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2. Optimal use of lipid-lowering therapy after acute coronary syndromes: A Position Paper endorsed by the International Lipid Expert Panel (ILEP)

Author

Banach, M. Penson, P.E. Vrablik, M. Bunc, M. Dyrbus, K. Fedacko, J. Gaita, D. Gierlotka, M. Jarai, Z. Magda, S.L. Margetic, E. Margoczy, R. Durak-Nalbantic, A. Ostadal, P. Pella, D. Trbusic, M. Udroiu, C.A. Vlachopoulos, C. Vulic, D. Fras, Z. Dudek, D. Reiner, Z. for the ACS EuroPath Central & South European Countries Project

Abstract

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), “lower is better for longer”, and the recent data have strongly emphasized the need of also “the earlier the better”. In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual's calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an ‘Extremely High Risk’ group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardiovascular risk in these patients. © 2021 The Authors

Published
2021

6. Risk factors for the occurrence and irreversibility of cardiotoxicity caused by trastuzumab therapy

Author

Gabric, I. D., Vazdar, L. J., Pintaric, H., Planinc, D., Mario Štefanović, Trbusic, M., Vinter, O., Jazvic, M., Soldic, Z., and Separovic, R.

Subjects
cardiotoxicity, trastuzumab, breast cancer, skin and connective tissue diseases
Abstract

Cardiotoxicity is the most important side effect of trastuzumab, humanized monoclonal antibody to the HER2 protein, in use for immunotherapy of breast cancer. It is mainly manifested as a reduction in left ventricular contractility without myocardial necrosis and the process is therefore mostly reversible. However, sometimes the disease can progress to irreversible dilated cardiomyopathy. So far, many risk factors explaining cardiotoxicity have been identified, but it is still unclear how to assess individual risk. Also, there are no defined factors that can predict irreversibility of the disease. Pts with D/D ACE genotype, tumor of the left breast and positive family history of cardiovascular disease have a higher risk of developing cardiotoxicity with trastuzumab therapy and should be treated as high risk pts. Trastuzumab induced cardiotoxicity ismore likely to be irreversible in pts with a more extensive decrease of the LVEF and a higher serum NT-proBNP level. The time between prior chemotherapy and administration of trastuzumab shorter than 30 days ismore often associated with irreversible cardiac impairment.

