treatment Among Young Israeli Patients Following Premature Acute Coronary Syndrome.

Introduction: Effective management of dyslipidemias is crucial for reducing morbidity and mortality among patients after acute coronary syndrome (ACS). Sex differences in dyslipidemia management after premature ACS in Israeli patients have not been extensively studied. This study aimed to investigate potential disparities between men and women in managing dyslipidemia, considering current guidelines. Methods: This retrospective cohort study examined patients who were 55 years old or younger and admitted to Meir Medical Center for ACS from January 2018 to February 2019. The study aimed to evaluate the use of lipid-lowering therapy (LLT), measure the achievement of target low-density lipoprotein cholesterol (LDL-C) levels, and analyze the occurrence of major adverse cardiovascular and cerebrovascular events (MACCE) in both male and female patients. Results: The study included a total of 687 participants, of which 23.3% were identified as females. Upon discharge, ∼80% of the patients were prescribed high-intensity statins. After 1 year, it was observed that females had higher levels of LDL-C and lower rates of achieving target LDL-C levels (<70 and 55 mg/dL) as compared with males (45% vs. 54.6% and 30% vs. 42.2%, respectively). The use of non-statin LLT at the 1-year mark was minimal in both groups. Finally, it was found that the occurrence of MACCE was similar between males and females. Conclusion: Sex disparities in dyslipidemia management after a premature ACS were apparent, with females having higher LDL-C levels and lower rates of target achievement. Intervention is necessary to address these disparities and encourage greater use of non-statin LLT.

Effectiveness and Safety of Remote Cardiac Rehabilitation for Patients After Acute Coronary Syndrome.

Cardiac rehabilitation improves cardiovascular outcomes in patients after acute coronary syndrome (ACS). Recently there has been a growing interest in remote cardiac rehabilitation (RCR) programs. We aimed to evaluate the effectiveness of RCR compared with center-based cardiac rehabilitation (CBCR). This is an observational study including patients after hospital admission for ACS. The study group included patients at low-to-moderate risk for cardiovascular complications who were referred for RCR. The control group included patients at similar risk who participated in CBCR. The primary end points were the improvement of at least 10% to 25% in exercise capacity after 6 months of cardiac rehabilitation. Included were 305 patients who completed 6 months of cardiac rehabilitation. Of them, 107 patients participated in RCR and 198 in CBCR. RCR patients were younger and more frequently males. Improvement of ≥10% in exercise capacity after 6 months was achieved more frequently in patients participating in RCR compared with CBCR (69.3% and 55% respectively, p = 0.03). A similar trend was observed for improvement of ≥25% in exercise capacity after 6 months (33.8% and 22.7% in RCR and CBCR, respectively, p = 0.05). While weight reduction and the increase in muscle mass were similar in the 2 groups, fat percent reduction was significantly greater in the RCR compared with the CBCR (2.5% and 1.4% respectively, p <0.005). We conclude that RCR program is an effective and safe option for low-risk patients after hospital admission for ACS. It enables optimizing the utilization of this important service for patients with coronary artery disease.

Lipid treatment status and goal attainment among patients with premature acute coronary syndrome in Israel.

BACKGROUND: There are significant health gaps between Arabs and Jews in Israel. However, there are limited data on the management and treatment of dyslipidemia among Israeli adults who experience premature acute coronary syndrome (ACS). This study aimed to assess the differences between Arabs and Jews with regard to lipid-lowering therapy administration and low-density lipoprotein cholesterol (LDL-C) levels goal attainment at 1 year post-ACS. METHODS: This study included patients aged ≤55 years who had been hospitalized for ACS at Meir Medical Center between 2018 and 2019. Outcomes included the rate of use of lipid-lowering medications, LDL-C levels 1 year post-admission, and major adverse cardiovascular and cerebrovascular events (MACCE) during 30 months of follow-up. RESULTS: The study population comprised 687 young adults with a median age of 48.5 years. 81.9% of the Arab patients and 79.8% of the Jewish patients were discharged on high intensity statins. At 1 year of follow-up, the proportions of Arab patients who had LDL-C levels <70 mg/dL and <55 mg/dL were lower than those of Jewish patients (43.8% vs. 58%, p < 0.001 and 34.5% vs. 45.3%, p < 0.001, respectively). At 1 year of follow-up, only 25% and 4% of both groups were treated with ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor. The incidence of MACCE was significantly higher among Arab patients. CONCLUSION: Our study highlighted the need for a more aggressive lipid-lowering strategy in both Arab and Jewish populations. Culturally adapted interventions are required to reduce gaps between Arab and Jewish patients.

Familial Hypercholesterolemia Among Young Adults With Acute Coronary Syndrome.

