Achievement of low density lipoprotein (LDL) cholesterol targets in primary and secondary prevention: Analysis of a large real practice database in Italy.

Authors:
Vivianne Presta
Vivianne Presta
University of Rome Sapienza
Roma | Italy
Ilaria Figliuzzi
Ilaria Figliuzzi
University of Rome Sapienza
Roma | Italy
Francesca Miceli
Francesca Miceli
University of Rome Sapienza
Roberta Coluccia
Roberta Coluccia
Sapienza University of Rome
Italy
Federica Fogacci
Federica Fogacci
University of Bologna
Fort Worth | United States
Andrea Ferrucci
Andrea Ferrucci
University of Rome "Sapienza"
Claudio Borghi
Claudio Borghi
University of Bologna
Italy

Atherosclerosis 2019 Apr 8;285:40-48. Epub 2019 Apr 8.

Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy. Electronic address:

Background And Aims: Target and intensity of low-density lipoprotein cholesterol (LDL-C) lowering therapy should be tailored according to the individual global cardiovascular (CV) risk. We aimed at retrospectively evaluating real-life LDL-C goal attainment and predictive factors for predefined LDL-C therapeutic goals both in primary and secondary prevention.

Methods: We collected data from a large cohort of outpatients aged 40-65 years, followed by general practitioners, cardiologists and diabetologists in Italy. All data were centrally analysed for global CV risk assessment and rates of control of major CV risk factors, including LDL-C. Study population was stratified according to the presence or absence of previous CV events, including coronary artery disease (CAD), peripheral artery disease (PAD) or stroke/TIA. CV risk profile characterization was based on the European SCORE. Predefined therapeutic goals were set according to the European guidelines on dyslipidaemia: LDL-C levels <70 mg/dl for very high CV risk patients in primary prevention and for those in secondary prevention; <100 mg/dl LDL-C levels for high CV risk patients in primary prevention. Logistic regression analysis with clinical covariates was used to identify predictive factors for achieving these goals; lipid lowering therapy entered in the analysis as continuous (model 1) or categorical variable (model 2).

Results: We included 4,142 outpatients (43,7% female, age 58.0 ± 5.2 years, BMI 28.5 ± 5.0 kg/m) among whom 2,964 (71.6%) in primary and 1,178 (28.4%) in secondary prevention. In primary prevention, none of the patients at very high CV risk had LDL-C <70 mg/dl and 8.9% of patients at high CV risk showed LDL-C <100 mg/dl. Only 5.8% of patients in secondary prevention had LDL-C levels <70 mg/dl, specifically 6.5% of patients with CAD, 2.6% of patients with PAD and 4.7% of patients with CVD (p < 0.001). Beyond diabetes and lipid lowering therapy, high risk SCORE estimation resulted a strong and independent predictor for the lack of achieving all predefined therapeutic targets, including LDL-C <100 mg/dl [OR: 0.806 (0.751-0.865)); p < 0.001], and LDL-C <70 mg/dl [OR: 0.712 (0-576-0.880); p = 0.002], in primary prevention.

Conclusions: Despite high or very high SCORE risk and use of lipid lowering therapies, we observed poor achievement of LDL-C targets in this large cohort of outpatients followed in a setting of real practice in Italy.

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Source
https://linkinghub.elsevier.com/retrieve/pii/S00219150193015
Publisher Site
http://dx.doi.org/10.1016/j.atherosclerosis.2019.03.017DOI Listing
April 2019
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