Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Low-density lipoprotein-cholesterol reduction in very high-risk patients through lipid lowering therapy in lipid clinic
D. Pinsdorf1, M. Bahar1, M. Steinmetz1, O. Petrikhovich1, A.-A. Mahabadi1, C. Rammos1, T. Rassaf1, J. Lortz1
1Klinik für Kardiologie und Angiologie, Universitätsklinikum Essen, Essen;
Background: Studies have shown the importance of reducing low-density lipoprotein cholesterol (LDL-C) in reducing risk of cardiovascular events in patients with cardiovascular disease (CVD). Therefore, to achieve target values, lipid lowering therapy (LLT) is not only initiated and followed up by e.g. general practitioners and cardiologists, but patients are also referred to lipid clinics. The reduction in LDL-C through different forms of LLT in lipid clinics has not yet been studied in depth.
Objective: To assess LDL-C reduction in very high-risk CVD patients achieved in a lipid clinic through different forms of LLT in comparison to standard care.

Methods: Data from 332 patients referred to a certified lipid clinic between April 2018 and December 2020 were analyzed retrospectively and compared to an historical cohort. High-risk patients were defined as either having CVD, severe chronic kidney disease or a risk factor combination of diabetes mellitus, active smoking and hypertension as according to the ESC cardiovascular risk categories. We investigated different combinations of LLT focusing on high intensity statins and PCSK9 inhibitors. Different LLT groups were high-intensity statin + ezetimibe (1), non-high-intensity statin + ezetimibe (2), PCSK9 inhibitor with high intensity statin + ezetimibe (3) and PCSK9 inhibitor without high intensity statin + ezetimibe (4). Achievement of LDL-C treatment goals according to ESC guidelines as well as LDL-C reduction were assessed via comparison of baseline LDL-C versus the values recorded in the latest visit.

Results: 171 patients (aged 64 ± 11 years at first visit, coronary artery disease (CAD) n = 111, peripheral artery disease (PAD) n = 71, cerebrovascular disease (CEVD) n = 26) at very high-risk for CVD were identified. Overall, the patients achieved a relative LDL-C reduction of 24.4 ± 31.5 % (n = 171, p < 0.01, median follow-up 182 days), whereas standard care patients had a relative LDL-C reduction of 7.1 ± 33.6 % (n = 84, p = 0.04, median follow-up 154 days). In comparison, the LDL-C-reduction in lipid clinic patients was significantly higher (p < 0.01). The individual LDL-C goal achievement (ESC guidelines 2019) in lipid clinic patients rose from 5.3 % at baseline to 29.2 % at the latest visit. Divided into subgroups, the largest LDL-C reduction was achieved via high-intensity statins, ezetimibe and PCSK9 inhibitors (71 ± 4.9 %, n = 3, p < 0.05 in comparison to the other three groups (High intensity statin + ezetimibe: 25.4 ± 33.4 %, n = 82, p < 0.01; non high-intensity statin + ezetimibe: 19.5 ± 26.2 %, n = 73, p < 0.01; PCSK9 inhibitor without high intensity statin + ezetimibe: 34 ± 37.7 %, n = 13, p < 0.01).

Conclusion: Treatment in a lipid clinic leads to a significant decrease of LDL-C in patients with very high-risk for CVD with the highest reduction under LLT with high-intensity statins, ezetimibe and PCSK9 inhibitors. Further referral algorithms have to be established to ensure an early and effective reduction of LDL-C and thereby lower the risk for atherosclerotic diseases in the population.
 

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