Current lipid lowering treatment and attainment of LDL targets recommended by ESC/EAS guidelines in very high-risk patients with established atherosclerotic cardiovascular disease: Insights from the START registry

Current European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidemias have further reduced low density lipoprotein-cholesterol (LDL-C) targets, as compared to the guidelines released in 2016. These targets are particularly restraining for...

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Bibliographic Details
Published in:International journal of cardiology 2020-10, Vol.316, p.229-235
Main Authors: De Luca, Leonardo, Arca, Marcello, Temporelli, Pier Luigi, Meessen, Jennifer, Riccio, Carmine, Bonomo, Paolo, Colavita, Angela Rita, Gabrielli, Domenico, Gulizia, Michele Massimo, Colivicchi, Furio
Format: Article
Language:English
Subjects:
Anticholesteremic Agents - therapeutic use
Atherosclerosis - drug therapy
Atherosclerosis - epidemiology
Atherosclerosis - prevention & control
Cardiology
Cardiovascular Diseases
Ezetimibe
Humans
Hydroxymethylglutaryl-CoA Reductase Inhibitors
Hypercholesterolemia
Italy
LDL-C
Proprotein Convertase 9
Registries
Statin
Treatment
Very high risk
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Summary:Current European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines for the management of dyslipidemias have further reduced low density lipoprotein-cholesterol (LDL-C) targets, as compared to the guidelines released in 2016. These targets are particularly restraining for patients at very high risk (VHR). Using the data from a nationwide, prospective registry on patients with established atherosclerotic cardiovascular disease (ASCVD), we sought to assess: 1) the contemporary use of conventional cholesterol-lowering therapies and the achievement of LDL-C goals according to previous and current ESC guidelines in subjects at VHR; 2) the proportion of VHR patients potentially eligible for proprotein convertase subtilisin/kexin type 9 inhibitor (PCSK9i) treatment. Among the 5053 patients with data available, 4751 (94.0%) were deemed as VHR. Among these patients, the mean LDL-C levels were 62.4 ± 47.7 mg/dl at enrollment. A high dose of statin was used in 54.9%, while the association of high dose statin and ezetimibe was prescribed in 4.8% of VHR patients. A target level of LDL-C 
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2020.05.055