Low-density Lipoprotein Cholesterol Target Attainment Research Articles

Monoclonal Anti-PCSK9 Antibodies: Real-World Data

Background: Real-world data on the use of lipid-lowering therapy (LLT) in clinical practice show that about 80% of (very) high-cardiovascular (CV)-risk patients disregard the 2019 European Society of Cardiology (ESC) Guidelines’ recommendations on dyslipidemias. The availability of proprotein convertase subtilisin/kexin type 9 monoclonal antibodies (PCSK9mAb) should reduce this gap. Our aim was to provide data on PCSK9mAb use in clinical practice, investigating the achievement of the ESC Guidelines’ recommendations in the real world. Methods: Between April 2018 and December 2022, patients who started on PCSK9mAb therapy (140 mg of evolocumab or 75 mg or 150 mg of alirocumab, subcutaneous injection every 2 weeks) were included in a prospective registry. Our cohort consisted of 256 patients: 95 (37.1%) were women (mean age: 65.43 ± 11.12 yrs), 53 (20.7%) were at high CV risk, and 203 (79.3%) were at very high CV risk. Results: After one year of PCSK9mAb treatment, nearly 60% of patients demonstrated full adherence to the ESC Guidelines’ recommendations, defined as achieving at least a 50% reduction in low-density lipoprotein cholesterol (LDL-C) levels along with reaching LDL-C target levels (≤55 and ≤70 mg/dL for very high and high risk, respectively). Concomitant high-dose statin therapy emerged as the primary predictor of LDL-C target attainment. Heterozygous familial hypercholesterolemia (HeFH), statin intolerance, and female gender were associated with a significant lower probability of achieving LDL-C target levels. Conclusions: Our analysis confirms that PCSK9mAb treatment is safe and effective, enabling 60% of our cohort to fully achieve the LDL-C guideline recommendations. The use of high-intensity statins emerged as a significant predictor of efficacy. Conversely, familial hypercholesterolemia and female gender were identified as predictors of therapeutic failure. Hence, it is crucial to address disparities in cardiovascular disease prevention between genders and to enhance strategies for managing elevated LDL-C in HeFH patients.

Implementation of risk-based lipid-lowering therapies in older (age ≥ 65 years) and very-old adults (age ≥ 75 years) with ischemic heart disease in the greater Salzburg region.

Introduction: European guidelines recommend the implementation of lipid-lowering therapies (LLTs) in adults (≥ 65years) with established atherosclerotic cardiovascular disease (ASCVD) and for risk-based primary prevention in older adults (≤ 75years), yet their use in very-old adults (> 75years) is controversial, discretionary, and oriented on the presence of risk factors. The aim of this retrospective study is to assess guideline-directed LLT implementation and low-density lipoprotein cholesterol (LDL-C) target achievement in high-/very-high-risk older/very-old adults (65-74 and ≥ 75years) at presentation for ST-segment elevation myocardial infarction (STEMI) and also to assess evidence-based care delivery to older adults in our region. Methods: All STEMI patients with available LDL-C and total cholesterol presenting for treatment at a large tertiary center in Salzburg, Austria, 2018-2020, were screened (n = 910). High-risk/very-high-risk patients (n = 369) were classified according to European guidelines criteria and divided into cohorts by age: < 65years (n = 152), 65-74years (n = 104), and ≥ 75years (n = 113). Results: Despite being at high-/very-high-risk, prior LLT use was < 40% in the total cohort, with no significant difference by age. Statin monotherapy predominated; 20%-23% of older/very-old adults in the entire cohort were using low-/moderate-intensity stains, 11%-13% were using high-intensity statins, 4% were on ezetimibe therapy, and none were taking proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors. In the secondary prevention cohort, 53% of older/very-old patients used prior LLTs. Significantly higher percentages of older/oldest ASCVD patients (43% and 49%) met LDL-C targets < 70mg/dL compared to patients < 65years (29%; p = 0.033), although just 22% and 30% of these older groups attained stricter LDL-C targets of < 55mg/dL. Low LLT uptake (16%) among older adults aged 64-74years for primary prevention resulted in 17% and 10% attainment of risk-based LDL-C targets < 70mg/dL and < 55mg/dL, respectively. Oldest adults (≥ 75years) in both primary and secondary prevention groups more often met risk-based targets than older and younger adults, despite predominantly receiving low-/moderate-intensity statin monotherapy. Conclusion: Secondary prevention was sub-optimal in our region. Less than half of older/very-old adults with established ASCVD met LDL-C targets at the time of STEMI, suggesting severe care-delivery deficits in LLT implementation. Shortcomings in initiation of risk-based LLTs were also observed among high-/very-high-risk primary prevention patients < 75years, with the achievement of risk-based LDL-C targets in 10%-48% of these patients.

