Comparison of profile and treatment of patients with uncontrolled arterial hypertension and/or dyslipidemia in specialist care and primary care in the Czech Republic: comparison of the results of the LipitenCliDec 1 and LipitenCliDec 2 studies

Česká verzia

Authors: Martin Šatný ¹; Eva Tůmová ¹; Michal Vrablík ¹; Jana Mašková ²; Jiří Laštůvka ³
Authors place of work: Centrum preventivní kardiologie, III. interní klinika – endokrinologie a metabolismu 1. LF UK a VFN v Praze ¹; NEOX s. r. o., Clinical Research, Praha ²; Interní oddělení, Masarykova nemocnice v Ústí nad Labem, o. z, Krajská zdravotní, a. s ³
Published in the journal: AtheroRev 2021; 6(3): 154-162
Category: Clinical Studies

Summary

In previous issues of this journal the results of the LipitenCliDec study phase 1 and 2. Phase 1 (LipitenCliDec 1) performed in general practitioners practices were published, the study aim of was to map the characteristics of patients with decompensated arterial hypertension (AH) and/or dyslipidemia (DLP), identify possible explanatory causes of poor compensation of these risk factors (RF), evaluate changes in their control 3–6 months after the initial intervention and last but not least also selection of patients with suspected familial hypercholesterolemia (FH). Due to the importance of previously obtained data from primary care, essentially the same project was launched at the workplaces of outpatient specialists, i.e. cardiologists and internists, named LipitenCliDec 2. The aim of this paper is to compare patient populations of both LipitenCliDec studies, especially pharmacotherapy. Unfortunately, the comparison of the results of both studies was complicated by the update of the recommendations for the diagnosis and treatment of DLP in August 2019, when the target values of LDL-cholesterol (LDL-C) were tightened. LipitenCliDec 2 study yields even more positive results, although it was a riskier population compared to the previous study. The assumption was fulfilled that outpatient specialists generally receive more polymorbid patients, who are, however, relatively more intensively treated compared to primary care. From the results of the follow-up study LipitenCliDec 2 we can see again that even in a relatively short time (3–6 months) it is possible to achieve better compensation of both AH and DLP. Both RFs were controlled in almost four times more patients after the initial intervention. Similar to the previous study, the EUROASPIRE or LipiCONTROL study series, we observe better control of AH, when combination therapy (ACEi + BKK + diuretic) is correctly indicated, while DLP is correctly treated with modern statins (atorvastatin or rosuvastatin), but unfortunately in relatively small doses (on average around 20 mg) and the use of combination therapy to affect LDL-C) levels is not so common, so the percentage of patients with uncontrolled DLP is much higher than with AH. The LipitenCliDec 2 study, ie a study mapping specialized care in the Czech Republic, points to a satisfactory penetration of current guidelines into routine clinical practice, where adequate cardioprotective treatment is correctly chosen, but this is again often titrated with too caution and slowly or neglected appropriate combination therapy.

Keywords:

arterial hypertension – dyslipidemia – cardiovascular risk – familial hypercholesterolemia – cardiovascular prevention

Zdroje

Townsend N, Wilson L, Prachi Bhatnagar P et al. Cardiovascular disease in Europe: epidemiological update 2016. Eur Heart J 2016; 37(42): 3232–3245. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehw334>.
Vrablík M, Piťha J, Bláha V et al. Stanovisko výboru České společnosti pro aterosklerózu k doporučením ESC/EAS pro diagnostiku a léčbu dyslipidemií z roku 2019. AtheroRev 2019; 4(3): 126–137.
Widimský J jr, Filipovský J, Ceral J et al. Diagnostické a léčebné postupy u arteriální hypertenze – verze 2017. Doporučení České společnosti pro hypertenzi. Hypertenze KV Prevence 2018; 7(Suppl): 2–22.
Vrablík M, Piťha J, Blaha V et al. Stanovisko výboru ČSAT k doporučením ESC/EAS pro diagnostiku a léčbu dyslipidemií z roku 2016. AtheroRev 2017; 2(3): 185–193.
Widimský J. Léčba hypertenze v každodenní praxi. Interní Med 2010; 12(5): 236–246.
Kotseva K, Wood D, De Backer G et al. Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 2009; 373(9667): 929–940. Dostupné z DOI: <http://dx.doi.org/10.1016/S0140–6736(09)60330–5>.
Šatný M, Mašková J, Tůmová E et al. Profil pacientů s nekontrolovanou arteriální hypertenzí a/nebo dyslipidemií v primární péči v Česku – studie LipitenCliDec: výsledky 1. fáze. Atherorev 2020, 5(1): 47–52.
Šatný M, Tůmová E, Vrablík M. LIPIcontrol: daří se zlepšovat úroveň kontroly hlavních rizikových faktorů kardiovaskulárních onemocnění v každodenní praxi?. Hypertenze KV Prevence 2018; 7(1): 15–21.
Šatný M, Vrablík M. Moderní kombinační léčba ke snížení kardiovaskulárního rizika. Practicus 2018; 17(3): 19–23.
Catapano AL, Graham I, De Backer G et al. ESC Scientific Document Group; 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>.
Vrablík M, Laštůvka J, Tůmová E et al. Šest otázek použití ezetimibu v roce 2018. Farmakoterapie 2018;14(1):88–93.
Piepoli MF, Hoes AW, Agewall S et al. 2016 European Guidelines on cardiovascular disease prevention in clinical practice: The Sixth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of 10 societies and by invited experts) Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2016; 37(29): 2315–2381. Dostupné z DOI: <http://dx.doi.org/10.1093/eurheartj/ehw106>.
Šatný M, Tůmová E, Vrablík M et al. Profil pacientů s nekontrolovanou arteriální hypertenzí a/nebo dyslipidemií v primární péči v Česku – studie LipitenCliDec: výsledky 2. fáze. AtheroRev 2020, 5(2): 117–123.