open access
Dyslipidemia treatment and attainment of LDL-cholesterol treatment goals in patients participating in the Managed Care for Acute Myocardial Infarction Survivors program
Affiliations- 3rd Department of Cardiology, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
- 1st Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia Katowice, Poland
- Jagiellonian University Medical College, Institute of Cardiology, Department of Interventional Cardiology, Kraków, Poland
- Clinical Department of Interventional Cardiology, John Paul II Hospital, Kraków, Poland
- Studenet Scientific Group of Modern Cardiac Therapy at the Department of Interventional Cardiology, Institute of Cardiology, Jagiellonian University Medical College
- 2nd Department of Cardiology, School of Medicine in Katowice, Medical University of Silesia Katowice, Poland
- Division of Medical Science in Zabrze, Medical University of Silesia, Katowice, Poland, Department of Cardiology Silesian Center for Heart Diseases
- Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland
- Department of Interventional Cardiology and Angiology, National Institute of Cardiology, Warszawa, Poland
- Department of Preventive Cardiology and Lipidology, Medical University of Lodz, Łódź, Poland
open access
Abstract
BACKGROUND: Patients after acute myocardial infarction (AMI) are at very high cardiovascular (CV) risk. Therefore, appropriate management of dyslipidemia with adequate lipid-lowering therapy is crucial for preventing subsequent CV events in these patients.
AIMS: Our analysis aimed to assess the treatment of dyslipidemia and the attainment of low-density lipoprotein (LDL) -cholesterol treatment goals in patients after AMI who participated in the Managed Care for Acute Myocardial Infarction Survivors (MACAMIS) program.
METHODS: This study is a retrospective analysis of consecutive patients with AMI who agreed to participate and completed the 12-month MACAMIS program at one of three tertiary referral cardiovascular centers in Poland between October 2017 and January 2021.
RESULTS: 1499 patients after AMI were enrolled in the study. High-intensity statin therapy was prescribed to 85.5% of analyzed patients at hospital discharge. Combined therapy with high-intensity statin and ezetimibe increased from 2.1% at hospital discharge to 18.2% after 12 months. In the whole study cohort, 20.4% of patients achieved the LDL-C target of
CONCLUSIONS: Our analysis suggests that participation in the managed care program might be associated with improved quality of dyslipidemia management in AMI patients. Nonetheless, only one-fifth of patients who completed the program achieved the treatment goal for LDL-C. This highlights the constant need for optimizing lipid-lowering therapy to meet treatment targets and to reduce CV risk in patients after AMI.
Abstract
BACKGROUND: Patients after acute myocardial infarction (AMI) are at very high cardiovascular (CV) risk. Therefore, appropriate management of dyslipidemia with adequate lipid-lowering therapy is crucial for preventing subsequent CV events in these patients.
AIMS: Our analysis aimed to assess the treatment of dyslipidemia and the attainment of low-density lipoprotein (LDL) -cholesterol treatment goals in patients after AMI who participated in the Managed Care for Acute Myocardial Infarction Survivors (MACAMIS) program.
METHODS: This study is a retrospective analysis of consecutive patients with AMI who agreed to participate and completed the 12-month MACAMIS program at one of three tertiary referral cardiovascular centers in Poland between October 2017 and January 2021.
RESULTS: 1499 patients after AMI were enrolled in the study. High-intensity statin therapy was prescribed to 85.5% of analyzed patients at hospital discharge. Combined therapy with high-intensity statin and ezetimibe increased from 2.1% at hospital discharge to 18.2% after 12 months. In the whole study cohort, 20.4% of patients achieved the LDL-C target of
CONCLUSIONS: Our analysis suggests that participation in the managed care program might be associated with improved quality of dyslipidemia management in AMI patients. Nonetheless, only one-fifth of patients who completed the program achieved the treatment goal for LDL-C. This highlights the constant need for optimizing lipid-lowering therapy to meet treatment targets and to reduce CV risk in patients after AMI.
Keywords
cardiovascular risk; low-density lipoprotein cholesterol; lipid-lowering therapy; myocardial infarction; secondary prevention
About this articleTitle
Dyslipidemia treatment and attainment of LDL-cholesterol treatment goals in patients participating in the Managed Care for Acute Myocardial Infarction Survivors program
Journal
Kardiologia Polska (Polish Heart Journal)
Issue
Article type
Original article
Published online
2023-02-19
Page views
140
Article views/downloads
40
DOI
10.33963/KP.a2023.0045
Pubmed
Keywords
cardiovascular risk
low-density lipoprotein cholesterol
lipid-lowering therapy
myocardial infarction
secondary prevention
Authors
Alicja Nowowiejska-Wiewióra
Krystian Wita
Zofia Mędrala
Lidia Tomkiewicz-Pająk
Kamil Bujak
Katarzyna Mizia-Stec
Piotr Brzychczy
Mariusz Gąsior
Zbigniew Gąsior
Aleksandra Kulbat
Zbigniew Kalarus
Wojciech Wojakowski
Przemysław Trzeciak
Adam Witkowski
Maciej Banach
Jacek Legutko
References (21)- Baigent C, Keech A, Kearney PM, et al. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet. 2005; 366(9493): 1267–1278.
