Title : Lipid-lowering therapy and dyslipidemia in patients with acute coronary syndrome: A 14-year follow-up
Abstract:
Aim: To evaluate lipid-lowering therapy and parameters of lipid spectrum in patients with acute coronary syndrome (ACS) in the long-term period.
Materials and Methods: 260 patients hospitalized in the Regional Vascular Center (Petrozavodsk, Russia) for ACS in 2009-2010 were included in research. Retrospective analysis of lipid-lowering therapy and lipid spectrum parameters was carried out in 12.2023. Data w?re received through telephone contacts with patients, from electronic archive of the Regional Vascular Center and electronic outpatient cards. Target parameters of lipid spectrum were determined based on current clinical guildnesses.
Results: The follow-up period was 14 years. Information about 212 patients was received: 19.8% of them were women, 80.2% - men. 82 people (38.7%) died during the observation period. The average age of the deceased was 60±8.2 years. The results of lipid spectrum analysis were available in 108 patients: dyslipidemia was detected in 103 of them (95.4%). All patients who have achieved target levels are alive. Data on prescribed lipid-lowering therapy were obtained in 128 patients. 14.8% of patients do not take medications. Three of them refused treatment, one patient had more than 3 times increased level of transaminases. The reason for lack of therapy in remaining patients is unknown. 89 patients (69.5%) receive monotherapy of statin, among them 42 (47.2%) have high-intensity therapy. A combination of a high-dose statin and ezetimibe was prescribed to 11.7% of patients. Two patients receive triple therapy (statin, ezetimibe and PCSK-9 inhibitor), two - ezetimibe alone (one of them does not receive statin due to the presence of autoimmune hepatitis) and one patient receives a combination of statin and fenofibrate. Target levels were achieved in both patients having triple therapy and in two other receiving a combination of rosuvastatin (40 mg, 20 mg) and ezetimibe. Repeated ACS developed in 43.5% of patients (data from 131 patients were available). 17.5% (10 patients) had repeated ACS in the first two years after the index event.
Conclusion: the results of the research show a high prevalence of dyslipidemia (96.3%) among patients in 14 years after ACS. Insufficient intensity of lipid-lowering therapy may be a cause of failure in achieving target levels. 1/6 of the observed patients do not receive drugs. Monotherapy of statin is prescribed to more than ½ of patients, and only 47.2% of them receive it in high doses. A small number of patients (11.7%) have ezetimibe added to the statin, and only two patients receive PCSK-9 inhibitors. Uncorrected dyslipidemia could be one of the reasons for the high mortality rate (38.7%) and high incidence of repeated ACS (43.5%). Most of the deceased are people of working age.
