Lipoprotein (a) is a predictor of non-achievement of LDL-C goals in patients with chronic heart disease. / Lipoproteína (a) es un factor predictor de no consecución de objetivos de C-LDL en pacientes con cardiopatía isquémica crónica.

INTRODUCTION AND OBJECTIVES: Lipoprotein (a) [Lp(a)] concentration influences serum low-density lipoprotein cholesterol (LDL-C) levels. How it influences the achievement of LDL-C targets established in the guidelines is not well studied. Our aim was to know the prevalence of elevated Lp(a) levels in patients with coronary artery disease, and to assess its influence on the achievement of LDL-C targets. METHOD: We conducted a cross-sectional study in a cardiology department in Spain. A total of 870 patients with stable coronary artery disease had their lipid profile determined, including Lp(a). Patients were stratified into 2 groups according to Lp(a)>50mg/dL and Lp(a)≤50mg/dL. The association of Lp(a)>50mg/dL with achievement of LDL-C targets was assessed by logistic regression analysis. RESULTS: The prevalence of Lp(a)>50mg/dL was 30.8%. Patients with Lp(a)>50mg/dL had higher baseline (142.30±47.54 vs. 130.47±40.75mg/dL; p=0.0001) and current (72.91±26.44 vs. 64.72±25.30mg/dL; p=0.0001), despite the fact that they were treated with more high-potency statins (77.2 vs. 70.9%; p=0.058) and more combination lipid-lowering therapy (37.7 vs. 25.7%; p=0.001). The proportion of patients achieving target LDL-C was lower in those with Lp(a)>50mg/dL. Independent predictors of having elevated Lp(a) levels>50mg/dL were the use of high-potency statins (OR 1.5; 95% CI 1.08-2.14), combination lipid-lowering therapy with ezetimibe (OR 2.0; 95% CI 1.45-2.73) and failure to achieve a LDL-C ≤55mg/dL (OR 2.3; 95% CI 1.63-3.23). CONCLUSIONS: Elevated Lp(a) levels influence LDL-C levels and hinder the achievement of targets in patients at very high cardiovascular risk. New drugs that act directly on Lp(a) are needed in these patients.

Low-Density Lipoprotein Cholesterol Targets in Patients With Coronary Heart Disease in Extremadura (Spain): LYNX Registry.

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C) contributes decisively to the development of cardiovascular disease (CVD). In the LYNX registry we determined the rate of achievement of the target value of LDL-C, the use of lipid-lowering therapy (LLT) and the predictive factors of not reaching the target in patients with stable coronary heart disease (CHD). METHODS: LYNX included consecutive patients with stable CHD treated at the University Hospital of Caceres, Extremadura (Spain) from September 2016 to September 2018, and those who must have an LDL-C target below 70 mg/dL according to the European Society of Cardiology (ESC) 2016 guidelines. The variables independently associated with the breach of the LDL-C objective were evaluated by multivariable logistic regression. RESULTS: A total of 674 patients with stable CHD were included. The average LDL-C levels were 68.3 ± 24.5 mg/dL, with 56.7% showing a level below 70 mg/dL. LLT was used by 96.7% of patients, 71.7% were treated with high-powered statins and 30.1% with ezetimibe. The risk of not reaching the target value of LDL-C was higher in women, in active smokers, and in those who had multivessel CHD or had atrial fibrillation. Patients with diabetes mellitus, those who took potent statins or co-administration treatment with ezetimibe were more likely to reach the target level of LDL-C. CONCLUSIONS: The treatment of dyslipidemia in patients with chronic CHD remains suboptimal; however, an increasing number of very high-risk patients achieve the LDL-C objective, although there is still enormous potential to improve cardiovascular outcome through the use of more intensive LLT.

Cambios en el síndrome coronario agudo en una década en un hospital de referencia provincial / Changes in acute coronary syndrome in a decade in a provincial referral hospital

Introducción y objetivo: Determinar el cambio en las características clínicas y pronósticas de pacientes ingresados por síndrome coronario agudo (SCA) durante un periodo de los años 2005 y 2015 en un hospital de referencia provincial. Material y método: Estudio observacional transversal que compara las características del SCA de los años 2005 y 2015. Se analizaron factores de riesgo cardiovascular, tratamientos al alta, complicaciones y mortalidad. Resultados: La incidencia de SCA en 2015 fue un 15,3% menor. La incidencia de hipertensión arterial, diabetes y dislipemia fue similar, pero hubo más fumadores en 2015 (25,9% vs 18,3%; p = 0,005). La reperfusión coronaria y la prescripción de tratamientos de prevención secundaria aumentaron respecto a 2005. La mortalidad hospitalaria fue similar. Conclusión: La incidencia de SCA ha disminuido en la última década en paralelo a una mejoría en el pronóstico relacionado con un uso más frecuente de los tratamientos recomendados en las guías

