Achievement of LDL-C goals in patients at moderate to very high cardiovascular risk on lipid-lowering drug therapy (cepheus II)

P41 Background: Recurrent coronary events and mortality are associated with elevated serum cholesterol levels in patients with acute myocardial infarction (AMI). It’s unclear what physicians’ current attitudes and practices are toward the management of high cholesterol levels in patients with recent AMI. We carried out a survey of practicing physicians to examine factors that influence physicians prescription of lipid-lowering and dietary therapy in patients with recent AMI and threshold levels of cholesterol for intervention. Methods: Mailed questionnaire survey of general internists, cardiologists, and family physicians practicing and/or having admitting privileges to all Worcester (MA) metropolitan hospitals. Results: Among the 257 responding physicians, lipid lowering therapy was more likely to be initiated in younger patients at lower total and LDL-cholesterol levels than in older patients. Younger physicians were more likely to initiate dietary and lipid lowering drug therapy at lower total and LDL-cholesterol levels. General practice physicians were more likely to initiate dietary therapy at lower total cholesterol levels, but more likely to initiate lipid lowering drug therapy at higher total and LDL-cholesterol levels, than internists and cardiologists. The most important factors reported by physicians which interfered with patient’s use of lipid lowering drug therapy were their concerns about medication costs, issues related to polypharmacy, and failure to recognize the importance of lipid lowering drugs. Several physician associated factors including provider responsibility and importance of other cardiac drugs were associated with the more widespread use of these medications. Conclusions: Results of this survey in a representative sample of community physicians suggest that older physicians are less likely to implement recommended treatment guidelines in patients with recent AMI and high cholesterol. Additional efforts are needed to modify potential barriers to the implementation of effective long-term cholesterol management in patients with recent AMI.

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Possibilities of combination lipid-lowering therapy in a patient with very high cardiovascular risk (сlinical case)

Consilium Medicum ◽

10.26442/20751753.2021.1.200604 ◽

2021 ◽

Vol 23 (1) ◽

pp. 70-73

Author(s):

Daria Yu. Sedykh ◽

◽

Natalia V. Fedorova ◽

Vasily V. Kashtalap ◽

◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Clinical Practice ◽

Cardiovascular Risk ◽

Lipid Lowering ◽

Lipid Lowering Therapy ◽

High Cardiovascular Risk ◽

Coronary Syndrome ◽

Lowering Therapy ◽

Lipid Metabolism Disorders ◽

Very High

The article demonstrates the possibility of prescribing an effective and safe lipid-lowering combination of the most tolerated doses of statins in combination with ezetimibe, using the example of a patient with severe lipid metabolism disorders in the post-infarction period. It has been shown that in real clinical practice, patients with acute coronary syndrome and persisting high LDL values are quite common, despite of the prescription of statins. These patients need closer follow-up and wider use of combined lipid-lowering therapy by adding ezetimibe to maximally tolerated doses of statins. Current clinical guidelines allow this to be done when patients fail to achieve target LDL values (>1.4 mmol/L) with statins monotherapy. This approach is effective and safe, which is illustrated by this hereditary clinical case. In routine clinical practice mandatory lipids control is required 4–6 weeks after patient’s discharge from the hospital for acute coronary syndrome. If the target lipids values were not achieved with the maximum dosage of statins, a mandatory using the combination therapy with ezetimibe is required. Keywords: myocardial infarction, dyslipidemia, improved prognosis, statins, ezetimibe For citation: Sedykh DYu, Fedorova NV, Kashtalap VV. Possibilities of combination lipid-lowering therapy in a patient with very high cardiovascular risk (сlinical case). Consilium Medicum. 2021; 23 (1): 70–73. DOI: 10.26442/20751753.2021.1.200604

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