scholarly journals Patient"s awareness of recommended LDL-C goals in primary prevention and observed achievement

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Ioannidis ◽  
A Pechlevanis ◽  
M Paraskelidou ◽  
D Lakias
Keyword(s):  
Primary Prevention ◽  
Risk Score ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Lipid Lowering Therapy ◽  
The Novel ◽  
Pcsk9 Inhibitor ◽  
Prevention Measure ◽  
Very High ◽  
Risk Categories

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The novel 2019 ESC/EAS Guidelines on lipids recommend more intensive reduction on LDL-C across CV risk categories in comparison with the 2016 edition. Purpose This cross-sectional observation study aims to assess whether patients on lipid lowering therapy, as a primary prevention measure, are aware of the new set goals and if they achieved them. Methods Patients, taking currently any statin as a primary prevention measure, visiting the Emergency Department of a tertiary hospital in northern Greece were invited to participate by answering a short questionnaire followed by a phone call to provide the exact lab results or other details. Results In total 412 eligible patients (54.1% female) were enrolled from January to October 2020 (mean age 61 ± 13 years old). Mean duration of statin prescription was about 8 years (7.8 ± 5 years). The majority (381, 92.5%) of patients reported lab tests yearly while most of them (394, 95.6%) were being followed up in outpatient clinics or private offices. Patients were allocated into CV categories: low (48, 11.7%), medium (239, 58.0%), high (108, 26.2%) and very high (17, 4.1%). The estimated 10-year risk of CV death was calculated using SCORE. Almost two thirds of the patients (282, 68.4%) were taking moderate intensity statins (as monotherapy) while one out of ten (45, 10.9%) was taking a statin plus ezetimibe combination. No patient was prescribed a PCSK9 inhibitor. Only two out of five (171, 41.5%) patients reached the LDL-C goal, though differences were noted between risk categories with almost half of the low and medium CV risk patients achieving the desired LDL-L level: low (23, 47.9%), medium (124, 51.9%), high (21, 19.4%) and very high (3, 17.6%). No significant difference was observed in terms of potency of statin. As expected, patients taking a statin and ezetimibe combination achieved lower LDL-C levels, with almost two thirds (31 out of 45 patients, 68.9%) reaching the goal. No information could be collected regarding why patients not reaching the goal were not offered a statin of higher potency and/or dosing, a combination with ezetimibe or a PCSK9 inhibitor. Disturbingly enough, none of the patient was aware that the LDL-C goals recommended by scientific societies had been lowered in 2019, while only 29 patients (7.0%) could recall discussing LDL-C goals with their physician. Moreover, merely three patients could remember the calculation of any CV risk score. The majority of the patients (379, 92.0%) reported that they would like to know their personal CV risk score and their LDL-C goal. Conclusions Greek primary prevention patients taking statins are overall unaware of the novel set LDL-C goals and it seems that they have not been offered a total CV risk score assessment. Hardly acceptable attainment of LDL-C goals was observed. Further research is warranted to assess the barriers that obstruct a satisfactory goal achievement. Abstract Figure.

Preoperative cardiovascular assessment as an opportunity to (re)affirm the 2019 ESC/EAS guidelines recommended LDL-C goal

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Ioannidis ◽  
V Giakoumi ◽  
A Pechlevanis ◽  
M Paraskelidou
Keyword(s):  
Lipid Lowering ◽  
Risk Category ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
City Hospital ◽  
The Novel ◽  
Observation Study ◽  
Pcsk9 Inhibitor ◽  
Cardiovascular Assessment ◽  
Risk Categories