Published
2015

8. Poster session Friday 13 December - PM: 13/12/2013, 14:00-18:00 * Location: Poster area

Author

Caiani, EG, Pellegrini, A, Carminati, MC, Lang, RM, Auricchio, A, Vaida, P, Obase, K, Sakakura, T, Komeda, M, Okura, H, Yoshida, K, Zeppellini, R, Noni, M, Rigo, T, Erente, G, Carasi, M, Costa, A, Ramondo, BA, Thorell, L, Akesson-Lindow, T, Shahgaldi, K, Germanakis, I, Fotaki, A, Peppes, S, Sifakis, S, Parthenakis, F, Makrigiannakis, A, Richter, U, Sveric, K, Forkmann, M, Wunderlich, C, Strasser, RH, Djikic, D, Potpara, T, Polovina, M, Marcetic, Z, Peric, V, Ostenfeld, E, Werther-Evaldsson, A, Engblom, H, Ingvarsson, A, Roijer, A, Meurling, C, Holm, J, Radegran, G, Carlsson, M, Tabuchi, H, Yamanaka, T, Katahira, Y, Tanaka, M, Kurokawa, T, Nakajima, H, Ohtsuki, S, Saijo, Y, Yambe, T, Dalto, M, Romeo, E, Argiento, P, Dandrea, A, Vanderpool, R, Correra, A, Sarubbi, B, Calabro, R, Russo, MG, Naeije, R, Saha, S K, Warsame, T A, Caelian, A G, Malicse, M, Kiotsekoglou, A, Omran, A S, Sharif, D, Sharif-Rasslan, A, Shahla, C, Khalil, A, Rosenschein, U, Erturk, M, Oner, E, Kalkan, AK, Pusuroglu, H, Ozyilmaz, S, Akgul, O, Aksu, HU, Akturk, F, Celik, O, Uslu, N, Bandera, F, Pellegrino, M, Generati, G, Donghi, V, Alfonzetti, E, Guazzi, M, Rangel, I, Goncalves, A, Sousa, C, Correia, AS, Martins, E, Silva-Cardoso, J, Macedo, F, Maciel, MJ, Lee, S, Kim, W, Yun, H, Jung, L, Kim, E, Ko, J, Enescu, OA, Florescu, M, Rimbas, RC, Cinteza, M, Vinereanu, D, Kosmala, W, Rojek, A, Cielecka-Prynda, M, Laczmanski, L, Mysiak, A, Przewlocka-Kosmala, M, Liu, D, Hu, K, Niemann, M, Herrmann, S, Cikes, M, Gaudron, PD, Knop, S, Ertl, G, Bijnens, B, Weidemann, F, Saravi, M, Tamadoni, AHMAD, Jalalian, ROZITA, Hojati, MOSTAF, Ramezani, SAEED, Yildiz, A, Inci, U, Bilik, MZ, Yuksel, M, Oyumlu, M, Kayan, F, Ozaydogdu, N, Aydin, M, Akil, MA, Tekbas, E, Shang, Q, Zhang, Q, Fang, F, Wang, S, Li, R, Lee, A PW, Yu, CM, Mornos, C, Ionac, A, Cozma, D, Popescu, I, Ionescu, G, Dan, R, Petrescu, L, Sawant, AC, Srivatsa, SV, Adhikari, P, Mills, PK, Srivatsa, SS, Boshchenko, A, Vrublevsky, A, Karpov, R, Trifunovic, D, Stankovic, S, Vujisic-Tesic, B, Petrovic, M, Nedeljkovic, I, Banovic, M, Tesic, M, Petrovic, M, Dragovic, M, Ostojic, M, Zencirci, E, Esen Zencirci, A, Degirmencioglu, A, Karakus, G, Ekmekci, A, Erdem, A, Ozden, K, Erer, HB, Akyol, A, Eren, M, Zamfir, D, Tautu, O, Onciul, S, Marinescu, C, Onut, R, Comanescu, I, Oprescu, N, Iancovici, S, Dorobantu, M, Melao, F, Pereira, M, Ribeiro, V, Oliveira, S, Araujo, C, Subirana, I, Marrugat, J, Dias, P, Azevedo, A, study, EURHOBOP, Grillo, M T, Piamonti, B, Abate, E, Porto, A, Dellangela, L, Gatti, G, Poletti, A, Pappalardo, A, Sinagra, G, Pinto-Teixeira, P, Galrinho, A, Branco, L, Fiarresga, A, Sousa, L, Cacela, D, Portugal, G, Rio, P, Abreu, J, Ferreira, R, Fadel, B, Abdullah, N, Al-Admawi, M, Pergola, V, Bech-Hanssen, O, Di Salvo, G, Tigen, M K, Pala, S, Karaahmet, T, Dundar, C, Bulut, M, Izgi, A, Esen, A M, Kirma, C, Boerlage-Van Dijk, K, Yamawaki, M, Wiegerinck, EMA, Meregalli, PG, Bindraban, NR, Vis, MM, Koch, KT, Piek, JJ, Bouma, BJ, Baan, J, Mizia, M, Sikora-Puz, A, Gieszczyk-Strozik, K, Lasota, B, Chmiel, A, Chudek, J, Jasinski, M, Deja, M, Mizia-Stec, K, Silva Fazendas Adame, P R, Caldeira, D, Stuart, B, Almeida, S, Cruz, I, Ferreira, A, Lopes, L, Joao, I, Cotrim, C, Pereira, H, Unger, P, Dedobbeleer, C, Stoupel, E, Preumont, N, Argacha, JF, Berkenboom, G, Van Camp, G, Malev, E, Reeva, S, Vasina, L, Pshepiy, A, Korshunova, A, Timofeev, E, Zemtsovsky, E, Jorgensen, P