Temporal trends and racial/ethnic- and sex-differences in LDL cholesterol control among US adults with self-reported atherosclerotic cardiovascular disease

ObjectiveCurrent guidelines for secondary prevention of atherosclerotic cardiovascular disease (ASCVD) recommend targeting a low-density lipoprotein cholesterol (LDL-C) of < 70 mg/dL. However, temporal trends and racial/ethnic- and sex-differences in achievement of LDL-C targets are not well described. We assessed trends and racial/ethnic- and sex-differences in achievement of LDL-C < 70 mg/dL using data from the National Health and Nutrition Examination Survey (NHANES) from 2005 to 2008 to 2017-March 2020. MethodsWe combined NHANES cycles into 4 periods: 2005–2008, 2009–2012, 2013–2016, and 2017-March 2020 and included participants ≥ 40 years with self-reported ASCVD. We estimated LDL-C < 70 mg/dL prevalence over time and further stratified by sex and race/ethnicity. We used multivariable logistic regression adjusted for social determinants of health and clinical covariates to model LDL-C target attainment. ResultsAmong 1,826 NHANES participants representing 7,161,221 US adults with self-reported ASCVD (59.6% ≥ 65 years, 56.4% male, 74.8% White), LDL-C target attainment increased from 19.0% (95% CI, 15.3%-23.3%) in 2005–2008 to 26.3% (95% CI, 20.4%-33.1%) in 2017-March 2020 (P = 0.012 for trend). Achievement of LDL-C < 70 mg/dL significantly rose among men from19.5% (95% CI, 15.1%-24.8%) to 29.4% (95% CI, 20.7%-29.9%) without significant change in women (from 18.3% [95% CI, 13.6%-24.2%] to 22.5% [95% CI, 13.0%-35.9%]; P = 0.241 for trend). Improvement in LDL-C target attainment was similar among White, Black, and Hispanic individuals (∼5–7% increase) and was greatest among individuals of other (non-White, Hispanic, or Black) race/ethnicity (23.1% increase). In our multivariable analysis, comorbid diabetes and ages 65–75 and > 75 years were associated with LDL-C target attainment. ConclusionLDL-C control modestly improved between 2005 and 2008 and 2017-March 2020; however, only ∼1/4 of individuals met guideline-directed LDL-C treatment targets by 2017-March 2020. Women had lower LDL-C control and lesser magnitude of improvement in LDL-C control than men, highlighting a need for targeted interventions to improve lipid-lowering therapy utilization in this population.

Prevalence and outcomes of familial hypercholesterolemia in young patients undergoing coronary bypass surgery

Abstract Background Familial hypercholesterolemia (FH) is an autosomal dominant genetic disorder of lipoprotein metabolism, with elevated low-density lipoprotein cholesterol (LDL) levels and increased risk of premature coronary disease. Appropriate management substantially reduces the risk of adverse events; however, FH is frequently under-recognised and under-treated. The prevalence of FH amongst younger patients undergoing coronary bypass surgery, as well as their clinical outcomes, has not been described. Purpose This study aimed to determine the prevalence of FH in patients undergoing coronary bypass surgery prior to age 60 years. The association of FH on attainment of LDL targets and subsequent adverse cardiovascular events was also determined. Methods A retrospective analysis of all patients undergoing coronary bypass surgery prior to the age of 60 years was conducted at an Australian tertiary hospital during the period April 2008 and July 2022. Exclusion criteria were severe renal or hepatic impairment, uncontrolled malignancy, severe inflammatory or infectious disease, or lipid data unavailable. Baseline demographics and risk factors at the time of surgery were identified by a search of the Statewide Cardiothoracic Database. Blood lipid levels (highest, pre-surgery and most recent) and clinical outcomes were obtained from digital medical records. Dutch Lipid Clinic Network Scores (DLCNS) were calculated for all patients and grouped as ‘unlikely FH’ (DLCNS &amp;lt;3), ‘possible FH’ (DLCNS 3 – 5), or ‘probable / definite FH’ (DLCNS ³ 6). Attainment of LDL targets (&amp;lt;1.8mmol/L and &amp;lt;1.4mmol/L) and subsequent major adverse cardiovascular events (MACE) were compared between the ‘unlikely’ and ‘probable / definite’ FH groups. Results During the study period, 683 patients underwent coronary bypass procedures prior to the age of 60. 93 were excluded, leaving a study population of 590, with a median follow up of 7.9 years [IQR 4.7, 12.1]. Baseline characteristics are outlined in table 1. 80 patients (13.6%) were classified as ‘definite/probable FH’, 249 (42.2%) as ‘possible FH’ and 261 (44.2%) ‘unlikely FH’. As observed in table 2, patients with definite/probable FH had a significantly higher prevalence of uncontrolled lipids (81.2%) and MACE (21.3%) compared to patients with unlikely FH. For MACE, this result remained statistically significant after adjusting for age, sex, smoking status, hypertension, diabetes and surgery type (elective vs urgent) - OR 2.52 [95% CI 1.0 - 6.4]. Conclusion FH is highly prevalent in young patients undergoing coronary bypass surgery. These patients are less likely to achieve LDL targets and are more likely to suffer adverse cardiovascular events in the years following surgery. Detection of these patients may improve LDL management and clinical outcomes as well as the yield of new cases through cascade testing of close relatives.Table 1:Baseline CharacteristicsTable 2:Outcomes