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The novel 2019 ESC/EAS Guidelines on lipids recommend a more intensive reduction on LDL-C across CV risk categories in comparison with the 2016 edition. Purpose This cross-sectional observation study aimed to assess whether patients on lipid lowering therapy were aware of the new set LDL-C goals and if they achieved them. Methods Patients, taking at the time any statin, attending the preoperative CV assessment outpatient clinic at a city hospital in northern Greece were invited to participate. Results In total 625 eligible patients (45.1% female) were enrolled during 2020 (mean age 67 ± 9 years old). Mean duration of statin prescription was about 10 years (9.7 ± 7 years). About two thirds of the patients (402, 64.3%) had established atherosclerotic cardiovascular disease (ASCVD) and the rest were allocated into CV risk categories: low (24, 10.8%), medium (135, 60.5%), high (59, 26.5%) and very high (5, 2.2%). The estimated 10-year risk of CV death was calculated using SCORE. The majority (552, 88.3%) of the patients reported lab tests at least biannually. The majority of the participants (556, 89.0%) were taking a statin as monotherapy of either low (17, 2.7%), medium (237, 37.9%) or high (302, 48.3%) potency. One tenth (65, 10.4%) were prescribed a combination of ezetimibe with a medium or high potency statin. Lastly, only four patients (0.6%) were prescribed a PCSK9 inhibitor. Less than a quarter of the participants (143, 22.9%) had achieved the recommended LDL-C levels. Approximately, one out of six patients with established ASCVD had a LDL-C lower than 55mg/dL (68, 16.9%), while only one out of three primary prevention patients (75, 33.6%) had reached the LDL-C levels recommended for their allocated risk category. As expected, the higher the potency of the statin, the higher the percentage of patients reaching the goal. Moreover, twelve out of the sixty five the patients (18.5%) on ezetimibe combination therapy achieved the LDL-C goal. Lastly, three of the four patients (75.0%) on a PCSK9 inhibitor had attained the desired LDL-C level. No information could be collected regarding why patients not reaching the goal were not offered a statin of higher potency and/or dosing, a combination with ezetimibe or a PCSK9 inhibitor, accordingly. Disturbingly enough, none of the patient was aware that the LDL-C goals recommended by scientific societies had been lowered in 2019, although 94 patients (15.0%) could recall discussing LDL-C goals with their physician. The majority of the patients (427, 93.0%) reported that they would like to know the recommended (personal) LDL-C goals. Conclusions Greek patients taking statins were overall unaware of the novel set LDL-C goals. Hardly acceptable attainment of the LDL-C goal was observed. The preoperative assessment visit can be used to monitor the guidelines implementation. Further research is warranted to assess the barriers that obstruct a satisfactory goal achievement. Abstract Figure. Patients achieving LDL-C goal

scholarly journals Evolocumab use in Europe: clinical guidelines vs. reimbursement thresholds – results from the HEYMANS study

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
K K Ray ◽  
E Bruckert ◽  
P Filardi ◽  
C Ebenbichler ◽  
A Vogt ◽  
...  
Keyword(s):  
Clinical Guidelines ◽  
Clinical Characteristics ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Lipid Lowering Therapy ◽  
Pcsk9 Inhibitors ◽  
Private Company ◽  
Statin Monotherapy ◽  
Very High