G, Jensen, JS, Fritz-Hansen, T, Biering-Sorensen, T, Jons, C, Olsen, NT, Henri, C, Magne, J, Dulgheru, R, Laaraibi, S, Voilliot, D, Kou, S, Pierard, L, Lancellotti, P, Tayyareci, Y, Dworakowski, R, Kogoj, P, Reiken, J, Kenny, C, Maccarthy, P, Wendler, O, Monaghan, MJ, Song, JM, Ha, TY, Jung, YJ, Seo, MO, Choi, SA, Kim, YJ, Sun, BJ, Kim, DH, Kang, DH, Song, JK, Le Tourneau, T, Topilsky, Y, Inamo, J, Mahoney, D, Suri, R, Schaff, H, Enriquez-Sarano, M, Bonaque Gonzalez, JC, Sanchez Espino, AD, Merchan Ortega, G, Bolivar Herrera, N, Ikuta, I, Macancela Quinonez, JJ, Munoz Troyano, S, Ferrer Lopez, R, Gomez Recio, M, Dreyfus, J, Cimadevilla, C, Brochet, E, Himbert, D, Iung, B, Vahanian, A, Messika-Zeitoun, D, Izumo, M, Takeuchi, M, Seo, Y, Yamashita, E, Suzuki, K, Ishizu, T, Sato, K, Aonuma, K, Otsuji, Y, Akashi, YJ, Muraru, D, Addetia, K, Veronesi, F, Corsi, C, Mor-Avi, V, Yamat, M, Weinert, L, Lang, RM, Badano, LP, Minamisawa, M, Koyama, J, Kozuka, A, Motoki, H, Izawa, A, Tomita, T, Miyashita, Y, Ikeda, U, Florescu, C, Niemann, M, Liu, D, Hu, K, Herrmann, S, Gaudron, PD, Scholz, F, Stoerk, S, Ertl, G, Weidemann, F, Marchel, M, Serafin, A, Kochanowski, J, Piatkowski, R, Madej-Pilarczyk, A, Filipiak, KJ, Hausmanowa-Petrusewicz, I, Opolski, G, Meimoun, P, Mbarek, D, Clerc, J, Neikova, A, Elmkies, F, Tzvetkov, B, Luycx-Bore, A, Cardoso, C, Zemir, H, Mansencal, N, Arslan, M, El Mahmoud, R, Pilliere, R, Dubourg, O, Ikonomidis, I, Lambadiari, V, Pavlidis, G, Koukoulis, C, Kousathana, F, Varoudi, M, Tritakis, V, Triantafyllidi, H, Dimitriadis, G, Lekakis, I, Kovacs, A, Kosztin, A, Solymossy, K, Celeng, C, Apor, A, Faludi, M, Berta, K, Szeplaki, G, Foldes, G, Merkely, B, Kimura, K, Daimon, M, Nakajima, T, Motoyoshi, Y, Komori, T, Nakao, T, Kawata, T, Uno, K, Takenaka, K, Komuro, I, Gabric, I D, Vazdar, LJ, Pintaric, H, Planinc, D, Vinter, O, Trbusic, M, Bulj, N, Nobre Menezes, M, Silva Marques, J, Magalhaes, R, Carvalho, V, Costa, P, Brito, D, Almeida, AG, Nunes-Diogo, AG, Davidsen, E S, Bergerot, C, Ernande, L, Barthelet, M, Thivolet, S, Decker-Bellaton, A, Altman, M, Thibault, H, Moulin, P, Derumeaux, G, Huttin, O, Voilliot, D, Frikha, Z, Aliot, E, Venner, C, Juilliere, Y, Selton-Suty, C, Yamada, T, Ooshima, M, Hayashi, H, Okabe, S, Johno, H, Murata, H, Charalampopoulos, A, Tzoulaki, I, Howard, LS, Davies, RJ, Gin-Sing, W, Grapsa, J, Wilkins, MR, Gibbs, JSR, Castillo, JMDC, Bandeira, AMPB, Albuquerque, ESA, Silveira, C, Pyankov, V, Chuyasova, Y, Lichodziejewska, B, Goliszek, S, Kurnicka, K, Dzikowska Diduch, O, Kostrubiec, M, Krupa, M, Grudzka, K, Ciurzynski, M, Palczewski, P, Pruszczyk, P, Arana, X, Oria, G, Onaindia, JJ, Rodriguez, I, Velasco, S, Cacicedo, A, Palomar, S, Subinas, A, Zumalde, J, Laraudogoitia, E, Saeed, S, Kokorina, MV, Fromm, A, Oeygarden, H, Waje-Andreassen, U, Gerdts, E, Gomez, ELENA, Vallejo, NURIA, Pedro-Botet, LUISA, Mateu, LOURDE, Nunyez, RAQUEL, Llobera, LAIA, Bayes, ANTONI, Sabria, MIQUEL, Antonini-Canterin, F, Mateescu, AD, La Carrubba, S, Vriz, O, Di Bello, V, Carerj, S, Zito, C, Ginghina, C, Popescu, BA, Nicolosi, GL, Mateescu, AD, La Carrubba, S, Vriz, O, Di Bello, V, Carerj, S, Zito, C, Ginghina, C, Popescu, BA, Nicolosi, GL, Antonini-Canterin, F, Pudil, R, Praus, R, Vasatova, M, Vojacek, J, Palicka, V, Hulek, P, P37/03, Prvouk, Pradel, S, Mohty, D, Damy, T, Echahidi, N, Lavergne, D, Virot, P, Aboyans, V, Jaccard, A, Mateescu, AD, La Carrubba, S, Vriz, O, Di Bello, V, Carerj, S, Zito, C, Ginghina, C, Popescu, BA, Nicolosi, GL, Antonini-Canterin, F, Doulaptsis, C, Symons, R, Matos, A, Florian, A, Masci, PG, Dymarkowski, S, Janssens, S, Bogaert, J, Lestuzzi, C, Moreo, A, Celik, S, Lafaras, C, Dequanter, D, Tomkowski, W, De