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  • Showing results for Achievement[Title] AND low[Title] AND density[Title] AND lipoprotein[Title] AND LDL[Title] AND cholesterol[Title] AND targets[Title] AND primary[Title] AND Analysis[Title] AND large[Title] AND real[Title] AND practice[Title] AND database[Title] AND Italy[Title]. Your search for Achievement of low density lipoprotein (LDL) cholesterol targets in primary and secondaryprevention: Analysis of a large real practice database in Italy retrieved no results.
Atherosclerosis. 2019 Jun;285:40-48. doi: 10.1016/j.atherosclerosis.2019.03.017. Epub 2019 Apr 8.

Achievement of low density lipoprotein (LDL) cholesterol targets in primary and secondary prevention: Analysis of a large real practice database in Italy.

Author information

1
Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy.
2
IRCCS Neuromed, Pozzilli, IS, Italy.
3
Medical and Surgical Sciences Department, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
4
Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
5
Hypertension Unit, Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy. Electronic address: giuliano.tocci@uniroma1.it.
6
Cardiology Unit, Emergency and Organ Transplantation Department, University of Bari, Bari, Italy.
7
Department of Clinic and Experimental Medicine, Chair of Metabolic Diseases, University of Padua, Padua, Italy.
8
Department of Emergency, University of Genova, San Martino Hospital, Genova, Italy.
9
Department of Pharmacological Sciences, University of Milan, Milan, Italy.
10
Department of Internal Medicine, University of Rome Tor Vergata, Rome, Italy.
11
Metabolism and Diabetes Unit, ASL Turin 5, Chiari, TO, Italy.
12
Department of Medical and Surgical Sciences, University of Padua, Padua, Italy.
13
Italian College of General Practice (SIMG), Florence, Italy.
14
Department of Cardiovascular Disease, San Giovanni-Addolorata Hospital, Rome, Italy.
15
Division of Endocrinology and Metabolic Disease, University of Napoli Federico II, Napoli, Italy.
16
Italian Federation of General Medicine, Turin, Italy.
17
Associazione Nazionale Cardiologi Ambulatoriali (ARCA), Rome, Italy.
18
Division of Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, University of Rome Sapienza, Sant'Andrea Hospital, Rome, IRCCS Neuromed, Pozzilli, IS, Italy; Cardiology Unit, ASL Napoli 3 Sud, Pompei, NA, Italy.

Abstract

BACKGROUND AND AIMS:

Target and intensity of low-density lipoprotein cholesterol (LDL-C) lowering therapy should be tailored according to the individual global cardiovascular (CV) risk. We aimed at retrospectively evaluating real-life LDL-C goal attainment and predictive factors for predefined LDL-C therapeutic goals both in primary and secondary prevention.

METHODS:

We collected data from a large cohort of outpatients aged 40-65 years, followed by general practitioners, cardiologists and diabetologists in Italy. All data were centrally analysed for global CV risk assessment and rates of control of major CV risk factors, including LDL-C. Study population was stratified according to the presence or absence of previous CV events, including coronary artery disease (CAD), peripheral artery disease (PAD) or stroke/TIA. CV risk profile characterization was based on the European SCORE. Predefined therapeutic goals were set according to the European guidelines on dyslipidaemia: LDL-C levels <70 mg/dl for very high CV risk patients in primary prevention and for those in secondary prevention; <100 mg/dl LDL-C levels for high CV risk patients in primary prevention. Logistic regression analysis with clinical covariates was used to identify predictive factors for achieving these goals; lipid lowering therapy entered in the analysis as continuous (model 1) or categorical variable (model 2).

RESULTS:

We included 4,142 outpatients (43,7% female, age 58.0 ± 5.2 years, BMI 28.5 ± 5.0 kg/m2) among whom 2,964 (71.6%) in primary and 1,178 (28.4%) in secondary prevention. In primary prevention, none of the patients at very high CV risk had LDL-C <70 mg/dl and 8.9% of patients at high CV risk showed LDL-C <100 mg/dl. Only 5.8% of patients in secondary prevention had LDL-C levels <70 mg/dl, specifically 6.5% of patients with CAD, 2.6% of patients with PAD and 4.7% of patients with CVD (p < 0.001). Beyond diabetes and lipid lowering therapy, high risk SCORE estimation resulted a strong and independent predictor for the lack of achieving all predefined therapeutic targets, including LDL-C <100 mg/dl [OR: 0.806 (0.751-0.865)); p < 0.001], and LDL-C <70 mg/dl [OR: 0.712 (0-576-0.880); p = 0.002], in primary prevention.

CONCLUSIONS:

Despite high or very high SCORE risk and use of lipid lowering therapies, we observed poor achievement of LDL-C targets in this large cohort of outpatients followed in a setting of real practice in Italy.

KEYWORDS:

European SCORE; High cardiovascular risk; Hypercholesterolemia; Lipid-lowering therapy; Low-density lipoprotein cholesterol; Therapeutic targets

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