Recommendations to improve lipid control. Consensus document of the Spanish Society of Cardiology

Escobar, Carlos; Anguita, Manuel; Arrarte, Vicente; Barrios, Vivencio; Cequier, Ángel; Cosı́n-Sales, Juan; Egocheaga, Isabel; de, Esteban; Pallarés, Vicente; Isla, Leopoldo Pérez de; Pintó, Xavier; Juanatey, José Ramón González; Zamorano, José Luís

doi:10.1016/j.rec.2019.08.012

Cited by 11 publications

(10 citation statements)

References 30 publications

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“…Traditionally, lipids control has been poor in secondary prevention patients [ 35 ]. Although more effective treatments are available, and there is more evidence about the benefits of achieving LDL cholesterol targets in this population [ 19 , 36 ], in our study, a target of LDL cholesterol < 70 mg/dL was achieved in nearly half of patients and <55 mg/dL in approximately one quarter of patients. Once again, these figures were even worse among PAD patients.…”

Section: Discussionmentioning

confidence: 63%

“…Fortunately, in the majority of patients, lipid-lowering therapy was modified in order to obtain better LDL cholesterol control. In contrast with 2019 ESC guidelines that considered a step-by-step approach, delaying the achievement of LDL cholesterol goals, current recommendations promote the early use of lipid-lowering combined therapy to attain recommended targets [ 19 , 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…In summary, despite the high-risk profile, the proportion of patients achieving cardiovascular risk factor control targets was dramatically low. As there is reimbursement for the great majority of cardiovascular drugs in Spain, the main reasons for poor cardiovascular risk factors control may include insufficient medical education, the wrong perception that patients were adequately controlled that led to an inadequate intensification of treatment and the underestimation of cardiovascular risk [ 36 , 39 , 40 ]. Among patients who developed myocardial infarction from the Atherosclerosis Risk in Communities (ARIC) study, achieving recommended targets, including smoking, adiposity, physical activity, diet, total cholesterol, blood pressure, and fasting glucose, was associated with better prognosis in later life [ 41 ].…”

Section: Discussionmentioning

confidence: 99%

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Clinical Profile and Management of Patient Patients with Ischemic Heart Disease and/or Peripheral Artery Disease in Clinical Practice: The APALUSA Study

Barrios

Escobar

Suárez

et al. 2022

JCM

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This study was aimed to ascertain the clinical profile and management of patients with ischemic heart disease (IHD) and/or peripheral artery disease (PAD). In this observational and cross-sectional study developed in 80 hospitals throughout Spain, consecutive adults with stable IHD and/or PAD were included. A total of 1089 patients were analyzed, of whom 65.3% had only IHD, 17.8% PAD and 16.9% both. A total of 80.6% were taking only one antiplatelet agent, and 18.2% were on dual antiplatelet therapy (mainly aspirin/clopidogrel). Almost all patients were taking ≥1 lipid lowering drug, mainly moderate-to-high intensity statins. IHD patients took ezetimibe more commonly than PAD (43.9% vs. 12.9%; p < 0.001). There were more patients with IHD that achieved blood pressure targets compared to PAD (<140/90 mmHg: 67.9% vs. 43.0%; p < 0.001; <130/80 mmHg: 34.1% vs. 15.7%; p < 0.001), LDL-cholesterol (<70 mg/dL: 53.1% vs. 41.5%; p = 0.033; <55 mg/dL: 26.5% vs. 16.0%; p = 0.025), and diabetes (HbA1c < 7%, with SGLT2i/GLP1-RA: 21.7% vs. 8.8%; p = 0.032). Modifications of antihypertensive agents and lipid-lowering therapy were performed in 69.0% and 82.3% of patients, respectively, without significant differences between groups. The use of SGLT2i/GLP1-RA was low. In conclusion, cardiovascular risk factors control remains poor among patients with IHD, PAD, or both. A higher use of combined therapy is warranted.

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Section: Discussionmentioning

confidence: 63%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical Profile and Management of Patient Patients with Ischemic Heart Disease and/or Peripheral Artery Disease in Clinical Practice: The APALUSA Study

Barrios

Escobar

Suárez

et al. 2022

JCM

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“…Regardless of their first diagnosis in the database, patients with ASCVD and hypercholesterolemia will be divided into (1) those who received statins, (2) those who were not on treatment with statins, and (3) those who were on other treatments to reduce cholesterol. The ability of the lipid-lowering treatment to reduce cholesterol (extreme, very high, high and moderate) will be also considered in this group of patients, according to the Consensus document of the Spanish Society of Cardiology ( 22 ) ( Table 1 ). Patients will be further classified considering their LDL levels at the time they received a ASCVD diagnosis after the earliest statin prescription.…”

Section: Methods and Analysismentioning

confidence: 99%

Treatment patterns and use of healthcare resources of patients with atherosclerotic cardiovascular disease and hypercholesterolemia and patients with familial hypercholesterolemia in Spain: Protocol of the Reality study

Barrios

Ruiz

Cerezo

et al. 2022

Front. Cardiovasc. Med.

