An innovative lipid-lowering approach to enhance attainment of low-density lipoprotein cholesterol goals. Issue 8 (December 2020)

• Record Type: Journal Article
• Authors: Buonvino, Camille; Chopard, Romain; Guillon, Benoît; Puymirat, Etienne; Farnier, Michel; Ferrières, Jean; Krempf, Michel; Bruckert, Eric; Meneveau, Nicolas; Schiele, François
• Is Part Of: European heart journal. Volume 9:Issue 8(2020)
• Page Start: 879
• Page End: 887
• Publication Date: 2020-12
• Subjects: Statin -- ezetimibe -- lipid-lowering therapy -- LDL cholesterol -- compliance -- prescription; 616.1205
• DOI: 10.1177/2048872620912639
• Languages: English
• ISSNs: 2048-8726

Abstract

Aims: To improve attainment of LDL-cholesterol (LDL-c) targets, an expert group proposed an algorithm for lipid-lowering therapy during hospitalization for acute coronary syndrome and during follow-up. We aimed to assess adherence to this algorithm, and evaluate its impact on LDL-c levels and on attainment of therapeutic LDL-c targets in a population of post-acute coronary syndrome patients. Methods and results: Prospective, observational study including patients admitted for acute coronary syndrome between February 2017 and September 2018. Patients admitted without statins or ezetimibe were considered 'naïve'. Baseline LDL-c was admission LDL-c in naïve patients, and for those taking lipid-lowering therapy at admission, baseline LDL-c was back-calculated. In line with the most recent guidelines, the target was a >50% reduction in naïve LDL-c and <55 mg/dL. In total, 270 patients were analysed, mean age 67 ± 12 years, 78% men, 26% diabetic. At admission, 175 (65%) were naïve, 95 (35%) had previous lipid-lowering therapy, of which 13 (5%) statin+ezetimibe. Average LDL-c at admission was 120 ± 47 mg/dL (136 ± 44 mg/dL in naïve, 91 ± 39 mg/dL in pretreated patients). Discharge prescription was in compliance with the algorithm in 204 (76%) patients. Average LDL-c at two months was 57 ± 28 mg/dL; it was <55 mg/dL in 135 (50%), and 178 (66%) achieved a >50% reduction. Overall, 125/270 (46%) achieved the LDL-c goal. The reduction in LDL-c observed at two months persisted at five months. Conclusion: Prescription of high-intensity statins, associated with ezetimibe where applicable, achieves LDL-c levels <55 mg/dL in 50% of patients at two months, and attains therapeutic goals defined by the European Society of Cardiology in 46% of cases.