Nursing Research Presentaion

Hyperlipidemia
Role in cardiovascular disease

Low density lipoprotein
Total cholesterol
Triglycerides
Typical Treatment
Statin therapy
10% reduction in all cause morbidity
20% reduction in CAD
Diet modifications
Nutrition
High density lipoprotein
Dietary supplementation
Diet modifications
SATURATED FATTY ACIDS

Have the strongest impact on elevating LDL-C
levels
Come mainly from animal sources including
meat and dairy
POLYUNSATURATED FATTY ACIDS

Aid in lowering LDL-C and total cholesterol levels
Omega-3
1.Eicosapentaenoic (EPA)
Found in oily fish
2.Docosahexaenoic acid (DHA)
Found in oily fish
3.-linolenic acid (LNA)
Found in seed oils, legumes, and leafy vegetables
American Heart Association recommends eating fish twice per week
NURSES HEALTH STUDY

(BARRETT)
Followed 84,688 female nurses
Found that women with higher consumption of
fish and omega -3 polyunsaturated fatty acids
have a lower risk of cardiovascular disease
DIET VS STATIN ON C-REACTIVE PROTEIN STUDY

(JENKINS)
An elevated c-reactive protein level is linked

to a persons increased risk for cardiovascular
disease.
76 participants
All had elevated LDL levels

(JENKINS)
Randomized into 3 groups
1. Statin group
a. Very low saturated fat, dairy and whole wheat diet with
statin
2. Control group
a. Very low saturated fat dairy and whole wheat diet without
statin
3. Portfolio group
a. Low saturated fat diet containing fiber, sterols, soy foods,
and almonds

(JENKINS)
Found that the statin group and portfolio

group had a reduction in c-reative protein
levels.
Concluded that a combination of foods can
reduce cholesterol levels as well as c-reactive
protein levels similar to that of a statin
Statin Therapy
Statin Therapy in the Community

Association Between Statin use and Lipid Status in
Quality Improvement Initiatives: Statin use, a
Potential Surrogate?
Attempts to identify a relationship between statin
use in the community and LDL control.

Observational study of Primary Care
attendants
109 different primary care facilities used
Total population

Results?
LDL control is vital for hyperlipidemia
Statins have a positive relationship with LDL
control

Limitations of the study
Lifestyle
comorbidities
Reflection
Hospital Record Statins Study

The Role of Lipid Lowering Therapy in the
Achievement of Therapeutic Goal among
Malaysian Hyperlipidemic Patients
The goal of this article is to observe lipid
levels of patients who had been treated with
statins and other medications, compared to
the healthy, un-medicated population
Hospital Record Statins Study

The study itself conducted by Alyaa Al-Khateeb and his
team included dyslipidemic profile hospital records from
980 patients
Standards for the study were
Patient had to be on standard dosage of statin
Patient had to be prescribed statins after the index date
of January 2007
Hospital Record Statins Study:

Findings
Those that were on the standard prescribed statin Lovastatin had the
highest goal achievement for LDL-C levels in the study, with only a
48% success rate
This finding is expected, as clinical trials always tend to result in
larger gai8ns compared to those found in review study were the
inclusion criteria are limited, diet and other lifestyle activities are
important ((Al-Khateeb, Al-Talib, Mohd, Yusof, Zilfalil, 274, 2013).
This statement by Al-Khateeb and his team lead to the conclusion that
combination therapy is the biggest factor in lowering lipid levels.
Hospital Record Statin Study:

Findings
The findings were that of; standard statin therapy was not effective in
the form to be perceived.
The statin levels of patients studied were compared to the normal
healthy population from other studies conducted
There was a significant difference in the lipid profiles between the
dyslipidemic patients in this study and healthy populations from
other studies for total cholesterol, low density lipoprotein
cholesterol, high density lipoprotein cholesterol and triglyceride
level, respectively. (Al-Khateeb, Al-Talib, Mohd, Yusof, Zilfalil, 272,
2013)
Hospital Record Statins Study:

Limitations
This study did not conduct without limitations
Patients studied were only receiving standard
level of statins
Patients medical records were the only thing
accessed, therefore patients diet and
physical exercise were not equated into
these levels.
Thailand: Statins Study

Using the electronic database at Maharaj Nakorn Chiang
Mai Hospital.
acute coronary syndrome patients
Patients selected were diagnosed with either angina
pectoris or acute myocardial infarction
Information Included data r/t demographic, pharmacologic,
and cholesterol levels of the patients
Patient Goal: achieve an LDL-C of <70mg/dL
Thailand Study Sample Selection

A total of 1,089 patients diagnosed with ACS were
identified
only 396 remained in the final analysis due to missing data
or baselines already below the target range (<70mg/dL).
Remaining sample was then categorized into two groups:
high and low statin potency
Thailand Study Sample Selection

In total, 396 patients were included in the study
229 (57.8%) treated with high potency statins
167 (42.2%) with low potency statins
Patients using high potency statins had higher total
cholesterol and LDL-C levels
therefore they were believed to have an increased severity
of illness
Thailand Study Expectations

Patients in the high potency statin group were treated with simvastatin (40 mg),
rosuvastatin (10 mg or 20 mg), atorvastatin (20 mg or 40 mg), or
pitavastatin (2 mg) daily,
This group was expected to achieve an LDL-C reduction of 40% based on
previous studies
The low potency statin group included patients on simvastatin (10 mg or 20
mg) or pravastatin (40 mg) daily
This group was expected LDL-C reduction of <40%
The patient goal was to reach below 70 mg/dL (<1.8 mmol/L) during the followup period of 2 weeks to 1 year (2015).
Thailand Study Results