Abstract Background 2019 ESC/EAS guidelines recommend a 50% lowering in untreated LDL-C and use of PCSK9 inhibitors (PCSK9i) for patients (pts) at very high cardiovascular (CV) risk when LDL-C goals of <1.4mmol/L are not met despite maximally tolerated statins and ezetimibe. However, the LDL-C threshold at which PCSK9i are reimbursed are higher than the goals recommended in clinical guidelines. Purpose This prospective observational cohort study describes clinical characteristics and LDL-C control among pts initiating evolocumab across 12 EU countries. Methods Pts are followed from evolocumab initiation (baseline). Demographic/clinical characteristics, lipid lowering therapy (LLT) and lipid values are being collected from medical records (6 months before evolocumab up to 30 months post initiation). We report interim data from pts initiating evolocumab from August 2015 followed-up until July 2020. Results Of the 1,952 pts in whom evolocumab was initiated as per local reimbursement criteria, most (1844 [94%]) had 12 months follow-up, 785 (40%) had 24 months follow-up; mean follow-up: 20 months. Mean (SD) age was 60 (10.8) years; 85% of pts had a history of CV disease, 45% had familial hypercholesterolemia, 19% had type 2 diabetes, 65% were hypertensive, 7% had chronic kidney disease and 51% were prior/current smokers. At evolocumab initiation, 60% reported statin intolerance and 41% were on no background LLT. Fewer than half (846 [43%]) were receiving a statin (± ezetimibe); of these, most received a high/moderate intensity (68%/22%), with 13% receiving statin monotherapy. Median (Q1, Q3) baseline LDL-C was 3.98 (3.17, 5.07) mmol/L. Within 3 months of initiation median LDL-C fell by 58% to 1.63mmol/L. This reduction was maintained over time (Figure 1). Overall, 58% of pts achieved at least one LDL-C <1.4mmol/L during follow-up. Among pts receiving background statins ± ezetimibe at evolocumab initiation, 67% (710/1053) achieved at least one LDL-C <1.4mmol/L, versus 44% (317/714) of pts not receiving background statins/ezetimibe. During follow-up background oral LLT did not materially change; 40–45% pts received no LLT, 41–44% received statin ± ezetimibe, 12–14% received statin monotherapy. Conclusion In Europe, pts initiated on evolocumab had baseline LDL-C levels almost 3x higher than the present threshold for PCSK9i use recommended in guidelines reflecting disparities between local reimbursement criteria and guidelines. Although evolocumab led to a >50% reduction in LDL-C, only ∼50% pts achieved an LDL-C <1.4mmol/L, as approximately 41% received only evolocumab as monotherapy. LDL-C goal attainment was however higher among pts receiving evolocumab with background LLT. Therefore, lowering the LDL-C threshold for PCSK9i reimbursement, would result in more patients receiving combination therapy with oral LLT plus PCSK9i, thus increasing the likelihood of more pts achieving very-high risk LDL-C goals. FUNDunding Acknowledgement Type of funding sources: Private company. Main funding source(s): Amgen Europe GmbH

scholarly journals Attainment of the 2019 ESC/EAS recommended LDL-C goal in Greek patients with established atherosclerotic cardiovascular disease

2021 ◽  
Vol 28 (Supplement_1) ◽  
Author(s):  
A Ioannidis ◽  
A Pechlevanis ◽  
M Paraskelidou
Keyword(s):  
Cardiovascular Disease ◽  
Phone Call ◽  
Lipid Lowering ◽  
Atherosclerotic Cardiovascular Disease ◽  
Lipid Lowering Therapy ◽  
The Novel ◽  
High Potency ◽  
Northern Greece ◽  
Observation Study ◽  
Pcsk9 Inhibitor

Abstract Funding Acknowledgements Type of funding sources: None. Introduction The novel 2019 ESC/EAS Guidelines on lipids recommend a more intensive reduction on LDL-C for patients with established atherosclerotic cardiovascular disease (ASCVD) in comparison with the 2016 edition. Purpose This cross-sectional observation study aims to assess whether patients on lipid lowering therapy, as a secondary prevention measure, are aware of the new set goals and if they achieved them. Methods Patients with known ASCVD, taking currently any statin, visiting the Emergency Department of a tertiary hospital in northern Greece were invited to participate by answering a short questionnaire followed by a phone call to provide the exact lab results or other details. Data were analyzed with the SPSS software version 20.0 for Windows (SPSS Inc., Chicago, Illinois, USA) Results In total 459 eligible patients (37.9% female) were enrolled from January to October 2020 (mean age 68 ± 12 years old). Mean duration of statin prescription was about 11 years (11.2 ± 6 years). The majority (431, 93.9%) of the patients reported lab tests yearly. The majority of the participants (406, 88.5%) were taking a statin as monotherapy of either low (11, 2.4%), medium (174, 37.9%) or high (221, 48.1%) potency. One tenth (50, 10.9%) were prescribed a combination of ezetimibe with a medium or high potency statin. Lastly, only three patients (0.7%) were prescribed a PCSK9 inhibitor. Approximately, one out of six patients had a LDL-C lower than 55mg/dL (78, 17.0%). As expected, the higher the potency of the statin, the higher the percentage of patients reaching the goal: low (1 of 11 patients, 9.1%), medium (21 of 174 patients, 12.1%) and high potency (45 of 221 patients, 20.4%). Moreover, nine out of the fifty the patients (18.0%) on ezetimibe combination therapy achieved the LDL-C goal. Lastly, two of the three patients (66.7%) on a PCSK9 inhibitor had attained the desired LDL-C level. No information could be collected regarding why patients not reaching the goal were not offered a statin of higher potency and/or dosing, a combination with ezetimibe or a PCSK9 inhibitor, accordingly. Disturbingly enough, none of the patient was aware that the LDL-C goals recommended by scientific societies had been lowered in 2019, although 71 patients (15.5%) could recall discussing LDL-C goals with their physician, even though none of the patients recalled the limit of 55mg/dL. The majority of the patients (427, 93.0%) reported that they would like to know their personal LDL-C goal. Conclusions Greek patients with established ASCVD taking statins are overall unaware of the novel set LDL-C goals. Hardly acceptable attainment of the LDL-C goal was observed. Further research is warranted to assess the barriers that obstruct a satisfactory goal achievement. Abstract Figure. Patients achieving LDL-C goal