Attainment of the low-density lipoprotein cholesterol treatment target and prognosis of heterozygous familial hypercholesterolemia

Abstract Background and aims No previous study has investigated the association between attainment of low-density lipoprotein (LDL) cholesterol treatment target and better prognosis in patients with familial hypercholesterolemia (FH). The current research aimed to examine the association between attainment of LDL cholesterol treatment target and major adverse cardiac events (MACEs) in patients with FH to validate the current LDL cholesterol treatment targets in primary (&amp;lt; 100 mg/dL) and secondary (&amp;lt; 70 mg/dL) prevention settings. Methods The data of patients with FH who were admitted to our university hospital between 2000 and 2020 and who were followed-up were retrospectively reviewed. The number of MACEs, including mortality associated with cardiovascular disease, unstable angina, and myocardial infarction per 1,000 person-years, was calculated for each stratum for the attainment of LDL cholesterol target. Results The median follow-up duration was 12.6 years. In total, 132 MACEs were recorded during the follow-up period. The numbers of patients who attained the LDL cholesterol target in the primary and secondary prevention groups were 228 (31.9%) and 40 (11.9%), respectively. The event rates per 1,000 person-years for LDL cholesterol levels of &amp;lt; 100 and ≥ 100 mg/dL in the primary prevention group were 2.6 and 4.4, respectively. The event rates per 1,000 person-years for LDL cholesterol levels of &amp;lt; 70 and ≥ 70mg/dL in the secondary prevention group were 15.3 and 27.5, respectively. Conclusion Attainment of the LDL cholesterol target is associated with better prognosis in patients with FH. However, the attainment rate is currently inadequate among Japanese.

Guideline-directed low-density lipoprotein cholesterol management following acute ischemic stroke: findings from Clalit health services

Abstract Background Patients with ischemic stroke are at high risk for future cardiovascular events and should be treated intensively with lipid-modifying agents. Combination lipid-lowering therapies are often needed to achieve updated (2019) guideline-directed treatment goals. However, real-world data on intensification of lipid-lowering therapies and attainment of low-density lipoprotein cholesterol (LDL-C) targets after ischemic stroke are limited. Methods Data from a single national health care service on patients hospitalized with acute ischemic stroke between Jan. 2020 and Feb. 2022. Included were 3027 patients surviving ≥1-year post-stroke, with documented LDL-C levels and lipid-lowering medications at 2 timepoints (&amp;lt;3 months and during 6-12 months post-discharge). Participants were classified according to preexisting stroke and/or coronary artery disease (CAD). Results LDL-C levels &amp;lt;70 mg/dL and &amp;lt;55 mg/dL were attained by 42.3% and 22.9% of patients early post-hospitalization, and in 49.5% and 27.1% during 6-12 months post-hospitalization, respectively. Attainment of guideline-recommended LDL-C goals was higher in those with preexisting cardiovascular disease. The use of combination lipid-lowering therapy (ezetimibe and/or PCSK9 inhibitor plus statin) increased between the 2 timepoints: from 2% to 3.2% in those without prior stroke and/or CAD, and from 5.4% to 7% in those with prior stroke and/or CAD. Conclusions Despite the advances in drug development and the availability of several mechanisms to lower cholesterol levels, the attainment of guideline-recommended LDL-C targets after acute ischemic stroke is suboptimal. Intensification of treatment with combination lipid-lowering therapies 6-12 months following hospitalization is uncommonly performed in clinical practice, even in those with preexisting cardiovascular disease.

Patients who suffer a first atherosclerotic cardiovascular event while taking statins are often far off of lipid targets

Background and aimsDespite considerable evidence that lipid-lowering therapies (LLTs) afford clinical benefit, the control of low-density lipoprotein cholesterol (LDL-C) is suboptimal, and available LLTs are underused, especially in patients at high and very high cardiovascular (CV) risk. This study assesses the real-world LDL-C target attainment rate in patients on LLT before experiencing a first major acute cardiovascular event (MACE). Methods and resultsThe HEARTBEAT was a retrospective, multicentre observational study. From March to June 2021 a total of 334 patients on LLT who had a first MACE while being on statins were included in the study. Of these patients, 83.2 % had a high (40.7 %) or very high CV risk (29.0 %) prior to MACE. Overall, 87.5 % and 89.7 % of the patients at high and very high CV risk, respectively, failed to reach the LDL-C target. Regarding LLTs, only 11.8 % and 19.6 % of the patients at high and very high risk had received high-intensity LLTs prior to MACE. It was estimated that if these patients had reached their recommended LDL-C targets, the risk of MACE may have been reduced by a median of 24.5 % and 23.2 % in patients at high and very high risk respectively. ConclusionsPatients who suffer a first MACE while on statin therapy often were at high/very high CV risk. Despite their risk, LDL-levels and being on statins they are undertreated, and too far from lipid targets. A proper use of high-intensity LLTs led to an increase attainment of LDL targets and lower CV events.

