Difficulties in achieving target levels of low density lipoproteid cholesterol in patients with atherosclerotic cardiovascular diseases in real clinical practice
DOI:
https://doi.org/10.34687/2219-8202.JAD.2023.04.0003Keywords:
atherosclerotic cardiovascular diseases, hyperlipidemia, LDL-C, lipid-lowering therapy, real clinical practiceAbstract
Aim. To evaluate the frequency of low-density lipoprotein cholesterol (LDL-C) target level achievement in patients with atherosclerotic cardiovascular diseases (CVD) in real clinical practice.
Methods. A non-interventional retrospective study to assess the quality of care for patients with CVD and hyperlipidemia in routine clinical practice. Data collection performed in the absence of intervention (intervention). The study was reviewed and approved by the ethics committee (protocol №10 of Interuniversity Ethical Commission meeting dated November 25, 2021). The planned sample size for analysis is 12918 patients and is administratively limited. The analysis will be performed based on the diseases coding according to the International Classification of Diseases (ICD).
Results. The study included 12918 patients with atherosclerotic CVD, 48.7% were men. The mean age of the patients was 62.1±13.0 years. Common variants of combined cardiovascular pathology were: hypertension + cerebrovascular diseases (25.2%), type 2 diabetes + hypertension (23.6%), peripheral arterial disease + hypertension (23.2%), ischemic heart disease + hypertension (17.0%), ischemic heart diseases + type 2 diabetes (9.1%). The LDL-C level in real clinical practice was determined in 52.2% (n=6747) of the analyzed medical histories. Attention is drawn to the extremely low frequency of determining the LDL-C concentration in patients with ischemic heart disease (53%) and peripheral arterial disease (45.9%). LDL-C level >3.0 mmol/l was detected in 53.0% cases with peripheral arterial disease, 44.5% with ischemic heart disease and 77.7% with hyperlipidemia. Half of patients with atherosclerotic CVD were not taking any lipid-lowering therapy. Combined lipid-lowering therapy with statins and ezetimibe was used in 0.07% of patients. There were no cases of prescribing PCSK9 inhibitors. Only 12.5% of atherosclerotic CVD patients achieved LDL-С level of less than 1.8 mmol/l.
Conclusion. In real clinical practice a low frequency of achieving and retaining the target LDL-С level has been revealed, which may primarily be due to doctors' failure to comply with the algorithm for prescribing lipid-lowering set out in the national guidelines on "Lipid metabolism disorders".
Downloads
References
Ray KK, Ference BA, Séverin T, Blom D, Nicholls SJ, Shiba MH, Almahmeed W, Alonso R, Daccord M, Ezhov M, Olmo RF, Jankowski P, Lanas F, Mehta R, Puri R, Wong ND, Wood D, Zhao D, Gidding SS, Virani SS, Lloyd-Jones D, Pinto F, Perel P, Santos RD. World Heart Federation Cholesterol Roadmap 2022. Glob Heart. 2022;17(1):75. doi: 10.5334/gh.1154.
Агеева Л.И., Александрова Г.А., Голубев Н.А., Кириллова Г.Н., Огрызко Е.В., Оськов Ю.И., Пак Ден Нам, Харькова Т.Л., Чумарина В.Ж. Здравоохранение в России. Росстат. 2021:171.
Relationship between baseline risk factors and coronary heart disease and total mortality in the Multiple Risk Factor Intervention Trial. Multiple Risk Factor Intervention Trial Research Group. Prev Med. 1986;15(3):254-73. doi: 10.1016/0091-7435(86)90045-9.
Vaduganathan M, Mensah GA, Turco JV, Fuster V, Roth GA. The Global Burden of Cardiovascular Diseases and Risk: A Compass for Future Health. J Am Coll Cardiol. 2022;80(25):2361-2371. doi: 10.1016/j.jacc.2022.11.005.
