Cholesterol Target Value Achievement and Lipid-lowering Therapy in Patients with Stable or Acute Coronary Heart Disease in Vietnam – Results from the Dyslipidemia International Study II

Abstract

Background
Patients with established coronary heart disease (CHD) and those who suffer an acute coronary syndrome (ACS) are at risk of recurrent adverse events. Hyperlipidemia is a major risk factor for cardiovascular disease; however, there is insufficient information available regarding the extent of lipid abnormalities and how they are managed in individual countries.

Methods
The Dyslipidemia International Study (DYSIS) II was a multinational observational study involving subjects with stable CHD and those being hospitalized with an ACS. The present article concerns the subjects enrolled in Vietnam. A full lipid profile and utilization of lipid-lowering therapy (LLT) were documented at baseline, and for the ACS cohort, at 4 months after hospital discharge. Low-density lipoprotein cholesterol (LDL-C) target attainment as per European guidelines was assessed, and multivariate regression was performed in order to identify predictors for achieving an LDL-C level of <70 mg/dL.

Results
A total of 612 patients were recruited from 4 sites in Vietnam, 407 with stable CHD and 205 with an ACS. At baseline, 95.8% of the CHD cohort and 73.7% of the ACS cohort were being treated with LLT. LDL-C levels were lower for treated than non-treated patients in both the CHD (89.2 vs. 120.8 mg/dL; p < 0.01) and ACS (90.2 vs. 112.6 mg/dL; p < 0.01) cohorts; accordingly, LDL-C target attainment was greater (CHD: 29.6% vs. 11.8%, p = 0.11; ACS: 33.8% vs. 14.8%, p < 0.01). By the 4-month follow-up, target attainment had increased significantly for the ACS patients (from 0.0% at baseline to 33.3% at 4-month), that had not originally been treated with LLT, which was in response to therapy initiation after hospitalization. However, there was little improvement for the patients that were already being treated prior to the ACS. Lipid levels were rarely re-checked in the 4 months after discharge from hospital.

Conclusions
The extent of hyperlipidemia is of significant concern for patients with CHD in Vietnam, with few patients displaying an LDL-C level at the recommended target. LLT was widely used, but was rarely maximized, indicating a need for improved monitoring and treatment of these very high-risk patients.​

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Keywords:
cholesterol - hyperlipidemia - statins - ezetimibe - acute coronary syndrome - myocardial infarction - lipids

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1 National Heart Institute - Bach Mai Hospital, Hanoi city;
2 Tam Duc Heart Hospital, Ho Chi Minh city;
3 Cho Ray Hospital, Ho Chi Minh city;
4 Heart Institute, Ho Chi Minh city;
5 National Heart Institute - Bach Mai Hospital;
6 MSD representative office in Ho Chi Minh city- Vietnam,
7 Merck & Co., Inc., Kenilworth, New Jersey, USA

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Correspondence to: Associate Professor Pham Nguyen Vinh, PhD- Tam Duc Heart Hospital;
Address: 4 Nguyen Luong Bang street, Tan Phu ward, District 7- Ho Chi Minh city- Viet Nam.
E-mail: phamnguyenvinh@yahoo.com ​

Affiliations: MSD representative office in Ho Chi Minh city- Vietnam; Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany; Merck & Co., Inc., Kenilworth, New Jersey, USA; Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany
Funding Source: This study was funded by Merck & Co., Inc., Kenilworth, New Jersey, USA

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Open Access: This article is distributed under the terms of the Creative Commons Attribution License (CC-BY 4.0) which permits any use, distribution, and reproduction in any medium, provided the original author(s) and the source are credited.

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Supplementary Material

Nil

 

References

1. World Health Organization. Disease and injury country estimates 2008 [Accessed July 2017]. Available from: http://www.who.int/healthinfo/global_burden_disease/estimates_country/en/.