Effect of lipid-lowering treatment on lipid and glycemic profile of patients with elevated lipoprotein(a) levels

Aim: The evaluation of the effect of lipid-lowering treatment in patients with elevated levels of lipoprotein(a) [Lp(a)]. Material and methods: A prospective study including 70 patients with dyslipidemia and elevated Lp(a) levels (&gt;30 mg/dL) attending a Lipid Clinic in Greece. Subjects were allocated to the following therapies according to the national guidelines for cholesterol management: high-intensity statin monotherapy (S; n=28), ezetimibe added to high-intensity statin (SE; n=31), and proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor added to high-intensity statin plus ezetimibe (SEP; n=11). Follow-up duration was 3 months. We investigated the effect of these lipid-lowering interventions on participants’ lipidemic and glycemic profile. Comparisons between groups were adjusted for the baseline levels of the studied parameters. Results: Mean age was 51 ± 15 years, 40% were male, 39% were diagnosed with familial hypercholesterolaemia (FH), 16% with atherosclerotic cardiovascular disease (ASCVD), while 36%, 33% and 15% were at very high, high, and moderate cardiovascular risk, respectively. All interventions significantly reduced apolipoprotein B (apoB), total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C), but only PCSK9 inhibitors significantly reduced Lp(a) levels (SEP: -28% vs SE: +11% vs S: +17%, p&lt;0.05). Patients in the SE group achieved the highest rates of LDL-C target attainment (SEP: 36.4% vs SE: 12.9% vs S: 3.6% for LDL-C &lt;55 mg/dL; SEP: 36.4% vs SE: 16.1% vs S: 7.1% for LDL-C &lt;70 mg/dL, p&lt;0.05 for the comparison among groups). No significant effect on glycemic profile across treatment groups was noted. Conclusions: Add-on PCSK9 inhibitors were associated with the highest rates of LDL-C target achievement compared with high-intensity statin ± ezetimibe in high-risk patients with elevated Lp(a) and were the only class to significantly lower Lp(a) levels.

Guideline-Directed Low-Density Lipoprotein Cholesterol Management After Acute Ischemic Stroke: Findings from a National Health Care Service

Patients with ischemic stroke are at high risk for future cardiovascular events and should be treated intensively with lipid-modifying agents. Combination lipid-lowering therapies are often needed to achieve updated guideline-directed treatment goals. However, real-world data on intensification of lipid-lowering therapies and attainment of low-density lipoprotein cholesterol (LDL-C) targets early after ischemic stroke are limited. We extracted data from the largest healthcare provider in Israel on patients hospitalized with acute ischemic stroke between January 2020 and February 2022. Included were 3,027 patients surviving ≥1 year after stroke, with documented LDL-C levels and lipid-lowering medications at 2 time periods (0 to 3months and 6 to 12months after discharge). Participants were classified according to preexisting stroke and/or coronary artery disease. The use of combination lipid-lowering therapy (ezetimibe and/or proprotein convertase subtilisin/kexin type 9 [monoclonal antibodies] inhibitor plus statin) in the study population increased between the 2 timepoints from 3.6% to 5.1%, reaching 10.5% in those with previous coronary artery disease and stroke. LDL-C levels <70 and <55mg/100ml were attained by 42.3% and 22.9% of patients early after hospitalization, and in 49.5% and 27.1% during 6 to 12months after hospitalization, respectively. Attainment of guideline-recommended LDL-C goals was higher in patients treated with combination lipid-lowering therapies and in those with preexisting cardiovascular disease. In conclusion, despite the advances in drug development and the availability of several mechanisms to lower cholesterol levels, the attainment of guideline-recommended LDL-C targets after acute ischemic stroke is suboptimal. Intensification of treatment with combination lipid-lowering therapies after hospitalization is uncommonly performed in clinical practice, even in those with preexisting cardiovascular disease.

Attainment of the low-density lipoprotein cholesterol treatment target and prognosis of heterozygous familial hypercholesterolemia

Background and aimsNo previous study has investigated the association between attainment of low-density lipoprotein (LDL) cholesterol treatment target and better prognosis in patients with familial hypercholesterolemia (FH). The current research aimed to examine the association between attainment of LDL cholesterol treatment target and major adverse cardiac events (MACEs) in patients with FH to validate the current LDL cholesterol treatment targets in primary (<100 mg/dL) and secondary (<70 mg/dL) prevention settings. MethodsThe data of patients with FH who were admitted to Kanazawa University Hospital between 2000 and 2020 and who were followed-up were retrospectively reviewed. The number of MACEs, including mortality associated with cardiovascular disease, unstable angina, and myocardial infarction per 1000 person-years, was calculated for each stratum for the attainment of LDL cholesterol target. ResultsThe median follow-up duration was 12.6 years. In total, 132 MACEs were recorded during the follow-up period. The numbers of patients who attained the LDL cholesterol target in the primary and secondary prevention groups were 228 (31.9%) and 40 (11.9%), respectively. The event rates per 1000 person-years for LDL cholesterol levels of <100 and ≥100 mg/dL in the primary prevention group were 2.6 and 4.4, respectively. The event rates per 1000 person-years for LDL cholesterol levels of <70 and ≥70 mg/dL in the secondary prevention group were 15.3 and 27.5, respectively. ConclusionsAttainment of the LDL cholesterol target is associated with better prognosis in patients with FH. However, the attainment rate is currently inadequate among Japanese.

