The Evaluation of Lipid-Lowering Treatment in Patients with Acute Coronary Syndrome in a Hungarian Invasive Centre in 2015, 2017, and during the COVID-19 Pandemic-The Comparison of the Achieved LDL-Cholesterol Values Calculated with Friedewald and Martin-Hopkins Methods

Abstract

Background/Objectives: Patients with acute coronary syndrome (ACS) represent a vulnerable population. We aimed to investigate serum lipid levels of patients with ACS upon admission and during one year of the COVID-19 pandemic in a rural county hospital, and compared these findings with the data of patients with ACS in 2015 and 2017. The secondary aim of this paper was the comparison of the LDL-C values calculated with the Friedewald and Martin-Hopkins methods. Methods: A retrospective analysis of lipid-lowering data of patients treated with ACS in 2015, 2017 and in a COVID-19 year (1 April 2020-31 March 2021) was performed; the patient's numbers were 454, 513 and 531, respectively. Results: In the COVID-19 period one year after the index event, only 42% of the patients had lipid values available, while these ratios were 54% and 73% in 2017 and in 2015, respectively. Using the Friedewald formula, in the COVID-19 era the median of LDL cholesterol (LDL-F) was 1.64 (1.09-2.30) mmol/L at six months and 1.60 (1.19-2.27) mmol/L at one year, respectively. These values were 1.92 (1.33-2.27) mmol/L and 1.73 (1.36-2.43) mmol/L using the Martin-Hopkins method (LDL-MH). The LDL-F yielded significantly lower values (15% lower at six months, p = 0.044; and 8% lower at one year, p = 0.014). The LDL-F reached the previous target of 1.8 mmol/L during the COVID-19 pandemic 36% at one year vs. 48% in 2017, and 37% in 2015. The recent target LDL-C level of 1.4 mmol/L was achieved in 22% of cases in the COVID-19 pandemic, 16% in 2015 and 19% in 2017. Conclusions: A significantly lower proportion of patients with ACS had available lipid tests during the COVID-19 pandemic. Besides the lower number of available samples, the proportion of achieved 1.4 mmol/L LDL-C target lipids was stable. More rigorous outpatient care in the follow-up period may help to improve the quality of lipid lowering treatments and subsequent secondary cardiovascular prevention. If direct LDL-C determination is not available, we prefer the LDL calculation with the Martin-Hopkins method.

Keywords: COVID-19 pandemic; Friedewald formula; LDL-cholesterol; Martin–Hopkins method; acute coronary syndrome.

Figure 1

The attainment rate of 1.8 and 1.4 mmol/L LDL-cholesterol target levels based on the calculations with the Friedewald formula (LDL-F) and the Martin–Hopkins method (LDL-MH) in patients with ACS in 2015 (from 1 January 2015 to 31 December 2015), 2017 (from 1 January 2017 to 31 December 2017) and the COVID-19 year (1 April 2020–31 March 2021) in Gyula Hospital. There was no significant difference regarding the LDL-C target attainment in 2015, 2017 and the COVID-19 year (p = 0.157). The dark grey part of the bar, with the % inside, shows the 1.8 mmol/L LDL-C attainment rate, and the light grey part of the bar, with the % inside, expresses the 1.4 mmol/L attainment.

Figure 2

The proportion of patients at a high risk of reaching the LDL targets of 1.8 mmol/L and 1.4 mmol/L based on European and Hungarian data. The dark grey part of the bar, with the % inside, shows the 1.8 mmol/L LDL-C attainment rate, and the light grey part of the bar, with the % inside, expresses the 1.4 mmol/L attainment.