Success in achieving LDL-C target values in a high-risk population in Slovakia: the SlovakLipid retrospective study

Abstract

Introduction: Slovakia is among the countries with the highest cardiovascular mortality; nevertheless, extensive data on the effectiveness of dyslipidaemia management are lacking. The aim of this study was to assess the implementation of European guidelines in the very high-risk population in Slovakia.

Material and methods: We retrospectively analysed anonymised low-density lipoprotein-cholesterol (LDL-C) values of patients at very high cardiovascular risk gathered between 2017 and 2019 from a collaborating laboratory with nationwide reach. Cardiovascular risk (CV) risk was based on the patient's International Classification of Diseases (ICD) diagnosis. LDL-C target values were based on the 2016 ESC/EAS recommendations, as well as current recommendations from 2019. Patients diagnosed with acute coronary syndrome (ACS), stroke, or overall very high-risk cardiovascular disease (CVD) were selected.

Results: A total of 220 657 LDL-C test results from 72 039 patients were processed. Only 8-9% of patients with ACS attained target LDL-C in a follow-up test each year. 6-9% of patients had LDL-C levels ≥ 4.9 mmol/l. Only 9-10% of patients with stroke achieved target LDL-C levels, and 7-8% had levels ≥ 4.9 mmol/l. In the very high CV risk group, only 7% of patients achieved target levels, and 7-8% had extremely high LDL-C levels ≥ 4.9 mmol/l. With the ESC/EAS 2019 recommendations only 2-3% of patients in each group achieved target levels each year.

Conclusions: Based on our results, we found that over 90% of patients with very high CVD risk do not achieve target LDL-C levels. This percentage is even higher when implementing the 2019 guidelines. These patients remain at high risk of subsequent CVD events and would benefit significantly from intensified hypolipaemic therapy.

Keywords: cardiovascular risk; dyslipidaemia; guidelines; low-density lipoprotein; target values.

Figure 1

Mean LDL-C concentrations in ACS patients in different years after the initial diagnosis from all the obtained data from all specialists

Figure 2

Mean LDL-C concentrations in stroke patients in different years after the initial diagnosis from all the obtained data from all specialists

Figure 3

Mean LDL-C concentrations of patients in group 3 in each year after the initial diagnosis from all the obtained data from all specialists

Figure 4

Attainment of target LDL-C (mmol/l) values in 2017–2019 in the ACS subgroup of patients with LDL-C tests done each year (n = 683)

Figure 5

Attainment of target LDL-C (mmol/l) values in 2017–2019 in group 2, in patients with dg. stroke with at least one examination in each year (n = 231)

Figure 6

Attainment of target LDL-C values (mmol/l) between years 2017–2019 in group 3, patients at very high CV risk, the subgroup of patients with LDL-C test done each year (n = 23 491)