Bassi tassi di raggiungimento degli obiettivi lipidici in pazienti in prevenzione secondaria

Il Dyslipidemia International Study II era uno studio multicentrico su oltre 10.600 pazienti con malattia coronarica stabile o affetti da sindrome coronarica acuta che ha indagato il raggiungimento del valore goal per il colesterolo LDL, l'uso della terapia ipolipemizzante e gli outcome cardiovascolari.
I livelli medi di LDL-C erano di 88 mg/dL e 108 mg/dL rispettivamente per i due gruppi, con solo il 29,4% e il 18,9% aventi un livello inferiore a 70 mg/dl. La terapia ipolipemizzante era utilizzata dal 93,8% e dal 95,6%. Tra i pazienti trattati, queli di sesso femminile, obesi o fumatori correnti avevano meno probabilità di raggiungere un livello di LDL-C <70 mg/dL, mentre i soggetti con diabete di tipo 2, malattia renale cronica o coloro che assumevano un dosaggio di statine più elevato avevano maggiore probabilità di raggiungere il goal.
Questi dati su pazienti ad alto rischio mostrano quindi tassi di raggiungimento dell’obiettivo terapeutico per il colesterolo LDL erano estremamente bassi. L'associazione di atorvastatina (o dosi equivalenti) con un migliore raggiungimento degli obiettivi suggerisce che dosi più alte e combinazioni di statine con trattamenti non statinici potrebbero ulteriormente migliorare i tassi di raggiungimento del goal e gli outcome cardiovascolari..

Cholesterol target value attainment and lipid-lowering therapy in patients with stable or acute coronary heart disease: Results from the Dyslipidemia International Study II

Gitt AK, Lautsch D, Ferrières J, De Ferrari GM, Vyas A, Baxter CA, Bash LD, Ashton V, Horack M, Almahmeed W, Chiang FT, Poh KK, Brudi P, Ambegaonkar B.

Atherosclerosis 2017;266:158-166

BACKGROUND AND AIMS: Low-density lipoprotein cholesterol (LDL-C) is a major contributor to cardiovascular disease. In the Dyslipidemia International Study II (DYSIS II), we determined LDL-C target value attainment, use of lipid-lowering therapy (LLT), and cardiovascular outcomes in patients with stable coronary heart disease (CHD) and those suffering from an acute coronary syndrome (ACS).
METHODS: DYSIS II included patients from 18 countries. Patients with either stable CHD or an ACS were enrolled if they were ≥18 years old and had a full lipid profile available. Data were collected at a physician visit (CHD cohort) or at hospital admission and 120 days later (ACS cohort).
RESULTS: A total of 10,661 patients were enrolled, 6794 with stable CHD and 3867 with an ACS. Mean LDL-C levels were low at 88 mg/dl and 108 mg/dl for the CHD and ACS cohorts respectively, with only 29.4% and 18.9% displaying a level below 70 mg/dl. LLT was utilized by 93.8% of the CHD cohort, with a mean daily statin dosage of 25 ± 18 mg. The proportion of the ACS cohort treated with LLT rose from 65.2% at admission to 95.6% at follow-up. LLT-treated patients, who were female, obese, or current smokers, were less likely to achieve an LDL-C level of <70 mg/dl, while those with type 2 diabetes, chronic kidney disease, or those taking a higher statin dosage were more likely.
CONCLUSIONS: Few of these very high-risk patients achieved the LDL-C target, indicating huge potential for improving cardiovascular outcome by use of more intensive LLT.

Atherosclerosis 2017;266:158-166