Low-density lipoprotein cholesterol target attainment among statin-naive Chinese atherosclerotic vascular disease patients

Abstract Background Low-density lipoprotein cholesterol (LDL-C) of patients with atherosclerotic vascular disease (ASCVD) is expected to be lowered by ≥50% and &amp;lt;1.4 mmol/L. Despite the use of lipid-lowering therapies, most of Chinese patients failed to meet the treatment target. Purpose We aimed to evaluate the potential of different statin intensities on LDL-C target attainment among statin-naïve Chinese ASCVD patients. Methods We retrospectively analyzed statin-naïve ASCVD patients who were initiated with statin therapy between January and July 2020 from 43 public hospitals or clinics in Hong Kong. Patients were divided into high-intensity (HI-S, atorvastatin 40–80 mg, rosuvastatin 20–40 mg), moderate-intensity (MI-S, atorvastatin 10–20 mg, rosuvastatin 5–10 mg, simvastatin 20–40 mg) and low-intensity (LI-S, simvastatin 10 mg) statin groups. With baseline and follow-up LDL-C, percentage reduction was calculated and the distance to LDL-C target was investigated within groups. Results Of 7,241 patients (mean age 61.8±12.4 years and 64.2% male), 4,451 (61.5%) had coronary artery disease, 109 (1.5%) peripheral artery disease, and 2,879 (39.8%) cerebrovascular disease. HI-S, MI-S and LI-S were prescribed in 20% (n=1,450), 61.1% (n=4,421) and 18.9% (n=1,370) patients, respectively. Mean baseline LDL-C was 2.9±1.0 mmol/L and mean follow-up value was 1.9±0.8 mmol/L with median LDL-C reduction of 46.1%, 40.4%, and 32.0% by HI-S, MI-S, and LI-S, respectively. 42.1%, 31.8%, and 14.7% of patients on HI-S, MI-S, and LI-S achieved ≥50% LDL-C reduction and only 23.5%, 18.2%, and 8.8% reached both ≥50% LDL-C reduction and &amp;lt;1.4 mmol/L. One in ten patients require further ≥50% LDL-C reduction to reach &amp;lt;1.4 mmol/L. Conclusion In statin-naïve Chinese ASCVD patients, most patients did not reach guidelines recommended LDL-C target even with high-intensity statin. Early statin up-titration or addition of non-statin lipid-lowering therapy may be required in majority of patients. Funding Acknowledgement Type of funding sources: None.

Prevalent use of high-intensity statin therapy and LDL-C target attainment among PAD patients undergoing angioplasty.

Background: The global burden of peripheral arterial disease (PAD) is substantial. Reducing the major modifiable risk factors for noncommunicable disease, including dyslipidaemia, represents a public health priority. Aim is to evaluate the prevalent adequate use of lipid-lowering therapy (LLT) and low-density lipoprotein cholesterol (LDL-C) attainment among patients with PAD of the lower extremities undergoing percutaneous transluminal angioplasty. Patients and methods: We screened PAD patients treated at the University Hospital Zurich (January 2012-December 2018). We excluded patients <18 years, without classifiable severity of PAD, or with missing LDL-C or medication data. In this cross-sectional study, we studied the prevalent LLT use and LDL-C values in target according to the most recent European guidelines. Available clinical data included demographic information, lipid profile, type and dose of LLT, characteristics of the artery obstruction and angioplasty. Results: A total of 2,148 angioplasties were performed in 956 patients: 614 (64%) were men; the mean age was 70.6 (SD 11.4) years. A total of 608 (64%) had a non-critical PAD (Fontaine stage I-IIb), whereas the remaining had a critical limb ischemia or a diabetic foot syndrome. Their median LDL-C value was 2.00 (Q1-Q3: 1.50-2.60) mmol/L. In accordance to the 2016 and 2019 European Society of Cardiology guidelines, the LDL-C target of 1.8 and 1.4 mmol/L was not reached in 63% (n=599) and in 79% (n=760) of patients, respectively. Only 41% (n=390) of patients were on high-intensity statin therapy. Conclusions: The attainment of LDL-C targets, as recommended by current European guidelines, and the use of high-intensity LLT were unsatisfactory in the majority of PAD patients.

