Dyslipidemia, highly elevated, low-density lipoprotein (LDL) cholesterol, is a major cardiovascular risk factor. Statins have been proven to effectively reduce the risk of atherosclerotic cardiovascular disease (ASCVD) and are recommended as a first-line therapy for the primary and secondary prevention of ASCVD. However, statins may not be sufficient in decreasing LDL cholesterol levels and pose a significant on-treatment residual risk of major cardiovascular events (i.e., residual cholesterol risk) according to meta-analyses of statin trials. Current guidelines for cholesterol management to achieve additional LDL cholesterol reduction and reduce ASCVD risk recommend two hyperlipidemic agents besides statins. Use of ezetimibe, a cholesterol absorption inhibitor, leads to additional LCL cholesterol reduction and decreased ASCVD risk, when added to statin therapy, without raising significant safety concerns. Furthermore, in combination with a mild-to-moderate statin intensity, ezetimibe is used in situations of statin-associated adverse effects such as myalgia and the combination therapy is relatively safer. Monoclonal antibody of proprotein convertase subtilisin/kexin type 9 (PCSK9), alirocumab, and evolocumab, have been approved to lower LDL cholesterol level. While there are drawbacks to the use of PCSK9 inhibitors, including high cost and adverse events such as injection site reaction, they significantly decreased serum LDL cholesterol levels and thereby ASCVD risks when added to maximally tolerated statin therapy.
Absorption ; Cardiovascular Diseases ; Cholesterol ; Cholesterol, LDL ; Dyslipidemias ; Ezetimibe ; Hydroxymethylglutaryl-CoA Reductase Inhibitors ; Lipoproteins ; Myalgia ; Proprotein Convertases ; Risk Factors ; Secondary Prevention

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Mitral Valve

OBJECTIVES: This study investigated the prevalence, incidence, and prognosis of cardiac amyloidosis (CA) in Korea. METHODS: This retrospective nationwide population-based study used the Health Insurance Review and Assessment Service databases between 2008 and 2020. All patients diagnosed with amyloidosis were included, and those with a diagnosis of heart failure or cardiomyopathy were classified as having CA. Both the special code for amyloidosis (V121), which enables coverage of medical expenses, and the corresponding International Classification of Diseases, 10th revision codes for amyloidosis (E850- E854, E858, E859) were used to improve the reliability of amyloidosis diagnosis. RESULTS: Among 2,239 patients with amyloidosis, 758 met the criteria for CA (mean age, 64.4±11.9 years; 59.1% male). The mean age of patients with CA increased from 59.5±14.7 years in 2009 to 68.1±13.9 years in 2020. The incidence and prevalence increased from 0.09 (95% confidence interval [CI], 0.06 to 0.12) to 0.22 (95% CI, 0.18 to 0.27) per 100,000 person-years and 0.20 (95% CI, 0.16 to 0.25) to 1.30 (95% CI, 0.12 to 0.42) per 100,000 persons, respectively (all p<0.001). Patients with light-chain CA showed similar trends. In-hospital mortality decreased from 17.3% (95% CI, 9.23 to 29.6) to 6.10% (95% CI, 4.21 to 8.48) between 2009 and 2020. While age-specific in-hospital mortality was significantly higher in patients aged ≥70 years (p=0.004), no significant age-specific difference in in-hospital mortality was observed in patients with CA aged <70 years (p=0.981). CONCLUSIONS The prevalence and incidence of CA have increased in Korea, predominantly affecting older individuals, particularly males. Notably, in-hospital mortality decreased significantly.

OBJECTIVES: This study investigated the prevalence, incidence, and prognosis of cardiac amyloidosis (CA) in Korea. METHODS: This retrospective nationwide population-based study used the Health Insurance Review and Assessment Service databases between 2008 and 2020. All patients diagnosed with amyloidosis were included, and those with a diagnosis of heart failure or cardiomyopathy were classified as having CA. Both the special code for amyloidosis (V121), which enables coverage of medical expenses, and the corresponding International Classification of Diseases, 10th revision codes for amyloidosis (E850- E854, E858, E859) were used to improve the reliability of amyloidosis diagnosis. RESULTS: Among 2,239 patients with amyloidosis, 758 met the criteria for CA (mean age, 64.4±11.9 years; 59.1% male). The mean age of patients with CA increased from 59.5±14.7 years in 2009 to 68.1±13.9 years in 2020. The incidence and prevalence increased from 0.09 (95% confidence interval [CI], 0.06 to 0.12) to 0.22 (95% CI, 0.18 to 0.27) per 100,000 person-years and 0.20 (95% CI, 0.16 to 0.25) to 1.30 (95% CI, 0.12 to 0.42) per 100,000 persons, respectively (all p<0.001). Patients with light-chain CA showed similar trends. In-hospital mortality decreased from 17.3% (95% CI, 9.23 to 29.6) to 6.10% (95% CI, 4.21 to 8.48) between 2009 and 2020. While age-specific in-hospital mortality was significantly higher in patients aged ≥70 years (p=0.004), no significant age-specific difference in in-hospital mortality was observed in patients with CA aged <70 years (p=0.981). CONCLUSIONS The prevalence and incidence of CA have increased in Korea, predominantly affecting older individuals, particularly males. Notably, in-hospital mortality decreased significantly.

