Low-density lipoprotein cholesterol target achievement: How about low-income countries

Abstract

Dylipidemias are a major cardiovascular risk factor especially for the LDLc. The control of low-density lipoprotein cholesterol (LDLc) level is one of the major targets in patients admitted for an acute coronary syndrome (ACS). It is in this sense that the latest European recommendations of 2019 about dyslipidemias fall into line. The objective of our work was to study the lipid profile after ACS and to assess the degree of applicability of the European recommendation in Tunisia. This was a prospective, multicentric, non-randomized study involving consecutive patients hospitalized for ACS in the cardiology departments of Abdrerrahman Mami Hospital, Mohamed Taher Maamouri Hospital and Internal Security Forces hospital in Tunisia between 26/10/2019 and 07/03/2020 and not on lipid lowering treatment; for whom a lipid assessment was carried out on admission and checked after four to six weeks of the ACS under high dose of statin. One hundred patients were included. The average age of our population was 58.7 ± 11.6 years and the sex ratio was 5.6. Obesity was prevalent in 15%, Diabetes in 35%, hypertension in 34% and smoking in 61% of cases. Our patients presented with an ST segment elevation myocardial infarction (STEMI) in 51% of cases. Initially, the mean total plasma cholesterol level was 1.72 ± 0.33 g/L; the mean plasma trigliceride level was 1.61 ± 1.1 g/L; for high-density lipoprotein cholesterol (HDLc) it was 0.38 ± 0.09 g/L and for LDLc it was 1.04 ± 0.26 g/L. All patients have received high doses of statins: 76% received 80 mg of atorvastatin, 15% received 40 mg of atorvastatin, 9% received 20 mg rosuvastatin. They all were blood tested four to six months later. The results showed a decrease of the cholesterol level by 27.5%, the triglyceride level by 20.6% and the LDLc level by 38.2% and an increase of HDLc level by 6.5%. A level of LDLc ≤ 0.55 g/L was achieved in 46% and a decrease by 50% or more was observed in 33%. The therapeutic target was reached in only 30% of cases. The only therapeutic alternative was the diet and lifestyle changes due to the unavailability of molecules recommended by the European society of cardiology in Tunisia. Our results demonstrate the difficulty of reaching the therapeutic target of LDLc after an ACS in Tunisia. Several factors can be identified, essentially the absence of medical products recommended in the second and third line by the ESC in Tunisia.