Biasio, M, Cervesato, E, Massa, L, Imazio, M, Watanabe, N, Kijima, Y, Akagi, T, Toh, N, Oe, H, Nakagawa, K, Tanabe, Y, Ikeda, M, Okada, K, Ito, H, Milanesi, O, Biffanti, R, Varotto, E, Cerutti, A, Reffo, E, Castaldi, B, Maschietto, N, Vida, VL, Padalino, M, Stellin, G, Bejiqi, R, Retkoceri, R, Bejiqi, H, Retkoceri, A, Surdulli, SH, Massoure, PL, Cautela, J, Roche, NC, Chenilleau, MC, Gil, JM, Fourcade, L, Akhundova, A, Cincin, A, Sunbul, M, Sari, I, Tigen, MK, Basaran, Y, Suermeci, G, Butz, T, Schilling, IC, Sasko, B, Liebeton, J, Van Bracht, M, Tzikas, S, Prull, MW, Wennemann, R, Trappe, HJ, Attenhofer Jost, C H, Pfyffer, M, Scharf, C, Seifert, B, Faeh-Gunz, A, Naegeli, B, Candinas, R, Medeiros-Domingo, A, Wierzbowska-Drabik, K, Roszczyk, N, Sobczak, M, Plewka, M, Krecki, R, Kasprzak, JD, Ikonomidis, I, Varoudi, M, Papadavid, E, Theodoropoulos, K, Papadakis, I, Pavlidis, G, Triantafyllidi, H, Anastasiou - Nana, M, Rigopoulos, D, Lekakis, J, Tereshina, O, Surkova, E, Vachev, A, Merchan Ortega, G, Bonaque Gonzalez, JC, Sanchez Espino, AD, Bolivar Herrera, N, Bravo Bustos, D, Ikuta, I, Aguado Martin, MJ, Navarro Garcia, F, Ruiz Lopez, F, Gomez Recio, M, Merchan Ortega, G, Bonaque Gonzalez, JC, Bravo Bustos, D, Sanchez Espino, AD, Bolivar Herrera, N, Bonaque Gonzalez, JJ, Navarro Garcia, F, Aguado Martin, MJ, Ruiz Lopez, MF, Gomez Recio, M, Eguchi, H, Maruo, T, Endo, K, Nakamura, K, Yokota, K, Fuku, Y, Yamamoto, H, Komiya, T, Kadota, K, Mitsudo, K, Nagy, A I, Manouras, AI, Gunyeli, E, Shahgaldi, K, Winter, R, Hoffmann, R, Barletta, G, Von Bardeleben, S, Kasprzak, J, Greis, C, Vanoverschelde, J, Becher, H, Hu, K, Liu, D, Niemann, M, Herrmann, S, Cikes, M, Gaudron, PD, Knop, S, Ertl, G, Bijnens, B, Weidemann, F, Di Salvo, G, Al Bulbul, Z, Issa, Z, Khan, AM, Faiz, AA, Rahmatullah, SH, Fadel, BM, Siblini, G, Al Fayyadh, M, Menting, M E, Van Den Bosch, AE, Mcghie, JS, Cuypers, JAAE, Witsenburg, M, Van Dalen, BM, Geleijnse, ML, Roos-Hesselink, JW, Olsen, FJ, Jorgensen, PG, Mogelvang, R, Jensen, JS, Fritz-Hansen, T, Bech, J, Biering-Sorensen, T, Agoston, G, Pap, R, Saghy, L, Forster, T, Varga, A, Scandura, S, Capodanno, D, Dipasqua, F, Mangiafico, S, Caggegi, A M, Grasso, C, Pistritto, A M, Imme, S, Ministeri, M, Tamburino, C, Cameli, M, Lisi, M, Dascenzi, F, Cameli, P, Losito, M, Sparla, S, Lunghetti, S, Favilli, R, Fineschi, M, Mondillo, S, Ojaghihaghighi, Z, Javani, B, Haghjoo, M, Moladoust, H, Shahrzad, S, Ghadrdoust, B, Altman, M, Aussoleil, A, Bergerot, C, Bonnefoy-Cudraz, E, Derumeaux, G A, Thibault, H, Shkolnik, E, Vasyuk, Y, Nesvetov, V, Shkolnik, L, Varlan, G, Gronkova, N, Kinova, E, Borizanova, A, Goudev, A, Saracoglu, E, Ural, D, Sahin, T, Al, N, Cakmak, H, Akbulut, T, Akay, K, Ural, E, Mushtaq, S, Andreini, D, Pontone, G, Bertella, E, Conte, E, Baggiano, A, Annoni, A, Formenti, A, Fiorentini, C, Pepi, M, Cosgrove, C, Carr, L, Chao, C, Dahiya, A, Prasad, S, Younger, JF, Biering-Sorensen, T, Christensen, LM, Krieger, DW, Mogelvang, R, Jensen, JS, Hojberg, S, Host, N, Karlsen, FM, Christensen, H, Medressova, A, Abikeyeva, L, Dzhetybayeva, S, Andossova, S, Kuatbayev, Y, Bekbossynova, M, Bekbossynov, S, Pya, Y, Farsalinos, K, Tsiapras, D, Kyrzopoulos, S, Spyrou, A, Stefopoulos, C, Romagna, G, Tsimopoulou, K, Tsakalou, M, Voudris, V, Cacicedo, A, Velasco Del Castillo, S, Anton Ladislao, A, Aguirre Larracoechea, U, Onaindia Gandarias, J, Romero Pereiro, A, Arana Achaga, X, Zugazabeitia Irazabal, G, Laraudogoitia Zaldumbide, E, Lekuona Goya, I, Varela, A, Kotsovilis, S, Salagianni, M, Andreakos, V, Davos, CH, Merchan Ortega, G, Bonaque Gonzalez, JC, Sanchez Espino, AD, Bolivar Herrera, N, Macancela Quinones, JJ, Ikuta, I, Ferrer Lopez, R, Munoz Troyano, S, Bravo Bustos, D, and Gomez Recio, M

