Lipid Management after Coronary Surgery: How Effective are we at Secondary Prevention?

Abstract Despite many improvements in its prevention and management, acute coronary syndrome (ACS) remains a major cause of morbidity and mortality in the developed world. Lipid management is an important part of secondary prevention after ACS, but many patients currently remain undertreated and do not attain guideline‐recommended levels of low‐density lipoprotein cholesterol reduction. This review details the current state of evidence on lipid management in patients presenting with ACS, provides directions for identification of patients who may benefit from early escalation of lipid‐lowering therapy, and discusses novel lipid‐lowering medication that is currently under investigation in clinical trials. Moreover, a treatment algorithm aimed at attaining guideline‐recommended low‐density lipoprotein cholesterol levels is proposed. Despite important advances in the initial treatment and secondary prevention of ACS, ≈20% of ACS survivors experience a subsequent ischemic cardiovascular event within 24 months, and 5‐year mortality ranges from 19% to 22%. Knowledge of the current state of evidence‐based lipid management after ACS is of paramount importance to improve outcomes after ACS.

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Non-Attendance at Secondary Prevention Clinics: The Effect on Lipid Management

Scottish Medical Journal ◽

10.1177/003693300505000204 ◽

2005 ◽

Vol 50 (2) ◽

pp. 54-56 ◽

Cited By ~ 3

Author(s):

A L McLeod ◽

L Brooks ◽

V Taylor ◽

A Wylie ◽

P F Currie ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Secondary Prevention ◽

Total Cholesterol ◽

Outpatient Clinic ◽

Lipid Profiles ◽

Lipid Management ◽

Cholesterol Levels ◽

Artery Disease

Background: Secondary prevention of coronary artery disease is effective in reducing morbitiy and mortality. Our aim was to assess lipid management following non-attendance to a hospital based secondary prevention clinic Methods: Data were collected over 5 years on statin usage and total cholesterol levels for patients with coronary artery disease following attendance at a cardiac nurse led outpatient clinic. Lipid levels were taken from a central laboratory database, for both patients discharged from clinic and non-attenders. Results: From 935 inpatients discharged from hospital, 248 (29%) defaulted from outpatient follow up. Lipid lowering drug usage was similar (72% vs. 74% for non-attenders, p=NS). Attenders at the nurse led outpatient clinic were more likely to achieve a total cholesterol <5mmol/L at discharge than non-attenders (70% vs. 43%;p<0.001), with a lower mean total cholesterol (4.75 ± 0.06 mmol/L vs. 5.33±0.08 mmol/L; p<0.001). Non-attenders subsequently had a greater number of cholesterol measurements than those who were discharged from the hospital based clinic (range 0–12, c2 23.8 on 12df, p<0.05). Lipid profiles in hospital non-attenders remained inferior with fewer achieving a total cholesterol <5mmol/L (61% vs. 78%; p<0.001), and having greater mean total cholesterol levels (4.85 ± 0.06 mmol/L vs. 4.52 ± 0.05 mmol/L; p< 0.001). Conclusions: Patients defaulting from hospital follow up have higher total cholesterols with fewer at target level compared to attenders. Though non-attenders receive subsequent lipid measurement, inferior lipid profiles persist compared to patients who completed hospital follow up to be discharged. Further implementation strategies are needed with regard to lipid management in this patient group.

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P6444Cardiovascular secondary prevention setting and lipid controlu, update data from PINNACLE BRAZIL REGISTRY

European Heart Journal ◽

10.1093/eurheartj/ehz746.1038 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

J F K Saraiva ◽

A Cordeiro Mattos ◽

G B F Saraiva ◽

I M Pinto ◽

A R Rombaldi ◽

...

