Current lipid-lowering approach and LDL target achievement in very high-risk patients: in-hospital results of a high-volume primary percutaneous coronary intervention tertiary center
European Journal of Preventive Cardiology
; 29(SUPPL 1):i80, 2022.
Article
in English
| EMBASE | ID: covidwho-1915576
ABSTRACT
Background:
Low-density lipoprotein-cholesterol (LDL-C) is a well-accepted causal risk factor for atherothrombotic cardiovascular disease. Several randomized controlled trials and meta-analyses have shown that lipid-lowering therapies reduce cardiovascular events and have a positive effect in reducing vulnerable plaques. In particular, the recommended target for LDL-C has become more and more stringent, moving to 1.4 mmol/l (55 mg/dl) for very high-risk patients. According to the 2019 ESC/EAS Guidelines, the current paradigm for lipid management favors a stepwise approach consisting of early initiation of high-intensity statin, followed by subsequent addition of ezetimibe, and ultimately a consideration of PCSK9 inhibitor treatment if LDL-C levels remain elevated.Methods:
We recruited 307 patients admitted for acute coronary syndrome (ACS) during the COVID-19 pandemic from March 2020 to December 2020. Baseline LDL-C concentration and prescribed hypolipemiant treatment at hospital admission and discharge were registered. Therefore, we included all consecutive patients identified as very-high cardiovascular risk, according to 2019 ESC guidelines. We stratified our population through variables independently associated with non-attainment of LDL-cholesterol such as hypertension, diabetes, peripheral arterial disease, clinical manifestations of ACS, number of main vessels treated, and complexity of the atherosclerotic disease.Results:
274 patients were included. Mean age was 69,9 years (SD 11,4), 20,8%were women, 23,7%had diabetes, 16,4%had PAD and 32,1 % suffered from valvular disease, mainly with mitral regurgitation or aortic stenosis no more than mild or moderate. Of 25.1% with a previous history of acute myocardial infarction, the 33,3% of whom didn't have statin therapy pre-ACS index (p =0,001). At admission, medium cholesterol levels of patients that underwent previous coronary revascularization (25,5% of the total population) were 84,21 ± 31,2 mg/dL, not in range according to both 2016 and 2019 ESC guidelines. At discharge, 77,37 % of all the patients included received only statin therapy VS 22,63% with statin plus ezetimibe. In the subpopulation of patients with recurring ACS events with LDL pre-admission > 100 mg/dL,despite high dose statin, only 25% of this population were discharged adding ezetimibe (VS 75% who kept on the treatment of high dose statin without up-titration).Conclusions:
Management of dyslipidemia is frequently suboptimal and the gap between guidelines and clinical practice for lipid management across Europe has been exacerbated by the 2019 guidelines. A greater utilization of non-statin lipid-lowering therapies is likely needed to reach the LDL-C optimal target. A correct stratification of the risk class would help to identify, in a personalized perspective of treatment, patients at very high risk that would take advantage of more aggressive therapy to reach the lowest target of LDL-C ('the lower is better'). (Figure Presented).
endogenous compound; ezetimibe; hydroxymethylglutaryl coenzyme A reductase inhibitor; lipid; low density lipoprotein; low density lipoprotein cholesterol; PCSK9 inhibitor; achievement; acute coronary syndrome; acute heart infarction; aged; aortic stenosis; atherosclerosis; blood vessel; cardiovascular disease; cardiovascular risk; clinical practice; clinical trial; conference abstract; controlled study; coronavirus disease 2019; diabetes mellitus; drug megadose; drug therapy; dyslipidemia; Europe; female; heart muscle revascularization; high risk patient; hospital admission; human; hypertension; low density lipoprotein cholesterol level; male; meta analysis; mitral valve regurgitation; pandemic; percutaneous coronary intervention; peripheral occlusive artery disease; practice guideline; randomized controlled trial (topic); risk assessment; titrimetry; valvular heart disease; vulnerable plaque
Full text:
Available
Collection:
Databases of international organizations
Database:
EMBASE
Type of study:
Experimental Studies
/
Prognostic study
Language:
English
Journal:
European Journal of Preventive Cardiology
Year:
2022
Document Type:
Article
Similar
MEDLINE
...
LILACS
LIS