2. Nguyen HN, Fujiyoshi A, Abbott RD, Miura K. Epidemiology of cardiovascular risk factors in Asian countries. Circ J 2013;77:2851-9. PubMed

3. Nguyen HL, Ha DA, Phan DT, et al. Sex differences in clinical characteristics, hospital management practices, and in-hospital outcomes in patients hospitalized in a Vietnamese hospital with a first acute myocardial infarction. PLoS One 2014;9:e95631. CrossRef  PubMed

4. Zhang X, Patel A, Horibe H, et al. Cholesterol, coronary heart disease, and stroke in the Asia Pacific region. Int J Epidemiol 2003;32:563-72. PubMed

5. Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-78. PubMed

6. Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016. CrossRef  PubMed

7. Gitt AK, Lautsch D, Ferrieres J, et al. Low-density lipoprotein cholesterol in a global cohort of 57,885 statin-treated patients. Atherosclerosis 2016;255:200-9. CrossRef   PubMed

8. Chiang CE, Ferrieres J, Gotcheva NN, et al. Suboptimal control of lipid levels: results from 29 countries participating in the Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS). J Atheroscler Thromb 2015. CrossRef  PubMed

9. Park JE, Chiang CE, Munawar M, et al. Lipid-lowering treatment in hypercholesterolaemic patients: the CEPHEUS Pan-Asian survey. Eur J Prev Cardiol 2012;19:781-94. CrossRef  PubMed

10. European Association for Cardiovascular Prevention & Rehabilitation, Reiner Z, Catapano AL, et al. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011;32:1769-818. CrossRef  PubMed

11. Weng TC, Yang YH, Lin SJ, Tai SH. A systematic review and meta-analysis on the therapeutic equivalence of statins. J Clin Pharm Ther 2010;35:139-51. CrossRef  PubMed

12. Nguyen HL, Nguyen QN, Ha DA, Phan DT, Nguyen NH, Goldberg RJ. Prevalence of comorbidities and their impact on hospital management and shortterm outcomes in Vietnamese patients hospitalized with a first acute myocardial infarction. PLoS One 2014;9:e108998. CrossRef  PubMed

13. Kotseva K, Wood D, De Bacquer D, et al. EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries. Eur J Prev Cardiol 2016;23:636-48. CrossRef  PubMed

14. Chan RH, Chan PH, Chan KK, et al. The CEPHEUS Pan-Asian survey: high low-density lipoprotein cholesterol goal attainment rate among hypercholesterolaemic patients undergoing lipidlowering treatment in a Hong Kong regional centre. Hong Kong Med J 2012;18:395-406. PubMed

15. Wang KF, Chang CC, Wang KL, et al. Determinants of low-density lipoprotein cholesterol goal attainment: Insights from the CEPHEUS Pan-Asian Survey. J Chin Med Assoc 2014;77:61-7. CrossRef  PubMed

16. Sung J, Kim SH, Song HR, Chi MH, Park JE. Lipidlowering treatment practice patterns in korea: comparison with the data obtained from the CEPHEUS Pan-Asian study. J Atheroscler Thromb 2014;21:1219-27. PubMed

17. Munawar M, Hartono B, Rifqi S. LDL Cholesterol Goal Attainment in Hypercholesterolemia: CEPHEUS Indonesian Survey. Acta Cardiol Sin 2013;29:71-81. PubMed

18. Nguyen T, Nguyen TH, Pham HT, et al. Physicians’ adherence to acute coronary syndrome prescribing guidelines in Vietnamese hospital practice: a crosssectional study. Trop Med Int Health 2015;20:627-37. CrossRef  PubMed

19. Cannon CP, Steinberg BA, Murphy SA, Mega JL, Braunwald E. Meta-analysis of cardiovascular outcomes trials comparing intensive versus moderate statin therapy. J Am Coll Cardiol 2006;48:438-45. PubMed