Abstract

Purpose: Cardiac deconditioning due to immobilization is a risk factor for cardiovascular disease. The physiology of cardiac adaptation to deconditioning has not been fully elucidated. The purpose of the present study was to assess the effects of 21-days of strict head-down (-6 degrees) bed-rest (BR) deconditioning on left ventricular (LV) dimensions and mass measured by MRI. Methods: Ten healthy men (mean age 32±6) were enrolled; the experiment was conducted at DLR (Koln, Germany) as part of the European Space Agency BR studies. Steady-state free precession MRI images (7mm thickness, no gap, no overlap) were obtained (Symphony 1.5T, Siemens) in a stack of short-axis views from LV base to LV apex, before (PRE), at the end of BR (HDT20), and four days after the BR conclusion (POST). Endocardial and epicardial semi-automated contouring was performed using freely available software (Segment). Results: At HDT20, significant reductions in LV mass (16%), end-diastolic (26%) and end-systolic (27%) volumes and stroke volume (27%) were observed, while ejection fraction did not change. These changes were accompanied by a measured decrease (14%) in plasma and blood volume (by gas-rebreathing technique), as well as by a significant reduction (14%) in VO2max aerobic power, measured using a graded cycle ergometer test protocol to volitional fatigue, at one day after the BR conclusion, while expiratory exchange ratio did not change. At POST, LV volumes were restored, while LV mass was still trending towards control values. Conclusions: Cardiac adaptation to deconditioning affected LV mass and dimensions, as a combined result of LV remodeling and fluids loss, accompanied by worsening in aerobic power. This should be taken into account in patients with cardiovascular diseases, when immobilized in bed, to proper adjust the therapy, or to define appropriate physical exercises when possible, in order to avoid further complications.   Cardiac MRI parameters PREHDT20POSTLV mass (g)121±6102±11*114±16End-diastolic volume (ml)119±2590±14*118±25End-systolic volume (ml)42±831±8*45±14Stroke volume (ml)76±2259±11*73±15Ejection fraction (%)64±665±762±7 *: p<.01 vs PRE (one-way Anova for paired data and Tukey test)

Published
2013
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9. Optimal use of lipid-lowering therapy after acute coronary syndromes: A Position Paper endorsed by the International Lipid Expert Panel (ILEP)

Author

K. Dyrbus, Maciej Banach, Roman Margoczy, Daniel Pella, Michal Vrablík, Peter E. Penson, Zoltan Jarai, Matjaz Bunc, Charalambos Vlachopoulos, Željko Reiner, Stefania Lucia Magda, Dusko Vulic, Dan Gaita, Marek Gierlotka, Matias Trbušić, Petr Ostadal, Cristian Alexandru Udroiu, Eduard Margetic, Jan Fedacko, Azra Durak-Nalbantic, Dariusz Dudek, Zlatko Fras, and Banach M, Penson PE, Vrablik M, Bunc M, Dyrbus K, Fedacko J, Gaita D, Gierlotka M, Jarai Z, Magda SL, Margetic E, Margoczy R, Durak-Nalbantic A, Ostadal P, Pella D, Trbusic M, Udroiu CA, Vlachopoulos C, Vulic D, Fras Z, Dudek D, Reiner Ž, ACS EuroPath Central & South European Countries Project, Cicero AFG.

Subjects
0301 basic medicine, RM, medicine.medical_specialty, Combination therapy, PCSK9 inhibitor, effectiveness, Treatment goals, Lipid-lowering therapy, 03 medical and health sciences, 0302 clinical medicine, Ezetimibe, medicine, Humans, Acute Coronary Syndrome, Intensive care medicine, Pharmacology, Statins, business.industry, Atherosclerotic cardiovascular disease, Anticholesteremic Agents, PCSK9, Effectivene, Disease Management, Atherosclerosis, Lipids, 030104 developmental biology, PCSK9 inhibitors, 030220 oncology & carcinogenesis, Position paper, Safety, business, Very high risk, medicine.drug
Abstract

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), “lower is better for longer”, and the recent data have strongly emphasized the need of also “the earlier the better”. In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual’s calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an ‘Extremely High Risk’ group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardio-vascular risk in these patients.

Published
2021

10. 2024 Recommendations on the Optimal Use of Lipid-Lowering Therapy in Established Atherosclerotic Cardiovascular Disease and Following Acute Coronary Syndromes: A Position Paper of the International Lipid Expert Panel (ILEP).

