Current approaches to the treatment of patients with dyslipidemia in the real practice in the outpatient stage
https://doi.org/10.18087/cardio.2023.4.n2396
Abstract
Aim To evaluate the frequency and structure of lipid-lowering therapy and of achieving the goal of low-density lipoprotein cholesterol (LDL-C) in patients with very high cardiovascular risk (CVR) who were monitored at the outpatient stage.
Material and methods A retrospective snapshot analysis was performed by continuous sampling method for 136 medical records of outpatient patients (71 men, 65 women) aged 42 to 91 years [median, 68 years; 25th and 75th percentiles (59; 78)].
Results 134 (98,53 %) patients took statins; 8 (5.88 %) patients took a combination of statin and ezetimibe; 2 (1.47 %) patients took proprotein convertase subtilisin/kexin type 9 enzyme inhibitors (PCSK9): 2 (1.47 %) patients took evolocumab and 1 (0.74%) of 2 PCSK9-treated patients took a combination of PCSK9 inhibitor and statin. Atorvastatin at a dose of 20 (20; 40) mg as recommended at the hospital was the most frequently prescribed statin. 5 (3.68%) patients achieved the goal LDL-C of ≤1.4 mmol/l.
Conclusion Statins prevail in the structure of lipid-lowering therapy in patients with very high CVR. The frequency of combination therapy (statin/ezetimibe, 5.88%; PCSK9 inhibitor/statin, 0.74%) and PCSK9 inhibitors was noted to be low. Only 3.68% of patients achieved the goal LDL-C during the lipid-lowering treatment.
About the Authors
V. N. LarinaRussian Federation
MD, PhD, Dr Med. Sc., Professor, Head of Department of outpatient Medicine
Moscow
Competing Interests:
No conflict of interest is reported.
T. N. Mironova
Russian Federation
PhD, assistant of Department of outpatient Medicine
Moscow
Competing Interests:
No conflict of interest is reported.
V. G. Larin
Russian Federation
MD, PhD, Associate Professor, Department of outpatient Medicine
Moscow
Competing Interests:
No conflict of interest is reported.
U. V. Makhova
Russian Federation
assistant of Department of outpatient Medicine
Moscow
Competing Interests:
No conflict of interest is reported.
D. A. Orlov
Russian Federation
PhD, assistant of Department of outpatient Medicine
Moscow
Competing Interests:
No conflict of interest is reported.
Yu. Yu. Varlamova
Russian Federation
PhD
Moscow
Competing Interests:
No conflict of interest is reported.
O. V. Kladovikova
Russian Federation
Deputy Chief Physician for Organizational and Methodological Work
Moscow
Competing Interests:
No conflict of interest is reported.
References
1. Sharapova O.V., Kicha D.I., Gerasimova L.I., Rukodaynyy O.V., Fomina R.V., Evzerikhina A.V. et al. Map analysis of morbidity and mortality from blood circulatory system diseases of the population of the Russian federation (2010-2019). Complex Issues of Cardiovascular Diseases. 2022;11(1):56–68. DOI: 10.17802/2306-1278-2022-11-1-56-68
2. World Health Organisation. Cardiovascular diseases (CVDs). [Internet] Available at: https://www.who.int/news-room/fact-sheets/detail/cardiovascular-diseases-(cvds)
3. Kukharchuk V.V., Ezhov M.V., Sergienko I.V., Arabidze G.G., Balakhonova T.V., Gurevich V.S. et al. Eurasian Association of Cardiology (EAC)/Russian National Atherosclerosis Society (RNAS, Russia) guidelines for the diagnosis and correction of dyslipidemia for the prevention and treatment of atherosclerosis (2020). Eurasian Heart Journal. 2020;2:6–29. DOI: 10.38109/2225-1685-2020-2-6-29
