Leonardo De Luca1, Marcello Arca2, Pier Luigi Temporelli3, Jennifer Meessen4, Carmine Riccio5, Paolo Bonomo6, Angela Rita Colavita7, Domenico Gabrielli8, Michele Massimo Gulizia9, Furio Colivicchi10. 1. Division of Cardiology, A.O. San Camillo-Forlaninil, Roma, Italy. Electronic address: leo.deluca@libero.it. 2. Departmentof Translational and Precision Medicine, Sapienza University of Roma, Italy. 3. Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Gattico-Veruno, Novara, Italy. 4. Department of Cardiovascular Research, Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milano, Italy. 5. Division of Cardiology, Azienda Ospedaliera Sant'Anna e San Sebastiano, Caserta, Italy. 6. Division of Cardiology, P.O. SS. Trinità, Cagliari, Italy. 7. Division of Cardiology, P.O. Cardarelli, Campobasso, Italy. 8. Division of Cardiology, Augusto Murri Hospital, Fermo, Italy. 9. Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy. 10. Division of Cardiology, S. Filippo Neri Hospital, Roma, Italy.
Abstract
BACKGROUND: Current European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidemias have further reduced low density lipoprotein-cholesterol (LDL-C) targets, as compared to the guidelines released in 2016. These targets are particularly restraining for patients at very high risk (VHR). METHODS: Using the data from a nationwide, prospective registry on patients with established atherosclerotic cardiovascular disease (ASCVD), we sought to assess: 1) the contemporary use of conventional cholesterol-lowering therapies and the achievement of LDL-C goals according to previous and current ESC guidelines in subjects at VHR; 2) the proportion of VHR patients potentially eligible for proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) treatment. RESULTS: Among the 5053 patients with data available, 4751 (94.0%) were deemed as VHR. Among these patients, the mean LDL-C levels were 62.4 ± 47.7 mg/dl at enrollment. A high dose of statin was used in 54.9%, while the association of high dose statin and ezetimibe was prescribed in 4.8% of VHR patients. A target level of LDL-C < 70 mg/dl recommended by 2016 ESC guidelines was reached by 58.1%, while a target of <55 mg/dl and LDL-C reduction ≥50% recommended by 2019 ESC guidelines, would be reached by 3.2% of patients at VHR. Accordingly, 9.4% and 1.4% of VHR patients would be eligible for PCSK9i according to ESC guidelines and Italian regulations, respectively. CONCLUSIONS: In VHR patients enrolled in this large cohort of established ASCVD managed by cardiologists, the lipid management and LDL-C targets attainment is largely suboptimal.
BACKGROUND: Current European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidemias have further reduced low density lipoprotein-cholesterol (LDL-C) targets, as compared to the guidelines released in 2016. These targets are particularly restraining for patients at very high risk (VHR). METHODS: Using the data from a nationwide, prospective registry on patients with established atherosclerotic cardiovascular disease (ASCVD), we sought to assess: 1) the contemporary use of conventional cholesterol-lowering therapies and the achievement of LDL-C goals according to previous and current ESC guidelines in subjects at VHR; 2) the proportion of VHR patients potentially eligible for proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) treatment. RESULTS: Among the 5053 patients with data available, 4751 (94.0%) were deemed as VHR. Among these patients, the mean LDL-C levels were 62.4 ± 47.7 mg/dl at enrollment. A high dose of statin was used in 54.9%, while the association of high dose statin and ezetimibe was prescribed in 4.8% of VHR patients. A target level of LDL-C < 70 mg/dl recommended by 2016 ESC guidelines was reached by 58.1%, while a target of <55 mg/dl and LDL-C reduction ≥50% recommended by 2019 ESC guidelines, would be reached by 3.2% of patients at VHR. Accordingly, 9.4% and 1.4% of VHR patients would be eligible for PCSK9i according to ESC guidelines and Italian regulations, respectively. CONCLUSIONS: In VHR patients enrolled in this large cohort of established ASCVD managed by cardiologists, the lipid management and LDL-C targets attainment is largely suboptimal.
Authors: Joaquim Barreto; Beatriz Luchiari; Vaneza L W Wolf; Isabella Bonilha; Ticiane G Bovi; Barbara S Assato; Ikaro Breder; Sheila T Kimura-Medorima; Daniel B Munhoz; Thiago Quinaglia; Otavio R Coelho-Filho; Luiz Sergio F Carvalho; Wilson Nadruz; Andrei C Sposito Journal: Diagnostics (Basel) Date: 2022-03-26
Authors: Vasilios G Athyros; Konstantinos Stavropoulos; Konstantinos P Imprialos; Michael Doumas Journal: Int J Cardiol Date: 2020-07-04 Impact factor: 4.164
Authors: Jacques Blacher; Amélie Gabet; Alexandre Vallée; Jean Ferrières; Eric Bruckert; Michel Farnier; Valérie Olié Journal: Medicine (Baltimore) Date: 2020-12-11 Impact factor: 1.817