- Cannon CP, Blazing MA, Giugliano RP, et al. Ezetimibe added to statin therapy after acute coronary syndromes. N Engl J Med. 2015; 372(25): 2387–2397.
- Baigent C, Blackwell L, Emberson J, et al. Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials. Lancet. 2010; 376(9753): 1670–1681.
- Sabatine MS, Giugliano RP, Keech AC, et al. Evolocumab and clinical outcomes in patients with cardiovascular disease. N Engl J Med. 2017; 376(18): 1713–1722.
- Banach M, Penson PE, Vrablik M, et al. Optimal use of lipid-lowering therapy after acute coronary syndromes: A Position Paper endorsed by the International Lipid Expert Panel (ILEP). Pharmacol Res. 2021; 166: 105499.
- Ray KK, Reeskamp LF, Laufs U, et al. Combination lipid-lowering therapy as first-line strategy in very high-risk patients. Eur Heart J. 2022; 43(8): 830–833.
- Mihaylova B, Emberson J, Blackwell L, et al. The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials. Lancet. 2012; 380(9841): 581–590.
- Gierlotka M, Zdrojewski T, Wojtyniak B, et al. Incidence, treatment, in-hospital mortality and one-year outcomes of acute myocardial infarction in Poland in 2009-2012--nationwide AMI-PL database. Kardiol Pol. 2015; 73(3): 142–158.
- Dyrbuś K, Gąsior M, Penson PE, et al. Extreme cardiovascular risk-do we need a new risk category? Eur Heart J. 2021 [Epub ahead of print]; 43(19): 1784–1786.
- Ray KK, Molemans B, Schoonen WM, et al. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: the DA VINCI study. Eur J Prev Cardiol. 2021; 28(11): 1279–1289.
- Vrablik M, Seifert B, Parkhomenko A, et al. Lipid-lowering therapy use in primary and secondary care in Central and Eastern Europe: DA VINCI observational study. Atherosclerosis. 2021; 334: 66–75.
- Jankowski P, Gąsior M, Gierlotka M, et al. Coordinated care after myocardial infarction. The statement of the Polish Cardiac Society and the Agency for Health Technology Assessment and Tariff System [in Polish]. Kardiol Pol. 2016; 74(8): 800–811.
- Kubielas G, Diakowska D, Uchmanowicz I. Survival analysis of patients with acute coronary syndrome receiving comprehensive coordinated care after myocardial infarction (KOS-Zawał). Kardiol Pol. 2022; 80(3): 415–321.
- Jankowski P, Topór-Mądry R, Gąsior M, et al. Innovative managed care may be related to improved prognosis for acute myocardial infarction survivors. Circ Cardiovasc Qual Outcomes. 2021; 14(8): e007800.
- Mach F, Baigent C, Catapano AL, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020; 41(1): 111–188.
- Cecha P, Chromik A, Piotrowska I, et al. Assessment of application of the new 2019 European Society of Cardiology/ European Atherosclerosis Society Guidelines for the Management of Dyslipidaemias in daily clinical practice - one center study. Folia Med Cracov. 2021; 61(3): 43–54.
- Jankowski P, Kosior DA, Sowa P, et al. Secondary prevention of coronary artery disease in Poland. Results from the POLASPIRE survey. Cardiol J. 2020; 27(5): 533–540.
- Jankowski P, Kozieł P, Setny M, et al. Dyslipidemia management in patients with coronary artery disease. Data from the POLASPIRE survey. J Clin Med. 2021; 10(16).
- Dyrbuś K, Gąsior M, Desperak P, et al. Risk-factors associated with extremely high cardiovascular risk of mid- and long-term mortality following myocardial infarction: Analysis of the Hyperlipidaemia Therapy in tERtiary Cardiological cEnTer (TERCET) registry. Atherosclerosis. 2021; 333: 16–23.
- Catapano AL, Graham I, De Backer G, et al. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR). Atherosclerosis. 2016; 253: 281–344.
- Cybulska B, Szostak WB, Filipiak KJ, et al. Polish Forum for Prevention Guidelines on Dyslipidaemia: Update 2016. Kardiol Pol. 2017; 75(2): 187–190.
