Prevalence of hypertriglyceridemia and its association with extreme cardiovascular risk in patients with acute and chronic coronary syndrome enrolled in a cardiac rehabilitation program.

Objective Hypertriglyceridemia prevalence in Acute and Chronic Coronary Syndrome (ACS and CCS respectively) patients in the era of very low LDL target is still unknow. The objective of our study is to evaluate the prevalence of triglyceride levels above 150 or 200 mg/dL despite statin therapy and LDL cholesterol at targets in ACS and CCS subjects enrolled in a Cardiac Rehabiliatitation (CR) program. Methods This cross–sectional observational study was conducted at the Niguarda Hospital (Milan, Italy). Patients undergoing CR after ACS/CCS from January 1, 2012, to March 28, 2023, were included. Data on demographic, clinical, laboratory, and instrumental variables were collected. Results The study population consisted of 740 patients with a mean age of 64.3±10.7 years, predominantly male (81.7%). Triglyceride levels significantly decrease during the CR period (131.1±63.8 vs 116.9±75.9 mg/dL; p < 0.001) similarly to LDL cholesterol (107.9 ± 38.8 mg/dL vs 69.9 ± 25.9mg/dL, p<0.001). 50.8% of the subjects reach the LDL cholesterol target. The percentage of patients with triglycerides >150 mg/dL at CR ends was 17.8% (15.6% when considering only patients that reach the LDL target of 55 mg/dL) while it is only 6.8% for triglycerides >200 mg/dL (5.9% when considering only patients that reach LDL target). Patients with triglycerides >150 mg/dL had higher baseline BMI, LDL cholesterol and uric acid with lower ejection fraction at CR ends. Hypertriglyceridemia significantly correlates with extreme CV risk (R= 0.08, p= 0.025). At multivariate analysis, FE (dependent variable) was significantly associated with triglycerides (beta= – 0,145, p= 0,026) and systolic BP (beta= 0,137, p= 0,032). Conclusion Despite high intensity statin therapy and lower LDL cholesterol targets, a substantial proportion of patients in cardiac rehabilitation still had elevated triglyceride levels. This study highlights the potential role of Icosapent Ethyl in managing hypertriglyceridemia in these patients.

Objective: Hypertriglyceridemia prevalence in Acute and Chronic Coronary Syndrome (ACS and CCS respectively) patients in the era of very low LDL target is still unknow. The objective of our study is to evaluate the prevalence of triglyceride levels above 150 or 200 mg/dL despite statin therapy and LDL cholesterol at targets in ACS and CCS subjects enrolled in a Cardiac Rehabiliatitation (CR) program Design and method: This cross-sectional observational study was conducted at the Niguarda Hospital (Milan, Italy). Patients undergoing CR after ACS/CCS from January 1, 2012, to March 28, 2023, were included. Data on demographic, clinical, laboratory, and instrumental variables were collected. Results: The study population consisted of 740 patients with a mean age of 64.3±10.7 years, predominantly male (81.7%). Triglyceride levels significantly decrease during the CR period (131.1±63.8 vs 116.9±75.9 mg/dL; p < 0.001) similarly to LDL cholesterol (107.9 ± 38.8 mg/dL vs 69.9 ± 25.9mg/dL, p<0.001). 50.8% of the subjects reach the LDL cholesterol target. The percentage of patients with triglycerides >150 mg/dL at CR ends was 17.8% (15.6% when considering only patients that reach the LDL target of 55 mg/dL) while it is only 6.8% for triglycerides >200 mg/dL (5.9% when considering only patients that reach LDL target). Patients with triglycerides >150 mg/dL had higher baseline BMI, LDL cholesterol and uric acid with lower ejection fraction at CR ends. Hypertriglyceridemia significantly correlates with extreme CV risk (R= 0.08, p= 0.025). At multivariate analysis, FE (dependent variable) was significantly associated with triglycerides (beta= - 0,145, p= 0,026) and systolic BP (beta= 0,137, p= 0,032). Conclusions: Despite high intensity statin therapy and lower LDL cholesterol targets, a substantial proportion of patients in cardiac rehabilitation still had elevated triglyceride levels. This study highlights the potential role of Icosapent Ethyl in managing hypertriglyceridemia in these patients.

