Use of lipid-lowering agents and achievement of therapeutic goals in high cardiovascular risk patients in Argentina

Abstract

Introduction: A keystone for the reduction of cardiovascular risk in patients in secondary prevention is a correct management of lipid-lowering treatment. High-dose statins, ezetimibe, and PCSK9i are the main tools that we have for these patients to meet therapeutic LDL cholesterol goals. Despite the overwhelming evidence in favor of these therapies, there is a great underutilization of them worldwide. There is scarce information available in Argentina about the quality of lipid-lowering treatment, and what percentage of patients in secondary prevention present a controlled lipid profile according to guidelines. Material and Methods: We designed a multicenter, cross-sectional study in patients in secondary prevention of cardiovascular events included prospectively and consecutively in hospitals of Argentina that have a Medical Residence system affiliated to CONAREC. Data collection was carried out from March to August 2020. The lipid-lowering treatment received by patients, the reasons behind the non-use of statins in adequate doses, if so, and the lipid profile values were collected. Results: 1,000 consecutive patients from 24 centers, corresponding to 11 provinces, were included. There was 85.9% treated with statins, 4.8% with ezetimibe, 2.4% with fibrates, and 13% without treatment. Between patients receiving statin therapy, 67% received high-dose statins. Among the total population, 509 patients had an LDL measurement within the last 6 months. The mean LDL value was 94 mg/dl, HDL 41 mg/dl, and triglycerides 151 mg/dl. Thirty percent had values below the 70 mg/dl cut-off point and 16% below 55 mg/dl. In 37% of patients, LDL >100 mg/dl was observed.
Conclusions: In this multicenter study of secondary prevention performed in Argentina, just over half of patients presented high-dose statin treatment, with little use of ezetimibe. Under-treatment was reflected in LDL values, with more than ⅔ of the patients outside the therapeutic range, and therefore with a higher risk of suffering new cardiovascular events.