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BackgroundAtherosclerotic cardiovascular diseases (ASCVD) and dyslipidemia are associated to a higher risk of cardiovascular events, mortality, use of healthcare resources and costs. In Spain, the evidence about the administration of lipid-lowering treatments in clinical practice, and their clinical effectiveness in patients with ASCVD and hypercholesterolemia and patients with FH is scarce. Therefore, a multidisciplinary working group of cardiologists, family physicians, internal medicine specialists and neurologists was gathered for the Reality study. The aim of this study is to describe the demographic and clinical characteristics, comorbidities, and concomitant medication of patients with ASCVD and hypercholesterolemia and of patients with familial hypercholesterolemia (FH). The use of healthcare resources and costs associated to the management of these diseases after their diagnosis were also considered.MethodsThis is an observational and retrospective study, based on the BIG-PAC® database, which includes the electronic medical registries (EMRs) of 1.8 million people from 7 Autonomous Communities in Spain (including public primary care centers and hospitals). The study includes patients who had a new or recurrent episode of ASCVD during the recruitment period (from 01/01/2017 to 31/12/2018). The index date will be defined as the date of the ASCVD event, and the follow-up period will be 24 months. According to their first diagnosis in the database, patients will be classified as ASCVD (5 groups: stable/unstable angina, acute myocardial infarction, ischemic stroke, transient ischemic attack, and peripheral arterial disease) or FH.DiscussionThis study aims to analyze the treatment patterns and use of healthcare resources of ASCVD and FH in Spain. The prevalence of these disorders will also be estimated. Due to the high morbidity and mortality associated with these diseases, it is expected that our study will provide useful information for healthcare systems and decision makers to improve the management of these disabling diseases.

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“…The LLT intensity was defined according to its ability to reduce LDLc ( 12 , 13 ). The moderate lipid-lowering ability group comprises moderate-intensity statins and low-intensity statin plus ezetimibe.…”

Section: Methodsmentioning

confidence: 99%

An intensive, structured, mobile devices-based healthcare intervention to optimize the lipid-lowering therapy improves lipid control after an acute coronary syndrome

Ruíz-Bustillo

Badosa

Cabrera-Aguilera

et al. 2022

Front. Cardiovasc. Med.

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AimsDespite the evidence, lipid-lowering treatment (LLT) in secondary prevention remains insufficient, and a low percentage of patients achieve the recommended LDL cholesterol (LDLc) levels by the guidelines. We aimed to evaluate the efficacy of an intensive, mobile devices-based healthcare lipid-lowering intervention after hospital discharge in patients hospitalized for acute coronary syndrome (ACS).Methods and resultsAmbiespective register in which a mobile devices-based healthcare intervention including periodic follow-up, serial lipid level controls, and optimization of lipid-lowering therapy, if appropriate, was assessed in terms of serum lipid-level control at 12 weeks after discharge. A total of 497 patients, of which 462 (93%) correctly adhered to the optimization protocol, were included in the analysis. At the end of the optimization period, 327 (70.7%) patients had LDLc levels ≤ 70 mg/dL. 40% of patients in the LDLc ≤ 70 mg/dL group were upgraded to very-high intensity lipid-lowering ability therapy vs. 60.7% in the LDLc > 70 mg/dL group, p < 0.001. Overall, 38.5% of patients had at least a change in their LLT. Side effects were relatively infrequent (10.7%). At 1-year follow-up, LDLc levels were measured by the primary care physician in 342 (68.8%) of the whole cohort of 497 patients. In this group, 71.1% of patients had LDLc levels ≤ 70 mg/dL.ConclusionAn intensive, structured, mobile devices-based healthcare intervention after an ACS is associated with more than 70% of patients reaching the LDLc levels recommended by the clinical guidelines. In patients with LDLc measured at 1-year follow-up, 71.1% had LDLc levels ≤ 70 mg/dL.

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Recommendations to improve lipid control. Consensus document of the Spanish Society of Cardiology

Cited by 11 publications

References 30 publications

Clinical Profile and Management of Patient Patients with Ischemic Heart Disease and/or Peripheral Artery Disease in Clinical Practice: The APALUSA Study

Clinical Profile and Management of Patient Patients with Ischemic Heart Disease and/or Peripheral Artery Disease in Clinical Practice: The APALUSA Study

Treatment patterns and use of healthcare resources of patients with atherosclerotic cardiovascular disease and hypercholesterolemia and patients with familial hypercholesterolemia in Spain: Protocol of the Reality study

An intensive, structured, mobile devices-based healthcare intervention to optimize the lipid-lowering therapy improves lipid control after an acute coronary syndrome

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