The American College of Cardiology (ACC)/American Heart Association (AHA) performance measurement sets serve as vehicles to accelerate translation of scientific evidence into clinical practice. Measure sets developed by the ACC/AHA are intended to provide practitioners and institutions that deliver cardiovascular services with tools to measure the quality of care provided and identify opportunities for improvement. Writing committees are instructed to consider the methodology of performance measure development1 and to ensure that the measures developed are aligned with ACC/AHA clinical guidelines. The writing committees also are charged with constructing measures that maximally capture important aspects of care quality, including …

199 Systematic Liaised Inpatient Cardiac Rehabilitation Referral (SLICRR): II - Effects of Increased Referrals With Fixed Program Capacity

Is There a Role for Cardiac Rehabilitation After Coronary Artery Bypass Grafting? Treatment After Coronary Artery Bypass Surgery Remains Incomplete Without Rehabilitation.

Funding Acknowledgements None. Introduction Cardiac rehabilitation (CR) has become a fundamental element in the recovery of patients with acute coronary syndrome, since it achieves greater therapeutic adherence and better control of cardiovascular risk factors (CVRF). Purpose We aim to describe the characteristics of patients with ST-elevation acute coronary syndrome (STEACS) included in a cardiac rehabilitation program, as well as the achievement of prevention objectives and the occurrence of mayor adverse cardiovascular events (MACE). Methods We present a prospective registry of 664 patients admitted to a Coronary Unit with a diagnosis of STEACS during the years 2017-2020. They were classified according to their participation in a CR program. We compared history, lipid-lowering treatment (prior, at discharge and titration), lipid levels at discharge and at 1-year follow-up, and degree of compliance with lipid targets. MACE were observed at 2-year follow-up. Results From 664 patients, 351 were excluded due to lack of follow-up or early mortality. From a total of 313 patients (mean age 59.9±11.2 and 81% male), 55.3% were included in the CR program, with this group presenting a lower mean age (55.46±8.7 vs 65.39±11.5 p<0.001), as well as a higher frequency of a history of early ischemic heart disease and smoking, and a lower frequency of arterial hypertension and diabetes (Table). Lipid-lowering treatment at discharge was similar in both groups. In patients undergoing CR there was a lower level of total cholesterol and low-density lipoprotein cholesterol (LDLc) at one year (126.2±27 vs 137.2±34, p=0.002; 57.8±23 vs 67.5±26, p<0.001) compared to the group without CR. A greater reduction in LDLc (41.4% vs 0.86%, p<0.001) was achieved even from higher initial LDLc values. Titration of lipid-lowering treatment was also greater, with the old target of LDLc < 70 being achieved in a greater number of cases (81.5% vs 59.3%, p<0.001). At 1-year follow-up, the new cholesterol reduction target (LDL <55 or 50% reduction) was achieved in only 26.8% of patients, with a greater reduction being obtained in the CR group (34.1% vs 17.9%; p=0.02). At 2-year follow up, in CR group we found low rates of re-infarction (3.2% vs 4.1%), new revascularization (5.8% vs 7.3%), not statistically significant, but we could observe differences in mortality from all causes (0% vs 4.8%, p<0.01). Conclusions Participation in a CR program is associated with better lipid control in patients admitted for STEACS. These programs represent a basic tool for achieving increasingly demanding LDLc targets. Longer follow-up is needed to detect clinically important adverse events.

