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Attainment of LDL-cholesterol goals in patients with previous myocardial infarction: a real-world cross-sectional analysis
Session:
Comunicações Orais - Sessão 25 - Prevenção Cardiovascular e Reabilitação
Speaker:
Daniel A. Gomes
Congress:
CPC 2023
Topic:
J. Preventive Cardiology
Theme:
29. Rehabilitation and Sports Cardiology
Subtheme:
29.2 Cardiovascular Rehabilitation
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Daniel A. Gomes; Mariana Sousa Paiva; Pedro Freitas; Francisco Albuquerque; Rita Lima; Rita Reis Santos; João Presume; Rita Bello; Sérgio Maltês; Marisa Trabulo; Carlos Aguiar; Jorge Ferreira; António M. Ferreira; Miguel Mendes
Abstract
<p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong>Background:</strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">ESC guidelines recommend an LDL-cholesterol (LDL-C) <55mg/dL for patients with established cardiovascular disease. While the Friedewald’s equation to estimate LDL-C is still widely used, the newer Martin-Hopkins’ formula has shown greater accuracy. The aims of this work were: 1) to assess the proportion of patients reaching their LDL-C goal and the therapies used, and 2) to assess the impact of using the Martin-Hopkins' method instead of Friedewald’s formula on the proportion of controlled patients.</span></span></p> <p> </p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong>Methods:</strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">Single-centre cross-sectional study including consecutive post-myocardial infarction patients followed by 20 different cardiologists in a tertiary hospital. Data were collected retrospectively from clinical appointments that took place after April 2022. Only those with an available ambulatory lipid profile performed at the hospital’s lab were considered. For each patient, LDL-C levels and goal attainment were estimated by both Friedewald’s and Martin-Hopkins’ equations.</span></span></p> <p> </p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong>Results:</strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">A total of 400 patients were included (age 67±13 years, 77% male, 31% diabetics). The last myocardial infarction had occurred a median of 4,5 years before the appointment. Using Friedewald’s equation, median LDL-C under therapy was 64 mg/dL [IQR (50-81)]. Overall, 125 patients (31%) had LDL-C within target (<strong><span style="color:#4472c4">Figure 1A</span></strong>). High intensity statins were used in 256 patients (64%), 146 (37%) were under ezetimibe, and 2 (0.5%) were under PCSK9 inhibitors. Combination therapy of high intensity statin + ezetimibe was used in 102 patients (26%) (<strong><span style="color:#4472c4">Figure 1B</span></strong>). These patients had a median LDL-C of 61mg/dL [IQR (45-75)], with 35% attaining LDL-C levels <55 mg/dL, and 11% remaining above 100 mg/dL. Applying the Martin-Hopkins method would reclassify a total of 31 patients (7.8% of total). Among those deemed controlled by the Friedewald’s equation, 27 (21.6%) would have a Martin-Hopkins’ LDL-C above the target, while 4 (1.5%) of the uncontrolled patients would have a recalculated LDL-C <55mg/dL. The following medical appointment was scheduled a median of 8 months (IQR 6-11) later.</span></span></p> <p> </p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt"><strong>Conclusion:</strong></span></span></p> <p><span style="font-family:Arial,Helvetica,sans-serif"><span style="font-size:12pt">In this cross-sectional study, less than one third of post-myocardial infarction patients followed in a tertiary hospital’s cardiology clinic had LDL-C values within the goal, with a prescription pattern suggesting a large underutilization of readily available therapies. Applying the Martin-Hopkins’ formula to calculate LDL-C would reclassify roughly one fifth of presumably controlled patients into the non-controlled group.</span></span></p>
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