Low-density lipoprotein cholesterol target attainment in post-acute coronary syndrome patients: About a prospective study

Background and Aims : - During acute coronary syndrome(ACS), lowering LDLc with high-dose statins reduces the risk of recurrent cardiovascular events, which is why the 2019 ESC recommendations advocate lowering LDLc to less than <0.55g/l and reducing the initial level by 50%. - In our country, little data is available on LDLc levels. through this study, never realized in Algeria before, We aimed to assess LDLc target attainment in post-ACS patients according to the latest recommendations.Methods: - This observational study was realized at the cardiology department of Hussein Dey hospital, from September 2020 to January 2021, 146 patients hospitalized for ACS were included, 80,8% were male. - lipid assessment was performed after admission and 08 weeks after the start of statin. All patients received « Atorvastatin 80mg » as a lipid-lowering treatment(LLT). - Statistical analyses were conducted using SPSS, factors associated with failure to achieve LDLc target were identified using multivariate logistic regression.View Large Image Figure ViewerDownload Hi-res image Download (PPT)View Large Image Figure ViewerDownload Hi-res image Download (PPT)Conclusions: - Despite the patient's adherence to treatment and the use of high-intensity statin, achieving an LDL-C target lower than 0.55 g/L is difficult. - The implementation of ezetimibe and PCSK9 inhibitors now seems unavoidable to help increase the achievement of the LDL-C target recommended. Background and Aims : - During acute coronary syndrome(ACS), lowering LDLc with high-dose statins reduces the risk of recurrent cardiovascular events, which is why the 2019 ESC recommendations advocate lowering LDLc to less than <0.55g/l and reducing the initial level by 50%. - In our country, little data is available on LDLc levels. through this study, never realized in Algeria before, We aimed to assess LDLc target attainment in post-ACS patients according to the latest recommendations. Methods: - This observational study was realized at the cardiology department of Hussein Dey hospital, from September 2020 to January 2021, 146 patients hospitalized for ACS were included, 80,8% were male. - lipid assessment was performed after admission and 08 weeks after the start of statin. All patients received « Atorvastatin 80mg » as a lipid-lowering treatment(LLT). - Statistical analyses were conducted using SPSS, factors associated with failure to achieve LDLc target were identified using multivariate logistic regression. Conclusions: - Despite the patient's adherence to treatment and the use of high-intensity statin, achieving an LDL-C target lower than 0.55 g/L is difficult. - The implementation of ezetimibe and PCSK9 inhibitors now seems unavoidable to help increase the achievement of the LDL-C target recommended.

Jena auf Ziel – JaZ” - A prospective cohort study aiming to get all patients with ST-elevation myocardial infarction on ESC/EAS LDL-C targets

Background and Aims : Low-density lipoprotein cholesterol (LDL-C) reduction is an essential part of the 2019 ESC/EAS dyslipidemia guidelines. “Jena auf Ziel – JaZ” is the first prospective study that aims at LDL-C target attainment in all patients with ST-elevation myocardial infarction (STEMI) and determination of reasons for failed target attainment.

Attainment of low-density lipoprotein cholesterol goals in statin treated patients: Real-world evidence from Australia.

Little is known about the attainment of low-density lipoprotein cholesterol (LDL-C) targets in patients treated with statins in Australian primary healthcare setting that are at increased risk of cardiovascular disease. A retrospective cohort study was conducted using data from electronic medical records of patients treated by general practitioners across Australia. LDL-C target attainment was defined as LDL-C levels ≤ 2 mmol/L for all risk groups, in line with Australian guidelines. Multivariable logistic regression was used to identify the factors associated with LDL-C target attainment. Overall, 61,407 patients were included in the analysis. The mean age was 65 years (± standard deviation [SD] 12.1); 52.0% were males.. Overall, the median LDL-C level was 2.3 mmol/L (IQR = 1.8 - 2.8) and 36.0% of the study population met therapeutic targets. Increased likelihood to achieve LDL-C targets was observed in patients diagnosed with type 2 diabetes (OR 2.07, 95% CI 1.92 - 2.24), stroke (OR = 1.58, 95% CI 1.39 - 1.79, P < 0.001) or chronic heart disease (OR = 1.67, 95% CI 1.55 - 1.81, P < 0.001). Patients diagnosed with dyslipidemia (OR = 0.59, 95% CI 0.55 - 0.64, P < 0.001), hypertension (OR = 0.91, 95% CI 0.83 - 1.00, P < 0.05) and current smokers (OR = 0.71, 95% CI 0.71 - 1.00, P < 0.05), were less likely to attain LDL-C targets, regardless of the type, intensity and length of use of the prescribed statin. Longer duration and higher intensity statin were associated with more patients achieving targeted LDL-C goal, however nearly two thirds of Australians still failed to achieve targeted outcome even after 24 months of statin therapy.

