Достижение целей в ведении пациентов с дислипидемиями в первичном звене здравоохранения: проблемы и решения

L. F. Badamshina; V. V.   Kashtalap; A. S. Vorobyov; O. V.  Kudryavtseva; I. A. Urvantseva

doi:10.34687/2219-8202.JAD.2024.03.0005

Authors

L. F. Badamshina District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery", Khanty-Mansiysk Autonomous Okrug – Yugra, Surgut, Russian Federation
V. V. Kashtalap Research Institute of Complex Problems of Cardiovascular Diseases, Kemerovo
A. S. Vorobyov District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery", Khanty-Mansiysk Autonomous Okrug – Yugra, Surgut, Russian Federation
O. V. Kudryavtseva District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery", Khanty-Mansiysk Autonomous Okrug – Yugra, Surgut, Russian Federation
I. A. Urvantseva District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery", Khanty-Mansiysk Autonomous Okrug – Yugra, Surgut, Russian Federation

DOI:

https://doi.org/10.34687/2219-8202.JAD.2024.03.0005

Keywords:

very high cardiovascular risk, survey, primary care physicians, low-density lipoprotein cholesterol, rosuvastatin, atorvastatin.

Abstract

Summary:

Purpose of the study. To analyze the awareness of primary care physicians in the city of Surgut regarding approaches to cardiovascular risk stratification adopted in the current clinical guidelines “Lipid Metabolism Disorders”, target levels of low-density lipoprotein (LDL) cholesterol, and modern aspects of lipid-lowering therapy.

Materials and methods. In February-March 2024, an anonymous survey of 93 general practitioners from city clinics in Surgut was conducted. The questionnaire based on the provisions of the clinical recommendations “Lipid metabolism disorders”, developed by employees of the Department of Cardiology of Surgut State University (SurSU), consisted of three blocks and contained 15 questions with several possible answers regarding the problem of dyslipidemia (the questionnaire is given in the appendix to the article). The protocol of the study and the questionnaire for interviewing doctors were approved by the Local Ethics Committee of Surgut State University. All doctors were informed about the purpose of the study and gave informed voluntary consent to participate in it.

Results. 85% of the surveyed doctors correctly identified a very high SVR. 92% of surveyed therapists observe patients with very high and high cardiovascular risk in their clinical practice. The most prescribed statins were atorvastatin and rosuvastatin. 40% of doctors prefer atorvastatin because of its availability and preferential terms, 34% of doctors more often prescribe rosuvastatin due to its high effectiveness. More than 48% of doctors most often prescribe rosuvastatin at a dose of 10-20 mg, while 69% of physicians prefer atorvastatin at a dose of 20 mg and 30% at a dose of 40 mg. Rosuvastatin at a dose of 40 mg is used by only 3% of primary care physicians, and atorvastatin at a dose of 80 mg is used by only 1 specialist. Reasons limiting the use of statins in maximum doses: 1) 60% of surveyed doctors due to the possibility of side effects and serious complications, as well as concerns about the risk of progression of liver disease. 2) 20% of surveyed doctors refuse due to the risk of developing rhabdomyolysis. Among the respondents, 51% and 21% of doctors are aware of the effectiveness and safety of alirocumab and evolocumab, respectively. After achieving the target values of LDL cholesterol in a patient with high and very high cardiovascular risk receiving the maximum dose of a statin, 46% of respondents responded to maintain treatment at the same dosage, 52% of respondents considered it possible to reduce the dose of statin. If severe hypercholesterolemia is detected, 53% of respondents are inclined to prescribe treatment; if the target LDL levels are not achieved, they refer the patient to a lipidologist. Only 17% of respondents suggested immediately referring the patient to a lipidologist. After unjustified withdrawal, 78% of surveyed doctors often resume statin therapy.

Conclusion: a survey of practicing physicians in outpatient medical organizations in Surgut showed that specialists in most cases have sufficient knowledge about the stratification of CV risk, however, in real practice there remains a low frequency of use of statins in high-intensity regimens, the use of combination lipid-lowering therapy, and insufficient knowledge of primary care specialists on the possibilities of effective routing of patients with severe dyslipidemia.

Downloads

Download data is not yet available.