scholarly journals What is the potential cardiovascular risk reduction associated with achieving LDL-C levels recommended in the ESC/EAS guidelines for very high-risk patients? Data from 18 European countries

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.K Ray ◽  
S Bray ◽  
A.L Catapano ◽  
N Poulter ◽  
G Villa
Keyword(s):  
High Risk ◽  
Risk Reduction ◽  
Absolute Risk ◽  
European Countries ◽  
Lipid Lowering ◽  
Funding Source ◽  
Lipid Lowering Therapy ◽  
Cardiovascular Risk Reduction ◽  
Private Company ◽  
Very High

Abstract Background/Introduction For patients at very-high risk of cardiovascular (CV) events, the 2016 ESC/EAS dyslipidaemia guidelines recommended lipid-lowering therapy (LLT) to achieve an LDL-C level below 70 mg/dL. This was lowered to an LDL-C level below 55 mg/dL in the 2019 guidelines. Purpose To assess: 1) the risk profile of European patients with established atherosclerotic CV disease (ASCVD) receiving LLT; and 2) the treatment gap between the estimated risk and the population benefits if all patients were to achieve LDL-C levels of 70 mg/dL and 55 mg/dL. Methods We used data from Da Vinci, an observational cross-sectional study conducted across 18 European countries. Data were collected at a single visit between June 2017 and November 2018, for consented adults who had received any LLT in the prior 12 months and had an LDL-C measurement in the prior 14 months. LDL-C level was assessed at least 28 days after starting the most recent LLT (stabilised LLT). For each patient with established ASCVD receiving stabilised LLT, we: 1) calculated their absolute LDL-C reduction required to achieve LDL-C levels of 70 mg/dL and 55 mg/dL; 2) predicted their 10-year CV risk using the REACH score based on demographic and medical history; 3) simulated their relative risk reduction (RRR) by randomly sampling from the probability distribution of the rate ratio per 38.7 mg/dL (1 mmol/L) estimated by the Cholesterol Treatment Trialists Collaboration meta-analysis; and 4) calculated their absolute risk reduction (ARR) achieved by meeting LDL-C levels of 70 mg/dL and 55 mg/dL. Results A total of 2039 patients with established ASCVD were included in the analysis. Mean (SD) LDL-C was 83.1 (35.2) mg/dL. 40.4% and 19.3% of patients achieved LDL-C levels of 70 mg/dL and 55 mg/dL, respectively. Mean (SD) 10-year CV risk calculated using the REACH score was 36.3% (15.4%). Mean absolute LDL-C reductions of 19.6 mg/dL and 30.4 mg/dL were needed to reach LDL-C levels of 70 mg/dL and 55 mg/dL, respectively. When adjusted for the LDL-C reduction required to achieve an LDL-C level of 70 mg/dL, mean ARR was 3.0%, leaving a mean (SD) residual 10-year CV risk of 33.3% (15.5%). When adjusted for the LDL-C reduction required to achieve an LDL-C level of 55 mg/dL, mean ARR was 4.6%, leaving a mean (SD) residual 10-year CV risk of 31.7% (15.2%). Conclusion(s) In a contemporary European cohort with ASCVD receiving LLT, the 10-year risk of CV events is high and many patients do not achieve LDL-C levels of 55 mg/dL or even of 70 mg/dL. Moreover, even if all patients were to achieve recommended LDL-C levels, they would still remain at a high residual risk of CV events. These data suggest these patients require even more intensive LLT. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen

Standard and intensive lipid-lowering therapy with statins for the primary prevention of vascular diseases: a population-based study

2013 ◽  
Vol 70 (1) ◽  
pp. 99-108 ◽  
Author(s):  
D. Macías Saint-Gerons ◽  
C. de la Fuente Honrubia ◽  
D. Montero Corominas ◽  
M. J. Gil ◽  
F. de Andrés-Trelles ◽  
...  
Keyword(s):  
Primary Prevention ◽  
Vascular Diseases ◽  
Population Based ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Population Based Study ◽  
Lowering Therapy

Do European patients with peripeheral arterial disease receive optimal lipid lowering therapy and achieve LDL-C goals? Results from the DA VINCI study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K.K Ray ◽  
M Feudjo Tepie ◽  
A.L Catapano ◽  
P Giovas ◽  
S Bray ◽  
...  
Keyword(s):  
Da Vinci ◽  
Arterial Disease ◽  
Lipid Lowering ◽  
Moderate Intensity ◽  
Funding Source ◽  
Lipid Lowering Therapy ◽  
Private Company ◽  
Cerebral Disease ◽  
Study Visit ◽  
Lowering Therapy

Abstract Background 2016 and 2019 EAS/ESC dyslipidemia guidelines recommend lipid lowering therapy (LLT) to reduce LDL-C in patients with peripheral arterial disease (PAD) with or without established cardiovascular (CV) disease, and recommend target LDL-C goals based on individual CV risk. Data regarding the implementation of these guidelines in clinical practice across Europe is currently lacking. Purpose Describe LLT and achievement of the target LDL-C goals recommended in EAS/ESC dyslipidemia guidelines in patients with PAD. Methods The cross-sectional Da Vinci study enrolled consenting adults who had received LLT in the 12 months prior to the study visit and had at least one LDL-C measurement in the 14 months prior to the study visit, seen in a primary or secondary care setting across 18 European countries. Patients with coronary, peripheral and cerebral disease were enrolled at a ratio of 1:2:2. FH patients with prior CV events were excluded. Data were collected from medical records at a single visit between Jun '17–Nov '18, including LLT and most recent LDL-C. Primary outcome was LDL-C goal attainment ≥28 days after starting most recent LLT (treatment-stabilised LLT). Results Of 5888 patients enrolled, 2794 met our definition of atherosclerotic cardiovascular disease (ASCVD). Of these ASCVD patients, 1036 (37%) had PAD. 31% (323/1036) of PAD patients were female and mean (SD) age was 69 (9.4) years. Concomitant CV risk factors included diabetes mellitus (473/1036 patients [46%]), hypertension (809/1036 [78%]) and smoking (794/1036 [77%]). 26% (271/1036) of patients with PAD also had coronary vascular disease and 12% (122/1036) also had cerebrovascular disease. At the visit date, approximately half (497/1036 [48%]) of all PAD patients were receiving moderate intensity statins and 41% (421/1036) were receiving high intensity statins. 818 (73%) of the PAD patients had a treatment-stabilised LDL-C measurement (median, 2.20 mmol/L), of whom 40% (326/818) achieved the 2016 EAS/ESC LDL-C goal of 1.8 mmol/L and only 19% (159/818) achieved the 2019 goal of 1.4mmol/L. Conclusions European patients with PAD are not treated as per EAS/ESC recommendations, with a large proportion receiving suboptimal LLT and fewer than half achieving target LDL-C levels. Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Amgen

