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. 2025 Jan 14;14(2):493.
doi: 10.3390/jcm14020493.

Therapeutic Inertia in Dyslipidemia Management for Secondary Cardiovascular Prevention: Results from the Italian ITACARE-P Network

Andrea Faggiano  1   2 , Anna Gualeni  3 , Lucia Barbieri  1   2 , Gian Francesco Mureddu  4 , Elio Venturini  5 , Francesco Giallauria  6 , Marco Ambrosetti  7 , Matteo Ruzzolini  8 , Francesco Maranta  9 , Maria Vittoria Silverii  10 , Laura Garau  1   2 , Davide Garamella  5 , Raffaele Napoli  6 , Luigi Maresca  7 , Gaetano Luca Panetta  8 , Antonio Maggi  3 , Stefano Carugo  1   2 , Francesco Fattirolli  10   11 , Pompilio Faggiano  3
Affiliations

Therapeutic Inertia in Dyslipidemia Management for Secondary Cardiovascular Prevention: Results from the Italian ITACARE-P Network

Andrea Faggiano et al. J Clin Med. .

Abstract

Background/Objectives: This study assessed the proportion of secondary cardiovascular prevention patients who achieved low-density lipoprotein (LDL) cholesterol targets as per the 2019 ESC/EAS Dyslipidemia Guidelines. We also evaluated whether lipid-lowering therapies (LLTs) were adjusted in patients not meeting targets and analyzed the likelihood of these modifications achieving recommended levels. Methods: A multicenter, cross-sectional observational study retrospectively reviewed medical records of 1909 outpatients in 9 Italian cardiac rehabilitation/secondary prevention clinics from January 2023 to June 2024. Inclusion criteria included prior atherosclerotic cardiovascular disease (ASCVD) and recent LDL-cholesterol levels. Data included demographics, ASCVD presentation, lipid profiles, and LLTs. Patients at very high risk had LDL targets of ≤55 mg/dL, or ≤40 mg/dL for recurrent events within 2 years. Clinicians' approaches to LLT modification in patients not at target were recorded, with LLT efficacy estimated based on percentage distance from LDL-cholesterol targets. Results: Of the 1909 patients, 41.3% met the LDL-cholesterol target. Predictors of achieving targets included male gender, cardiac rehabilitation, recent acute coronary syndrome, diabetes, and triple therapy (statin + ezetimibe + PCSK9 inhibitors). Conversely, a target of ≤40 mg/dL, lack of therapy, and monotherapy were negative predictors. Among 1074 patients not at target, LLT modifications were proposed for 48.6%. Predictors of LLT modification included recent ASCVD events, cardiac rehabilitation, and greater percentage distance from the LDL target, while advanced age and an LDL target of ≤40 mg/dL were negative predictors. However, only 42.3% of modified therapies were predicted to be effective in reaching LDL targets. Conclusions: Despite 2019 ESC/EAS guidelines, a significant proportion of high-risk patients did not achieve LDL targets, and proposed LLT modifications were often insufficient. More intensive LLT regimens are needed to improve outcomes in this population.

Keywords: dyslipidemia; lipid-lowering therapies; low-density lipoprotein cholesterol; secondary cardiovascular prevention; therapeutic inertia.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Different lipid-lowering therapies in patients who achieved versus those who did not achieve low-density lipoprotein cholesterol (LDL-c) targets. PCSK9-i: proprotein convertase subtilisin/kexin type 9 serine protease inhibitors.
Figure 2
Figure 2
Patient groups stratified by percentage distance from low-density lipoprotein cholesterol (LDL-c ≤ 6%, 7–25%, >25%) and lipid-lowering therapy (LLT) modification status.
Figure 3
Figure 3
Types of lipid-lowering therapy (LLT) modifications and implementations prescribed. PCSK9-i: proprotein convertase subtilisin/kexin type 9 serine protease inhibitors.
See this image and copyright information in PMC

References

    1. Mach F., Baigent C., Catapano A.L., Koskinas K.C., Casula M., Badimon L., Chapman M.J., De Backer G.G., Delgado V., Ference B.A., et al. 2019 ESC/EAS Guidelines for the Management of Dyslipidaemias: Lipid Modification to Reduce Cardiovascular Risk. Eur. Heart J. 2020;41:111–188. doi: 10.1093/eurheartj/ehz455. - DOI - PubMed
    1. Ray K.K., Molemans B., Marieke Schoonen W., Giovas P., Bray S., Kiru G., Murphy J., Banach M., De Servi S., Gaita D., et al. EU-Wide Cross-Sectional Observational Study of Lipid-Modifying Therapy Use in Secondary and Primary Care: The DAVINCI Study. Eur. J. Prev. Cardiol. 2021;28:1279–1289. doi: 10.1093/eurjpc/zwaa047. - DOI - PubMed
    1. Vrablik M., Seifert B., Parkhomenko A., Banach M., Jóźwiak J.J., Kiss R.G., Gaita D., Rašlová K., Zachlederova M., Bray S., et al. Lipid-Lowering Therapy Use in Primary and Secondary Care in Central and Eastern Europe: DA VINCI Observational Study. Atherosclerosis. 2021;334:66–75. doi: 10.1016/j.atherosclerosis.2021.08.035. - DOI - PubMed
    1. Ray K.K., Haq I., Bilitou A., Manu M.C., Burden A., Aguiar C., Arca M., Connolly D.L., Eriksson M., Ferrières J., et al. Treatment Gaps in the Implementation of LDL Cholesterol Control among High- and Very High-Risk Patients in Europe between 2020 and 2021: The Multinational Observational SANTORINI Study. Lancet Reg. Health—Eur. 2023;29:100624. doi: 10.1016/j.lanepe.2023.100624. - DOI - PMC - PubMed
    1. Ray K.K., Aguiar C., Arca M., Connolly D.L., Eriksson M., Ferrières J., Laufs U., Mostaza J.M., Nanchen D., Bardet A., et al. Use of Combination Therapy Is Associated with Improved LDL Cholesterol Management: 1-Year Follow-up Results from the European Observational SANTORINI Study. Eur. J. Prev. Cardiol. 2024;31:1792–1803. doi: 10.1093/eurjpc/zwae199. - DOI - PubMed

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