Faggiano Andrea, Gualeni Anna, Barbieri Lucia, Mureddu Gian Francesco, Venturini Elio, Giallauria Francesco, Ambrosetti Marco, Ruzzolini Matteo, Maranta Francesco, Silverii Maria Vittoria, Garau Laura, Garamella Davide, Napoli Raffaele, Maresca Luigi, Panetta Gaetano Luca, Maggi Antonio, Carugo Stefano, Fattirolli Francesco, Faggiano Pompilio
Department of Cardio-Thoracic-Vascular Diseases, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy.
J Clin Med. 2025 Jan 14;14(2):493. doi: 10.3390/jcm14020493.
This study assessed the proportion of secondary cardiovascular prevention patients who achieved low-density lipoprotein (LDL) cholesterol targets as per the 2019 ESC/EAS Dyslipidemia Guidelines. We also evaluated whether lipid-lowering therapies (LLTs) were adjusted in patients not meeting targets and analyzed the likelihood of these modifications achieving recommended levels. A multicenter, cross-sectional observational study retrospectively reviewed medical records of 1909 outpatients in 9 Italian cardiac rehabilitation/secondary prevention clinics from January 2023 to June 2024. Inclusion criteria included prior atherosclerotic cardiovascular disease (ASCVD) and recent LDL-cholesterol levels. Data included demographics, ASCVD presentation, lipid profiles, and LLTs. Patients at very high risk had LDL targets of ≤55 mg/dL, or ≤40 mg/dL for recurrent events within 2 years. Clinicians' approaches to LLT modification in patients not at target were recorded, with LLT efficacy estimated based on percentage distance from LDL-cholesterol targets. Of the 1909 patients, 41.3% met the LDL-cholesterol target. Predictors of achieving targets included male gender, cardiac rehabilitation, recent acute coronary syndrome, diabetes, and triple therapy (statin + ezetimibe + PCSK9 inhibitors). Conversely, a target of ≤40 mg/dL, lack of therapy, and monotherapy were negative predictors. Among 1074 patients not at target, LLT modifications were proposed for 48.6%. Predictors of LLT modification included recent ASCVD events, cardiac rehabilitation, and greater percentage distance from the LDL target, while advanced age and an LDL target of ≤40 mg/dL were negative predictors. However, only 42.3% of modified therapies were predicted to be effective in reaching LDL targets. Despite 2019 ESC/EAS guidelines, a significant proportion of high-risk patients did not achieve LDL targets, and proposed LLT modifications were often insufficient. More intensive LLT regimens are needed to improve outcomes in this population.
本研究评估了根据2019年欧洲心脏病学会/欧洲动脉粥样硬化学会血脂异常指南达到低密度脂蛋白（LDL）胆固醇目标的二级心血管预防患者的比例。我们还评估了未达目标的患者是否调整了降脂治疗（LLT），并分析了这些调整达到推荐水平的可能性。一项多中心横断面观察性研究回顾性分析了2023年1月至2024年6月期间意大利9家心脏康复/二级预防诊所1909例门诊患者的病历。纳入标准包括既往动脉粥样硬化性心血管疾病（ASCVD）和近期LDL胆固醇水平。数据包括人口统计学、ASCVD表现、血脂谱和LLT。极高风险患者的LDL目标为≤55mg/dL，或2年内复发事件的目标为≤40mg/dL。记录了临床医生对未达目标患者进行LLT调整的方法，并根据与LDL胆固醇目标的百分比距离估计LLT疗效。在1909例患者中，41.3%达到了LDL胆固醇目标。达到目标的预测因素包括男性、心脏康复、近期急性冠状动脉综合征、糖尿病和三联疗法（他汀类药物+依折麦布+PCSK9抑制剂）。相反，目标为≤40mg/dL、未接受治疗和单药治疗是负性预测因素。在1074例未达目标的患者中，48.6%的患者建议调整LLT。LLT调整的预测因素包括近期ASCVD事件、心脏康复以及与LDL目标的百分比距离更大，而高龄和LDL目标为≤40mg/dL是负性预测因素。然而，预计只有42.3%的调整治疗对达到LDL目标有效。尽管有2019年欧洲心脏病学会/欧洲动脉粥样硬化学会指南，但仍有相当比例的高危患者未达到LDL目标，且建议的LLT调整往往不足。需要更强化的LLT方案来改善该人群的结局。