20. Josan K, Majumdar SR, McAlister FA. The efficacy and safety of intensive statin therapy: a meta-analysis of randomized trials. CMAJ 2008;178:576-84. CrossRef  PudMed

21. Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med 2015;372:2387-97. CrossRef  PubMed

22. Yu CC, Lai WT, Shih KC, et al. Efficacy, safety and tolerability of ongoing statin plus ezetimibe versus doubling the ongoing statin dose in hypercholesterolemic Taiwanese patients: an openlabel, randomized clinical trial. BMC Res Notes 2012;5:251. CrossRef  PubMed

23. Setia S, Fung SS, Waters DD. Doctors’ knowledge, attitudes, and compliance with 2013 ACC/AHA guidelines for prevention of atherosclerotic cardiovascular disease in Singapore. Vasc Health Risk Manag 2015;11:303-10. CrossRef  PubMed

24. Hirsh BJ, Smilowitz NR, Rosenson RS, Fuster V, Sperling LS. Utilization of and adherence to guideline recommended lipid-lowering therapy after acute coronary syndrome: opportunities for improvement. J Am Coll Cardiol 2015;66:184-92. CrossRef  PubMed​

25. Chan JC, Kong AP, Bao W, Fayyad R, Laskey R. Safety of atorvastatin in Asian patients within clinical trials. Cardiovasc Ther 2016;34:431-40. CrossRef  PubMed​

26. Birmingham BK, Bujac SR, Elsby R, et al. Rosuvastatin pharmacokinetics and pharmacogenetics in Caucasian and Asian subjects residing in the United States. Eur J Clin Pharmacol 2015;71:329-40. CrossRef  PubMed​

27. Li YF, Feng QZ, Gao WQ, Zhang XJ, Huang Y, Chen YD. The difference between Asian and Western in the effect of LDL-C lowering therapy on coronary atherosclerotic plaque: a meta-analysis report. BMC Cardiovasc Disord 2015;15:6. CrossRef  PubMed​

28. Truong QB et al. The 2015 National Heart Association guideline on Dyslipidemia Diagnosis and Management. The Journal of Vietnamese Cardiology online: http://vnha.org.vn/cate.asp?cate_id=167, accessed on September 9, 2017

About this Article

Title

Cholesterol Target Value Achievement and Lipid-lowering Therapy in Patients with Stable or Acute Coronary Heart Disease in Vietnam - Results from the Dyslipidemia International Study II

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Open Access

Available under Open Access

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Journal

>> ASEAN Heart Journal 
>> 25:1

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Online Date

21 November 2019

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DOI

10.31762/AHJ1825.0101

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Online ISSN

2315-4551

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Publisher

ASEAN Federation of Cardiology

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Additional Links

>> About The AHJ/

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Topics

Cardiology

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Keywords

cholesterol
hyperlipidemia
statins
ezetimibe
acute coronary syndrome
myocardial infarction
lipids

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Author Affiliations

1. National Heart Institute - Bach Mai Hospital, Hanoi city
2. Tam Duc Heart Hospital, Ho Chi Minh city
3. Cho Ray Hospital, Ho Chi Minh city
4. Heart Institute, Ho Chi Minh city
5. National Heart Institute - Bach Mai Hospital
6. MSD representative office in Ho Chi Minh city- Vietnam
7. Merck & Co., Inc., Kenilworth, New Jersey, USA

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Correspondence to

Associate Professor Pham Nguyen Vinh, PhD, phamnguyenvinh@yahoo.com
address: 4 Nguyen Luong Bang street, Tan Phu ward, District 7- Ho Chi Minh city- Viet Nam. ​

Affiliations
MSD representative office in Ho Chi Minh city- Vietnam
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany
Merck & Co., Inc., Kenilworth, New Jersey, USA
Klinikum der Stadt Ludwigshafen, Medizinische
Klinik B, Ludwigshafen, Germany

Funding Source
This study was funded by Merck & Co., Inc., Kenilworth, New Jersey, USA

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