RESUMO
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.
RESUMO
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)
Assuntos
Humanos , Doença das Coronárias/fisiopatologia , Dislipidemias/epidemiologia , Colesterol/sangue , HDL-Colesterol/sangue , LDL-Colesterol/sangue , Triglicerídeos/sangue , 50293 , Fatores de RiscoRESUMO
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.
