Kardiovaskulární choroby i přes pokles v poslední době zůstávají hlavní příčinou úmrtnosti a nemocnosti a jejich výskyt s věkem stoupá. Dyslipidemie představují základní rizikový faktor těchto chorob. Zahájení léčby dyslipidemií závisí na stanovení míry rizika. U starších pacientů s dokumentovanou kardiovaskulární chorobou je doporučen stejný postup jako u pacientů mladších. U starších nemocných bez dokumentované kardiovaskulární nemoci by mělo být zahájení léčby dyslipidemií zváženo v případě velmi vysokého rizika s ohledem k předpokládané délce života, adherenci k léčbě, lékovým interakcím, geriatrické křehkosti a preferenci nemocných.
Despite recent decline, cardiovascular diseases remain the main cause of mortality and morbidity and their occurrence is increasing with age. Dyslipidaemia represents a basic risk factor for cardiovascular disease. Dyslipidaemia treatment initiation depends on patient risk stratification. In older patients with documented cardiovascular disease, treatment is recommended in the same way as in younger patients. In older patients without documented cardiovascular disease, treatment should be considered in very-high-risk patients about estimated life expectancy, patient adherence, drug interactions, geriatric frailty and patient preference.
- MeSH
- dyslipidemie * farmakoterapie MeSH
- hodnocení rizik MeSH
- kardiovaskulární nemoci prevence a kontrola MeSH
- lidé MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- statiny terapeutické užití MeSH
- Check Tag
- lidé MeSH
- senioři nad 80 let MeSH
- senioři MeSH
- Publikační typ
- přehledy MeSH
- MeSH
- ezetimib farmakologie terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- LDL-cholesterol * účinky léků MeSH
- lidé MeSH
- randomizované kontrolované studie jako téma MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- statiny farmakologie terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- komentáře MeSH
- souhrny MeSH
- MeSH
- aterosklerotický plát patologie MeSH
- ateroskleróza * farmakoterapie patofyziologie prevence a kontrola MeSH
- blokátory kalciových kanálů aplikace a dávkování terapeutické užití MeSH
- dyslipidemie farmakoterapie komplikace MeSH
- hypertenze farmakoterapie komplikace MeSH
- inhibitory ACE aplikace a dávkování terapeutické užití MeSH
- kombinovaná farmakoterapie MeSH
- LDL-cholesterol MeSH
- lidé MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- statiny aplikace a dávkování terapeutické užití MeSH
- zdravé chování MeSH
- Check Tag
- lidé MeSH
- MeSH
- dyslipidemie farmakoterapie MeSH
- kardiovaskulární nemoci prevence a kontrola MeSH
- LDL-cholesterol * účinky léků MeSH
- lidé MeSH
- statiny * farmakologie terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- novinové články MeSH
- MeSH
- ezetimib farmakologie terapeutické užití MeSH
- hypercholesterolemie * farmakoterapie prevence a kontrola MeSH
- LDL-cholesterol škodlivé účinky MeSH
- lidé MeSH
- PCSK9 inhibitory farmakologie terapeutické užití MeSH
- rizikové faktory kardiovaskulárních chorob MeSH
- statiny farmakologie terapeutické užití MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- přehledy MeSH
BACKGROUND: Concomitant medications may potentially affect the outcome of cancer patients. In this sub-analysis of the ARON-2 real-world study (NCT05290038), we aimed to assess the impact of concomitant use of proton pump inhibitors (PPI), statins, or metformin on outcome of patients with metastatic urothelial cancer (mUC) receiving second-line pembrolizumab. METHODS: We collected data from the hospital medical records of patients with mUC treated with pembrolizumab as second-line therapy at 87 institutions from 22 countries. Patients were assessed for overall survival (OS), progression-free survival (PFS), and overall response rate. We carried out a survival analysis by a Cox regression model. RESULTS: A total of 802 patients were eligible for this retrospective study; the median follow-up time was 15.3 months. PPI users compared to non-users showed inferior PFS (4.5 vs. 7.2 months, p = 0.002) and OS (8.7 vs. 14.1 months, p < 0.001). Concomitant PPI use remained a significant predictor of PFS and OS after multivariate Cox analysis. The use of statins or metformin was not associated with response or survival. CONCLUSIONS: Our study results suggest a significant prognostic impact of concomitant PPI use in mUC patients receiving pembrolizumab in the real-world context. The mechanism of this interaction warrants further elucidation.
Purpose: We examined clinical characteristics and low-density lipoprotein cholesterol (LDL-C) lowering in patients initiating evolocumab in real-world practice in a Central and Eastern European (CEE) cohort from the pan-European HEYMANS study. Methods: Patients from Bulgaria, Czech Republic, and Slovakia were enrolled at initiation of evolocumab (baseline) as per local reimbursement criteria. Demographic/clinical characteristics, lipid-lowering therapy (LLT) and lipid values were collected from medical records for ≤6 months before baseline and ≤30 months after evolocumab initiation. Results: Overall, 333 patients were followed over a mean (SD) duration of 25.1 (7.5) months. At initiation of evolocumab, LDL-C levels were markedly elevated in all three countries, with a median (Q1, Q3) LDL-C of 5.2 (4.0, 6.6) mmol/L in Bulgaria, 4.5 (3.8, 5.8) mmol/L in the Czech Republic, and 4.7 (4.0, 5.6) mmol/L in Slovakia. Within the first three months of evolocumab treatment, LDL-C levels were reduced by a median of 61% in Bulgaria, 64% in the Czech Republic, and 53% in Slovakia. LDL-C levels remained low throughout the remaining period of observation. The 2019 ESC/EAS guideline-recommended risk-based LDL-C goals were attained by 46% of patients in Bulgaria, 59% in the Czech Republic, and 43% of patients in Slovakia. LDL-C goal attainment was higher in patients receiving a statin ± ezetimibe-based background therapy (Bulgaria: 55%, Czech Republic: 71%, Slovakia: 51%) compared to those receiving evolocumab alone (Bulgaria: 19%, Czech Republic: 49%, Slovakia: 34%). Conclusion: In the HEYMANS CEE cohort, patients initiated on evolocumab had baseline LDL-C levels approximately three-fold higher than guideline-recommended thresholds for PCSK9i initiation. Risk-based LDL-C goal attainment was highest in patients receiving high-intensity combination therapy. Lowering the LDL-C reimbursement threshold for PCSK9i initiation would allow more patients to receive combination therapy, thus improving LDL-C goal attainment. Trial registration: ClinicalTrials.gov (NCT02770131; registration date: 27 April 2016).
- MeSH
- anticholesteremika * škodlivé účinky MeSH
- LDL-cholesterol MeSH
- lidé MeSH
- statiny * terapeutické užití MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- pozorovací studie MeSH
- práce podpořená grantem MeSH
- Geografické názvy
- východní Evropa MeSH