Introduction and objective: To determine the changes in the clinical and prognostic characteristics of patients admitted due to acute coronary syndrome (ACS) during the period between the years 2005 and 2015 in a provincial referral hospital. Material and method: Cross-sectional observational study was conducted comparing the characteristics of ACS between 2005 and 2015. An analysis was made of the cardiovascular risk factors, treatment at discharge, complications, and mortality. Results: The incidence of ACS in 2015 was 15.3% lower. The incidence of hypertension, diabetes and dyslipidaemia was similar, but there were more smokers in 2015 (25.9% vs 18.3%, P=.005). Coronary reperfusion and the prescription of secondary prevention treatments increased compared to 2005. Hospital mortality was similar. Conclusion: The incidence of ACS has decreased in the last decade, in parallel with an improvement in the prognosis related to a more frequent use of the treatments recommended in the guidelines

Changes in acute coronary syndrome in a decade in a provincial referral hospital. / Cambios en el síndrome coronario agudo en una década en un hospital de referencia provincial.

INTRODUCTION AND OBJECTIVE: To determine the changes in the clinical and prognostic characteristics of patients admitted due to acute coronary syndrome (ACS) during the period between the years 2005 and 2015 in a provincial referral hospital. MATERIAL AND METHOD: Cross-sectional observational study was conducted comparing the characteristics of ACS between 2005 and 2015. An analysis was made of the cardiovascular risk factors, treatment at discharge, complications, and mortality. RESULTS: The incidence of ACS in 2015 was 15.3% lower. The incidence of hypertension, diabetes and dyslipidaemia was similar, but there were more smokers in 2015 (25.9% vs 18.3%, P=.005). Coronary reperfusion and the prescription of secondary prevention treatments increased compared to 2005. Hospital mortality was similar. CONCLUSION: The incidence of ACS has decreased in the last decade, in parallel with an improvement in the prognosis related to a more frequent use of the treatments recommended in the guidelines.

Comunicación entre niveles asistenciales: una oportunidad de mejora en la prevención cardiovascular / Communication between levels of care: An opportunity for improvement in cardiovascular prevention

La existencia de una buena coordinación entre los distintos niveles asistenciales constituye un factor fundamental en el desarrollo de una asistencia sanitaria de calidad y eficiente. El médico de atención primaria es fundamental en la prevención secundaria de la enfermedad cardiovascular, y la estrecha colaboración entre atención primaria y cardiología constituye un factor clave en el control de la enfermedad cardiovascular. El proyecto CAPaCERES (Colaboración AP-Cardiología en Cáceres) pretende mejorar la coordinación entre atención primaria y cardiología desde la perspectiva del conocimiento mutuo y la mejora de la comunicación entre los profesionales que la desarrollan, y con ello a mejorar la calidad de la asistencia al paciente crónico con enfermedad cardiovascular

The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Cáceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease

Communication between levels of care: An opportunity for improvement in cardiovascular prevention. / Comunicación entre niveles asistenciales: una oportunidad de mejora en la prevención cardiovascular.

The existence of good coordination between the different levels of care is an essential factor in the development of quality and efficient healthcare. The primary care physician is fundamental in the secondary prevention of cardiovascular disease and the close collaboration between primary care and cardiology is a key factor in the control of cardiovascular disease. The CAPaCERES project (AP-Cardiology Collaboration in Cáceres) aims to improve the coordination between primary care and cardiology from the perspective of mutual knowledge and the improvement of communication between the professionals who develop it, and with that to improve the quality of care chronic patient with cardiovascular disease.

Control lipídico en pacientes con enfermedad coronaria del Área de Salud de Cáceres (España): estudio LIPICERES / Lipid control in patients with coronary artery disease in a healthcare area in Cáceres (Spain): LIPICERES study