Author Biographies

L. F. Badamshina, District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery", Khanty-Mansiysk Autonomous Okrug – Yugra, Surgut, Russian Federation

cardiologist of the budgetary institution of Khanty-Mansiysk Autonomous Okrug – Yugra "District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery", Khanty-Mansiysk Autonomous Okrug – Yugra, Surgut, Russian Federation

A. S. Vorobyov, District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery", Khanty-Mansiysk Autonomous Okrug – Yugra, Surgut, Russian Federation

ция;

O. V. Kudryavtseva, District Cardiology Dispensary "Center for Diagnostics and Cardiovascular Surgery", Khanty-Mansiysk Autonomous Okrug – Yugra, Surgut, Russian Federation

ерация;

References

Список используемой литературы:

Vodnala D, Rubenfire M, Brook RD. Secondary causes of dyslipidemia.

Am J Cardiol. 2012;110(6):823-825. https://doi.org/10.1016/j.amjcard.2012.04.062

Elisaf M, Tsimihodimos V. Editorial: secondary dyslipidemias. Open Cardiovasc Med J. 2011;5:22-23. https://doi.org/10.2174/1874192401105010022

2018 ESC/ESH Guidelines for the management of arterial hypertension. The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH). European Heart J. 2018;39,3021-3104. https://doi.org/10.1093/eurheartj/ehy339.

2019 ESC/EAS Guidelines for themanagement of dyslipidaemias: lipid modification to reduce cardiovascular risk. The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur Heart J. 2020;41(1):111-188. https://doi.org/10.1093/eurheartj/ehz455.

Ezhov M.V., Kukharchuk V.V., Sergienko i.V., Alieva A.S., Antsiferov M.B., Ansheles A.A., Arabidze G.G., Aronov D.M., Arutyunov G.P., Akhmedzhanov N.M., Balakhonova T.V., Barbarash O.L., Boytsov S.A., Bubnova M.G., Voevoda M.I., Galstyan G.R., Galyavich A.S., Gornyakova N.B., Gurevich V.S., Dedov I.I., Drapkina O.M., Duplyakov D.V., Eregin S.Ya., Ershova A.I., Irtyuga O.B., Karpov R.S., Karpov Yu.A., Kachkovsky M.A., Kobalava Zh.D., Koziolova N.A., Konovalov G.A., Konstantinov V.O., Kosmacheva E.D., Kotovskaya Yu.V., Martynov A.I., Meshkov A.N., Nebieridze D.V., Nedogoda S.V., Obrezan A.G., Oleinikov V.E., Pokrovsky S.N., Ragino Yu.I., Rotar O.P., Skibitsky V.V., Smolenskaya O.G., Sokolov A.A., Sumarokov A.B., Filippov E., Halimov Yu.Sh., Chazova I.E., Shaposhnik I.I., Shestakova M.V., Yakushin S.S., Shlyakhto E.V. Disorders of lipid metabolism. Clinical Guidelines 2023. Russian Journal of Cardiology. 2023;28(5):5471. (In Russ.) 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

Schiele F, Catapano AL, De Caterina R, et al. Quality Control to improve low-density lipoprotein cholesterol management in patients with acute coronary syndromes based on the ACS EuroPath IV project [published online ahead of print, 2023 Oct 13]. Eur Heart J Acute Cardiovasc Care. 2023;zuad119. doi:10.1093/ehjacc/zuad119.

Akhmedzhanov N.M., Nebieridze D.V., Safaryan A.S. et al. Analysis of the prevalence of hypercholesterolemia in an outpatient practice (according to the ARGO study). Part 1//Rational pharmacotherapy in cardiology. 2015. T. 11. № 3. P. 253-260 (in Russian). Ахмеджанов Н.М., Небиеридзе Д.В., Сафарян А.С. и др. Анализ распространенности гиперхолестеринемии в условиях амбулаторной практики (по данным исследования АРГО). Часть 1 // Рациональная фармакотерапия в кардиологии. 2015. Т. 11. № 3. С. 253–260.

Sergienko I.V., Ansheles A.A., Boytsov S.A. Risk factors, lipid profile indicators and lipid-lowering therapy in patients of different cardiovascular risk categories: Atherostop registry data. JAD. 2023;2(51):43-53 (in Russian) Сергиенко И.В., Аншелес А.А., Бойцов С.А. Факторы риска, показатели липидного профиля и гиполипидемическая терапия у пациентов различных категорий сердечно-сосудистого риска: данные регистра Атеростоп. Атеросклероз и дислипидемии. 2023;2(51):43-53. DOI: 10.34687/2219-8202.JAD.2023.02.0005

Ray KK, Molemans B, Schoonen WM, Giovas P, Bray S, Kiru G, Murphy J, Banach M, De Servi S, Gaita D, Gouni-Berthold I, Hovingh GK, Jozwiak JJ, Jukema JW, Kiss RG, Kownator S, Iversen HK, Maher V, Masana L, Parkhomenko A, Peeters A, Clifford P, Raslova K, Siostrzonek P, Romeo S, Tousoulis D, Vlachopoulos C, Vrablik M, Catapano AL, Poulter NR; DA VINCI study. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study. Eur J Prev Cardiol. 2021 Sep 20;28(11):1279-1289. doi: 10.1093/eurjpc/zwaa047. PMID: 33580789.

