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Lipid Risk Control in Secondary Prevention

Diana, Barbonta; Laurentiu, Jomir

Alba-Iulia City Hospital, Romania

SUMMARY
Objective: To assess the current standard of lipid risk factors control in a high-risk group - the group of atherosclerotic coronary heart disease subjects.
Subjects and method: We have analyzed the lipid values in 750 subjects with documented atherosclerotic ischaemic heart disease, as defined by ATP II, diagnosed for more than 6 months. The results were compared to the desirable recommended values in secondary prevention. We have also determined the number of subjects requiring lipid-regulating drug therapy, and the usage of international recommendations regarding the management of lipids in secondary prevention.
Results: In the 750 subjects group, 77% had a full lipid evaluation; 12,82% had desirable (calculated) LDL-C values of < 100mg/dl; 62,28% had seric triglycerides < 150mg/dl; in no more than 6,39% of the group HDL-C ratio was <3,5 in only 2,85% of the group, 95,89% having values of >5. In the subgroup that had a full lipid evaluation, 89,08% required lipid-regulating drug therapy, but only 22,17% were on lipid-regulating drug treatment. In the drug-treated group 78,4% were receiving fibrates, while 21,6% were on statins. Having LDL-C values of >100mg/dl 6 months after being diagnosed with atherosclerotic ischaemic heart disease, 97% of the group required lipid-regulating drug treatment with statins, however statins were prescribed in only 7% of the studied group.
Conclusions: Lipid risk control in secondary prevention is inadequate, in the group that we studied, the majority of the subjects that we have evaluated were not achieving the desirable lipid targets 6 months after diagnosis, the usage of international guidelines is precarious, the selection of lipid regulating drug therapy is, oftenly, inappropriate.

OBJECTIVES

- To assess the current standard of lipid risk factors control in a high-risk group - the group of atherosclerotic coronary heart disease subjects.
- To appreciate lipid risk in secondary prevention according to international recommendations.

BACKGROUND
   Reducing the mortality by atherosclerotic coronary disease is attribute for 50% by controlling the cardiovascular risk factors.

   The prevalence of the atherosclerotic coronary heart disease and coronary disease premature mortality in eastern European countries has reached a very high rate.

   The pharmacological hypolipemiant therapy is an essential point in the strategy for the management of atherosclerotic disease in primary prevention but also had a decisive role in secondary prevention.

SUBJECTS AND METHOD
   We have made a transversal study for 750 subjects during 1.01.2000 to 1.12.2000, subjects with documented atherosclerotic ischaemic heart disease, as defined by ATP II, diagnosed for more than 6 months in which we analyzed the plasmatic lipid values determined in basal conditions (TC, TG, HDL-C, CT/HDL-C). The subjects with acute myocardial infarction were excluded, as well as those with ischaemic heart disease recently diagnosed (less than 6 months). The results were compared to the desirable international recommended values in secondary prevention.

   We have evaluated:

- the percentage of the subjects which reached the optim values recommended in 6 months after being diagnosed
- the ways in which actual international recommendations regarding hypolipeminat therapy are performed

   The age of selected group is shown in table 1.

RESULTS
   In the 750 subjects group, 77% (578) had a full lipid evaluation: TC, TG, HDL-C. 12,82% had desirable (calculated) LDL-C values of < 100mg/dl; 62,28% had seric triglycerides <150mg/dl. Optim HDL-C values (>45 mg/dl) had only 6,39% of subjects.

   In no more than 2,85% of the group CT/HDL-C ratio was <3,5 (Figure 1) but 95,89% were having values of >5 (Figure 2).

   In the subgroup that had a full lipid evaluation, 89,08% required lipid-regulating drug therapy, but only 32,5% were on lipid-regulating drug treatment (Figure 3).

   In the drug-treated group 78,4% were receiving fibrates, while 21,6% were on statins (Figure 4).

   Having LDL-C values of >100mg/dl 6 months after being diagnosed with atherosclerotic ischaemic heart disease, 97% of the group required lipid-regulating drug treatment with statins, however statins were prescribed in only 7% of the studied group.

CONCLUSIONS

1. Lipid risk control in secondary prevention is inadequate, in the group that we studied; the majority of the subjects that we have evaluated were not achieving the desirable lipid targets 6 months after diagnosis.
2. The usage of international guidelines is precarious, the selection of lipid regulating drug therapy is, oftenly, inappropriate.
3. Statins are the fundamental part in the management of atherosclerotic heart disease as secondary prevention but they are still low used in clinical practice.
4. The usage of international guidelines is limited by:

- economic or financial reasons
- patients non compliance at a long lipid-regulating drug therapy
- the lack of knowledge and applicability of the medical instructions on different levels
- the inadequate conclusions of the medical team on this therapy.

 

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2nd Virtual Congress of Cardiology

Dr. Florencio Garófalo
Steering Committee
President
Dr. Raúl Bretal
Scientific Committee
President
Dr. Armando Pacher
Technical Committee - CETIFAC
President
fgaro@fac.org.ar
fgaro@satlink.com
rbretal@fac.org.ar
rbretal@netverk.com.ar
apacher@fac.org.ar
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