Author

Banach M, Reiner Ž, Surma S, Bajraktari G, Bielecka-Dabrowa A, Bunc M, Bytyçi I, Ceska R, Cicero AFG, Dudek D, Dyrbuś K, Fedacko J, Fras Z, Gaita D, Gavish D, Gierlotka M, Gil R, Gouni-Berthold I, Jankowski P, Járai Z, Jóźwiak J, Katsiki N, Latkovskis G, Magda SL, Margetic E, Margoczy R, Mitchenko O, Durak-Nalbantic A, Ostadal P, Paragh G, Petrulioniene Z, Paneni F, Pećin I, Pella D, Postadzhiyan A, Stoian AP, Trbusic M, Udroiu CA, Viigimaa M, Vinereanu D, Vlachopoulos C, Vrablik M, Vulic D, and Penson PE

Subjects
Humans, Anticholesteremic Agents therapeutic use, Cholesterol, LDL blood, Hydroxymethylglutaryl-CoA Reductase Inhibitors therapeutic use, Review Literature as Topic, Acute Coronary Syndrome blood, Acute Coronary Syndrome drug therapy, Acute Coronary Syndrome etiology, Atherosclerosis blood, Atherosclerosis complications, Atherosclerosis drug therapy, Hypolipidemic Agents therapeutic use
Abstract