Lin I, Sung J, Sanchez RJ, Mallya UG, Friedman M, Panaccio M, Koren A, Neumann P, Menzin J. Patterns of Statin Use in a Real-World Population of Patients at High Cardiovascular Risk. J Manag Care Spec Pharm. 2016 Jun;22(6):685-98. doi: 10.18553/jmcp.2016.22.6.685. PMID: 27231796; PMCID: PMC10397919.

Gharaibeh L, Zoubi S. Al, Sartawi H, Ayyad D, Al-Hawamdeh M, Alrashdan R. The appropriateness of the use of statins for the secondary and primary prevention of atherosclerotic cardiovascular disease: a cross-sectional study from Jordan Eur Rev Med Pharmacol SciYear: 2023 Vol. 27 - N. 12 Pages: 5480-5492 DOI: 10.26355/eurrev_202306_32785

Nelson AJ, Haynes K, Shambhu S, Eapen Z, Cziraky MJ, Nanna MG, Calvert SB, Gallagher K, Pagidipati NJ, Granger CB. High-Intensity Statin Use Among Patients With Atherosclerosis in the U.S. J Am Coll Cardiol. 2022 May 10;79(18):1802-1813. doi: 10.1016/j.jacc.2022.02.048. PMID: 35512860; PMCID: PMC9344279.

M.V. Yezhov, I.V. Sergienko, T.E. Kolmakova, N.A. Tmoyan, U.V. Chubykina, S.A. Bliznyuk, I.A. Alekseeva. Familial hypercholesterolemia/ Moscow: Patiss LLC, 2021 – p. 84. (in Russian) М.В. Ежов, И.В. Сергиенко, Т.Е. Колмакова, Н.А. Тмоян, У.В. Чубыкина, С.А. Близнюк, И.А. Алексеева. Семейная гиперхолестеринемия / – Москва: ООО «Патисс», 2021 – с. 84.

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, 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 AV, Konstantinov VO, Serebrenitskaya MP, Zafiraki VK, Bizyaeva NN, Androsyuk NG, Kiseleva MA, Grigorieva YuG, Korennova OYu, Yukhina YuE, Devyatova MD, Isaeva AV, Ivanova ON, Vasiliev PA, Avdeeva IV, Oleinikov VE, Vorobieva YuA, Ermakova YuA, Mukha NV, Zaitsev DN, Vasilenko PA, Zykov MV, Petelina TI, Mikova EV, Bednova SE. Compliance of patients with heterozygous familial hypercholesterolemia: 5-year follow-up of the renaissance registry. Russian Cardiology Bulletin. 2023;18(3):35‑48. (In Russ.) Doi.org/10.17116/Cardiobulletin20231803135. 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., 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., Исаева А.В., Иванова О.Н., Васильев П.А., Авдеева И.В., Олейников В.Э., Воробьева Ю.А., Ермакова Ю.А., Муха Н.В., Зайцев Д.Н., Василенко П.В., Зыков М.В., Петелина Т.И., Микова Е.В., Беднова С.Е. Комплаентность пациентов с гетерозиготной семейной гиперхолестеринемией: 5 лет наблюдения регистра ренессанс. Кардиологический вестник. 2023;18(3):35‑48. Doi.org/10.17116/Cardiobulletin20231803135

Ezhov M.V., Barbarash O.L., Voevoda M.I., Gurevich V.S., Vezikova N.N., Sadykova D.I., Sergienko I.V., Kashtalap V.V., Meshkov A.N., Duplyakov D.V., Sokolov A.A., Boytsov S.A. Organization of lipid centers operation in the Russian Federation — new opportunities. Russian Journal of Cardiology. 2021;26(6):4489. (in Russian) Doi.org/10.15829/1560-4071-2021-4489. Ежов М.В., Барбараш О.Л., Воевода М.И., Гуревич В.С., Везикова Н.Н., Садыкова Д.И., Сергиенко И.В., Кашталап В.В., Мешков А.Н., Дупляков Д.В., Соколов А.А., Бойцов С.А. Организация работы липидных центров в Российской Федерации — новые возможности. Проект Национального общества по изучению атеросклероза (НОА). Российский кардиологический журнал. 2021;26(6):4489. doi:10.15829/1560-4071-2021-4489.