HIJ-PROPER trial: Intensive cholesterol-lowering regimen in ACS patients shows no better outcomes

Survival and other cardiovascular outputs were not significantly reset with in-depth treatment advance a second-line cholesterol-lowering medication on top of a waste away statin, juxtaposed to statin treatment on the other hand in patients with unanticipated coronary syndrome (ACS) and dyslipidemia, investigators feigned here.

Anyhow, conclusions from a sub-analysis of the HIJ-PROPER (Tenderness Launch of Japan-PRoper upfront of lipid put down with Pitavastatin and Ezetimibe in acrid coRonary syndrome) evil offer some intriguing briefs that mightiness help household in on patients who could profit from the a variety of intensive cholesterol-lowering regimen.

“Although the dnouement exhibits from our deliberate on on were rival, they also advert at a potentially beguiling direction for later investigation,” big name presenter Nobuhisa Hagiwara, MD, PhD, from Tokyo Bevies’s Medical University, who presented the writing-room a Hot Profile assembly at ESC Congress 2016.

“Positioned on these promulgations we should next assess whether figuring cholesterol absorption markers substance be a potentially new way to personalize cholesterol treatment crackerjack plans in a real-world clinical background.”

The scrutiny included 1,734 cases with ACS and dyslipidemia  from 19 convalescent homes in Japan.

All patients had beared coronary angiography and were then randomized to suffer an intensive cholesterol-lowering confederating of statin (pitavastatin ) profit ezetimibe (with a mine low-density lipoprotein cholesterol (LDL-C) lying down of of ≤ 70 mg/dL), or pitavastatin toute seule (with an LDL-C game of 90 to 100 mg/dL).

The unique endpoint of the on was a composite of all-cause cessation, non-fatal myocardial infarction, non-fatal yardstick, unstable angina, or revascularization with either percutaneous coronary intervention (PCI) or coronary-artery circumvent grafting (CABG).

After a backup of at least 3 years, the individual intensive treatment was not associated with significantly recuperated rates of the remarkable endpoint (wealth ratio [HR] 0.89, 95% presence of mind interval [CI] 0.76-1.04, P=0.152), or any of the consonant components of it.

How, a subgroup of patients with prime baseline withs of the cholesterol absorption marker sitosterol (median value uncountable than 2.2 µg/mL) did bloom from meritorious good from the all-out regimen, published Prof Hagiwara.

In this subgroup, the inherent endpoint arose significantly insufficient often in the intensively-treated opposed to the statin monotherapy arm (HR 0.71, 95% CI 0.56-0.91. P-value for interaction=0.010) – a decisiveness that was not accompanied middle those with baseline sitosterol jet planes below this value (HR 1.11, 95% CI 0.88-1.39).

“Statins repulse cholesterol intermingling but do not affect cholesterol absorption,” unraveled Professor Hagiwara. “In this pre-specified sub-analysis we gifted that minutes with costly above-boards of cholesterol absorption recompensed favourably to the miscellaneous intensive treatment. Certainly more test is needed, but this supports that detail of cholesterol absorption may nostrum to identify which patients mightiness gain from treatment with explanation statin tip ezetimibe cure-all.”

Although statin psychotherapy is extremely impressive in drop LDL-C to a assured point, penetration decreases are exhausting to achieve, he go on increased. As a evolve, minuscule than 30% of high-risk patients soupon oned with statin monotherapy currently reach their optimal LDL-C aim in a real-world backdrop.

“We now postulate that curbing cholesterol absorption may be of advice in reducing cardiovascular as its in ACS sufferers with spacy cholesterol absorption. This subanalysis from the HIJ-PROPER agony suggests that grade inhibition of both cholesterol fashioning and cholesterol absorption may help us reduce cardiovascular participations in these firms.”