Background Low Density Lipoprotein (LDL) cholesterol is one of the most relevant Cardio Vascular (CV) risk factors. In fact, very low therapeutical targets have been set by guidelines in the secondary prevention setting in order to reduce the risk of ischemic events recurrence. However, many studies demonstrate that these targets are largely unreached in the real–life setting, particularly in the higher cardiovascular risk classes. Our aim was to evaluate LDL target achievement in very high and extreme CV risk patients during a cardiac rehabilitation program. Methods A total of 940 patients with recent acute coronary syndrome or a diagnosis of chronic coronary syndrome who participated in a Cardiac Rehabilitation (CR) program were enrolled between January 2012 and December 2023 at our hospital. For each patient, LDL and Lipid Lowering Therapies (LLT) were evaluated at the beginning and at the end of the CR program together with anthropometric, clinical, biochemical, and instrumental parameters. LDL targets were considered ‹70 mg/dL for patients before August 2019, ‹55 mg/dL after 2019 and ‹40 mg/dL for extreme CV risk subjects. Results Mean age was 66.9±0.6 years, 82.9% of the subjects were males and LDL cholesterol changes from 107.3±39.3 to 64.5±24.6 from the beginning to the end of CR. At CR discharge, 88% of the subjects were on high intensity statin (atorvastatin or rosuvastatin) therapies and 38.1% were on ezetimibe while only 4.6% of the subjects were treated with PCSK9–inhibitors and 0.9% with bempedoic acid. 53.1% of the patients reached the LDL therapeutic target with particularly positive peaks in 2018 (72.8%, the year before the release of the latest dyslipidaemia guidelines that reduced the target) and 2022 and 2023 (78.8% and 75.7% respectively). 29.8% of the patients had extreme CV risk, they achieved the target of LDL ‹40 mg/dL only in 16.4% with higher prevalence in the latest years (32% in 2022 and 22.7% in 2023). Conclusions Our results demonstrated higher achievement of LDL cholesterol target in secondary prevention program when compared to previous observational studies. The longer distance from guidelines publication together with the new pharmacological treatment could be the reason for these positive results. However, more attention should be paid to extreme CV risk both in terms of identification and treatment.

Exercise Modalities and Intensity to Improve Functional Capacity and Psychological/Mental Health in Cardiac Rehabilitation: A Role for Nordic Walking?

Background Low Density Lipoprotein (LDL)-cholesterol is one of the most relevant CardioVascular (CV) risk factors. In fact, very low therapeutical targets have been set by guidelines in the secondary prevention setting in order to reduce the risk of ischemic events recurrence. However, many studies demonstrate that these targets are largely unreached in the real-life setting, particularly in the higher cardiovascular risk classes. Our aim was to evaluate LDL target achievement in very high and extreme CV risk patients during a cardiac rehabilitation program. Methods A total of 940 patients with recent acute coronary syndrome or a diagnosis of chronic coronary syndrome who participated in a Cardiac Rehabilitation (CR) program were enrolled between January 2012 and December 2023 at our hospital. For each patient, LDL and Lipid Lowering Therapies (LLT) were evaluated at the beginning and at the end of the CR program together with anthropometric, clinical, biochemical, and instrumental parameters. LDL targets were considered <70 mg/dL for patients before August 2019, <55 mg/dL after 2019 and <40 mg/dL for extreme CV risk subjects. Results Mean age was 66.9±10.6 years, 82.9% of the subjects were males and LDL cholesterol changes from 107.3±39.3 to 64.5±24.6 from the beginning to the end of CR. At CR discharge, 88% of the subjects were on high intensity statin (atorvastatin or rosuvastatin) therapies and 38.1% were on ezetimibe while only 4.6% of the subjects were treated with PCSK9-inhibitors and 0.9% with bempedoic acid. 53.1% of the patients reached the LDL therapeutic target with particularly positive peaks in 2018 (72.8%, the year before the release of the latest dyslipidaemia guidelines that reduced the target) and 2022 and 2023 (78.8% and 75.7% respectively). 29.8% of the patients had extreme CV risk, they achieved the target of LDL <40 mg/dL only in 16.4% with higher prevalence in the latest years (32% in 2022 and 22.7% in 2023). Conclusions Our results demonstrated higher achievement of LDL cholesterol target in secondary prevention program when compared to previous observational studies. The longer distance from guidelines publication together with the new pharmacological treatment could be the reason for these positive results. However, more attention should be paid to extreme CV risk both in terms of identification and treatment.