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Fortunately, as much as two thirds of this disease's burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that, with respect to low-density lipoprotein cholesterol (LDL-C), "lower is better for longer", and recent data have strongly emphasised the need for also "the earlier the better". In addition to statins, which have been available for several decades, ezetimibe, bempedoic acid (also as fixed dose combinations), and modulators of proprotein convertase subtilisin/kexin type 9 (PCSK9 inhibitors and inclisiran) are additionally very effective approaches to LLT, especially for those at very high and extremely high cardiovascular risk. In real life, however, clinical practice goals are still not met in a substantial proportion of patients (even in 70%). However, with the options we have available, we should render lipid disorders a rare disease. In April 2021, the International Lipid Expert Panel (ILEP) published its first position paper on the optimal use of LLT in post-ACS patients, which complemented the existing guidelines on the management of lipids in patients following ACS, which defined a group of "extremely high-risk" individuals and outlined scenarios where upfront combination therapy should be considered to improve access and adherence to LLT and, consequently, the therapy's effectiveness. These updated recommendations build on the previous work, considering developments in the evidential underpinning of combination LLT, ongoing education on the role of lipid disorder therapy, and changes in the availability of lipid-lowering drugs. Our aim is to provide a guide to address this unmet clinical need, to provide clear practical advice, whilst acknowledging the need for patient-centred care, and accounting for often large differences in the availability of LLTs between countries., Competing Interests: Declarations. Funding: No external funding was used in the preparation of this article. Conflict of interest: Dr. Banach has received research grant(s)/support from Amgen, Daiichi-Sankyo, Mylan/Viatris, and Sanofi, and has received honoraria and/or served as a consultant for Adamed, Amgen, Daiichi-Sankyo, Esperion, Kogen, KRKA, Lilly, MSD, Mylan/Viatris, NewAmsterdam Pharma, Novartis, Novo Nordisk, Polfarmex, Polpharma, Sanofi-Regeneron, Servier, Teva, and Zentiva. Dr. Reiner has received honoraria from Sanofi and Novartis. Dr. Cicero has received personal fees from Mylan-Viatris, Sharper, and Servier. Dr. Dyrbuś has received fee for scientific activities from Novartis, Sanofi-Aventis, and Amgen. Dr. Fedacko has received a consultancy fee from Sanofi, Amgen and Novo Nordisk, and a research grant from Pfizer. Dr. Fras has received grants and fees for scientific activities from Amgen, Krka, Novartis, Swix BioPharma, and Viatris. Dr. Gaita has received honoraria from Amgen, AstraZeneca, Bayer, Berlin Chemie, Biofarm, Boehringer Ingelheim, Galenica, GSK, Gedeon Richter, Krka, MSD, Novartis, Novo Nordisk, Pfizer, Sanofi, Servier, Terapia, Vifor Pharma, and Zentiva. Dr. Gierlotka reports honoraria from Sanofi, Novartis, Bayer, Amgen, Novo Nordisk, AstraZeneca, Servier. Dr. Gouni-Berthold has served as consultant and received honoraria from Akcea, Amgen, Daiichi-Sankyo, Novartis, Sanofi-Regeneron, Ultragenyx, and Amarin. Dr. Jankowski has received a research grant from Sanofi and has served as a consultant for Novartis, Servier, and Zentiva. Dr. Járai has served as a consultant for and received honoraria from Bayer, Berlin-Chemie, Boehringer Ingelheim, Egis, MSD, Novartis (Sandoz), Novo Nordisk, Pfizer, Richter Gedeon, Sanofi, Servier, and Teva. Dr. Latkovskis has given talks, attended conferences, received consultancy fees, and/or participated in trials sponsored by Abbott Laboratories, Amgen, AstraZeneca, Berlin-Chemie/Menarini, Bayer, Boehringer Ingelheim, GlaxoSmithKline, Grindex, KRKA, MSD, Mylan, Novartis, Novo Nordisk, Pfizer, Sanofi, Servier Laboratories, Siemens Laboratories, and Zentiva. Dr. Magda has received consultation fees from Novartis, Sanofi, and Servier. Dr. Margetic has received a fee for scientific activities from Novartis and Sanofi. Dr. Ostadal has received honoraria from Getinge, Abiomed, Edwards, Fresenius/Xenios, AstraZeneca, Bayer, Boehringer Ingelheim, Amgen, Sanofi, Servier, Novartis, Pfizer, AOP, and GSK. Dr Paragh has received lectures fees from Hungarian branches of Novartis, Richter Gedeon, and Sandoz. Dr. Paneni has received honoraria from Novo Nordisk. Dr. Pećin has received grants and fees for scientific activities from Amgen, Bayer, Novartis, and Sanofi. Dr. Pella has received grant support and honoraria from Sanofi, Amgen, MSD, Servier, Novartis, and Pfizer. Dr. Postadzhiyan reports fees for educational activities from Amgen, AstraZeneca, KRKA, Novartis, Servier, Teva, and Zentiva. Dr. Stoian has given lectures, received honoraria and research support, and participated in conferences, advisory boards, and clinical trials sponsored by pharmaceutical companies, from AstraZeneca, Amgen, Boehringer Ingelheim, Coca-Cola, Eli Lilly, Merck, Medtronic, MSD, Medochemie, Novo Nordisk, Novartis, Roche Diagnostics, Servier, Sandoz, and Sanofi. Dr. Trbusic has received a fee for scientific activities from Novartis and Sanofi. Dr. Udroiu has received a fee for scientific activities from AstraZeneca and Pfizer. Dr. Viigimaa reports fees for educational activities from Amgen, AstraZeneca, Novartis, Novo Nordisk, Menarini, Servier, and Swixx BioPharma. Dr. Vinereanu has received research grants and expert fees from Amgen, Sanofi, Novartis, and Servier. Dr. Vlachopoulos has received grants and fees for scientific activities from Amgen, Sanofi, and MSD. Dr. Vrablik has received personal fees from Abbott, Amgen, AstraZeneca, BMS, Genzyme, KRKA, MSD Idea, Novartis, Pfizer, and Sanofi-Regeneron. Dr. Vulic has received a fee for scientific activities from Sanofi. Dr. Penson owns four shares in AstraZeneca PLC and has received honoraria from Amgen and Sanofi and travel/accommodation reimbursement for events sponsored by AKCEA, Amgen, AMRYT, Link Medical, Mylan, and Napp. All other authors declare that they have no potential conflicts of interest that might be relevant to the contents of this article. Authors’ contributions: Dr. Banach: Conceptualisation; data curation; methodology; project administration; supervision; validation; visualisation; writing, reviewing, and editing; revisions; preparing the final version of the paper. Dr. Penson: Data curation; investigation; methodology; validation; visualisation; first draft preparation; reviewing and editing. Dr Surma: data curation, visualisation, draft figures preparations; reviewing and editing. Drs. Reiner, Bajraktari, Bielecka-Dabrowa, Bunc, Bytyçi, Ceska, Cicero, Dudek, Dyrbuś, Fedacko, Fras, Gaita, Gavish, Gierlotka, Gil, Gouni-Berthold, Jankowski, Járai, Jóźwiak, Katsiki, Latkovskis, Magda, Margetic, Margoczy, Mitchenko, Durak-Nalbantic, Ostadal, Paragh, Petrulioniene, Paneni, Pećin, Pella, Postadzhiyan, Stoian, Trbusic, Udroiu, Viigimaa, Vinereanu, Vlachopoulos, Vrablik, and Vulic: Investigation, methodology; validation; writing, reviewing, and editing; final revisions and approval. Data availability statement: Data sharing is not applicable to this article as no datasets were generated for this article. Ethics approval: Not applicable. Code availability: Not applicable. Consent to participate: Not applicable. Consent for publication: Not applicable., (© 2024. The Author(s).)

Published
2024
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11. Optimal use of lipid-lowering therapy after acute coronary syndromes: A Position Paper endorsed by the International Lipid Expert Panel (ILEP).