4. Susekov A.V. Topical issues concerning modern lipid-lowering therapy. Consilium Medicum. 2022;24(1):20–7.DOI: 10.26442/20751753.2022.1.201484
5. Shalnova S.A., Deev A.D., Metelskaya V.A., Evstifeeva S.E., Rotar O.P., Zhernakova Yu.V. et al. Awareness and treatment specifics of statin therapy in persons with various cardiovasular risk: the study ESSE-RF. Cardiovascular Therapy and Prevention. 2016;15(4):29–37 DOI: 10.15829/1728-8800-2016-4-29-37
6. Kukharchuk V.V., Ezhov M.V., Sergienko I.V. Clinical recommendations Lipid metabolism disorders. Av. at: https://cr.minzdrav.gov.ru/schema/752_1#doc_a1.2023 . https://cr.minzdrav.gov.ru/schema/752_1#doc_a1
7. Ray KK, Reeskamp LF, Laufs U, Banach M, Mach F, Tokgözoğlu LS et al. Combination lipid-lowering therapy as first-line strategy in very high-risk patients. European Heart Journal. 2022;43(8):830–3. DOI: 10.1093/eurheartj/ehab718
8. Gogolashvili N.G., Yaskevich R.A. Effectiveness of lipid-lowering therapy in outpatients with coronary artery disease living in a large industrial center of Eastern Siberia. Cardiovascular Therapy and Prevention. 2022;20(8):82–90. DOI: 10.15829/1728-8800-2021-3135
9. Ezhov M.V., Bliznyuk S.A., Tmoyan N.A., Rozhkova Т.А., Duplyakov D.V., Salchenko V.A. et al. Register of patients with familial hypercholesterolemia and patients of very high cardiovascular risk with lipid-lowering therapy underperformance (RENES-SANS). Russian Journal of Cardiology. 2019;24(5):7–13. DOI: 10.15829/1560-4071-2019-5-7-13
10. Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L et al. 2019 ESC/EAS Guidelines for themanagement of dyslipidaemias: lipid modification to reduce cardiovascular risk. Russian Journal of Cardiology. 2020;25(5):121–93. DOI: 10.15829/1560-4071-2020-3826
11. Shlyakhto E.V., Zvartau N.E., Villevalde S.V., Yakovlev A.N., Soloveva A.E., Alieva A.S. et al. Cardiovascular risk management system: prerequisites for developing, organization principles, target groups. Russian Journal of Cardiology. 2019;24(11):69–82. DOI: 10.15829/1560-4071-2019-11-69-82
12. Ezhov M.V., Kukharchuk V.V., Sergienko I.V., Akhmedzhanov N.M., Voevoda M.I., Gurevich V.S. et al. Existing problems and new possibilities in the treatment of dyslipidemia Joint Conclusion Based on the Results of the Expert Council. Rational Pharmacotherapy in Cardiology. 2021;17(1):169–72. DOI: 10.20996/1819-6446-2021-02-02
13. State Register of Medicines. Instructions for the medical use of the drug Sibrava (inclusiran). LP-No(000689)-RG-RU. Av. at: https://grls.rosminzdrav.ru/GRLS.aspx?RegNumber=&MnnR=&lf=&TradeNmR=%d0%a1%d0%b8%d0%b1%d1%80%d0%b0%d0%b2%d0%b0&OwnerName=&MnfOrg=&MnfOrgCountry=&isfs=0®type=1%2c6&pageSize=10&order=RegDate&orderType=desc&pageNum=1.
14. Starodubov V.I., Mishina O.S., Dvornikov A.S. Principles of organization of medical and social assistance to the population on the basis of the model ‘Support of chronic patients throughout life’ (using the example of patients with psoriasis). Social aspects of public health. 2015;3(43):1–13.
Review
For citations:
Larina V.N., Mironova T.N., Larin V.G., Makhova U.V., Orlov D.A., Varlamova Yu.Yu., Kladovikova O.V. Current approaches to the treatment of patients with dyslipidemia in the real practice in the outpatient stage. Kardiologiia. 2023;63(4):11-15. https://doi.org/10.18087/cardio.2023.4.n2396