DF21-0402 Excessive Daytime Sleepiness Is Associated with Failure of Treatment Targets Attainment in Type 2 Diabetes

Background: The relationship between excessive daytime sleepiness (EDS) and glycemic control in people with type 2 diabetes (T2D) had been reported. However, the relationships of EDS with blood pressure and lipid control, as well as overall attainment of treatment targets remain unclear. Aim: To examine the association between EDS and treatment targets attainment in T2D. Method: This was a cross-sectional analysis of people with T2D enrolled in the Hong Kong Diabetes Register (HKDR). EDS was defined as a score >10 based on the Epworth Sleepiness Scale (ESS). Insomnia and anxiety/depression states were assessed using the Insomnia Severity Index (ISI) and the EQ-5D questionnaires respectively. Sleep habits including habitual snoring were assessed by a validated sleep questionnaire. Treatment targets attainment was defined as (1) glycated haemoglobin (HbA1c) < 7% (2) blood pressure < 140/90 mmHg, and (3) low density lipoprotein cholesterol (LDL-C) < 2.6 mmol/L. Results: Between 6th July 2010 and 27th May 2015, a total of 3637 T2D from HKDR were included in the present analysis. Among them, 19.8% had EDS. Using multivariate logistic regression analysis, EDS was associated with failure of attainment of all three treatment targets [Odds Ratio (OR) = 1.53 (95% confidence interval, CI=1.20, 1.95), p < 0.001] and LDL-C target [OR= 1.22 (95% CI= 1.02, 1.46), p = 0.033] after adjustment for age, gender, body mass index (BMI), T2D duration, insomnia and anxiety/depression status, use of anti-diabetic agents, anti-hypertensives, lipid regulating drugs and aspirin. For subgroup analysis of T2D with obesity (BMI > 25kg/m2), there were associations between EDS and failure to attain all three treatment targets [OR = 1.77 (95% CI=1.29, 2.43), p < 0.001], HbA1c target [OR = 1.32 (95% CI=1.05, 1.66), p = 0.018] and LDL-C target [OR = 1.29 (95% CI=1.03, 1.62), p = 0.029]. In contrast, there was no significant association between EDS and treatment targets in non-obese T2D. After further adjustment for habitual snoring, the association between EDS and failure to attain all three treatment targets [OR = 1.68 (95% CI= 1.21, 2.34), p = 0.002] and HbA1c target [OR = 1.28 (95% CI= 1.00, 1.63), p = 0.046] remained significant in obese T2D, while that with LDL-C target attainment was attenuated [OR = 1.25 (95% CI = 0.98, 1.59), p = 0.069]. Discussion: EDS is independently associated with failure of achieving glycemic and lipid targets, as well as a composite of all three treatment targets in obese individuals with T2D. Prospective studies are required to elucidate the causal relationship between EDS and metabolic control in obese T2D.

Risk stratification and low-density lipoprotein cholesterol goal attainment rates in patients with very high-risk or extreme high-risk atherosclerotic cardiovascular diseases regarding three guidelines

Objective: To explore the differences of risk stratification of very high-risk or extreme high-risk atherosclerotic cardiovascular diseases (ASCVD) and the attainment rates of low-density lipoprotein cholesterol (LDL-C) management targets evaluated by three different criteria, and the causal attributions of these differences. Methods: Patients with ASCVD were consecutively enrolled from January 1 to December 31 in 2019, and were evaluated for very high-risk or extreme high-risk and LDL-C goal attainment rates with 2018 American guideline on the management of blood cholesterol (2018AG), 2019 China Cholesterol Education Program (CCEP) Expert Advice for the management of dyslipidemias (2019EA) and 2020 Chinese expert consensus on lipid management of very high-risk ASCVD patients(2020EC), respectively. The causal attributions of the differences in attainment rates were analyzed as well. Results: A total of 1 864 ASCVD patients were included in this study. According to 2018AG, 2019EA and 2020EC, the proportions of the patients with very high-risk or extreme high-risk were 59.4%, 90.7%, and 65.6%, respectively. The absolute LDL-C target attainment rates were 37.2%, 15.7%, and 13.7%, respectively, the differences between each two rates were statistically significant (all P<0.001). As to the differences in attainment rates between 2020EC and 2018AG, 61.5% were due to the different LDL-C goal attainment values and 38.5% were caused by the different risk stratifications, while for the differences between 2020EC and 2019EA attainment rates, different LDL-C goal attainment values were responsible for 13.2%, and different risk stratifications were responsible for 86.8% of the differences. Conclusions: There are significant differences in the proportions and LDL-C attainment rates among the three different criteria for very high-risk or extreme high-risk ASCVD. 2020EC showed a moderate proportion of patients with extreme high-risk, and had the lowest LDL-C attainment rate. The differences between 2020EC and 2018AG are mainly due to the LDL-C target values, and the differences between 2020EC and 2019EA are mainly caused by the risk stratifications.

Long-term clinical impact of low-density lipoprotein cholesterol target attainment according to lesion complexity after percutaneous coronary intervention.

