Low-Density Lipoprotein Cholesterol Targets in Patients With Coronary Heart Disease in Extremadura (Spain): LYNX Registry

Abstract

Background: Low-density lipoprotein cholesterol (LDL-C) contributes decisively to the development of cardiovascular disease (CVD). In the LYNX registry we determined the rate of achievement of the target value of LDL-C, the use of lipid-lowering therapy (LLT) and the predictive factors of not reaching the target in patients with stable coronary heart disease (CHD). Methods: LYNX included consecutive patients with stable CHD treated at the University Hospital of Caceres, Extremadura (Spain) from September 2016 to September 2018, and those who must have an LDL-C target below 70 mg/dL according to the European Society of Cardiology (ESC) 2016 guidelines. The variables independently associated with the breach of the LDL-C objective were evaluated by multivariable logistic regression. Results: A total of 674 patients with stable CHD were included. The average LDL-C levels were 68.3 ± 24.5 mg/dL, with 56.7% showing a level below 70 mg/dL. LLT was used by 96.7% of patients, 71.7% were treated with high-powered statins and 30.1% with ezetimibe. The risk of not reaching the target value of LDL-C was higher in women, in active smokers, and in those who had multivessel CHD or had atrial fibrillation. Patients with diabetes mellitus, those who took potent statins or co-administration treatment with ezetimibe were more likely to reach the target level of LDL-C. Conclusions: The treatment of dyslipidemia in patients with chronic CHD remains suboptimal; however, an increasing number of very high-risk patients achieve the LDL-C objective, although there is still enormous potential to improve cardiovascular outcome through the use of more intensive LLT.

Real-World Attainment of Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Cardiovascular Disease Treated with High-Intensity Statins: The TERESA Study

“…In the current study, a higher proportion of patients with diabetes mellitus attained the recommended LDL-C goal compared with patients without diabetes, which is in agreement with many studies, including the Spanish LYNX and REPAR studies and the international CEPHEUS and DYSIS II studies, among others [13,15,25,26,31,38]. These findings suggest that clinicians may be paying more attention to CV risk factors management in diabetic patients in the real-world setting.…”

“…We found an overall achievement rate for the risk-based LDL-C goals of only 31.1%, despite all patients being on high-intensity statins, even with 62% of them on combination therapy of high-intensity statins plus ezetimibe. Regardless of differences in the recommended LDL-C targets, baseline CV risk of patients, or LLT used for CVD prevention, our findings are consistent with several international and Spanish studies that have consistently reported low rates of LDL-C goal attainment in high-or very high-risk patients, ranging from 4% to 57% [6,[10][11][12][13][14][17][18][19][20][21][22][23][24][25][26]. It must be highlighted that most patients included in the TERESA study were categorized as very high CVD risk as they were recruited in cardiology and internal medicine units.…”

“…The present study showed that established CVD was significantly associated with the non-attainment of LDL-C targets. Thus, a lower proportion of patients with a confirmed diagnosis of CVD achieved the recommended LDL-C goal compared with patients without CVD, as previously reported in the Spanish LYNX study [13]. On the contrary, other studies, including the international CEPHEUS study, showed that a history of CVD or previous acute myocardial infarction were associated with better LDL-C control rates [30][31][32].…”

“…In the Spanish subset of the EUROASPIRE study, 49% of subjects achieved their LDL-C goals [10,11]. Similar rates were obtained in three Spanish studies, where around 55% of patients at very high CV risk achieved LDL-C <70 mg/dL [12][13][14]. Previous Spanish registries showed even lower rates of LDL-C target achievement.…”