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Atherosclerosis. 2017 Nov;266:158-166. doi: 10.1016/j.atherosclerosis.2017.08.013. Epub 2017 Aug 21.

Cholesterol target value attainment and lipid-lowering therapy in patients with stable or acute coronary heart disease: Results from the Dyslipidemia International Study II.

Author information

1
Herzzentrum Ludwigshafen, Germany; Institut für Herzinfarktforschung Ludwigshafen, Germany. Electronic address: gitta@klilu.de.
2
Merck & Co., Inc., Kenilworth, NJ, USA.
3
Rangueil Hospital, Toulouse University School of Medicine, Toulouse, France.
4
Department of Molecular Medicine University of Pavia, and Cardiac Intensive Care Unit and Laboratories for Experimental Cardiology, IRCCS Fondazione Policlinico San Matteo, Pavia, Italy.
5
Rutgers University, School of Public Health, Piscataway, NJ, USA.
6
MSD Ltd, Hoddesdon, UK.
7
Agile-1 for Merck & Co., Inc., Kenilworth, NJ, USA.
8
Institut für Herzinfarktforschung Ludwigshafen, Germany.
9
Sheikh Khalifa Medical City, Abu Dhabi, United Arab Emirates; Heart and Vascular Institute, Cleveland Clinic Abu Dhabi, United Arab Emirates.
10
National Taiwan University Hospital, Taipei, Taiwan and Fu-Jen Catholic University Hospital, Taipei, Taiwan.
11
Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Department of Cardiology, National University Heart Center Singapore, National University Health System, Singapore.

Abstract

BACKGROUND AND AIMS:

Low-density lipoprotein cholesterol (LDL-C) is a major contributor to cardiovascular disease. In the Dyslipidemia International Study II (DYSIS II), we determined LDL-C target value attainment, use of lipid-lowering therapy (LLT), and cardiovascular outcomes in patients with stable coronary heart disease (CHD) and those suffering from an acute coronary syndrome (ACS).

METHODS:

DYSIS II included patients from 18 countries. Patients with either stable CHD or an ACS were enrolled if they were ≥18 years old and had a full lipid profile available. Data were collected at a physician visit (CHD cohort) or at hospital admission and 120 days later (ACS cohort).

RESULTS:

A total of 10,661 patients were enrolled, 6794 with stable CHD and 3867 with an ACS. Mean LDL-C levels were low at 88 mg/dl and 108 mg/dl for the CHD and ACS cohorts respectively, with only 29.4% and 18.9% displaying a level below 70 mg/dl. LLT was utilized by 93.8% of the CHD cohort, with a mean daily statin dosage of 25 ± 18 mg. The proportion of the ACS cohort treated with LLT rose from 65.2% at admission to 95.6% at follow-up. LLT-treated patients, who were female, obese, or current smokers, were less likely to achieve an LDL-C level of <70 mg/dl, while those with type 2 diabetes, chronic kidney disease, or those taking a higher statin dosage were more likely.

CONCLUSIONS:

Few of these very high-risk patients achieved the LDL-C target, indicating huge potential for improving cardiovascular outcome by use of more intensive LLT.

KEYWORDS:

Acute coronary syndrome; Cholesterol; Coronary heart disease; Dyslipidemias; Hydroxymethylglutaryl-CoA reductase inhibitors; LDL; Myocardial infarction; Unstable angina

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