Observational study of dyslipidemia management in the Czech Republic

Česká verzia

Authors: Lukáš Zlatohlávek ¹; Michaela Šnejdrlová ¹; Ian Bridges ²; Romana Šindelářová ³
Authors place of work: III. interní klinika 1. LF UK a VFN v Praze ¹; Amgen Limited, Cambridge, Velká Británie ²; Amgen s. r. o., Praha ³
Published in the journal: AtheroRev 2019; 4(3): 162-169
Category: clinical studies

Summary

Introduction: A retrospective/prospective observational study was conducted to explore the current management of dyslipidemia in high and very high cardiovascular (CV) risk patients in Bulgaria, Czech Republic (CR), Croatia, Poland, Romania, Slovakia and Israel. We present data from the Czech subpopulation of the study.

Methods: Adult patients who attended their physician between June and December 2016 were enrolled at 11 sites in the CR if they were receiving lipid-modifying therapy and had a record of their LDL-C levels. Data were collected from medical records of the 12 months before enrolment. Prospective follow up lasted for up to 6 months.

Results: Out of the 201 Czech patients, mean age 67.3 years (SD 11.01), 128 were receiving LMT in secondary prevention, 32 after STEMI, 90 had diabetes and 27 familial hypercholesterolemia. 28 (13.9%) were classified as high risk and 173 (86.1%) as very high risk according to the ESC/EAS guidelines. Time since diagnosis was ≥5 years in 135 patients (67.2%). Almost all patients (192; 95.5%) were receiving statins, however, only in 40.8% (n = 82) high-intensity dosing regimen was prescribed. 18.4% of patients (n = 37) were treated with ezetimibe in combination with statins. 46.4% of high risk patients achieved their recommended LDL-C level < 2.6 mmol/L and 56.1% of very high risk patients achieved the target of < 1.8 mmol/L. Mean LDL-C at the first visit of the retrospective period was 2.55 mmol/L (SD 1.10).

Conclusions: The LDL-C serum concentrations were higher than the target recommended for prevention of fatal CV events in approximately a half of the Czech patients in high and very high CV risk. A large proportion of patients did not benefit from all available treatment options.

Keywords:

combination therapy – LDL-cholesterol – cardiovascular risk – dyslipidemia

Zdroje

World Health Organization: Cardiovascular diseases. Fact sheet 2017. Dostupné z WWW: <http://www.who.int/mediacentre/factsheets/fs317/en/>.
Catapano AL, Graham I, De Backer G et al. [Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS)]. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016; 37(39): 2999–3058. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehw272>.
Baigent C, Blackwell L, Emberson J et al. [Cholesterol Treatment Trialists Collaboration]. Efficacy and safety of more intensive lowering of LDL cholesterol: A meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet 2010; 376(9753): 1670–1681. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(10)61350–5>.
Reiner Z, Catapano AL, De Backer G et al. ESC/EAS Guidelines for the management of dyslipidaemias: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS). Eur Heart J 2011; 32(14): 1769–1818. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehr158>.
Marrett E, Zhao C, Zhang NJ et al. Limitations of real-world treatment with atorvastatin monotherapy for lowering LDL-C in high-risk cardiovascular patients in the US. Vasc Health Risk Manag 2014; 10: 237–246. Dostupné z DOI: <http://dx.doi.org/10.2147/VHRM.S54886>.
Reiner Z, De Backer G, Fras Z et al. Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries; Findings from the EUROASPIRE IV survey. Atherosclerosis 2016; 246: 243–250. Dostupné z DOI: <http://dx.doi.org/10.1016/j.atherosclerosis.2016.01.018>.
Gitt AK, Lautsch D, Ferrieres J et al. Low-density lipoprotein cholesterol in a global cohort of 57,885 statin-treated patients. Atherosclerosis 2016, 255: 200–209. Dostupné z DOI: <http://dx.doi.org/10.1016/j.atherosclerosis.2016.09.004>.
Petrov I, Dumitrescu A, Snejdrlova M et al. Clinical Management of High and Very High Risk Patients with Hyperlipidaemia in Central and Eastern Europe: An Observational Study. Adv Ther 2019; 36(3): 608–620. Dostupné z DOI: <http://dx.doi.org/10.1007/s12325–019–0879–1>.
Hovingh GK, Davidson MH, Kastelein JJ et al. Diagnosis and treatment of familial hypercholesterolaemia. Eur Heart J 2013; 34(13): 962–971. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/eht015>.
Bruthans J, Mayer O, Galovcova M et al. State of secondary prevention in Czech coronary patients in the EUROASPIRE IV study. Cor Vasa 2014; 56(2): e105–e112. Dostupné z DOI: <https://doi.org/10.1016/j.crvasa.2014.02.012>.
Rosolova H, Nussbaumerova B, Mayer O, Jr et al. Success and failure of cardiovascular disease prevention in Czech Republic over the past 30 years. Czech part of the EUROASPIRE I-IV surveys. Physiol Res 2017; 66 (Supplementum 1): S77-S84.
Banach M, Stulc T, Dent R et al.: Statin non-adherence and residual cardiovascular risk: There is need for substantial improvement. Int J Cardiol 2016; 225: 184–196.
Benn M, Watts GF, Tybjaerg-Hansen A et al. Familial hypercholesterolemia in the Danish general population: Prevalence, coronary artery disease, and cholesterol-lowering medication. J Clin Endocrin Met 2012; 97: 3956–3964.
Vrablik M, Vaclova M, Tichy L et al. Familial hypercholesterolemia in the Czech Republic: more than 17 years of systematic screening within the MedPed project. Physiol Res 2017; 66(Supplementum 1): S1-S9.
Ceska R, Freiberger T, Vaclova M et al. ScreenPro FH: from the Czech MedPed to international collaboration. ScreenPro FH is a participating project of the EAS-FHCS. Physiol Res 2017; 66(Supplementum 1): S85-S90.
ADEZOP. Informace dostupné z WWW: <http://www.sukl.cz/modules/medication/detail.php?code=0232943&tab=prices>.
Laufs U, Filipiak KJ, Gouni-Berthold I et al. Practical aspects in the management of statin associated muscle symptoms (SAMS). Atheroscler Suppl 2017; 26: 45–55.
Pella D, Vrablik M et al. Myopatie asociovaná se statiny: Klinické doporuceni Slovenskej asociacie aterosklerozy a Ceské spolecnosti pro aterosklerozu. AtheroRev 2016; 1(1): 7–13.
Deshpande S, Queck GWR, Forbes CA et al. Systematic review to assess adherence and persistence with statins. Curr Med Res Op 2017; 33: 769–778.
Ofori-Asenso R, Jakhu A, Yomer E et al. Adherence and Persistence Among Statin Users Aged 65 Years and Over: A Systematic Review and Meta-analysis. J Gerontol A Biol Sci Med Sci 2018; 73(6): 813–819. Dostupné z DOI: <http://dx.doi.org/10.1093/gerona/glx169>.
Sabatine MS, Giugliano RP, Keech AC et al. Evolocumab and Clinical Outcomes in Patients with Cardiovascular Disease. N Engl J Med 2017; 376(18): 1713–1722. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1615664>.
Schwartz GG, Steg PG, Szarek M et al. Alirocumab and Cardiovascular Outcomes after Acute Coronary Syndrome. New Engl J Med 2018; 379(22): 2097–2107. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1801174>.
Giugliano RP, Mach F, Zavitz K et al. Cognitive Function in a Randomized Trial of Evolocumab. N Engl J Med 2017; 377(7): 633–643. Dostupné z DOI: <http://dx.doi.org/10.1056/NEJMoa1701131>.