Lipid-lowering therapy and low-density lipoprotein cholesterol goal achievement in patients with acute coronary syndromes: The ACS patient pathway project.
Acute coronary syndrome
Guidelines
Lipid-lowering therapies
Low-density lipoprotein cholesterol
Statins
Journal
Atherosclerosis. Supplements
ISSN: 1878-5050
Titre abrégé: Atheroscler Suppl
Pays: Netherlands
ID NLM: 100973461
Informations de publication
Date de publication:
Dec 2020
Dec 2020
Historique:
entrez:
16
2
2021
pubmed:
17
2
2021
medline:
28
10
2021
Statut:
ppublish
Résumé
Post-acute coronary syndrome (ACS) patients are at very high risk for recurrent events and mortality, despite the availability of effective pharmacological approaches. Aim of this survey was to evaluate the compliance to ESC/EAS guidelines during the management of ACS patients and the effectiveness of secondary prevention in seven European countries. By means of an online questionnaire, data on 2775 ACS patients (either acute case or follow-up patients) were collected, including data on lipid profile, medications, follow-up visit planning, screening for familial hypercholesterolemia. Lipid profiles were obtained for 91% of ACS patients in the acute phase, mostly within the first day of hospitalization (73%). During hospitalization, 93% of the patients received a lipid-lowering treatment; at discharge, only 66% of the patients received a high intensity statin therapy. At the first follow-up, most of the patients (77.6%) had LDL-C >70 mg/dL; among them, 41% had no change in their lipid-lowering therapies. Similar data were obtained during the second follow-up visit. The analysis of a subgroup of patients with at least 2 follow-up visits and known LDL-C levels showed that the percentage of patients at goal increased from 9% to 32%, and patients with LDL-C <100 mg/dL raised from 23% to 72%. Among acute cases, 44 were admitted with a diagnosis of familial hypercholesterolemia (FH); only 18% of the remaining patients were screened for FH. Contemporary lipid management of very high CV risk patients is sub-optimal despite available treatments. Greater efforts are warranted to optimize cardiovascular prevention.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
Post-acute coronary syndrome (ACS) patients are at very high risk for recurrent events and mortality, despite the availability of effective pharmacological approaches. Aim of this survey was to evaluate the compliance to ESC/EAS guidelines during the management of ACS patients and the effectiveness of secondary prevention in seven European countries.
METHODS
METHODS
By means of an online questionnaire, data on 2775 ACS patients (either acute case or follow-up patients) were collected, including data on lipid profile, medications, follow-up visit planning, screening for familial hypercholesterolemia.
RESULTS
RESULTS
Lipid profiles were obtained for 91% of ACS patients in the acute phase, mostly within the first day of hospitalization (73%). During hospitalization, 93% of the patients received a lipid-lowering treatment; at discharge, only 66% of the patients received a high intensity statin therapy. At the first follow-up, most of the patients (77.6%) had LDL-C >70 mg/dL; among them, 41% had no change in their lipid-lowering therapies. Similar data were obtained during the second follow-up visit. The analysis of a subgroup of patients with at least 2 follow-up visits and known LDL-C levels showed that the percentage of patients at goal increased from 9% to 32%, and patients with LDL-C <100 mg/dL raised from 23% to 72%. Among acute cases, 44 were admitted with a diagnosis of familial hypercholesterolemia (FH); only 18% of the remaining patients were screened for FH.
CONCLUSIONS
CONCLUSIONS
Contemporary lipid management of very high CV risk patients is sub-optimal despite available treatments. Greater efforts are warranted to optimize cardiovascular prevention.
Identifiants
pubmed: 33589224
pii: S1567-5688(21)00011-8
doi: 10.1016/j.atherosclerosissup.2021.01.009
pii:
doi:
Substances chimiques
Anticholesteremic Agents
0
Cholesterol, LDL
0
Hydroxymethylglutaryl-CoA Reductase Inhibitors
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e49-e58Informations de copyright
Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest U. Landmesser has received speaker and advisory honorary from Sanofi, Amgen, Medicines Company, Berlin Chemie and Novartis; A. Pirillo has nothing to disclose; M. Farnier reports having received grants, consulting fees and/or honoraria and delivering lectures for Abbott, Akcea/Ionis, Amarin, Amgen, AstraZeneca, Daiichi-Sankyo, Eli Lilly, Kowa, Merck and Co, Mylan, Pfizer, Sanofi/Regeneron and Servier; JW Jukema/his department has received research grants from and/or was speaker (with or without lecture fees) on a. o.(CME accredited) meetings sponsored by Amgen, Athera, Astra-Zeneca, Biotronik, Boston Scientific, Dalcor, Daiichi Sankyo, Lilly, Medtronic, Merck-Schering-Plough, Pfizer, Roche, Sanofi Aventis, The Medicine Company, the Netherlands Heart Foundation, CardioVascular Research the Netherlands (CVON), the Netherlands Heart Institute and the European Community Framework KP7 Programme; U. Laufs reports fees for lectures/consulting from Amgen and Sanofi; F. Mach has nothing to disclose; L. Masana reports fees for lectures and advisory work from Amgen, Sanofi, MSD, Mylan, Daichii/Sankyo; T.R. Pedersen has nothing to disclose; F. Schiele reports personal fees from Sanofi-Aventis, Amgen, Pfizer, Astra Zeneca, MSD, BMS, and Bayer outside the submitted work; G. Steg reports research grant from Amarin, Bayer, Sanofi, and Servier and speaking or consulting fees from Amarin, Amgen, AstraZeneca, Bayer/Janssen, Boehringer-Ingelheim, Bristol-Myers-Squibb, Idorsia, Novartis, Novo-Nordisk, Pfizer, Regeneron, Sanofi, Servier; M. Tubaro reports speaker/consulting fees from Bayer, Bristol Myers Squibb and Pfizer; A. Zaman reports speaker/consulting fees and/or research grants from: Sanofi, Daiichi-Sankyo, BMS, Amgen, Pfizer, Boehringer, Bayer, Astra; P. Zamorano has nothing to disclose; A.L. Catapano reports grants from Sanofi, Regeneron, Merck, Mediolanum, grants from SigmaTau, Menarini, Kowa, Recordati, Eli Lilly, personal fees from Merck, Sanofi, Regeneron, AstraZeneca, Amgen, Sigma Tau, Recordati, Aegerion, Kowa, Menarini, Eli Lilly, Genzyme, outside the submitted work.