Ежов М.В., Кухарчук В.В., Сергиенко И.В., Алиева А.С., Анциферов М.Б., Аншелес А.А., Арабидзе Г.Г., Аронов Д.М., Арутюнов Г.П., Ахмеджанов Н.М., Балахонова Т.В., Барбараш О.Л., Бойцов С.А., Бубнова М.Г., Воевода М.И., Галстян Г.Р., Галявич А.С., Горнякова Н.Б., Гуревич В.С., Дедов И.И., Драпкина О.М., Дупляков Д.В., Ерегин С.Я., Ершова А.И., Иртюга О.Б., Карпов С.Р., Карпов Ю.А., Качковский М.А., Кобалава Ж.Д., Козиолова Н.А., Коновалов Г.А., Константинов В.О., Космачева Е.Д., Котовская Ю.В., Мартынов А.И., Мешков А.Н., Небиеридзе Д.В., Недогода С.В., Обрезан А.Г., Олейников В.Э., Покровский С.Н., Рагино Ю.И., Ротарь О.П., Скибицкий В.В., Смоленская О.Г., Соколов А.А., Сумароков А.Б., Филиппов А.Е., Халимов Ю.Ш., Чазова И.Е., Шапошник И.И., Шестакова М.В., Якушин С.С., Шляхто Е.В. Нарушения липидного обмена. Клинические рекомендации 2023. Российский кардиологический журнал. 2023;28(5):5471. https://doi.org/10.15829/1560-4071-2023-5471
Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, Chapman MJ, De Backer GG, Delgado V, Ference BA, Graham IM, Halliday A, Landmesser U, Mihaylova B, Pedersen TR, Riccardi G, Richter DJ, Sabatine MS, Taskinen MR, Tokgozoglu L, Wiklund O; ESC Scientific Document Group. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41(1):111-188. doi: 10.1093/eurheartj/ehz455.
Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, Braun LT, de Ferranti S, Faiella-Tommasino J, Forman DE, Goldberg R, Heidenreich PA, Hlatky MA, Jones DW, Lloyd-Jones D, Lopez-Pajares N, Ndumele CE, Orringer CE, Peralta CA, Saseen JJ, Smith SC Jr, Sperling L, Virani SS, Yeboah J. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2019;73(24):3168-3209. doi: 10.1016/j.jacc.2018.11.002.
Vrablik M, Seifert B, Parkhomenko A, Banach M, Jóźwiak JJ, Kiss RG, Gaita D, Rašlová K, Zachlederova M, Bray S, Ray KK. Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study. Atherosclerosis. 2021;334:66-75. doi: 10.1016/j.atherosclerosis.2021.08.035.
Ray KK, Haq I, Bilitou A, Manu MC, Burden A, Aguiar C, Arca M, Connolly DL, Eriksson M, Ferrières J, Laufs U, Mostaza JM, Nanchen D, Rietzschel E, Strandberg T, Toplak H, Visseren FLJ, Catapano AL; SANTORINI Study Investigators. Treatment gaps in the implementation of LDL cholesterol control among high- and very high-risk patients in Europe between 2020 and 2021: the multinational observational SANTORINI study. Lancet Reg Health Eur. 2023;29:100624. doi: 10.1016/j.lanepe.2023.100624.
