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. 2024 Oct 9;14(10):1044.
doi: 10.3390/jpm14101044.

Evaluating the Efficacy of a Pre-Established Lipid-Lowering Algorithm in Managing Hypercholesterolemia in Patients at Very High Cardiovascular Risk

Jean Philippe Henry  1 , Laurence Gabriel  1 , Maria-Luiza Luchian  1 , Julien Higny  1 , Martin Benoit  1 , Olivier Xhaët  1 , Dominique Blommaert  1 , Alin-Mihail Telbis  1 , Benoit Robaye  1 , Antoine Guedes  1 , Fabian Demeure  1
Affiliations

Evaluating the Efficacy of a Pre-Established Lipid-Lowering Algorithm in Managing Hypercholesterolemia in Patients at Very High Cardiovascular Risk

Jean Philippe Henry et al. J Pers Med. .

Abstract

Background: Recent data from European studies (EUROASPIRE V, DA VINCI, SANTORINI) indicate that achieving the LDL cholesterol (LDL-C) target in patients at very high cardiovascular risk is uncommon. Additionally, using a combination therapy involving statins and ezetimibe remains infrequent.

Methods: A single-center assessment of a pre-defined lipid lowering treatment algorithm's effectiveness at achieving the LDL-C target in patients at very high cardiovascular risk one month and one year after hospitalization.

Results: 81 patients were included, all in secondary prevention. The average age of the patient was 66.9 years, and the main cardiovascular risk factors included hypertension, diabetes mellitus, and smoking history. Following the predefined lipid-lowering algorithm specific to our study, which involves initiating high-intensity statin therapy or a combination of statin and ezetimibe depending on initial LDL-C levels and patient history; 30 (37%) patients initiated high-intensity statin therapy (Atorvastatin (40 mg, 80 mg) or Rosuvastatin (20 mg, 40 mg)), while 51 (63%) started combination therapy with high-intensity statin and ezetimibe 10 mg. After one year, 57 (70.4%) remained adherent to their initial treatment, achieving a mean LDL-C of 49.5 ± 16.9 mg/dL, with 36 (63.2%) of them reaching the LDL-C target of <55 mg/dL. A total of 13 patients discontinued treatment, and 9 were lost to follow-up, withdrew from the study, or died.

Conclusion: Initiating dual statin and ezetimibe therapy or high-intensity statin therapy early, based on the expected treatment efficacy, holds the potential to more rapidly and effectively achieve LDL-C targets in a larger proportion of very high-risk cardiovascular patients.

Keywords: cardiovascular risk; combination therapy; hypercholesterolemia; lipid-lowering treatment.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Algorithm for adapting lipid-lowering therapy in patients at very high cardiovascular risk. DLCN: Dutch Lipid Clinic Network; Ezetimibe: Ezetimibe 10 mg, FH: Familial Hypercholesterolemia; high-intensity statin: Atorvastatin (40 mg, 80 mg) or Rosuvastatin (20 mg, 40 mg); moderate-intensity statin: Atorvastatin (10 mg, 20 mg), Rosuvastatin 10 mg or Pravastatin 40 mg; ACS: Acute Coronary Syndrome. Red boxes: FH should be screened.
See this image and copyright information in PMC

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