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Published on: November 17, 2018
A new rational approach to reach LDL-cholesterol concentration objectives after an acute coronary syndrome
Núria Ribas1, Lluís Recasens2, Silvia Pérez3
1Servicio de Cardiología, Hospital del Mar, Barcelona, España; Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Departamento Medicina, Universidad Autónoma de Barcelona, Barcelona, España.
Insights
Achieving optimal low-density lipoprotein cholesterol (LDLc) control after acute coronary syndrome (ACS) is vital for secondary prevention. Adhering to Masana's recommendations for lipid-lowering therapy significantly improves LDLc target achievement in ACS patients.
Area of Science:
- Cardiology
- Preventive Medicine
- Lipid Metabolism
Background:
- Adequate low-density lipoprotein cholesterol (LDLc) control is critical for secondary prevention after acute coronary syndrome (ACS).
- Existing LDLc-lowering treatment dosage tables lack validation in ACS populations.
- Predictors of optimal LDLc and the efficacy of Masana's recommendations in ACS require investigation.
Purpose of the Study:
- To analyze variables associated with optimal LDLc levels (<70 mg/dL) post-ACS.
- To evaluate the therapeutic yield of Masana's recommendations for lipid-lowering therapy in ACS patients.
Main Methods:
- A cohort of 326 ACS patients was studied from January 2015 to May 2016.
- Baseline LDLc and hospital discharge hypolipidemic treatment were recorded.
- Variables linked to achieving LDLc <70 mg/dL during follow-up were analyzed.
Main Results:
- 60% of patients received hypolipidemic treatment aligned with Masana's recommendations at discharge.
- 45% of patients achieved target LDLc levels (<70 mg/dL) at follow-up (median 122 days).
- Masana's recommendations adherence (56% vs. 30%) and male gender were independent predictors of LDLc goal attainment.
Conclusions:
- Optimal mid-term LDLc control is achieved in less than half of ACS patients.
- Implementing Masana's recommendations for lipid-lowering therapy dosage aids in achieving therapeutic LDLc goals post-ACS.
Introduction And Objectives:
Adequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimize the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analyzed and the therapeutic yield of the use of Masana's recommendations in this setting.
Methods:
A total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analyzed the variables associated with optimal LDLc levels (<70mg/dL) control during follow-up.
Results:
Among our patient population (72% male, age 66±13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66-184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; P<.001). The male gender (P<.001), the absence of prior history of dyslipemia (P<.001) and the adherence to Masana's recommendations (P=.007) were independent predictors for the achievement of targeted LDLc levels during follow-up.
Conclusions:
In less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal.
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