September 2018, 25:1
13 September 2018
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
Nguyen Lan Viet, Pham Nguyen Vinh, Vo Thanh Nhan, Do Quang Huan, Pham Manh Hung, Dang Mai Tram, Baishali Ambegaonkar, Carl A Baxter, Philippe Brudi, Martin Horack, Dominik Lautsch, Anselm Gitt.
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.
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.
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.
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.
cholesterol - hyperlipidemia - statins - ezetimibe - acute coronary syndrome - myocardial infarction - lipids
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
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.
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
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.