scholarly journals SAT0586 PREVALENCE AND RISK FACTORS FOR CARDIO-METABOLIC ABNORMALITIES IN PATIENTS WITH INFLAMMATORY ARTHRITIS ATTENDING CARDIO-RHEUMATOLOGY PRIMARY PREVENTION CLINICS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1252.1-1252
Author(s):  
L. Eder ◽  
S. Akhtari ◽  
P. Harvey ◽  
K. Bindee
Keyword(s):  
Risk Factors ◽  
Primary Prevention ◽  
Inflammatory Arthritis ◽  
Clinical Laboratory ◽  
Hdl Cholesterol ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Metabolic Abnormalities ◽  
Research Support ◽  
Obesity And Diabetes

Background:Cardio-metabolic abnormalities are common in patients with inflammatory arthritis (IA) but tend to be under-recognized and under-treated.Objectives:We aimed to compare the prevalence and risk factors for cardio-metabolic abnormalities between patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and ankylosing spondylitis (AS).Methods:Consecutive patients enrolled in the University of Toronto Cardio-Rheumatology Network from July 2017 to August 2019 were analyzed. This is a primary prevention program that uses structured clinical, laboratory and multimodal imaging to diagnose and treat cardiovascular disease (CVD). Patients with a rheumatologist-confirmed diagnosis of RA, PsA or AS with no known CVD were evaluated. Information about IA diagnosis, medications and comorbidities was recorded. Each patient was evaluated by a cardiologist focusing on CVD risk assessment. We evaluated the prevalence of previously recorded and newly recognized cardio-metabolic risk factors including hypertension, dyslipidemia, obesity and diabetes. The prevalence of these abnormalities was compared between IA diagnoses. Regression models were used to assess the association between diagnosis and cardio-metabolic abnormalities after adjusting for demographics, smoking, BMI, measures of disease activity and medications.Results:A total of 358 patients (201 RA, 124 PsA, 33 AS) were assessed (mean age 59±10.5 years, 68.7% female). Hypertension was reported in 33%, dyslipidemia in 26.8%, diabetes mellitus in 8.9% and overweight/obesity in 69.7% (Figure 1). Newly detected elevations in lipids were frequent for triglycerides (9.3%,), non-HDL-cholesterol (6%,) and LDL-cholesterol (2.7%). Elevated HbA1c occurred in 1.4% and newly diagnosed hypertension occurred in 9.8%. A total of 32.8% patients required a change or initiation of medications for their cardio-metabolic abnormalities (21.7% lipid-lowering therapy, 14.6% aspirin, 11.1% anti-hypertension therapy). Patients with PsA had the highest prevalence of cardio-metabolic abnormalities including dyslipidemia, obesity and hypertension. Having hypertension (prior or new diagnosis), elevated levels of triglycerides, non-HDL cholesterol, total cholesterol and BMI were associated with PsA vs. RA after adjusting for potential confounders (all p<0.05) (Figure 2). No significant association was found between cardio-metabolic abnormalities and AS vs. PsA or RA.Conclusion:Dedicated cardio-rheumatology clinics have improved CVD screening and management in an IA population. The burden of cardio-metabolic abnormalities is elevated in PsA and suggests that tailored strategies to reduce adverse CVD events are particularly needed in this subgroup.Disclosure of Interests:Lihi Eder Grant/research support from: Abbvie, Lily, Janssen, Amgen, Novartis, Consultant of: Janssen, Speakers bureau: Abbvie, Lily, Janssen, Amgen, Novartis, Shadi Akhtari: None declared, Paula Harvey: None declared, Kuriya Bindee Grant/research support from: Abbvie, Pfizer, Sanofi, BMS, Consultant of: Abbvie, Eli Lily, Pfizer

scholarly journals Lipid-Lowering Therapy for Primary Cardiovascular Prevention in Older Adults. Consensus Statement of the Russian Association of Gerontologists and Geriatricians, National Society on Atherosclerosis, Russian Society of Cardiology, Association of Clinical Pharmacologists

