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LDL levels in very high cardiovascular risk patients - A call for intensive lipid-lowering therapy
Session:
Posters (Sessão 1 - Écran 8) - Dislipidémia, Diabetes e Obesidade
Speaker:
Bruno Castilho
Congress:
CPC 2023
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.3 Secondary Prevention
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Bruno Miranda Castilho; Rita Veiga; Catarina Ceolho; Nuno Cotrim; Ana Rita Moura; Mariana Saraiva; Kevin Domingues; Ana Filipa Damásio; Vítor Martins
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt">INTRODUCTION</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">European society of cardiology (ESC) guidelines on dyslipidemias were published in 2019 updating the LDL recommended values for very high cardiovascular (CV) risk patients from <70mg/dL to <55mg/dL, as lower LDL levels improve prognosis in this population. This study aims to evaluate LDL levels in a population of very high CV risk and its trend over the years, assess its prognosis impact on acute coronary syndromes (ACS) admissions and evaluate the lipid-lowering therapy medication regimen in this population.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt">METHODS:</span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective study based on the analysis of patients who were admitted due to ACS between 2017 and 2021 and that before admission were already in the very high CV risk category. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">LDL levels variation was assessed from 2017 to 2021. Lipid-lowering therapy regimen was assessed using three categories: No statin, statin alone, and statin plus ezetimibe. Outcomes of admission were assessed according to LDL levels and the following endpoints were evaluated: proportion of STEMI, left ventricular dysfunction (<50%), complications during admission and mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt">RESULTS:</span></strong> </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">228 patients were included, mean age of 67 ± 11.6 years and 65% male. Overall, only 31% of the patients had LDL values < 70mg/dL (82 ± 28 mg/dL), and only 16% of the patients had LDL < 55mg/dL. Mean LDL levels in 2021 were slightly lower than in 2017, without significance (P= 0.283). ACS admission outcomes analysis revealed that patients with LDL>70 presented with a significantly higher proportion of STEMI (P=0,025) and had significantly more complications during admission (P=0,031). Analysis of lipid-lowering therapy regimens revealed that most of the patients are treated with statin alone (70,6%) and only 26.7% of the patients are treated with statin + ezetimibe.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:14.0pt">CONCLUSION: </span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Most of the patients in the very high CV risk category who are admitted due to ACS are above the ESC LDL recommended levels, translating into worse outcomes. Only a small percentage of this population is treated with combination lipid-lowering therapy. The results of this study restate the need for aggressive lipid-lowering therapy in very high CV risk patients.</span></span></p> <p style="text-align:justify"> </p> <p style="text-align:justify"> </p> <p> </p>
Slides
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