OBJECTIVES: This study investigated the prevalence, incidence, and prognosis of cardiac amyloidosis (CA) in Korea. METHODS: This retrospective nationwide population-based study used the Health Insurance Review and Assessment Service databases between 2008 and 2020. All patients diagnosed with amyloidosis were included, and those with a diagnosis of heart failure or cardiomyopathy were classified as having CA. Both the special code for amyloidosis (V121), which enables coverage of medical expenses, and the corresponding International Classification of Diseases, 10th revision codes for amyloidosis (E850- E854, E858, E859) were used to improve the reliability of amyloidosis diagnosis. RESULTS: Among 2,239 patients with amyloidosis, 758 met the criteria for CA (mean age, 64.4±11.9 years; 59.1% male). The mean age of patients with CA increased from 59.5±14.7 years in 2009 to 68.1±13.9 years in 2020. The incidence and prevalence increased from 0.09 (95% confidence interval [CI], 0.06 to 0.12) to 0.22 (95% CI, 0.18 to 0.27) per 100,000 person-years and 0.20 (95% CI, 0.16 to 0.25) to 1.30 (95% CI, 0.12 to 0.42) per 100,000 persons, respectively (all p<0.001). Patients with light-chain CA showed similar trends. In-hospital mortality decreased from 17.3% (95% CI, 9.23 to 29.6) to 6.10% (95% CI, 4.21 to 8.48) between 2009 and 2020. While age-specific in-hospital mortality was significantly higher in patients aged ≥70 years (p=0.004), no significant age-specific difference in in-hospital mortality was observed in patients with CA aged <70 years (p=0.981). CONCLUSIONS The prevalence and incidence of CA have increased in Korea, predominantly affecting older individuals, particularly males. Notably, in-hospital mortality decreased significantly.

OBJECTIVES: This study investigated the prevalence, incidence, and prognosis of cardiac amyloidosis (CA) in Korea. METHODS: This retrospective nationwide population-based study used the Health Insurance Review and Assessment Service databases between 2008 and 2020. All patients diagnosed with amyloidosis were included, and those with a diagnosis of heart failure or cardiomyopathy were classified as having CA. Both the special code for amyloidosis (V121), which enables coverage of medical expenses, and the corresponding International Classification of Diseases, 10th revision codes for amyloidosis (E850- E854, E858, E859) were used to improve the reliability of amyloidosis diagnosis. RESULTS: Among 2,239 patients with amyloidosis, 758 met the criteria for CA (mean age, 64.4±11.9 years; 59.1% male). The mean age of patients with CA increased from 59.5±14.7 years in 2009 to 68.1±13.9 years in 2020. The incidence and prevalence increased from 0.09 (95% confidence interval [CI], 0.06 to 0.12) to 0.22 (95% CI, 0.18 to 0.27) per 100,000 person-years and 0.20 (95% CI, 0.16 to 0.25) to 1.30 (95% CI, 0.12 to 0.42) per 100,000 persons, respectively (all p<0.001). Patients with light-chain CA showed similar trends. In-hospital mortality decreased from 17.3% (95% CI, 9.23 to 29.6) to 6.10% (95% CI, 4.21 to 8.48) between 2009 and 2020. While age-specific in-hospital mortality was significantly higher in patients aged ≥70 years (p=0.004), no significant age-specific difference in in-hospital mortality was observed in patients with CA aged <70 years (p=0.981). CONCLUSIONS The prevalence and incidence of CA have increased in Korea, predominantly affecting older individuals, particularly males. Notably, in-hospital mortality decreased significantly.