The changes in achievement of target LDL-cholesterol levels between 2006 and 2017 in Czech patients with chronic coronary heart disease
Abstract
Several clinical trials have shown that patients with coronary heart disease (CHD) benefit from more aggressive treatment to achieve lower target LDL cholesterol. We aimed to analyze the changes in achievement of guideline recommended LDL target during last 10 years and the usual dosage of statin in secondary prevention of CHD.
We analyzed 1349 patients (21.7% females) aged 64.9 years (standard deviation [SD] +/- 9.0) after acute coronary syndrome and/or coronary revascularization from three different cohorts (Czech samples of EUROASPIRE III, IV and V). Overall control of hypercholesterolemia substantially improved from year 2006 to year 2017, 52% of CHD patients did not achieve the guideline target LDL <1.8 mmol/L in 2016/2017 cohort.
Accordingly, despite the fact that prescription rate of maximal potent statins (atorvastatin 80 mg or equivalent) significantly increased, it still accounted to only 23% in the most recent cohort. On the basis of individual LDL concentrations we might approximate that after maximal possible up-titration of statin, the adherence to recent LDL target may improve by further 12%.
Provided ezetimibe is added into combination, up to 73% patients would have LDL <1.8 mmol/L, as recommended. In conclusion, although majority of CHD patients are currently being treated with statin, the usual doses and adherence to the recommended target remains unsatisfactory.
Maximal statin up-titration and namely more frequent use of combination of hypolipidemic drugs may substantially improve this situation.