Treatment patterns and low-density lipoprotein cholesterol (LDL-C) goal attainment among patients receiving high- or moderate-intensity statins

Fox, Kathleen M.; Tai, Ming-Hui; Kostev, Karel; Hatz, M.; Qian, Yi; Laufs, Ulrich

doi:10.1007/s00392-017-1193-z

Cited by 63 publications

(45 citation statements)

References 33 publications

(34 reference statements)

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“…24% did not receive statins despite a known CHD. This finding is in accordance with a large multicentre observation, which found similar cholesterol target value attainments [14,15]. However, the efficacy of LDL-lowering therapy for patients with CHD is well established for statins and was contemporary proven by the three randomised controlled PCSK9-inhibitor trials [6,[16][17][18][19].…”

Section: Discussionsupporting

confidence: 87%

Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort

et al. 2019

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Background Inflammation drives atherosclerosis and its complications. Anti-inflammatory therapy with interleukin 1 beta (IL-1β) antibody reduces cardiovascular events in patients with elevated high-sensitive C-reactive protein (hsCRP). This study aims to identify the share of patients with coronary heart disease (CHD) and residual inflammation who may benefit from anti-inflammatory therapy. Methods hsCRP and low-density lipoprotein (LDL) levels were determined in 2741 all-comers admitted to the cardiological ward of our tertiary referral hospital between June 2016 and June 2018. Patients without CHD, with acute coronary syndrome, chronic or recurrent systemic infection, use of immunosuppressant or anti-inflammatory agents, chronic inflammatory diseases, chemotherapy, terminal organ failure, traumatic injury and pregnancy were excluded. Results 856 patients with stable CHD were included. 42.7% of those had elevated hsCRP ≥ 2 mg/l. Within the group of patients with LDL-cholesterol < 70 mg/dl, 30.9% shared increased hsCRP indicating residual inflammation. After multivariate adjusted backward selection elevated Lipoprotein (a) (OR 1.61, p = 0.048), elevated proBNP (OR 2.57, p < 0.0001), smoking (OR 1.70, p = 0.022), and obesity (OR 2.28, p = 0.007) were associated with elevated hsCRP. In contrast, the use of ezetimibe was associated with normal hsCRP (OR 0.51, p = 0.014). In the subgroup of patients with on-target LDLcholesterol < 70 mg/dl, backward selection identified elevated proBNP (OR 3.49, p = 0.007) as independent predictor of elevated hsCRP in patients with LDL-cholesterol < 70 mg/dl. Conclusion One-third of all-comers patients with CHD showed increased levels of hsCRP despite a LDL-cholesterol < 70 mg/ dl potentially qualifying for an anti-inflammatory therapy. Elevated proBNP is an independent risk factor for hsCRP elevation.

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Section: Discussionsupporting

confidence: 87%

Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort

et al. 2019

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“…The largest undeveloped potential to reach LDL-C target values therefore lies in initiating lipid-lowering treatment in the first place. This finding, surprising as it may seem, is in line with study results covering several other major European healthcare systems [ 17 , 18 , 19 ]. The second largest potential lies with the 45% of patients receiving conventional lipid-lowering drug treatment at submaximal intensity.…”

Section: Discussionsupporting

confidence: 90%

The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice

Meier

Rachamin

Rosemann

et al. 2020

JCM

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The aim of this study was to assess the impact of the 2019 published European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guideline on cardiovascular (CV) risk management compared with its predecessor from 2016 in a cohort in general practice. We performed a cross-sectional retrospective study with data from electronic medical records. The study cohort included 103,351 patients with known CV risk. We assessed changes in CV risk classification and low-density lipoprotein cholesterol (LDL-C) target values, the impact on LDL-C achievement rates, and the current lipid-lowering treatments. Under the 2019 ESC guideline, CV risk categories changed in 27.5% of patients, LDL-C target levels decreased in 71.4% of patients, and LDL-C target achievement rate dropped from 31.1% to 16.5%. Among non-achievers according to the 2019 guideline, 52.2% lacked lipid-lowering drugs entirely, and 41.5% had conventional drugs at a submaximal intensity. Of patients in the high-risk and very high-risk categories, at least 5% failed to achieve the LDL-C target level despite treatment at maximal intensity with conventional lipid-lowering drugs, making them eligible for PCSK-9 inhibitors. In conclusion, the 2019 ESC/EAS guideline lowered LDL-C target values for the majority of patients in general practice and halved LDL-C target achievement rates. There is still a large undeveloped potential to lower CV risk by introducing conventional lipid-lowering drugs, particularly in patients at high or very high CV risk. A substantial proportion of the patients can only achieve their LDL-C targets using PCSK-9 inhibitors, which would currently require an at least 10-fold increase in prescribing of these drugs.

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“…Regarding the LLT, the prescription of high-intensity statins after AMI is far from ideal; de-escalation of treatment often occurs during follow-up and, as a result, the proportion of patients who are not at target LDL-C is above 50%, as shown in recent registries. [24][25][26]56 Recalling the therapeutic targets recommended by guidelines may improve prescription rates at discharge, and increase maintenance and adherence during follow-up. 57 Additionally, explanations about the importance of LLT, efficacy, tolerance and compliance also have an educational value, not only for the patient, but also for the PCP.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, LLT intensity is likely to be reduced during follow-up. 23 As a result, less than one-third of patients [24][25][26] reach the recommended LDL-C target at 12 months after ACS, [24][25][26] leaving huge potential for improvement in secondary prevention.…”

Section: Assessment Of Ldl-c Is Recommended 4-6 Weeksmentioning

confidence: 99%

Proposal for a standardized discharge letter after hospital stay for acute myocardial infarction

Schiele

Lemesle

Angoulvant

et al. 2020

European Heart Journal. Acute Cardiovascular Care

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In patients admitted for acute myocardial infarction, the communication and transition from specialists to primary care physicians is often delayed, and the information imparted to subsequent healthcare providers (HCPs) may be sub-optimal. A French group of cardiologists, lipidologists and diabetologists decided to establish a consensus to optimize the discharge letter after hospitalization for acute myocardial infarction. The aim is to improve both the timeframe and the quality of the content transmitted to subsequent HCPs, including information regarding baseline assessment, procedures during hospitalization, residual risk, discharge treatments, therapeutic targets and follow-up recommendations in compliance with European Society of Cardiology guidelines. A consensus was obtained regarding a template discharge letter, to be released within two days after patient’s discharge, and containing the description of the patient’s history, risk factors, acute management, risk assessment, discharge treatments and follow-up pathway. Specifically for post acute MI patients, tailored details are necessary regarding the antithrombotic regimen, lipid-lowering and anti-diabetic treatments, including therapeutic targets. Lastly, the follow-up pathway needs to be precisely mentioned in the discharge letter. Additional information such as technical descriptions, imaging, and quality indicators may be provided separately. A template for a standardized discharge letter based on 8 major headings could be useful for implementation in routine practice and help to improve the quality and timing of information transmission between HCPs after acute MI.

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Treatment patterns and low-density lipoprotein cholesterol (LDL-C) goal attainment among patients receiving high- or moderate-intensity statins

Cited by 63 publications

References 33 publications

Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort

Residual inflammatory risk in coronary heart disease: incidence of elevated high-sensitive CRP in a real-world cohort

The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice

Proposal for a standardized discharge letter after hospital stay for acute myocardial infarction

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