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Background <p>Cardiovascular disease remains the leading cause of morbidity and mortality worldwide, with dyslipidemia playing a key role in its progression. Despite advances in lipid-lowering therapy (LLT), LDL-C (Low-Density Lipoprotein Cholesterol) goal achievement remains suboptimal. This study evaluated LDL-C goal attainment in Colombian patients with very high cardiovascular risk (CVR) due to coronary artery disease (CAD) following ESC/EAS guidelines updates.</p> Methods <p>EDHIPO MARCA (<b>E</b>valuación <b>D</b>e adherencia a la terapia <b>HIPO</b>lipemiante en pacientes de <b>M</b>uy <b>A</b>lto <b>R</b>iesgo <b>CA</b>rdiovascular) is a retrospective, multicenter study assessing LDL-C goal achievement in patients with CAD. Data were collected from previous coronary angiogram reports and medical records across 11 Colombian healthcare institutions with certified interventional cardiology services. Patients with CAD who had at least one follow-up LDL-C measurement and an LLT prescription within 12 months post-angiogram were included. LDL-C goal attainment was assessed across three periods—2011–2012, 2016–2017, and 2021–2022—corresponding to the updates of ESC/EAS guidelines (2011, 2016, and 2019, respectively). The LDL-C goals were &lt;70&#xa0;mg/dL for the first two periods and &lt;55&#xa0;mg/dL for the most recent one. LDL-C was measured or estimated using the Friedewald equation. Descriptive analyses were performed.</p> Results <p>A total of 1,788 patients were included, with a median age of 66 years (IQR: 59–74), and 70.7% were male. Hypertension (67.5%) and overweight (40.8%) were the most common comorbidities. At discharge, statins were prescribed in 84.1% (95% CI: 82.4–85.8%) of patients, increasing to 99.1% (95% CI: 98.6–99.5%) at the end of follow-up (median 6.8 months); PCSK9 inhibitors were prescribed in 1.5%, exclusively in 2019. At the end of follow-up, 36.6% (95% CI: 34.3%, 38.8%) achieved LDL-C goals. By guideline period, goal attainment was 12.1% (95% CI: 5.4%, 18.8%) in 2011, 42.3% (95% CI: 37.9%, 46.8%) in 2016, and 36.2% (95% CI: 33.5%, 38.9%) in 2019. By number of follow-ups, LDL-C goal achievement increased from 32.9% (1 follow-up) to 44.0% (4 follow-ups).</p> Conclusions <p>Despite widespread LLT use, LDL-C target achievement remains suboptimal. Frequent follow-up and greater use of combination therapy beyond statins may be essential to improve lipid control in very high CVR patients.</p>

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From guidelines to practice: LDL-C achievement in very high cardiovascular risk patients – analysis of the EDHIPO MARCA registry

  • 期刊论文

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  • 发表日期：

    2025年9月2日

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  • Brayan Daniel Cordoba-Melo,
  • Sebastián Seni-Molina,
  • Juan Pablo Arango-Ibanez,
  • Milton René Ayala,
  • José Fidel Tatis-Méndez,
  • Viviana Quintero Yepez,
  • Luz Aída Mejía Cadavid,
  • José D. Cruz-Cuevas,
  • Nicolás Ariza-Ordóñez,
  • Andrés Buitrago,
  • Jose Patricio Lopez-Lopez,
  • Alfredo Hinestrosa,
  • Jorge Sabogal,
  • Cristian Reyes-Vargas,
  • Álvaro Herrera-Escandon,
  • Juan Sebastián Hurtado,
  • Juan Fernando Velásquez Osorio,
  • Sergio Londoño,
  • Carlos Salamanca,
  • Liliana Vallecilla,
  • Hoover Leon-Giraldo,
  • Alvaro J. Ruiz,
  • Dora Inés Molina,
  • Juan Esteban Gomez-Mesa

摘要

Background

Cardiovascular disease remains the leading cause of morbidity and mortality worldwide, with dyslipidemia playing a key role in its progression. Despite advances in lipid-lowering therapy (LLT), LDL-C (Low-Density Lipoprotein Cholesterol) goal achievement remains suboptimal. This study evaluated LDL-C goal attainment in Colombian patients with very high cardiovascular risk (CVR) due to coronary artery disease (CAD) following ESC/EAS guidelines updates.

Methods

EDHIPO MARCA (Evaluación De adherencia a la terapia HIPOlipemiante en pacientes de Muy Alto Riesgo CArdiovascular) is a retrospective, multicenter study assessing LDL-C goal achievement in patients with CAD. Data were collected from previous coronary angiogram reports and medical records across 11 Colombian healthcare institutions with certified interventional cardiology services. Patients with CAD who had at least one follow-up LDL-C measurement and an LLT prescription within 12 months post-angiogram were included. LDL-C goal attainment was assessed across three periods—2011–2012, 2016–2017, and 2021–2022—corresponding to the updates of ESC/EAS guidelines (2011, 2016, and 2019, respectively). The LDL-C goals were <70 mg/dL for the first two periods and <55 mg/dL for the most recent one. LDL-C was measured or estimated using the Friedewald equation. Descriptive analyses were performed.

Results

A total of 1,788 patients were included, with a median age of 66 years (IQR: 59–74), and 70.7% were male. Hypertension (67.5%) and overweight (40.8%) were the most common comorbidities. At discharge, statins were prescribed in 84.1% (95% CI: 82.4–85.8%) of patients, increasing to 99.1% (95% CI: 98.6–99.5%) at the end of follow-up (median 6.8 months); PCSK9 inhibitors were prescribed in 1.5%, exclusively in 2019. At the end of follow-up, 36.6% (95% CI: 34.3%, 38.8%) achieved LDL-C goals. By guideline period, goal attainment was 12.1% (95% CI: 5.4%, 18.8%) in 2011, 42.3% (95% CI: 37.9%, 46.8%) in 2016, and 36.2% (95% CI: 33.5%, 38.9%) in 2019. By number of follow-ups, LDL-C goal achievement increased from 32.9% (1 follow-up) to 44.0% (4 follow-ups).

Conclusions

Despite widespread LLT use, LDL-C target achievement remains suboptimal. Frequent follow-up and greater use of combination therapy beyond statins may be essential to improve lipid control in very high CVR patients.