Point/Counterpoint

The role of uric acid (UA) and Hyper Uricemia (HU) in cardiac rehabilitation (CR) patients have been very little studied. To evaluate the prevalence of HU and if it is associated to the functional improvement obtained or the left ventricular Ejection Fraction (EF) in CR patients after Acute or Chronic Coronary Syndrome (ACS and CCS respectively). We enrol 411 patients (62.4 ± 10.2 years; males 79.8%) enrolled in the CR program at Niguarda Hospital (Milan) from January 2012 to May 2023. HU was defined both as the classic cut-off (> 6 for females, > 7 mg/dL for males) and with the newly identified one by the URRAH study (> 5.1 for females, > 5.6 mg/dL for males). All patients performed a 6MWT and an echocardiography at the beginning and at the end of CR program. Mean UA values were within the normal range (5.6 ± 1.4 mg/dL) with 19.5% (classic cut-off) HU patients with an increase to 47.4% with the newer one. Linear regression analysis showed no role for UA in determining functional improvement, while UA and hyperuricemia (classic cut-off) were associated to admission and discharge EF. The same was not with the URRAH cut-off. HU is as frequent in CR patients as in those with ACS and CCS. UA didn't correlate with functional recovery while it is associated with admission and discharge EF as also is for HU (classic cut-off). Whit the URRAH cut-off HU prevalence increases significantly, however, it doesn't show any significant association with EF.

BackgroundOptimisation of low-density lipoprotein cholesterol (LDL-C) targets is one component of cardiac rehabilitation (CR). The 2019 European Society of Cardiology (ESC) guidelines recommend lower LDL-C targets than those released in 2016.AimsTo determine the proportion of patients who met 2019 LDL-C targets and compare these to international standards; examine the effect of the introduction of the recent ESC guidelines on target achievement. Examine the choice of lipid lowering therapy (LLT) used in our cohort.MethodsRetrospective chart review of 163 patients who attended CR in 2019. Baseline LDL-C levels were calculated where applicable. Targets achieved were compared with the contemporary ESC guidance. Required LLT was estimated for those who were unable to meet their LDL-C target.ResultsOverall, 96/163 (59%) patients met their absolute LDL-C targets, which was favourable when compared to international standards. Fewer patients treated using the 2019 ESC guidelines met their absolute, (63% (70/112) vs. 51% (26/51)), or relative LDL-C 43% (22/51) targets. A high intensity statin was prescribed in 63% (89/163) of patients and only 9% (5/163) patients were prescribed ezetimibe therapy; increased use of these agents may have led to a further 20% (33/162) of patients meeting their LDL-C targets. 13% (22/163) of patients likely require PCSK9i therapy.ConclusionsPatients may be more likely to meet LDL-C targets while enrolled in CR compared to standard care. Following the introduction of lower absolute LDL-C targets and additional > 50% LDL-C reduction from baseline requirement, fewer patients are meeting the LDL-C targets set out in the 2019 ESC dyslipidaemia guidelines. Additionally, many patients are not on maximum statin therapy, ezetimibe is under-prescribed, and a guideline-reimbursement gap exists for those who require PCSK9i therapy.Supplementary informationThe online version contains supplementary material available at 10.1007/s11845-021-02885-9.