Kardiologiia ◽  
2020 ◽  
Vol 60 (6) ◽  
pp. 119-132
Author(s):  
Y. V. Kotovskaya ◽  
O. N. Tkacheva ◽  
I. V. Sergienko
Keyword(s):  
Primary Prevention ◽  
Statistical Power ◽  
Density Lipoprotein ◽  
Cardiovascular Prevention ◽  
Lipid Lowering ◽  
Russian Society ◽  
National Society ◽  
Lipid Lowering Therapy ◽  
Lowering Therapy ◽  
Age Related

 Completed randomized clinical studies did not have a sufficient statistical power for demonstrating clearly the efficacy of lipid-lowering therapy for primary prevention in patients aged 75 years and older and did not evaluate the effect of lipid-lowering therapy on development and course of key geriatric syndromes. Age-related alterations of skeletal muscles, cognitive decline, senile asthenia, comorbidities, polypragmasy, potential changes in drug pharmacokinetics and pharmacodynamics, and impaired renal function may adversely affect the benefit to harm ratio of statins in older patients. Key questions for administration of a lipid-lowering therapy for primary prevention in patients aged 75 years and older are: 1. Does the relationship between increased low-density lipoprotein cholesterol (LDL CS) and death rate persist? 2. Does a benefit from decreasing the level of LDL CS persist? 3. Is the lipid-lowering therapy safe? 4. What scales for risk stratification and determining indications for lipid-lowering therapy should be used?

scholarly journals Lipid Clinic is an Efficacious Model of Preventive Medicine

2021 ◽  
Vol 17 (1) ◽  
pp. 4-10
Author(s):  
A. V. Blokhina ◽  
A. I. Ershova ◽  
A. N. Meshkov ◽  
A. S. Limonova ◽  
V. I. Mikhailina ◽  
...  
Keyword(s):  
Lipid Metabolism ◽  
Preventive Medicine ◽  
Medical Center ◽  
Lipid Lowering ◽  
Lipid Lowering Therapy ◽  
Medical Care System ◽  
Lipid Clinic ◽  
Lowering Therapy ◽  
Target Values ◽  
Very High

Aim. To characterize patients accessing lipid clinic and assess the efficiency of treatment in a specialized medical center.Material and methods. A retrospective analysis of the surviving medical records of outpatients who visited the lipid clinic of the National Research Center for Therapy and Preventive Medicine (Moscow, Russia) in 2011-2019 (n=675) was carried out. Cardiovascular risk (CVR) and target lipoproteins levels were evaluated in accordance with actual guidelines for the diagnostics and correction of dyslipidemias.Results. The mediana of lipid clinic patients age was 57 [46;65] years. Female persons attend lipid clinic more often (61.5%). 48.5% of patients had low density lipoprotein cholesterol (LDL-c) >4.9 mmol/L, 7.7% had triglycerides level >5.5 mmol/L. Most of the patients were diagnosed with type IIa hyperlipidemia (44,1%) or type IIb (28,0%). Inherited impaired lipid metabolism was diagnosed in 27.7% individuals. 12.7% of the patients had familial hypercholesterolemia, 57.4% – had secondary causes of impaired lipid metabolism. More than half of the patients (52.4%) had low or moderate CVR, 28.1% had a very high CVR. High or very high CVR individuals revisited the lipid clinic more often than people with lower risk (68.2% vs. 35.4%). Revisiting patients (25.4%) reached LDL-c targets more often (33.3% of very high CVR patients; 45.5% of moderate-risk people) than in ordinary outpatient practice. High-intensity statin therapy was recommended for 32% of patients, and combined lipid-lowering therapy – for 14.8%. Among very high CVR individuals, combined lipid-lowering therapy was prescribed for 38.5%. Given the lipid-lowering therapy prescribed in the lipid clinic, LDL-с<1.8 mmol/L and<1.5 mmol/L will be achieved at 40.7% and 32.9% of patients with very high СVR.Conclusion. Lipid clinic is an important part of the medical care system for long-term follow-up of patients with impaired lipid metabolism, and it is more efficient in achieving target values of lipids and correcting risk factors in comparison with the primary medical service.

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