Do acute coronary events affect lipid management and cholesterol goal attainment in Germany?

Abstract

Hospitalization for an acute event does not greatly alter lipid management in acute coronary syndrome patients in Germany. Both lipid-lowering therapy doses and rates of low-density lipoprotein cholesterol target value attainment remained essentially the same several months after the event.

Lipid-lowering therapy and low-density lipoprotein cholesterol goal attainment after acute coronary syndrome: a Danish population-based cohort study

“…Similar findings were demonstrated in the Netherlands among 2431 hospitalized ACS patients where no substantial difference in the proportion of patients achieving LDL-C goal was seen irrespective of treatment with statins plus ezetimibe or statin as monotherapy [7]. In general, poor LDL-C goal attainment have been reported in several European studies among patients hospitalized for ACS (18.9-55%) [7,8,[23][24][25]. It is well-documented that lowering LDL-C in very-high risk patients have direct cardiovascular benefits.…”

“…Yet, a high rate of LLT utilization was observed among the study population after being diagnosed with ACS. A similar high LLT use among ACS patients has been reported in previously studies (at admission: 90.7 and 96.6%, at 120-days follow-up: 85.9 and 96.6%) [24,25]. Despite this, we found that only few were treated with intensive LLT throughout the study period, which is in discordance with the treatment guidelines recommending initiation of intensive LLT immediately regardless of baseline cholesterol levels until treatment goal attainment [3].…”

Low-density lipoprotein cholesterol goal attainment in Germany: Results from the DA VINCI study

“…In Germany, dyslipidaemia management practices and LDL-C goal attainment have been widely studied over the years in different datasets and from various perspectives, such as general practice of dyslipidaemia management, cardiac rehabilitation, or familial hypercholesterolaemia. Germany participated in the Dyslipidaemia International Study (DYSIS) I [ 25 ] and DYSIS II [ 14 , 15 , 26 ], and has extensive data from the post-MI cardiac rehabilitation-focussed PATIENT CARE registry [ 16 ], the familial hypercholesterolemia CaRe High registry [ 17 ], and other large datasets [ 18 , 27 ]. Even though these studies included very different patient populations, there was a consistent finding that LDL-C goal attainment is suboptimal, irrespective of the LDL-C goals recommended at the time by the ESC/EAS guidelines.…”

“…This has most notably been observed in EUROASPIRE V [ 11 , 12 ]. Importantly, DYSIS II showed that suboptimal lipid management and the associated low LDL-C goal attainment was not corrected even when patients were hospitalized for an acute coronary event [ 26 ]. The consistent finding of suboptimal dyslipidaemia management is especially important in light of the 2019 iteration of the ESC/EAS guidelines [ 9 ] that recommend more stringent LDL-C goals to accommodate an increasing body of evidence showing that further lowering of LDL-C levels reduces CV risk [ [4] , [5] , [6] ].…”