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Target Lipid Goals In Very High Risk Cardiovascular Patients – Results from a Secondary Prevention Outpatient Program
Session:
Sessão de Posters 10 - Dislipidémia e metabolismo lipídico
Speaker:
Ana Raquel Fernandes Soares
Congress:
CPC 2024
Topic:
J. Preventive Cardiology
Theme:
28. Risk Factors and Prevention
Subtheme:
28.14 Risk Factors and Prevention - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Raquel Soares; Sofia Picão Eusébio; Sofia Jacinto; José Viegas; Pedro Brás; Tiago Pack; Teresa Ferreira; Luís Almeida Morais; António Mário Santos; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Introduction: </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Hyperlipidemia, particularly low-density lipoprotein cholesterol (LDL-C), is one of the main therapeutic targets when preventing atherosclerotic cardiovascular disease. Recently, our institution developed an outpatient program to optimize cardiovascular prevention in those with coronary artery disease and high-risk cardiovascular profile, in a shared effort between Cardiology and Internal Medicine. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Purpose: </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">We aim to analyze lipid lowering therapy options and efficacy, comparing with national data. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Methods: </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Patients followed in a dedicated secondary prevention outpatient program at a single tertiary center, between February 2020 and November 2023, were analyzed. Clinical variables, laboratory data in particular serum lipid levels, and medication were assessed. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Results: </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">From a cohort of 77, 72 (93.5%) very-high risk patients were compliant with follow-up. </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Upon admission, mean HDL-C was 42±11mg/dL; LDL-C 92</span><span style="font-size:12.0pt">±</span><span style="font-size:12.0pt">51mg/dL; total cholesterol 158</span><span style="font-size:12.0pt">±</span><span style="font-size:12.0pt">59mg/dL and triglyceride 144</span><span style="font-size:12.0pt">±90</span><span style="font-size:12.0pt">mg/dL. Thirteen (18.1%) and 31 (43.1%) presented serum LDL-C<55mg/dL and <70mg/dL, respectively. Diabetics (OR 3.054; p=.024), CKD patients (OR 5.842, p=.006) and those </span><span style="font-size:12.0pt">≥</span><span style="font-size:12.0pt">65 years-old (OR 3.346, p=.016) presented more frequently under 70mg/dL LDL-C at admission. Women (45.5% vs 13.1% male, p=.010) and CKD patients (37.5% vs 12.5% no-CKD, p=.022) presented more frequently an optimal LDL-C level. </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">At a mean follow-up of 316±171 days, mean </span><span style="font-size:12.0pt">HDL-C was 43</span><span style="font-size:12.0pt">±</span><span style="font-size:12.0pt">9mg/dL; LDL-C 72</span><span style="font-size:12.0pt">±</span><span style="font-size:12.0pt">40 mg/dL; total cholesterol 136</span><span style="font-size:12.0pt">±</span><span style="font-size:12.0pt">48mg/dL; triglyceride 135</span><span style="font-size:12.0pt">±83</span><span style="font-size:12.0pt">mg/dL. Twenty-two (30.6%) and 38 (52.8%) presented serum LDL-C <55mg/dL and <70mg/dL, respectively. No significant clinical predictors of achieving target lipid goals were found. Of those starting with LDL-C >70mg/dL, 38,2% achieved <70mg/dL and 26.5% achieved <55mg/dL LDL-C. </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">At last appointment, 50.0% and 44.4% were under atorvastatin and rosuvastatin, respectively. Combination with ezetimibe was used in 84.7%. Only one patient was approved for a PCSK9 inhibitor. Two significant adverse events (myalgia) during statin therapy were reported.</span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Conclusion: </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt">Our data supports the benefit of a dedicated multidisciplinary program targeting very high-risk patients. Therapeutic adherence and optimal LDL-C goals were considerably increased comparatively to previously reported real-world nationwide data (LATINO study). More favorable results may not have been achieved due to limited access to advanced lipid-lowering therapy. This notion may enable the development of future specific policies, in order to comply with international guideline LDL-C targets.</span></span></span></p>
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