There are limited data on the prevalence and treatment of familial hypercholesterolemia (FH) among Israeli adults who experience premature acute coronary syndrome (ACS). This study aimed to assess the prevalence of FH among young Israeli adults with ACS, examine the rates of lipid-lowering therapy administration, and determine low-density lipoprotein-cholesterol (LDL-C) levels 1 year after ACS. Patients aged ≤55 years hospitalized for ACS at Meir Medical Center between 2018 and 2019 were included. Probable/definite FH was defined using the Dutch Lipid Clinic criteria. Outcomes included the proportion of patients with probable or definite FH, rate of use of lipid-lowering medications, LDL-C levels 1 year postadmission, and major adverse cardiovascular and cerebrovascular events during 30 months of follow-up. The study population comprised 687 young adults with a median age of 48.5 years. Definite/probable FH was present in 61 patients (8.9%). At 1 year of follow-up, the proportions of patients without FH who had LDL-C levels <70 and <55 mg/100 ml were higher than those of patients with FH (55.9% vs 18%, p <0.001 and 35.8% vs 11.5%, p <0.001, respectively). At 1 year of follow-up, only 47.5% and 22% of patients with FH were treated with ezetimibe and proprotein convertase subtilisin/kexin type 9 inhibitor than were those without FH. The incidence of major adverse cardiovascular and cerebrovascular events was significantly higher among patients with FH. In conclusion, clinically defined FH was present in nearly 1 of 11 patients with premature ACS. There is a necessity for more aggressive lipid-lowering therapies in patients with FH after experiencing ACS.

Cardiovascular Fitness and Neurocognitive Performance among Older Adults in the Maintenance Stage of Cardiac Rehabilitation.

BACKGROUND: Cardiovascular fitness is associated with cognition in advanced age. Cardiovascular disease (CVD) is a risk factor for cognitive decline beyond the normal aging process, thus we investigated this association in CVD patients. METHOD: Patients in phase III of cardiac rehabilitation were divided into high and low cardiovascular fitness groups based on their predicted peak VO2. Cognition was assessed by a battery of neuropsychological tests examining memory, attention, visual spatial function, executive function and global cognitive score. RESULTS: The two groups were similar on reported physical activity and on the Mini-Mental State Examination (MMSE). However, the high fitness group had significantly higher scores than the lower fitness group on attention and on the global cognitive score, and marginally significant scores on executive functioning. LIMITATION: Due to the small sample size no differentiation was made among the various CVD conditions. CONCLUSION: Higher cardiovascular fitness of CVD patients is associated with superior cognition - predominantly in attention and executive functioning.

Dynamics of support perceptions among couples coping with cardiac illness: the effect on recovery outcomes.

OBJECTIVE: The current prospective study explored how male cardiac patients' perceptions of received support (i.e., active engagement, protective buffering, and overprotection) moderated the associations between female partners' perceptions of provided support and patients' recovery outcomes: psychological well-being, cholesterol levels, and smoking cessation. METHODS: Couples (N = 86) completed surveys at the initial hospitalization after patients' Acute Coronary Syndrome (ACS), and 1 and 6 months later. Partners' ways of providing support and patients' concurrent perceptions of these ways were measured using the Ways of Giving Support Questionnaire; patients' depressive and anxiety symptoms were measured using the Brief Symptom Inventory (BSI). Patients' cholesterol levels were assessed during hospitalization and 6 months later, and smoking habits were reported by the patients. RESULTS: Female partners' protective buffering was positively associated with male patients' depressive symptoms at follow-up only when male patients' own perceptions of partners' protective buffering were low. Female partners' active engagement was positively associated with better odds for male patients' cessation of smoking only when patients' own perceptions of partners' active engagement were high. Finally, female partners' overprotection was associated with higher levels of male patients' harmful blood lipids at follow-up, but only when patients' own perceptions of partners' overprotection were high. CONCLUSIONS: As hypothesized, the effect of partners' perceptions of support provided on patients' recovery was moderated by patients' own perceptions of the support received. The effect of this interaction was determined by the specific types of support provided or received and by the specific recovery outcome that was measured. The clinical and theoretical implications of the findings are discussed.

Spousal support and cardiac patients' distress: the moderating role of attachment orientation.

Based on the Person-Environment Fit Model, the current prospective study explored the contribution of the interaction between spouses' ways of providing support and patients' attachment orientations to the patients' levels of psychological distress 6 months after experiencing a first Acute Coronary Syndrome (ACS). One hundred and eleven patients completed a measure of attachment orientations during hospitalization, while their spouses completed a measure of ways of providing support 1 month later. The outcome measures were patients' depressive and anxiety symptoms 6 months after their ACS. Whereas active engagement was associated with lower levels of anxiety symptoms among patients high in attachment anxiety, it was also associated with higher levels of anxiety symptoms among patients low on this orientation. In addition, none of the ways of providing support moderated the association between avoidance and distress. These results shed light on the possible interplay between providers' support and recipients' personalities.