Second-line treatments for dyslipidemia in patients at risk of cardiovascular disease.

Previous studies have shown that approximately 50% patients at risk of cardiovascular disease do not achieve lipid management goals. Thus, improvements dyslipidemia management are needed. We investigated the clinical choice and efficacy of second-line treatments for dyslipidemia in the Japanese clinical setting. Using a retrospective cohort design, we collected lipid profile data from patients who had been treated with hypolipidemic agents at a stable dosage for at least 12 weeks. These patients had then been administered a second-line treatment for dyslipidemia because they had not achieved the low-density lipoprotein cholesterol (LDL-C) management goals. We included data from 641 patients in our analysis. The top three choices for second-line treatment were adding ezetimibe, switching to strong statins (statin switching), and doubling the original statin dosage (statin doubling). Adding ezetimibe, statin switching, and statin doubling decreased LDL-C levels by 28.2 ± 14.5%, 23.2 ± 24.4%, and 23.5 ± 17.2%, respectively. Among these three strategies, adding ezetimibe decreased LDL-C levels to the maximum extent. In patients with dysglycemia, baseline-adjusted change in hemoglobin A1c (HbA1c) levels decreased slightly in the adding-ezetimibe, statin-switching, and statin-doubling groups, but the differences were not statistically significant among the groups (-0.10 ± 0.62%, -0.22 ± 0.54%, and -0.12 ± 0.52%, p = 0.19). In conclusion, the most common second-line treatment options for dyslipidemia were adding ezetimibe, statin switching, or statin doubling. Adding ezetimibe resulted in the highest reduction in LDL-C levels. These strategies did not increase HbA1c levels when administered with conventional diabetes treatment.

The association of cardiac function, structure, and glycemic control in patients with old myocardial infarction: a study using cardiac magnetic resonance.

PURPOSE: Cardiac magnetic resonance imaging (MRI) can provide noninvasive and accurate quantitative assessment of the left ventricular (LV) structure and function. We investigated the association between LV MRI measures and glycemic control in patients with old myocardial infarction (OMI). MATERIALS AND METHODS: The study population consisted of 51 OMI patients. By using a 1.5-T MRI scanner, we acquired cine MRI and late gadolinium-enhanced MRI. We calculated the LV volume, LV mass (LVM), LV function and percentage of infarcted myocardial volume over the total LV myocardial volume (%LGE). Patients were allocated to three groups: normal glucose tolerance (NGT), n = 9; impaired glucose tolerance (IGT)/impaired fasting glucose (IFG), n = 15; diabetes mellitus (DM), n = 27; respectively. RESULTS: LVM was significantly increased in the DM group compared with the NGT group (p = 0.002). Multiple linear regression analysis demonstrated that HbA1c levels were significantly and independently associated with LVM after adjustment for risk factors of congestive heart failure and  %LGE (p = 0.009). The LV ejection fraction (EF) was not associated with HbA1c levels. CONCLUSION: Our findings suggest that glucose tolerance in patients with OMI may be associated with LV wall thickness. LVM calculation by cine MRI might be useful for longitudinal follow-up of the effect of diabetic treatment on OMI patients.