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Management of Hyperlipidemia in Very High and Extreme Risk Patients in Croatia: an observational study of treatment
Hrvoje Pintarić1, Marijana Knezović Florijan1, Ian Bridges1
11University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 2Sestre milosrdnice University Hospital Centre, Department of Internal Medicine, Zagreb, Croatia; 3Amgen Ltd., Cambridge, United Kingdom; 4Osijek University Hospital Centre, Department of Cardiology, Osijek, Croatia; 5Rijeka University Hospital Centre, Rijeka, Croatia; 6University of Zagreb, School of Medicine, Department of Cardiovascular Diseases, Zagreb University Hospital Centre, Zagreb, Croatia.
Insights
Many secondary prevention patients with high cardiovascular risk in Croatia exceed LDL-C targets. Current statin therapy is insufficient for many, indicating a need for optimized treatment strategies, especially for extreme risk patients.
Area of Science:
- Cardiology
- Lipidology
- Public Health
Background:
- Elevated low-density lipoprotein cholesterol (LDL-C) is a major risk factor for cardiovascular events, particularly in secondary prevention patients.
- European and American Association of Clinical Endocrinologists (AACE) guidelines define very high risk (VHR) and extreme risk (ER) categories with specific LDL-C targets.
- Optimal management of dyslipidemia in these high-risk populations is crucial for reducing future cardiovascular events.
Purpose of the Study:
- To evaluate the current management of elevated LDL-C in adult secondary prevention patients classified as VHR and ER in Croatia.
- To assess the proportion of patients achieving guideline-recommended LDL-C targets.
- To identify potential gaps in current treatment strategies, including statin intensity and use of concomitant therapies.
Main Methods:
- Retrospective observational study of patient records from specialist clinics in Croatia over 12 months.
- Patients were categorized as VHR (European guidelines) or ER (AACE criteria).
- Data collected included current lipid-lowering treatments and last recorded LDL-C levels.
Main Results:
- A significant proportion of VHR (58.5%) and ER (72.9%) patients did not achieve their LDL-C targets (<1.8 mmol/L and <1.42 mmol/L, respectively).
- While most patients received statins, only a minority were on high-intensity statin therapy, and even fewer received additional lipid-lowering treatments.
- Median LDL-C levels were 1.9 mmol/L for VHR and 2.1 mmol/L for ER patients.
Conclusions:
- Current management of elevated LDL-C in Croatian secondary prevention patients, including those at VHR and ER, is suboptimal, with many failing to reach guideline targets.
- There is a need to optimize the use of high-intensity statin therapy and consider additional lipid-lowering agents, particularly for ER patients.
- Identifying ER patients and their specific lipid profiles is essential for tailoring more effective treatment strategies to improve LDL-C control.
Abstract:
Our observational study evaluated current management of elevated low-density lipoprotein cholesterol (LDL-C) in adult secondary prevention patients (all very high risk (VHR) by European guidelines) attending specialist clinics across Croatia. Data were collected retrospectively from patient records for the preceding 12 months. The subset judged to be at extreme risk (ER; American Association of Clinical Endocrinologists (AACE) criteria; n=48) were compared with the remaining patients (VHR group; n=41). All patients were receiving statins (75.6% VHR/81.3% ER at high-intensity), with only a minority receiving concomitant lipid-lowering treatment (7.3% VHR/16.7% ER). Median (Q1, Q3) LDL-C levels at the last visit were 1.9 (1.6, 2.4) mmol/L for VHR and 2.1 (1.5, 3.1) mmol/L for ER, with only 41.5% (95% CI 26.3-57.9) of VHR patients and 27.1% (15.3-41.9) of ER patients attaining their LDL-C targets (<1.8 mmol/L and <1.42 mmol/L, respectively). Thus, we found that a substantial proportion of VHR and ER secondary prevention patients being treated across Croatia had LDL-C levels exceeding the targets recommended in the European and newer AACE guidelines, but not all were receiving high-intensity statins. Identification of ER patients and their lipid patterns may help optimize usage of high-intensity statin treatment, alone or along with newer treatments, for better control of elevated LDL-C.
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