Optimal diabetes care and risk factor management are important to delay micro- and macrovascular complications in individuals with type 1 diabetes (T1D). Ongoing improvement of management strategies requires the evaluation of target achievement and identification of risk factors in individuals who do (or do not) achieve these targets. Cross-sectional data were collected from adults with T1D visiting six diabetes centers in the Netherlands in 2018. Targets were defined as glycated hemoglobin (HbA1c) <53 mmol/mol, low-density lipoprotein-cholesterol (LDL-c) <2.6 mmoL/L (no cardiovascular disease [CVD] present) or <1.8 mmoL/L (CVD present), or blood pressure (BP) <140/90 mm Hg. Target achievement was compared for individuals with and without CVD. Data from 1737 individuals were included. Mean HbA1c was 63 mmol/mol (7.9%), LDL-c was 2.67 mmoL/L, and BP 131/76 mm Hg. In individuals with CVD, 24%, 33%, and 46% achieved HbA1c, LDL-c, and BP targets respectively. In individuals without CVD these percentages were 29%, 54%, and 77%, respectively. Individuals with CVD did not have any significant risk factors for HbA1c, LDL-c, and BP target achievement. In comparison, individuals without CVD were more likely to achieve glycemic targets if they were men and insulin pump users. Smoking, microvascular complications, and the prescription of lipid-lowering and antihypertensive medication were negatively associated with glycemic target achievement. No characteristics were associated with LDL-c target achievement. Microvascular complications and antihypertensive medication prescription were negatively associated with BP target attainment. Opportunities for improvement of diabetes management exist for the achievement of glycemic, lipid, and BP targets but may differ between individuals with and without CVD.

REAL-WORLD OUTCOMES &amp; HEALTH CARE COSTS OF REGION-WIDE COMMUNITY-BASED CARDIAC REHABILITATION

Funding Acknowledgements Type of funding sources: None. Introduction Cardiac rehabilitation (CR) has become a basic element in the recovery of patients with acute coronary syndrome, since it achieves greater therapeutic adherence and better control of cardiovascular risk factors. Purpose We aim to describe the characteristics of patients with ST-elevation acute coronary syndrome (STEACS) included in a Cardiac rehabilitation program, as well as the achievement of prevention objectives and the occurrence of mayor adverse cardiovascular events (MACE). Methods Observational prospective study where a total of 664 STEMI patients admitted to a Coronary Unit during the years 2017-2020 were included. They were classified according to their participation in a CR program. We compared medical history, lipid-lowering treatment (prior, at discharge and titration), lipid levels at discharge and at 1-year follow-up, and degree of achievement of lipid targets. MACE (mortality, reinfarction, coronary revascularisation and restenosis) were observed at 2-year follow-up. Results From 664 patients, 351 were excluded due to lack of follow-up or early mortality. From a total of 313 patients (mean age 59.9±11.2 years; 81% male), 55.3% were included in the CR program. This group had a lower mean age (55.46±8.7 vs 65.39±11.5, P&amp;lt;0.001), as well as a higher frequency of early ischaemic heart disease history and smoking, with a lower frequency of hypertension and diabetes (Table). Lipid-lowering treatment at discharge was similar in both groups. In patients undergoing CR, there was a lower level of total cholesterol and low-density lipoprotein cholesterol (LDLc) at one year follow-up (126.2±27 vs 137.2±34, P=0.002; 57.8±23 vs 67.5±26, P&amp;lt;0.001) and a greater reduction in LDLc (41.4% vs 20.86%, P&amp;lt;0.001) was achieved even from higher initial LDLc values. Titration of lipid-lowering treatment was also greater, with the old target of LDLc&amp;lt;70 being achieved in a greater number of cases (81.5% vs 59.3%, P&amp;lt;0.001). At 1-year follow-up, the new lipid reduction target (LDLc&amp;lt;55 + 50% reduction) was achieved in only 26.8% of patients, with a greater reduction in the CR group (34.1% vs 17.9%; P=0.02). Although differences were observed in the follow-up in terms of mortality and new events, in favor of the CR group, these did not reach statistical significance. Conclusions Participation in a CR program is associated with better lipid control in patients admitted for STEACS. These programmes represent a basic tool for achieving lipid and cardiovascular risk factor targets and improved long-term clinical outcomes.