Abstract 18677: Residual Cardiovascular Risk Reduction Through a Digital App

Abstract

Introduction: atherosclerotic cardiovascular disease (ASCVD) is the first cause of disability and death globally and represents the main etiological agent of myocardial infarction and ischemic stroke. The causal association between LDL cholesterol (LDL chol) and ASCVD is one of the most consolidated topics of modern medicine: it has gone from the demonstration that high levels of LDL Chol are a necessary condition for atherogenesis to the awareness that "the lower the better" and "the earlier the better" to underline the need for secondary and primary prevention to reduce atherosclerotic burden. Hypothesis: we hypothesized that motivational alerts sent through telemedicine to patients could affect escalation therapy in ASCVD patients. Aim: we evaluated the impact of a digital-APP in dyslipidemia management, and other CV risk factors, but focusing mainly on LDL chol. Methods: fifty dyslipidemic patients (APP_pts; 40 males; mean age 62±9 years; age range 40÷81 yrs) were followed through telemedicine-based APP from March 2022 to May 2023, in comparison with additional 50 dyslipidemic patients (ST_pts; 43 males; mean age 63±9 years; age range 40÷81 yrs) who underwent standard outpatient visits. Patients’ access to digital APP was remotely monitored and reports were used for therapy adjustments. Statistical analysis was performed with GraphPad Prism 7; comparisons were carried out by two-way ANOVA and by chi-square test. Results: baseline LDL chol values were 93,3±36,4 mg/dL, and 90,8±43,8 mg/dL, in APP_pts and in, ST_pts, respectively; six months after enrollment, both cohorts experienced significant reductions (APP_pts, 72,1±35,2 mg/dL, p=0,024; ST_pts, 76,7±38,6 mg/dL, p=0,008) vs baseline. We further subdivided both groups into ischemic and non-ischemic subjects (APP_pts: 26 vs 24; ST_pts : 33 vs 17). Remarkably, telemedicine control showed a 32% reduction in LDL chol for ischemic pts, while ischemic ST_pts gained only 11%. Overall, dyslipidemic control in non-ischemic pts appeared less beneficial (17 vs 15%). Finally, telemedicine-based APP resulted more effective than standard monitoring (p=0,04). Conclusion: aggressive lipid lowering therapies should be implemented with remote patients monitoring, mostly in the post-ischemic setting.