Degree of lipid control in a Healthcare Management Area in patients at very high cardiovascular risk

Abstract

Introduction: The latest cardiovascular risk guides, European and American, establish hard lipid control objectives, that suppose a therapeutic challenge for both, doctor and patient. The objective of this study is determine the degree of adequacy of low-density lipoprotein cholesterol levels (LDLc) presented by patients with very high cardiovascular risk in our healthcare area, with respect to European and American cardiovascular risk guidelines.

Methods: This is an observational and retrospective study of 446 patients discharged between June 2017 and June 2018 with a diagnosis of acute coronary syndrome, ischemic stroke and peripheral arterial disease. We have defined a series of variables among which we want to highlight the levels of LDLc at admission, and its follow-up at discharge, in order to know the degree of lipid control according to current European guidelines, which set the threshold to consider optimal control in patients of very high cardiovascular risk, below 55mg/dl.

Results: The revised data indicates a control of the patients in 36.6% according to the 2016 guidelines (LDLc <70mg/dl) and 14.8% according to the current 2019 guidelines (LDLc <55mg/dl), 75.3% of them received lipid lowering treatment. We have also found that the number of absolute events increases exponentially depending on the levels of LDLc, being more evident in patients with acute coronary syndrome.

Conclusions: In this study, we demonstrated that the adequacy of the vascular risk clinical practice guidelines is insufficient in the population with very high vascular risk, in line with other published studies, further studies would be needed to determine the causes. A solution to this problem could be collaboration with the Internal Medicine service that has been launched in our healthcare area in order to derivate patients to the Vascular Consultation whom could be beneficiated by the administration of the PCSK9 inhibitors.

Keywords: Cardiovascular risk; Dislipidemia; Dyslipidaemia; LDLc; Riesgo cardiovascular; cLDL.