Keyword(s):

Clinical Practice ◽

Secondary Prevention ◽

Statin Therapy ◽

Case Report Form ◽

Lipid Management ◽

Electronic Case Report Form ◽

Artery Disease ◽

Lipid Control ◽

One Year

Abstract Introduction Lipid control is highly effective and improves clinical outcomes in coronary artery disease (CAD) patients, thus is one of the pillars of the cardiovascular secondary prevention. Purpose The aim of this preliminary analysis was to describe the lipid management in CAD patients in Brazil after one year of the clinical practice registry. Methods Patients with documented CAD were included by using electronic case report form based on the ACC PINNACLE Registry. The registry has been enrolling patients from general practitioners and specialists. Patients data were evaluated after 01 year of follow-up on regular clinical appointments and the differences on clinical practice were evaluated Results Currently, PINNACLE-Brazil enrolled individuals, with 2234 (29.4%) patients with CAD. Prescription of statin therapy was identified in 85.6% baseline and 78.3% follow-up. CAD patients with LDL-c <100 mg/dL were 47.3% baseline and 38.5% follow-up and at least one lipid profile assessment occurred in 60.9% baseline and 51.2% follow-up. CAD patients who have an LDL-c result <100 mg/dL, or >100 mg/dL with a documented plan to achieve LDL-c <100 mg/dL, were 48.1% (baseline) and 38.5% (follow-up). Conclusion The preliminary results of PINNACLE-Brazil show that, despite the relatively high prescription rate of statin therapy, LDL-c targeted level for CVD secondary prevention has not been achieved in the majority of patients after 01 year of follow-up. Nationwide knowledge translation initiatives are needed to improve the CVD burden in Brazil Acknowledgement/Funding ACC Foundation

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Therapeutic inertia in lipid management of diabetic patients in secondary prevention

Endocrine Abstracts ◽

10.1530/endoabs.70.ep125 ◽

2020 ◽

Author(s):

Lorea Herráiz ◽

Rona Penso ◽

Grado Teresa De ◽

Irene Crespo ◽

Laura Mola ◽

...

Keyword(s):

Secondary Prevention ◽

Diabetic Patients ◽

Lipid Management ◽

Therapeutic Inertia

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Lipid lowering therapy in primary and secondary prevention in Austria: are LDL-C goals achieved?

Wiener klinische Wochenschrift ◽

10.1007/s00508-021-01978-w ◽

2021 ◽

Author(s):

Peter Siostrzonek ◽

Helmut Brath ◽

Robert Zweiker ◽

Heinz Drexel ◽

Robert Hoelzl ◽

...

Keyword(s):

Secondary Prevention ◽

High Intensity ◽

Lipid Lowering ◽

Moderate Intensity ◽

Lipid Lowering Therapy ◽

Pcsk9 Inhibitors ◽

Cross Sectional ◽

Lipid Management ◽

Lowering Therapy ◽

Statin Monotherapy

Summary Background Cardiovascular disease (CVD) is the most frequent cause of death in Austria. The European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines recommend intensive lipid lowering therapy (LLT) in patients at high or very high CV risk. Lipid management and achievement of low-density lipoprotein cholesterol (LDL-C) goals in Austria have not recently been assessed. Methods Subgroup analysis for Austria of a European 18 country, cross-sectional, observational study. Patients received LLT for primary (PP) or secondary prevention (SP). Data including LLT in the preceding 12 months and most recent LDL‑C were collected during a single visit between June 2017 and November 2018. Achievement of the risk-based 2016 and 2019 ESC/EAS LDL‑C goal while receiving stabilized LLT was assessed. Results A total of 293 patients were enrolled from 8 Austrian sites, of which 200 (PP = 104, SP = 96) received stabilized LLT at the LDL‑C measurement date. Overall, 58% (71% PP, 43% SP) and 38% (52% PP, 23% SP) achieved the risk-based 2016 and 2019 goals, respectively. Most patients received moderate-intensity statin monotherapy (46%), while 34% used high-intensity statin monotherapy. Combination therapy of moderate/high-intensity statin with ezetimibe (12%), or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors with statin ± ezetimibe (1%), was used infrequently. Conclusion The current Austrian routine lipid management using mainly moderate-intensity or high-intensity statin monotherapy is insufficient to attain ESC/EAS guideline goals, in particular the more stringent 2019 recommendations, a situation comparable to other participating European countries. In addition to switching to and optimizing doses of high-intensity statins, a combination with ezetimibe or PCSK9 inhibitors will be needed in many cases.

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