Inertia – a possible reason for not reaching LDL-cholesterol targets: results of a multicenter observational study

Česká verzia

Authors: Michal Vrablík ¹; Ivana Šarkanová ²; Katarína Breciková ²; Petra Šedová ^3,4,5; Martin Šatný ¹; Aleš Tichopád ⁶
Authors place of work: Centrum preventivní kardiologie, III. interní klinika – endokrinologie a metabolismu 1. LF UK a VFN v Praze ¹; CEEOR, spol. s r. o., Praha ²; I. interní kardiologická klinika LF MU a FN U Sv. Anny v Brně ³; I. neurologická klinika a International Clinical Research Center (ICRC) LF MU a FN U Sv. Anny v Brně ⁴; Neurology Department, Mayo Clinic, Rochester, USA ⁵; Oddělení biomedicínských technologií, České vysoké učení technické v Praze ⁶
Published in the journal: AtheroRev 2024; 9(2): 73-79
Category:

Summary

Atherosclerotic cardiovascular diseases (ASCVD) are the leading cause of morbidity and mortality not only in the Czech Republic but also globally. Cholesterol carried by apolipoprotein B (apoB)-containing particles, i.e. predominantly LDL particles, is considered to be their major, i.e. causal, risk factor (RF). Although increasing attention is being paid to innovative therapies, it appears that nonadherence to treatment or (unfortunately) medical inertia is often behind the lack of control of dyslipidemia (DLP). The aim of this multicenter retrospective cross-sectional study was to map DLP control and treatment strategies in a group of patients at high or very high cardiovascular (CV) risk, in outpatient cardiologists/internists’ offices. A total of 450 patients were enrolled in the study-80% at very high CV risk and 12.7% at high CV risk; the remaining percentages were misclassified probands. Only 19.4% and 28.1% of the very high CV-risk and high-risk patients, respectively, achieved target LDL-cholesterol (LDL-C) levels. More than 60% of the treating cardiologists (despite recommended practices) preferred slow (cautious) dose titration of hypolipidemic agents; only 17% of clinicians indicated prompt modification of established therapy (dose increase, change of preparation, or addition of another drug) to achieve LDL-C reduction. A surprising finding was that over 60% of clinicians were satisfied with the current treatment, despite not achieving target lipid parameters. A very slow (unfortunately unsatisfactory) penetration of the recommended procedures into clinical practice is evident. Thus, it can be assumed that with maximum use of currently available treatment options, satisfactory control of DLP will be achieved in a large proportion of patients with minimal additional costs.

Keywords:

atherosclerotic cardiovascular diseases (ASCVD) – dyslipidemia (DLP) – (non)adherence – lipid parameters

Zdroje

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