Long-term clinical outcomes of low-density lipoprotein cholesterol (LDL-C) target attainment according to coronary lesion complexity are limited. We investigated the clinical outcomes of LDL-C target attainment after percutaneous coronary intervention (PCI) according to coronary lesion complexity. A total of 1285 patients who underwent PCI was categorized by LDL-C target attainment at 1 year and lesion complexity: LDL-C levels less than or equal to 70 mg/dl ( n = 179) and greater than 70 mg/dl ( n = 308) in complex PCI; LDL-C levels less than or equal to 70 mg/dl ( n = 315) and greater than 70 mg/dl ( n = 483) in noncomplex PCI. The primary endpoint was major adverse cardiovascular events (MACEs) and defined as cardiac death, nonfatal myocardial infarction, and target vessel revascularization. At 8-year follow-up, comparison of patients with 1-year LDL-C levels less than or equal to 70 mg/dl and 1-year LDL-C levels greater than 70 mg/dl showed similar MACE incidence in the noncomplex PCI group (8.3% vs. 11.6%; P = 0.074) and significantly lower MACE incidence in the complex PCI group (11.7% vs. 19.2%; P = 0.023). After IPTW adjustment, 1-year LDL-C levels less than or equal to 70 mg/dl was associated with reduced MACE rate in both complex PCI and noncomplex PCI groups. Although the attainment of LDL-C levels less than or equal to 70 mg/dl was associated with reduced MACE rate in both complex PCI and noncomplex PCI groups, long-term clinical benefits were prominent in the complex PCI group.

Evaluation of Low-density Lipoprotein Cholesterol Target Attainment Rates According to the 2016 and 2019 European Society of Cardiology/European Atherosclerosis Society Dyslipidemia Guidelines for Secondary Prevention in Patients with Acute Myocardial Infarction.

High-intensity statin (HIS) therapy is widely recommended for secondary prevention after an acute myocardial infarction (AMI). The 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidemia guidelines have lowered the target low-density lipoprotein cholesterol (LDL-C) level, which necessitates a more frequent use of nonstatin therapies. The objectives of the study were to investigate the rate of LDL-C target attainment for secondary prevention in AMI patients. This retrospective investigation included 1360 patients diagnosed with AMI in a tertiary heart center. Lipid parameters were collected within 24 h of admission and within 1 year after discharge. The medications used were retrieved from medical records, and the lowest LDL-C levels after statin treatment were used to assess the effectiveness of the therapy. LDL-C target attainment was defined according to the 2016 ESC/EAS dyslipidemia guidelines as an LDL-C level of < 70 mg/dL and a ≥ 50% reduction from baseline. In addition, the rate of LDL-C target attainment according to the 2019 fromESC/EAS guidelines was defined as an LDL-C level of < 55 mg/dL and a ≥ 50% reduction baseline. In total, 502 (36.9%) and 247 (18.2%) patients reached the LDL-C targets according to the 2016 and 2019 ESC/EAS guidelines, respectively. The admission LDL-C levels were significantly lower and HIS treatment was used more frequently in patients who subsequently attained the LDL-C goal. Remarkably, 461 (34%) patients failed to reach the LDL-C goals despite HIS treatment. Only 27 (1.9%) patients were prescribed ezetimibe. The rate of LDL-C goal attainment in AMI patients was low, which indicates the need for combination statin and non-statin lipid-lowering therapies.

A Narrative Review and Expert Panel Recommendations on Dyslipidaemia Management After Acute Coronary Syndrome in Countries Outside Western Europe and North America.

Patients who have experienced an acute coronary syndrome (ACS) are at very high risk of recurrent atherosclerotic cardiovascular disease (CVD) events. Dyslipidaemia, a major risk factor for CVD, is poorly controlled post ACS in countries outside Western Europe and North America, despite the availability of effective lipid-modifying therapies (LMTs) and guidelines governing their use. Recent guideline updates recommend that low-density lipoprotein cholesterol (LDL-C), the primary target for dyslipidaemia therapy, be reduced by ≥ 50% and to < 1.4 mmol/L (55 mg/dL) in patients at very high risk of CVD, including those with ACS. The high prevalence of CVD risk factors in some regions outside Western Europe and North America confers a higher risk of CVD on patients in these countries. ACS onset is often earlier in these patients, and they may be more challenging to treat. Other barriers to effective dyslipidaemia control include low awareness of the value of intensive lipid lowering in patients with ACS, physician non-adherence to guideline recommendations, and lack of efficacy of currently used LMTs. Lack of appropriate pathways to guide follow-up of patients with ACS post discharge and poor access to intensive medications are important factors limiting dyslipidaemia therapy in many countries. Opportunities exist to improve attainment of LDL-C targets by the use of country-specific treatment algorithms to promote adherence to guideline recommendations, medical education and greater prioritisation by healthcare systems of dyslipidaemia management in very high risk patients. Video Electronic supplementary materialThe online version of this article (10.1007/s12325-020-01302-4) contains supplementary material, which is available to authorized users.