24.9% of the patients using high potency statins reached
their target LDL-C
23.4% of patients using low potency statin group reached
their target.
According to the authors based on these findings, high
potency statins were not associated with increased
LDL-C goal attainment
Thailand Study Critique

One factor which may have attributed to the low target attainment rate
was the LDL-C goal (<70 mg/dL),
based on the guidelines of the European Society of Cardiology and the
European Atherosclerosis Society (ESC/EAS).
The National Cholesterol Education Program/Adult Treatment Panel III
guideline is <200 mg/dL
However, more aggressive LDL-C targets are recommended for ACS
patients compared to healthy patients. (Chinwong, 2015).
Statins Study Critique

The high potency statins of this study, as they are defined, fall
into the category of low to moderate potency category as
used in another study by Rallidis et al. (Chinwong, 2015).
Statins Study Critique

Approximately 25% of patients in this study (with LDL-C higher than
140 mg/dL at baseline) would require combination therapy,
including a statin to achieve their target LDL-C.
However, only seven patients (1.8%) were prescribed combination
therapy,
consistent with other studies reviewed by Chinwong et al., reporting
that statin combination therapy was used less frequently in routine
practice (2015).
Statin Study Discussion

Cardiologists were possibly reluctant to titrate statin doses upwards, Due to
potential adverse effects, including an increase in muscle toxicity
Especially since doubling the dose of a statin results in lowering LDL-C by only
an additional 6% (Chinwong et al., 2015).
Simvastatin (40 mg), the most commonly used high potency statin, can only
result in about 43% LDL-C reduction and cannot decrease the LDL-C level
to <70 mg/dL in patients with a baseline level at <140 mg/dL
according to L. Osc, D. Budinski, N. Hounslow, and V. Arneson. In this
situation, atorvastatin, rosuvastatin or statin combination therapy should be
used to lower LDL-C to the target level (as cited in Chinwong et al.,
2015, p. 130).
Statins Study Conclusion

A positive relationship between statin potency and LDL-C
goal attainment is well established in some randomized
controlled trials, while Chinwong et al. and other studies
have shown results which suggest that the potency of
the statin used does not increase the likelihood of
reaching the recommended goal (2015). Combination
therapy may be necessary to reach ideal patient
outcomes.
Presentation Conclusion
Diet modifications
Statin Therapy
Combination of both
References
Al-Khateeb, A., Al-Talib, H., Mohd, M., Yusof, Z., & Zilfalil, B. (2013). The Role of Lipid
Lowering Therapy in the Achievement of Therapuetic Goal among Malaysian
Hyperlipidemic Patients. Inernational Medical Journal, 20(3), 272-275. Retrieved April
1, 2015, from CINAHL.
American Heart Association. 2004. Building Healthier Lives Free of Cardiovascular Disease and
Stroke. Accessed April 6th 2015. http://www.heart.org/HEARTORG/
Barrett, S. (2013). The role of omega-3 polyunsaturated fatty acids in cardiovascular health.
Alternative Therapies in Health & Medicine, 1926-30.
Bojadzievski, T., Schaefer, E., Hollenbeak, C. S., & Gabbay, R. A. (2012). Association between statin use and lipid
status in quality improvement initiatives: statin use, a potential surrogate?. Quality In Primary Care, 20(6), 401-407
Catapano, A. L. , Reiner, Z (2011). 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). Athereosclerosis,
217 (1), 16-27.
Chinwong, D., Patumanond, J., Chinwong, S., Siriwattana, K., Gunaparn, S., Hall, J. J., & Phrommintikul, A. (2015).
Statin therapy in patients with acute coronary syndrome: low-density lipoprotein cholesterol goal attainment and effect of
statin potency. Therapeutics & Clinical Risk Management, 11127-136. doi:10.2147/TCRM.S75608
Jenkins, D. A., Kendall, C. C., Marchie, A., Faulkner, D. A., Josse, A. R., Wong, J. W., &...
Connelly, P. W. (2005). Direct comparison of dietary portfolio vs statin on C-reactive
protein.European Journal Of Clinical Nutrition, 59(7), 851-860.
doi:10.1038/sj.ejcn.1602152

Nursing Research Presentaion

Uploaded by

Copyright:

Available Formats

Nursing Research Presentaion

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Nursing Research Presentaion

Uploaded by

Copyright:

Available Formats

Hyperlipidemia

Role in cardiovascular disease

SATURATED FATTY ACIDS

POLYUNSATURATED FATTY ACIDS

NURSES HEALTH STUDY

DIET VS STATIN ON C-REACTIVE PROTEIN STUDY

An elevated c-reactive protein level is linked

DIET VS STATIN ON C-REACTIVE PROTEIN STUDY

DIET VS STATIN ON C-REACTIVE PROTEIN STUDY

Found that the statin group and portfolio

Statin Therapy in the Community

Statin Therapy in the Community

Statin Therapy in the Community

Statin Therapy in the Community

Hospital Record Statins Study

Hospital Record Statins Study

Hospital Record Statins Study:

Hospital Record Statin Study:

Hospital Record Statins Study:

Thailand: Statins Study

Thailand Study Sample Selection

Thailand Study Sample Selection

Thailand Study Expectations

Thailand Study Results

Thailand Study Critique

Statins Study Critique

Statins Study Critique

Statin Study Discussion

Statins Study Conclusion

You might also like

Pfad - The Proxy pFad of © 2024 Garber Painting. All rights reserved.