PRESCRIPTIVE APPROPRIATENESS OF CHOLESTEROL-LOWERING DRUGS AMONG PATIENTS ATTENDING CARDIAC REHABILITATION AFTER ATHEROSCLEROTIC CARDIOVASCULAR DISEASE. RETROSPECTIVE STUDY

Abstract

Objective: Cardiovascular (CV) diseases still represent one on the main causes of death. The promotion of a healthy lifestyle and active treatment of CV risk factors such as cholesterol level is mandatory to reduce risk of unfavourable outcome. Aim of the present study was to investigate the prescriptive appropriateness of cholesterol-lowering drugs among patients who experienced an atherosclerotic CV disease (ASCVD). Design and method: We investigate 155 patients who experienced an ASCVD and underwent cardiac rehabilitation in 2020. The ESC 2021 guidelines on CVD prevention and 2019 ESC Guidelines on dyslipidaemias were followed to detect appropriateness; SCORE2 and SCORE2-OP risk estimation were used to detect patients’ CV risk profile. For the analysis patients were divided into two groups: 1 (n = 118) patients admitted for the first CV event, 2A (n = 18) patients who experienced a previous CV event and were admitted for a second event, 2B (n = 19) patients within a previous CV event within 2 years. LDL cholesterol (c-LDL) was detected at admission to hospital, during rehabilitation and at the first visit after rehabilitation, within 6 to 12 months. Results: Mean age of study participants was 66 years (41-88), 88.4% were males, 72% were overweight/obese, 25% diabetic, 37% smokers, 60% hypertensives, 57% dyslipidemic. Among group 1 patients, with no previous CV events, only 5.1% had low/moderate risk, 44.1% high risk and 50.8 very high risk according to SCORE2 or SCORE2-OP calculator. Mean c-LDL at admission to hospital was 121.5 mg/dl, 58.8 mg/dl during rehabilitation 58mg/dl at the subsequent medical visit. 32.6% reached c-LDL<55 mg/dl, 96.6% with high intensity statin (as monotherapy or associated to ezetimibe). 67.4% did not reach c-LDL<55mg/dl, despite 93.3% were treated with high intensity statin alone or plus ezetimibe. Among group 2A patients 47.1% reached c-LDL<55 mg/dl by mean of high intensity statin (87.5%), while among 2B patients only 3 subjects reached c-LDL<40 mg/dl. Conclusions: This retrospective study confirmed the importance of primary prevention and the utility to calculate CV risk profile. The main limitations for the efficacy lipid lowering drugs resulted: patient's compliance, drugs side effects, lifestyle habits and collaboration with general practitioner.