Table

Values, mg/dLBeforeapheresis

Afterapheresis

Percentchange

Total cholesterol 111 40 64Triglycerides 195 88 47HDL 27 18 34LDL-C 62 12 81Lp(a) 81 13 84Fibrinogen 346 179 48C-RP 2.63 0.95 64

218 Journal of Clinical Lipidology, Vol 4, No 3, June 2010

and elevated Lp(a) is lacking. This is the first case study ex-amining the acute clinical benefits of LDL-a for a patientwith CHD, cerebrovascular disease, and angina while hav-ing normal LDL-C but abnormally high levels of Lp(a).Purpose: To examine the acute clinical benefits of LDL-ain patients with angina having normal LDL-C but abnor-mally high levels of Lp(a).Methods: A 48-year-old female FH patient with a historyof CHD (coronary artery bypass grafting and stents), pe-ripheral arterial disease (femoral/popliteal stent), cerebro-vascular disease (left endarterectomy) and unstable anginafor the last 2 years despite intense antianginal medication(nitroglycerin transdermal, 0.6–0.8 mg/h patch, and sublin-gual, 0.6 mg/PRN) was referred to the Kansas UniversityAtherosclerosis and LDL-a Center for further evaluationand treatment. The patient had an LDL-C of 62 mg/dLwith an Lp(a) of 81 mg/dL (nL , 30) while taking vytorin,fenofibrate, and O-3-FA. On the basis of her known intoler-ance to niacin therapy and uncontrolled angina, it was de-cided to initiate LDL-a.Results: The first treatment of LDL-a (Liposorber; Kaneka,Osaka, Japan) improved laboratory values (Table) and com-pletely eradicated angina symptoms which resulted in thepatient discontinuing her nitroglycerin therapy. Addition-ally, the patient claimed improvement of her PAD symp-toms. After 1 year of biweekly LDL-a therapy the patienthas had no vascular events and continues to be anginapain free without the need of nitroglycerin.Conclusions: LDL-a can immediately improve symptomsof unstable angina. The etiology of its benefit may includechanges to Lp(a). This case report forms the basis for futurestudies that may validate the use of LDL-a for loweringLp(a) in patients with clinical symptoms of angina.

141

Predictors of Combination Therapy for the Treatment ofDyslipidemia in the Actual Clinical Practice-Setting

Radhika Nair, PhD, Woodie Zachry, (Round Rock, TX)

Synopsis: Several factors play a role in the selection oftreatment for patients with dyslipidemia in the actual clin-ical-practice setting.

Purpose: To determine the predictors for prescribing com-bination therapy versus monotherapy to control lipid abnor-malities in a clinical-practice setting.Methods: A retrospective claims database analysis wasconducted with the use of i3 InVision� Data Mart. Pa-tients with a lipid panel between January 2004 and March2008 were selected and followed from the first occurrence(index date) of the following: low-density lipoprotein-C60–180 mg/dL; high-density lipoprotein cholesterol ,55mg/dL for women; high-density lipoprotein cholesterol,50 mg/dL for men; and TG ,750 mg/dL. Additional in-clusion criteria were age 40–64 years, enrollment .179days before and after index date, more than two diabetesmedical claims, or more than 89 days’ supply of a pre-scription for diabetes treatment during the 6 months pre-in-dex, and no lipid-altering therapy during the 6-month pre-index period. Patients were classified into 4 groups basedon treatment during the 6-month post-index period: Mono-therapy only, statin and fenofibrate combination therapy,other combination therapy (other than statin/fenofibratecombination), and no therapy. Logistic regression wasused to identify demographic and clinical factors availablein the claims data that predict for prescribing of combina-tion therapy.Results: A total of 141,595 patients met inclusion/exclusioncriteria. The majority of the patients either did not receiveany treatment (n 5 124,464) or were treated with monother-apy (n 5 16,559) during the 6-month post-index period.Only 181 patients received statin and fenofibrate combina-tion therapy at least once during the 6 months after index,whereas 391 patients received other combinations. A diagno-sis of chronic ischemic heart diseases (odds ratio [OR], 2.94,95% confidence interval [95% CI], 1.38–6.28; P 5 .005) anddyslipidemia (OR, 1.68; 95% CI, 1.03–2.74; P 5 .037)before index date were associated with greater likelihoodof treatment with statin and fenofibrate combinationtherapy than monotherapy. A diagnosis of stroke (OR,2.16; 95% CI, 1.003–4.67) and chronic ischemic heart dis-ease (OR, 3.04; 95% CI, 1.81–5.12, P , .0001) before theindex date were associated with greater likelihood of treat-ment with other combination therapy than a monotherapyor no treatment.Conclusions: Certain diagnoses, such as previous CVDevent coupled with dyslipidemia, increase the likelihoodof prescribing a combination therapy in diabetes patientsin the actual clinical-practice setting.

142

The Treatment of Dyslipidemia in Actual PracticeSettings That Use Similar Inclusion Criteria to theACCORD Lipid Trial

Radhika Nair, PhD, Woodie Zachry, (Round Rock, TX)

Synopsis: Although clinical trials are a crucial source of in-formation, it is important to understand the applicability of