Author

Banach M, Penson PE, Vrablik M, Bunc M, Dyrbus K, Fedacko J, Gaita D, Gierlotka M, Jarai Z, Magda SL, Margetic E, Margoczy R, Durak-Nalbantic A, Ostadal P, Pella D, Trbusic M, Udroiu CA, Vlachopoulos C, Vulic D, Fras Z, Dudek D, and Reiner Ž

Subjects
Acute Coronary Syndrome blood, Anticholesteremic Agents adverse effects, Atherosclerosis blood, Disease Management, Ezetimibe adverse effects, Humans, Lipids blood, PCSK9 Inhibitors adverse effects, Acute Coronary Syndrome drug therapy, Anticholesteremic Agents therapeutic use, Atherosclerosis drug therapy, Ezetimibe therapeutic use, PCSK9 Inhibitors therapeutic use
Abstract

Atherosclerotic cardiovascular disease (ASCVD) and consequent acute coronary syndromes (ACS) are substantial contributors to morbidity and mortality across Europe. Much of these diseases burden is modifiable, in particular by lipid-lowering therapy (LLT). Current guidelines are based on the sound premise that with respect to low density lipoprotein cholesterol (LDL-C), "lower is better for longer", and the recent data have strongly emphasized the need of also "the earlier the better". In addition to statins, which have been available for several decades, the availability of ezetimibe and inhibitors of proprotein convertase subtilisin/kexin type 9 (PCSK9) are additional very effective approach to LLT, especially for those at very high and extremely high cardiovascular risk. LLT is initiated as a response to an individual's calculated risk of future ASCVD and is intensified over time in order to meet treatment goals. However, in real-life clinical practice goals are not met in a substantial proportion of patients. This Position Paper complements existing guidelines on the management of lipids in patients following ACS. Bearing in mind the very high risk of further events in ACS, we propose practical solutions focusing on immediate combination therapy in strict clinical scenarios, to improve access and adherence to LLT in these patients. We also define an 'Extremely High Risk' group of individuals following ACS, completing the attempt made in the recent European guidelines, and suggest mechanisms to urgently address lipid-medicated cardiovascular risk in these patients., (Copyright © 2021 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Published
2021
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12. Nutritional Considerations of Cardiovascular Diseases and Treatments.

Author

Boban M, Bulj N, Kolačević Zeljković M, Radeljić V, Krcmar T, Trbusic M, Delić-Brkljačić D, Alebic T, and Vcev A

Abstract

Nutritional considerations of many chronic diseases are not fully understood or taken into consideration in everyday clinical practice. Therefore, it is not surprising that high proportion of hospitalized patients with cardiovascular diseases remains underdiagnosed with malnutrition. Malnourished patients have increased risk of poor clinical outcomes, complications rate, prolonged hospital stay, more frequent rehospitalizations, and lower quality of life. The purpose of this review is to recapitulate recent data on nutritional considerations in cardiovascular medicine., Competing Interests: Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Published
2019
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13. Ratio of End-Systolic Volume to Left Atrial Area Is a Solid Benchmark of Systolic Dysfunction in Non-Ischemic Cardiomyopathies.

Author

Boban M, Zulj M, Pesa V, Persic V, Trbusic M, and Vcev A

Subjects
Adult, Aged, Area Under Curve, Atrial Function, Left physiology, Biomarkers blood, Blood Pressure physiology, Female, Heart Atria physiopathology, Humans, Male, Middle Aged, Myocardium pathology, Predictive Value of Tests, Prospective Studies, Stroke Volume physiology, Systole, Ventricular Dysfunction, Left physiopathology, Ventricular Function, Left physiology, Cardiomyopathies diagnostic imaging, Cardiomyopathies pathology
Abstract

BACKGROUND Impairment of systolic function and late gadolinium enhancement (LGE) are well-known negative prognostic markers in non-ischemic cardiomyopathies (NICMPs). There is limited knowledge of the geometrical rearrangements of the ventricle volumes over size of the left atrium and their connections with systolic dysfunction and existence of LGE. MATERIAL AND METHODS Consecutive cases of NICMPs with impaired systolic function and controls were included from a computerized database of cardiac magnetic resonance exams for a 2.5-year period. Ratios made from volumetric parameters over left atrial area (LAA) area were calculated. RESULTS Our study included 205 cases referred to cardiac magnetic resonance (CMR); age was 48.7±17.0 years (range 15.2-80.4), male-to-female ratio 137 (66.8%): 68 (33.2%), (both p>0.05). LGE was significantly correlated with impairment of systolic function (Rho CC=0.395; p<0.001). For detection of systolic impairment, a critical value of end-systolic-volume (ESV)/LAA of ≥2.7 had an area under curve (AUC) of 0.902 (0.853-0.939), p<0.001; stroke-volume (SV)/LAA ≤3.0 had AUC=0.782(0.719-0.837), p<0.001, and end-diastolic volume (EDV)/LAA <7.4 had an AUC of 0.671 (0.602-0.735); p<0.001. In analyses of LGE, a value of SV/LAA of ≤3.0 had an AUC of 0.681 (0.612-0.744), p<0.001; while ESV/LAA and EDV/LAA were not significant (both p<0.05). ESV/LAA was correlated with systolic dysfunction (Rho-correlation-coefficient: 0.688; p<0.001) and existence of linear midventricular LGE stripe (Rho-CC=0.446; p<0.001). CONCLUSIONS ESV/LAA was the most effective for detection of systolic impairment and was associated with the existence of LGE. Prospective validation for clinical applicability and prognostic relations are warranted in future studies.

Published
2018
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