Abstract
Introduction: Patients with established coronary artery disease (CAD) are at very high risk for cardiovascular events. Methods: The DAUSSET study is a national, multicenter, non-interventional study that included very high-risk CAD patients followed by French cardiologists. It aimed to describe real-life clinical practices for low-density lipoprotein (LDL) cholesterol control in the secondary prevention of CAD. Results: A total of 912 patients (mean age, 65.4 years; men, 76.1%; myocardial infarction, 69.4%; first episode, 80.1%) were analyzed. The LDL cholesterol goal was 70 mg/dL in most cases (84.9%). The LDL cholesterol goal <70 mg/dL was achieved in 41.7% of patients. Of the 894 (98.0%) patients who received lipid-lowering therapy, 81.2% had been treated more intensively after the cardiac event, 27.0% had been treated less intensively and 13.1% had been maintained. Participating cardiologists were very satisfied or satisfied with treatment response in 72.6% of patients. Moderate satisfaction or dissatisfaction with lipid-lowering therapy was related to not achieving objectives (100%), treatment inefficacy (53.7%), treatment intolerance (23.4%) and poor adherence (12.3%). Conclusion: These real-world results show that lipid control in very high-risk patients remains insufficient. More than half of the patients did not achieve the LDL cholesterol goal. Prevention of cardiovascular events in these very high-risk patients could be further improved by better education and more intensive lipid-lowering therapy.
Highlights
Patients with established coronary artery disease (CAD) are at very high risk for cardiovascular events
Hypercholesterolemia is a major contributor to the development of CAD and high levels of low-density lipoprotein cholesterol (LDL-C) are associated with an increased risk of CAD [3]
Ezetimibe is recommended for patients who are intolerant to statins or who do not achieve LDL-C goal with statin monotherapy [6,7]
Summary
Patients with established coronary artery disease (CAD) are at very high risk for cardiovascular events. Methods: The DAUSSET study is a national, multicenter, noninterventional study that included very high-risk CAD patients followed by French cardiologists. It aimed to describe real-life clinical practices for low-density lipoprotein (LDL) cholesterol control in the secondary prevention of CAD. Prevention of cardiovascular events in these very high-risk patients could be further improved by better education and more intensive lipid-lowering therapy. As a result, reducing levels of LDL-C has become a major objective of guidelines for the treatment and secondary prevention of atherosclerotic cardiovascular disease [2,5–8]. In the 2019 ESC/EAS dyslipidemia guidelines, a target of 55 mg/dL LDL-C is recommended for all patients with very high-risk criteria and 40 mg/dL for patients with a second vascular event within 2 years [7]
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