Why the study?
In 2019, the ESC lowered secondary prevention LDL-C targets from <1.8 mmol/L to <1.4 mmol/L, but their real-world clinical impact on lipid-lowering therapy and target achievement in cardiac rehabilitation was unconfirmed.
Does the publication of the 2019 ESC/EAS dyslipidaemia guidelines improve the achievement of LDL-C targets and intensify lipid-lowering therapies in CAD patients participating in ambulatory cardiac rehabilitation?
Does the publication of the 2019 ESC/EAS dyslipidaemia guidelines improve the achievement of LDL-C targets and intensify lipid-lowering therapies in CAD patients participating in ambulatory cardiac rehabilitation?
The implementation of the 2019 ESC/EAS dyslipidaemia guidelines significantly increased the use of intensive lipid-lowering therapies and improved the achievement of the <1.4 mmol/L LDL-C target in CAD patients undergoing cardiac rehabilitation.
Stricter LDL-C targets may prompt therapy intensification in CAD rehab patients; leaves open whether implementation improves outcomes in real-world cohorts.
In 2019 the European Society of Cardiology (ESC) lowered the target values for low-density lipoprotein cholesterol (LDL-C) from <1.8 mmol/L to <1.4 mmol/L for secondary prevention of cardiovascular disease (CVD). The aim of this study was to determine the clinical impact of the 2019 ESC/EAS dyslipidaemia guidelines on lipid-lowering therapies and achievement rates of LDL-C targets in a contemporary cohort of CAD patients participating in an ambulatory cardiac rehabilitation (CR) program.We conducted a retrospective analysis of prospectively collected data from the Swiss Secondary Prevention Registry (SwissPR) in patients with Coronary Artery Disease (CAD), who completed the ambulatory cardiovascular rehabilitation program (CR) of the University Hospital Basel, Switzerland from January 2017 to April 2021. To evaluate the impact of the guideline publication, the cohort was split into a pre-Guideline 2019 group (A) and a post-Guideline 2019 group (B). In total 1320 patients were screened leaving 875 patients for analysis. At discharge, more patients in group B were on maximal statin doses (20% vs. 9%, p < 0.0001) and on combination therapy with ezetimibe (51% vs. 17%, p < 0.0001) than in group A, which resulted in 53% of patients reaching the LDL-C target of <1.4 mmol/L in group B. Regression analysis revealed that dyslipidaemia and positive smoking history represent independent predictors for intensified lipid-lowering medication, whereas absolving CR after publication of the 2019 guidelines was the only significant predictor for reduced LDL-C at CR discharge. We found a significant difference in prescription rates of lipid-lowering medication, especially combination therapies and statin doses, after publication of the 2019 ESC/EAS dyslipidaemia guidelines resulting in an achievement rate of >50% of the LDL-C target <1.4 mmol/L in CAD patients participating in ambulatory CR.
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Haegele et al. (2022) studied this question.
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