Introducción y objetivos: En pacientes con enfermedad coronaria las guías establecen como objetivo un colesterol asociado a lipoproteínas de baja densidad (cLDL) <70mg/dl. A pesar de las evidencias del beneficio de un estricto control lipídico, el grado de consecución de objetivos es alarmantemente bajo en los estudios más recientes. Hemos analizado el grado de cumplimiento de objetivos lipídicos en pacientes coronarios de nuestra área sanitaria. Métodos: Estudio observacional y transversal realizado en el Área de Salud de Cáceres (España). Se incluyeron 741 pacientes coronarios ingresados entre 2009-2015 con un perfil lipídico en los últimos 3 años. Se analizaron: colesterol total, cLDL, colesterol asociado a lipoproteínas de alta densidad (cHDL), triglicéridos (TG) y colesterol-no-HDL. Resultados: El 74,4% eran varones. La edad media fue de 68,5±13,1 años: 76,3 ± 11,8 en las mujeres y 65,8 ± 12,6 en los varones (p < 0,001). El 52,3% tenían un cLDL < 70 mg/dl, sin diferencias entre sexos; estaban en objetivos el 44,8% de los pacientes < 55 años frente al 59,3% de los > 75 años. Tenían un cHDL > 40 mg/dl el 68,2% de los varones y un cHDL > 50 mg/dl el 54,8% de las mujeres. Mostraron unos TG < 150 mg/dl el 79,4%, sin diferencias entre sexos, y un colesterol-no-HDL< 100 mg/dl el 59,8%. Conclusiones: La mitad de pacientes coronarios no alcanzan los objetivos de control lipídico, y esta proporción es muy inferior a la comunicada en estudios previos. No existen diferencias en el cumplimiento de objetivos por sexos, y la edad es un predictor de cumplimiento

Introduction and objectives: Current guidelines recommend a low-density lipoprotein cholesterol (LDLc) target of < 70 mg/dl for patients with coronary artery disease. Despite the well-established benefits of strict lipid control, the most recent studies show that control rate of lipid targets are alarmingly low. An analysis was performed on the lipid targets attained according to current guidelines for the prevention of cardiovascular disease in coronary patients in a Caceres healthcare area. Methods: An observational and cross-sectional study was carried out in a healthcare area in Caceres (Spain). The study included a total of 741 patients admitted for coronary disease between 2009 and 2015 with available lipid profile in the last 3 years Total cholesterol, high-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and non-HDLc were analysed. Results: The majority (74.4%) of patients were male, with a mean age of 68.5±13.1 years; 76.3 ± 11.8 for women and 65.8 ± 12.6 for men (P < .001). A total of 52.3% patients achieved the LDLc target of < 70 mg/dl, with no gender differences. Only 44.8% of the patients < 55 years achieved their lipid targets, compared to 59.3% of the patients > 75 years. About 68.2% of men had an HDLc > 40 mg/dl, and 54.8% of women had an HDLc > 50 mg/dl. Overall, 79.4% of patients had a TG < 150 mg/dl, with no gender differences, and 59.8% had a non-HDLc < 100 mg/dl. Conclusions: Approximately one half of patients with coronary disease do not achieve their target lipid levels as defined in the European guidelines, and this rate is less than reported in previous studies. There are no gender differences in achieving lipid goals, and age is a predictor of adherence (AU)

[Lipid control in patients with coronary artery disease in a healthcare area in Cáceres (Spain): LIPICERES study]. / Control lipídico en pacientes con enfermedad coronaria del Área de Salud de Cáceres (España): estudio LIPICERES.

INTRODUCTION AND OBJECTIVES: Current guidelines recommend a low-density lipoprotein cholesterol (LDLc) target of <70mg/dl for patients with coronary artery disease. Despite the well-established benefits of strict lipid control, the most recent studies show that control rate of lipid targets are alarmingly low. An analysis was performed on the lipid targets attained according to current guidelines for the prevention of cardiovascular disease in coronary patients in a Caceres healthcare area. METHODS: An observational and cross-sectional study was carried out in a healthcare area in Caceres (Spain). The study included a total of 741 patients admitted for coronary disease between 2009 and 2015 with available lipid profile in the last 3 years Total cholesterol, high-density lipoprotein cholesterol (LDLc), high-density lipoprotein cholesterol (HDLc), triglycerides (TG) and non-HDLc were analysed. RESULTS: The majority (74.4%) of patients were male, with a mean age of 68.5±13.1 years; 76.3±11.8 for women and 65.8±12.6 for men (P<.001). A total of 52.3% patients achieved the LDLc target of <70mg/dl, with no gender differences. Only 44.8% of the patients <55 years achieved their lipid targets, compared to 59.3% of the patients >75 years. About 68.2% of men had an HDLc>40mg/dl, and 54.8% of women had an HDLc>50mg/dl. Overall, 79.4% of patients had a TG<150mg/dl, with no gender differences, and 59.8% had a non-HDLc<100mg/dl. CONCLUSIONS: Approximately one half of patients with coronary disease do not achieve their target lipid levels as defined in the European guidelines, and this rate is less than reported in previous studies. There are no gender differences in achieving lipid goals, and age is a predictor of adherence.