Disconcordance between ESC prevention guidelines and observed lipid profiles in patients with known coronary artery disease.
Coronary artery disease
ESC-guidelines
LDL-cholesterol
Secondary prevention
Statin
Journal
International journal of cardiology. Heart & vasculature
ISSN: 2352-9067
Titre abrégé: Int J Cardiol Heart Vasc
Pays: Ireland
ID NLM: 101649525
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
received:
08
08
2018
accepted:
16
12
2018
entrez:
4
1
2019
pubmed:
4
1
2019
medline:
4
1
2019
Statut:
epublish
Résumé
We aimed to describe whether updated low-density lipoprotein (LDL)-targets in patients with manifest coronary artery disease (CAD) led to a change in lipid profile over time. We retrospectively included patients with manifest CAD from 2009-2010, 2012-2013, and 2015-2016 (n = 500 each). Lipid levels and medication at the different time-points as well as rate of accordance to guidelines (<100 for 2009-2010, <70 mg/dl for 2012-2013 and 2015-2016) were evaluated. Overall, 1500 subjects (mean age: 68.4 ± 11.2 years, 75.8% male) from 813 attending primary care physicians were included. Mean LDL-level was 98.0 ± 35.7 mg/dl, whereas 34.1% reached LDL-targets according to guidelines as applied at each time-point. Reduction of LDL-goals in 2011 lead to an initial decrease in LDL from 98.3 ± 33.4 mg/dl in 2009-2010 to 93.9 ± 36.3 mg/dl in 2012-2013 (p = 0.045). This effect was no longer present in 2015-2016 (101.6 ± 36.6 mg/dl, p = 0.17). The rate of patients meeting recommended LDL-targets decreased over time (2009-2010: 56.6%, 2012-2013: 25.4%, 2015-2016: 20.2%, p < 0.0001 for trend). Likewise, the frequency of statin-intake decreased over time (93.6% in 2009-2010 to 83.7% in 2015-2016, p < 0.0001). While use of medium intensity statins was most frequent (69.4%), only 20.9% of patients with medium intensity statins reached LDL-targets according to guidelines. In a large clinical cohort of patients with known coronary artery disease, reduction of LDL-targets in ESC-guidelines in 2011 led to an initial decline in LDL-levels, while this effect was attenuated over time with the majority of patients missing treatment goals. Higher acceptance and compliance of statin therapy is warranted to utilize its effect in secondary prevention in CAD-patients.
Sections du résumé
BACKGROUND
BACKGROUND
We aimed to describe whether updated low-density lipoprotein (LDL)-targets in patients with manifest coronary artery disease (CAD) led to a change in lipid profile over time.
METHODS
METHODS
We retrospectively included patients with manifest CAD from 2009-2010, 2012-2013, and 2015-2016 (n = 500 each). Lipid levels and medication at the different time-points as well as rate of accordance to guidelines (<100 for 2009-2010, <70 mg/dl for 2012-2013 and 2015-2016) were evaluated.
RESULTS
RESULTS
Overall, 1500 subjects (mean age: 68.4 ± 11.2 years, 75.8% male) from 813 attending primary care physicians were included. Mean LDL-level was 98.0 ± 35.7 mg/dl, whereas 34.1% reached LDL-targets according to guidelines as applied at each time-point. Reduction of LDL-goals in 2011 lead to an initial decrease in LDL from 98.3 ± 33.4 mg/dl in 2009-2010 to 93.9 ± 36.3 mg/dl in 2012-2013 (p = 0.045). This effect was no longer present in 2015-2016 (101.6 ± 36.6 mg/dl, p = 0.17). The rate of patients meeting recommended LDL-targets decreased over time (2009-2010: 56.6%, 2012-2013: 25.4%, 2015-2016: 20.2%, p < 0.0001 for trend). Likewise, the frequency of statin-intake decreased over time (93.6% in 2009-2010 to 83.7% in 2015-2016, p < 0.0001). While use of medium intensity statins was most frequent (69.4%), only 20.9% of patients with medium intensity statins reached LDL-targets according to guidelines.
CONCLUSION
CONCLUSIONS
In a large clinical cohort of patients with known coronary artery disease, reduction of LDL-targets in ESC-guidelines in 2011 led to an initial decline in LDL-levels, while this effect was attenuated over time with the majority of patients missing treatment goals. Higher acceptance and compliance of statin therapy is warranted to utilize its effect in secondary prevention in CAD-patients.
Identifiants
pubmed: 30603665
doi: 10.1016/j.ijcha.2018.12.004
pii: S2352-9067(18)30160-X
pmc: PMC6310742
doi:
Types de publication
Journal Article
Langues
eng
Pagination
73-77Références
J Am Coll Cardiol. 2004 Nov 2;44(9):1772-9
pubmed: 15519006
N Engl J Med. 2005 Apr 7;352(14):1425-35
pubmed: 15755765
JAMA. 2006 Apr 5;295(13):1556-65
pubmed: 16533939
N Engl J Med. 2008 Nov 20;359(21):2195-207
pubmed: 18997196
Ann Intern Med. 1991 Nov 1;115(9):687-93
pubmed: 1929036
BMJ. 2009 Jun 30;338:b2376
pubmed: 19567909
Eur J Prev Cardiol. 2012 Apr;19(2):221-30
pubmed: 21450578
BMJ. 2011 Mar 30;342:d1672
pubmed: 21450800
Eur Heart J. 2011 Jul;32(14):1769-818
pubmed: 21712404
Eur Heart J. 2012 Jul;33(13):1635-701
pubmed: 22555213
N Engl J Med. 1990 Jun 14;322(24):1700-7
pubmed: 2342536
Circulation. 2014 Jun 24;129(25 Suppl 2):S1-45
pubmed: 24222016
J Am Coll Cardiol. 2014 Jul 1;63(25 Pt B):2889-934
pubmed: 24239923
JAMA Intern Med. 2014 Feb 1;174(2):186-93
pubmed: 24247275
Curr Med Res Opin. 2014 Apr;30(4):655-65
pubmed: 24495126
Atherosclerosis. 2015 Mar;239(1):118-24
pubmed: 25585031
Atherosclerosis. 2016 Mar;246:243-50
pubmed: 26812002
Clin Res Cardiol. 2016 Sep;105(9):783-90
pubmed: 27120330
Eur Heart J. 2016 Oct 14;37(39):2999-3058
pubmed: 27567407
JACC Cardiovasc Imaging. 2017 Feb;10(2):143-153
pubmed: 27665163
Int J Cardiol. 2016 Dec 15;225:184-196
pubmed: 27728862
J Am Coll Cardiol. 2016 Nov 8;68(19):2123-2125
pubmed: 27810054
JAMA. 2016 Dec 13;316(22):2373-2384
pubmed: 27846344
N Engl J Med. 2017 May 4;376(18):1713-1722
pubmed: 28304224
N Engl J Med. 2017 Aug 24;377(8):787-8
pubmed: 28834471
Lancet. 2017 Oct 28;390(10106):1962-1971
pubmed: 28859947
Atherosclerosis. 2017 Nov;266:158-166
pubmed: 29028484
Arteriosclerosis. 1988 May-Jun;8(3):207-11
pubmed: 3370018
Prev Med. 1984 Jul;13(4):355-66
pubmed: 6504864
Eur Heart J. 1994 Oct;15(10):1300-31
pubmed: 7821306
N Engl J Med. 1998 Nov 5;339(19):1349-57
pubmed: 9841303