ABSTRACT
Objective To explore the efficacy and safety of evolocumab in elderly patients with high-risk cardiovascular diseases.Methods A total of 153 patients with poor lipid control after conventional statin therapy who were hospitalized in the cardiologic departments in the First,Sec-ond,Sixth and Eighth Medical Centers of Chinese PLA General Hospital from November 2019 to November 2022 were included,and divided into non-elderly group(＜60 years old,46 cases),eld-erly group(60-74 years old,66 case)and very elderly group(≥75 years old,41 cases).They were all given evolocumab treatment according to guidelines.Another 50 over-75-year-old patients with high-risk cardiovascular diseases and poor lipid control who were hospitalized in the above cardiologic departments during the same period were treated with a statin drug combined with ezetimibe,and served as conventional treatment group(control group).The baseline clinical data and the blood indicators at 4th and 12th week after drug administration,and the occurrence of ad-verse drug reactions and major adverse cardiovascular events(MACE)within 12 weeks were com-pared among the groups.Results The levels of LDL-C and TC were significantly decreased in the three evolocumab treatment groups at 4 and 12 weeks after medication when compared with the baseline values(P＜0.05,P＜0.01),but there were no obvious differences in the 2 levels among the 3 groups at 12 weeks(P＞0.05).At the time point,no statistical difference was observed in the incidence of adverse events in the three groups(2.2％vs 3.0％vs 2.4％,P＞0.05).The levels of LDL-C and TC were decreased significantly in the very elderly group and the conventional treatment group at the 12th week when compared with the baseline levels(P＜0.05,P＜0.01),and the LDL-C level at the week was notably lower in the very elderly group than the convention-al treatment group(1.36±0.44 mmol/L vs 1.87±0.56 mmol/L,P＜0.01).But no difference was seen in the incidence of MACE between the 2 groups(12.2％vs 16.0％,P＞0.05),either in sur-vival rate between them(P=0.576).Conclusion For patients of all ages,evolocumab has good short-term efficacy in lipid control,and for those over 75 years old,the drug also shows good effi-cacy and sound safety.
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Objective To study the efficacy and safety of different rivaroxaban medications in prevention and treatment of thromboembolic disease in very old patients.Methods One hundred and ninety-eight very old thromboembolic disease patients were divided into low dose (2.5-7.5 mg)rivaroxaban treatment group (n =35),routine dose (10-20 mg) rivaroxaban treatment group (n=138),combined (10 mg) rivaroxaban and (75 mg) clopidogrel treatment group (n=25).Their baseline data were recorded.The incidence of major adverse thromboembolic disease and bleeding events in 3 groups was compared by Kaplan-Meiers survival analysis.Results No significant difference was found in gender,risk factors for and past history of thromboembolic disease and bleeding events,laboratory testing parameters in 3 groups (P＞0.05).The age was significantly older in low dose rivaroxaban treatment group than in routine dose rivaroxaban treatment group (90.43±5.02 vs 86.80±5.52,P=0.000).Kaplan-Meiers survival analysis showed no significant difference in the incidence of thromboembolic disease and bleeding events in 3 groups (P＞0.05).Conclusion Low dose rivaroxaban is effective in prevention and treatment of thromboembolic disease while combined clopidogrel and rivaroxaban is not only effective but also safe in prevention and treatment of thromboembolic disease in very old patients.
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Objective To study the diagnostic value of serum N-terminal probrain natriutetic peptide (NT-proBNP) level and its influencing factors in very old male heart failure (HF) patients with preserved ejection fraction.Methods Two hundred and thirty-six very old male HF patients with preserved ejection fraction admitted to our hospital from February 2008 to July 2016 were divided into HF group (n=92) and HF-free grup (n=144).Their biochemical parameters were tested and analyzed by correlation analysis.Results The serum NT-proBNP level and logNT-proBNP were significantly higher in HF group than in HF-free group (2205.4±2128.4 ng/L vs 457.3± 312.2 ng/L,P=0.000;3.3±0.3 vs 2.5±0.3,P=0.004).Univariate correlation analysis showed that serum NT-proBNP level was positively related with AF,diuretics,LVEF,left atrium diameter,eGFR,creatinine and logcTnI (P＜0.05,P＜0.01).Multivariate linear regression analysis revealed that AF,LVEF,left atrium diameter,eGFR,and logcTnI were the independent risk factors for NT-proBNP and that NT-proBNP was negatively related with LVEF and eGFR.Conclusion The serum NT-proBNP level in very old male HF patients with preserved ejection fraction can be influenced by a variety of factors.Increasing LVEF and eGFR can reduce their serum NT-proBNP level and improve their outcome.
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Objective: To compare the efifcacy and safety of rivaroxaban and warfarin on thrombolytic disease prevention in very elderly patients. Methods: A total of 90 patients with high risk of venous thrombosis treated in our hospital from 2012-03 to 2014-03 were enrolled. The patients' mean age was (82.4±5.5) years and randomized into 2 groups: Rivaroxaban group, patients received oral rivaroxaban 10 mg/day,n=44 including 34 male and 10 female; Warfarin group, patients received oral warfarin, INR was monitored and kept at stable level of 1.6-2.5,n=46 including 38 male and 8 female. All patients were followed-up for 12 months. Hemoglobin and platelet levels, coagulation, liver and kidney functions, end point events were monitored before and 1, 3, 6, 12 months after treatment. Major efficacy endpoints included all-cause death, recurrent or new onset of venous thrombosis, pulmonary embolism, cerebral and cardiovascular events; major safety endpoints included massive hemorrhages, clinically relevant bleeding and worsening of liver, kidney functions. Results: No patient died during follow-up period. The average INRs in Warfarin group were (2.02±0.46), (1.98±0.54), (2.03±0.56) and (2.04±0.46) at 1, 3, 6 and 12 months of treatment. Efficacy and safety were similar between 2 groups, Warfarin group had 7 patients with massive hemorrhages at 12 months of treatment and it was 2 patients more than that in Rivaroxaban group which had no statistic meaning. Hemoglobin and platelet levels, coagulation, liver and kidney functions were similar between 2 groups.Conclusion: Oral rivaroxaban was effective for preventing thromboembolic disease in very elderly patients, 10 mg/day was a safe dose; efifcacy of rivaroxaban was similar to warfarin while it was easier to use and with better compliance.