Suboptimal treatment of dyslipidemia in clinical practice

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Recent European Society of Cardiology (ESC) guidelines on the treatment of dyslipidemia recommend a target threshold <55 mg/dL of low density lipoprotein (LDL) cholesterol in patients with coronary artery disease. Some studies have suggested that most patients do not reach their LDL target. There is little evidence about the extend of this problem among patients treated in a University Hospital. Purpose Patterns of statin treatment and efficasy based on the achivement of LDL target level according to current and previous ESC guidelines. Methods We obtained clinical and laboratory data from 100 consecutive patients, whom were previously diagnosed and treated for coronary artery disease, and were readmitted at our hospital either for planned intervention or for signs or symptoms of ischemic heart disease. During the period between the 2 hospitalizations, all patients were under the supervision of their family physician or local cardiologyst. We analyzed patterns of statin treatment and their effect on cholesterol level regarding achivement of target threshold based on current and previous ESC guidelines. Results At first hospitalization, mean age was 65 +/- 9. 80% of the patinets were male. Mean total cholesterol levels were 190+/-52 mg/dl and mean LDL cholesterol levels were 133 +/-45 mg/dl on admission. On discharge a high intensity statin was prescribed in 75% of the patients, and a combination of Ezetimibe with statin was prescribed in 5% of them. On readmission mean total cholesterol levels were 163+/-46 mg/dl and mean LDL cholesterol levels were 109 +/-42 mg/dl. 79% of the patients were on a high intensity statin regime, and none of them were taking Ezetimibe. A target LDL chol <70 mg/dl recommended by 2016 ESC guidelines was reached in 21% of the patients, while a target LDL chol < 55 mg/dl recommended by 2019 ESC guidelines was reached in only 8% of the patients. Between the two hospitalizations, 39 (39%) of the patients had their lipid lowering therapy modified. 26 (26%) of them had an increase in statin dosage, all of them following their cardiologyst reccomendation. 13 patinets (13%) had a reduction in statin dosage and interruption of Ezetimibe treatment, despite the lack of any side effect. 4 of them following their cardiologyst reccomendation, 6 following their family physician, lab physician or pharmacist reccomendation and the last 3 patient decided on their own. Conclusions Implementation of guidelines in dyslipidemia treatment for secondary prevention in clinical practice is far from optimal even for patients discharged from an University Hospital. Additional efforts should be done to raise the awareness of all health care actors about the necessity of treatment with high dose statins and achivements of recommendet LDL target threshold for patienst with coronary artery disease.