Ezhov MV, Barbarash OL, Voevoda MI, Gurevich VS, Vezikova NN, Sadykova DI, Sergienko IV, Kashtalap VV, Meshkov AN, Duplyakov DV, Sokolov AA, Boytsov SA. Organization of lipid centers operation in the Russian Federation — new opportunities. Russian Journal of Cardiology. 2021;26(6):4489. (In Russ.) Ежов МВ, Барбараш ОЛ, Воевода МИ, Гуревич ВС, Везикова НН, Садыкова ДИ, Сергиенко ИВ, Кашталап ВВ, Мешков АН, Дупляков ДВ, Соколов АА, Бойцов СА. Организация работы липидных центров в Российской Федерации — новые возможности. Российский кардиологический журнал 2021;26(6):4489. doi:10.15829/1560-4071-2021-4489
Boytsov S., Katapano A., Barbarash O., Yezhov M., Meshkov A., Voevoda M., Gurevich V., Kashtalap V., Duplyakov D., Vezikova N., Sadykova D. Actual issues of lipid centers’ operation in Russian Federation. Cardiovascular Therapy and Prevention. 2021;20(1):2759. (In Russ.) Бойцов С.А., Катапано А., Барбараш О.Л., Ежов М.В., Мешков А.Н., Воевода М.И., Гуревич В.С., Кашталап В.В., Дупляков Д.В., Везикова Н.Н., Садыкова Д.И. Актуальные вопросы работы липидных центров на территории Российской Федерации. Кардиоваскулярная терапия и профилактика. 2021;20(1):2759. https://doi.org/10.15829/1728-8800-2021-2759
Chubykina UV, Ezhov MV, Rozhkova TA, Tamaeva BM, Sokolov AA, Ershova AI, Meshkov AN, Mikhailina VI, Blokhina AV, Limonova AS, Kopylova OV, Shaposhnik II, Genkel VV, Gurevich VS, Urazgildeeva SA, Tregubov AV, Muzalevskaya MV, Voevoda MI, Timoshchenko OV, Shakhtshneider EV, Ragino YuI, Leontyeva IV, Egorov LV, Zakharova IN, Pshenichnikova II, Sadykova DI, Slastnikova ES, Galimova LF, Kosmacheva ED, Namitokov AM, Alieva AS, Galyavich AS, Kim ZF, Korneva VA, Kuznetsova TYu, Filippov AE, Tuktarov AM, Vorobyov AS, Astrakhantseva ID, Bogdanov DYu, Kachkovsky MA, Egorova V, Konstantinov VO, Serebrenitskaya MP, Zafiraki VK, Bizyaeva NN, Androsyuk NG, Kiseleva MA, Grigorieva YuG, Korennova OYu, Yukhina YuE, Devyatova MD, Ivanova ON, Vasiliev PA, Avdeeva IV, Oleinikov VE, Vorobieva YuA, Ermakova YuA, Mukha NV, Zaitsev DN, Zykov MV, Isaeva AV, Petelina TI, Mikova EV. A five-year follow-up period in homo- and heterozygous familial hypercholesterolemia patients of the RENAISSANCE registry. Atherosclerosis and Dyslipidemia. 2023;1(50):5–18. (In Russ.) Чубыкина У.В, Ежов М.В., Рожкова Т.А., Тамаева Б.М., Соколов А.А., Ершова А.И., Мешков А.Н., Михайлина В.И., Блохина А.В., Лимонова А.С., Копылова О.В., Шапошник И.И., Генкель В.В., Гуревич В.С., Уразгильдеева С.А., Трегубов А.В., Музалевская М.В., Воевода М.И., Тимощенко О.В., Шахтшнейдер Е.В., Рагино Ю.И., Леонтьева И.В., Егоров Л.В., Захарова И.Н., Пшеничникова И.И., Садыкова Д.И., Сластникова Е.С., Галимова Л.Ф., Космачева Е.Д., Намитоков А.М., Алиева А.С., Галявич А.С., Ким З.Ф., Корнева В.А., Кузнецова Т.Ю., Филиппов А.Е., Туктаров А.М., Воробьев А.С., Астраханцева И.Д., Богданов Д.Ю., Качковский М.А., Егорова А.В., Константинов В.О., Серебреницкая М.П., Зафираки В.К., Бизяева Н.Н., Андросюк Н.Г., Киселева М.А., Григорьева Ю.Г., Кореннова О.Ю., Юхина Ю.Е., Девятова М.Д., Иванова О.Н., Васильев П.А., Авдеева И.В., Олейников В.Э., Воробьева Ю.А., Ермакова Ю.А., Муха Н.В., Зайцев Д.Н., Зыков М.В., Исаева А.В., Петелина Т.И., Микова Е.В. Пятилетний период наблюдения за пациентами с гомо- и гетерозиготной семейной гиперхолестеринемией в регистре РЕНЕССАНС. Атеросклероз и Дислипидемии. 2023;1(50):5–18. doi: 10.34687/2219-8202.JAD.2023.01.0001
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2023 Марат Владиславович Ежов, Ульяна Валериевна Чубыкина, Виктор Дмитриев
This work is licensed under a Creative Commons Attribution 4.0 International License.
