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Secondary Prevention after Acute Coronary Syndrome – Can we achieve Dyslipidemia guideline targets?
Session:
Painel 12 - Prevenção / Reabilitação Cardíaca3
Speaker:
Miguel Martins de Carvalho
Congress:
CPC 2020
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.4 Lipids
Session Type:
Posters
FP Number:
---
Authors:
Miguel Martins De Carvalho; Tânia Proença; Ricardo Alves Pinto; Paulo Maia Araújo; Alzira Nunes; Pedro Grilo Diogo; Sofia Torres; Carlos Xavier Resende; Joana Duarte Rodrigues; Vitor Araujo; Paula Dias; J. Afonso Rocha; Fernando Parada Pereira; Maria Júlia Maciel Barbosa
Abstract
<p><strong>Introduction:</strong> Lipid control is one of the most important secondary cardiovascular prevention targets. New studies showed the importance of aggressive lipid control. The European Society of Cardiology (ESC) Dyslipidemia Guidelines recently published changed the recommendation of LDL targets from below 70 mg/dL to below 55 mg/dL in very high risk patients.</p> <p><strong>Purpose:</strong> To observe the dyslipidemia control in a secondary prevention population (with coronary artery disease) in light of the 2019 ESC Dyslipidemia Guidelines.</p> <p><strong>Methods</strong>: We retrospectively analyzed all patients who participated in a Coronary Rehabilitation Program (after an Acute Coronary Syndrome) at a Portuguese center from May 2008 to December 2017. Clinical data was collected at presentation and during a 12 months follow up (FUP).</p> <p><strong>Results:</strong> 989 patients were enrolled in a Cardiac Rehabilitation Program (85% male, mean age 54±10 years). 561 (56,7%) patients had dyslipidemia, 410 (41,5%) had hypertension, 179 (18,1%) were diabetic, 723 (73,1%) were smokers or previous smokers, 257 (26,0%) had family history of coronary disease and 138 (14,0%) had previous coronary disease (acute coronary syndrome or >50% coronary artery stenosis). The vast majority of patients (97,5%) were medicated with statin at hospital discharge and maintained the prescription during the FUP (97,1%). At hospital admission, mean LDL concentration was 121,7±38,8 mg/dL with 2,9% of the patients below 55 mg/dL and 7,6% below 70 mg/dL. During the FUP, at the end of the rehabilitation program (3 months after event), there was a significant decrease of LDL values (p<0.001) with 18,7% patients below 55 mg/dL and 46,3% below 70 mg/dL (mean LDL 76.6 ±23.6 mg/dL). At 1-year FUP, the lipid control was better than at admission but inferior than at the end of the rehabilitation program, both findings statistically significant (11,0% patients were below 55 mg/dL and 33,1% were below 70 mg/dL, with a mean LDL of 82.7±28.3 mg/dL; p<0.001).</p> <p><strong>Conclusion</strong>: Our real life observational cohort showed that guideline recommended LDL control is not achieved in the majority of very high risk patients in a structured coronary rehabilitation program. Of note, the number of patients at LDL target decreased from 3 months to 1 year FUP. This state the importance of a sustained therapy adherence, lifestyle changes and aggressive pharmacologic therapy.</p>
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