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Characterization and LDL-C management in a cohort of high and very high cardiovascular risk patients: The
Cristina Gavina1,2,3, Daniel Seabra-Carvalho1, Carlos Aguiar4
1Hospital Pedro Hispano - Unidade Local de Saúde de Matosinhos, Portugal.
Insights
Low-density lipoprotein cholesterol (LDL-C) control remains very low in patients at high cardiovascular (CV) risk, indicating a significant gap in implementing dyslipidemia management guidelines into clinical practice.
Area of Science:
- Cardiology
- Public Health
- Clinical Pharmacy
Background:
- Cardiovascular disease (CVD) remains a leading cause of mortality globally.
- Effective management of dyslipidemia, particularly lowering low-density lipoprotein cholesterol (LDL-C), is crucial for CVD prevention.
- Current European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines provide targets for LDL-C control based on cardiovascular risk stratification.
Purpose of the Study:
- To characterize the sociodemographic and clinical profiles of patients with increased cardiovascular (CV) risk.
- To assess the utilization of lipid-lowering therapies (LLTs) within this population.
- To evaluate the achievement of LDL-C control targets according to contemporary dyslipidemia guidelines.
Main Methods:
- A cross-sectional observational study utilizing electronic health records from a Portuguese healthcare network (2000-2020).
- Inclusion criteria required at least one year of clinical data and specific primary care contact history.
- Patients were stratified into three cohorts: high CV risk, atherosclerotic cardiovascular disease (ASCVD) risk equivalents, and established ASCVD.
Main Results:
- Over 51,000 patients were analyzed, with distinct numbers in high CV risk (23,457), ASCVD risk equivalents (19,864), and ASCVD (8,288) groups.
- LDL-C control rates were notably low: 32% (2016 guidelines) and 7% (2019 guidelines) for high CV risk; 10% and 3% for ASCVD risk equivalents; 18% and 7% for ASCVD.
- A significant proportion of patients, ranging from 15% to 37%, were not prescribed any LLTs.
Conclusions:
- Achieving LDL-C control targets is significantly suboptimal across all assessed cardiovascular risk strata.
- A substantial disparity exists between established dyslipidemia management guidelines and their actual clinical application.
- Urgent interventions are needed to bridge the gap between guideline recommendations and clinical practice for effective cardiovascular risk reduction.
Aim:
This study aims to characterize sociodemographic and clinical characteristics, use of lipid-lowering therapies (LLTs), and low-density lipoprotein cholesterol (LDL-C) control in a population with increased cardiovascular (CV) risk.
Methods:
A cross-sectional observational study that uses electronic health records of patients from one hospital and across 14 primary care health centers in the North of Portugal, spanning from 2000 to 2020 (index date). Patients presented at least (i) 1 year of clinical data before inclusion, (ii) one primary care appointment 3 years before the index date, and (iii) sufficient data for CV risk classification. Patients were divided into three cohorts: high CV risk; atherosclerotic cardiovascular disease (ASCVD) risk equivalents without established ASCVD; evidence of ASCVD. CV risk and LDL-C control were defined by the 2019 and 2016 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) dyslipidemia guidelines.
Results:
A total of 51 609 patients were included, with 23 457 patients classified as high CV risk, 19 864 with ASCVD equivalents, and 8288 with evidence of ASCVD. LDL-C control with 2016 ESC/EAS guidelines was 32%, 10%, and 18% for each group, respectively. Considering the ESC/EAS 2019 guidelines control level was even lower: 7%, 3%, and 7% for the same cohorts, respectively. Patients without any LLT prescribed ranged from 37% in the high CV risk group to 15% in patients with evidence of ASCVD.
Conclusion:
We found that LDL-C control was very low in patients at higher risk of CV events. An alarming gap between guidelines on dyslipidemia management and clinical implementation persists, even in those at very high risk or with established ASCVD.
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