Evaluation of the effectiveness of the implementation of recommendations on lipid-lowering therapy in patients with very high cardiovascular risk in medical organizations of the North-Western federal district

Cardiovascular pathology remains the leading cause of death in Russia, which determines the priority of correcting modifiable risk factors: high systolic blood pressure, poor nutrition, dyslipidemia. According to the 2023 clinical guidelines on lipid disorders, patients at very high cardiovascular risk should start on a combination of a statin and ezetimibe. A study was conducted on the adequacy of dyslipidemia correction in patients of the Northwestern Federal District in 2023. In order to assess the dynamics of prescribing initial combination therapy to patients with very high cardiovascular risk in 2025, we initiated a repeat study. Materials and methods. The study was conducted using a specially designed questionnaire: 165 patients in 2023 and 281 patients in 2025. The results were comparable to the large-scale, ESS-Russia (2012-2014), ARGO-3, ICEBERG, ESS-Russia-2 (2017) studies. Statistical significance was tested using Fisher's two-sample z-test. The results and their discussion. The number of patients with grade 1-3 obesity increased significantly (from 18.8% to 39.9%; z-criterion 4.62; p < 0.00001), and the proportion of overweight patients decreased (from 47.8% to 38.4%; z-criterion -1.95; p < 0.051). Patients with physical inactivity became significantly less common (60.0% vs. 38.4%; z-criterion 4.42; p < 0.00001). The number of patients with postinfarction cardiosclerosis increased significantly (9.6% vs. 37.2%; z-criterion 6.92; p < 0.00001). In 2025, statin monotherapy was prescribed to patients three times more often (94.7% vs 36.9%). There was a significant increase in prescribing the combined statin + ezetimibe regimen in the 2025 group (53.6% vs 0.0%). A control study of the lipidogram was performed in 74.8% of patients in 2025 and 78.1% in 2023, at the outpatient stage, correction of therapy was performed only in 17.0% of patients in 2025 and 16.3% in 2023. The target level of LDL-C < 1.4 mmol/L in 2023 was observed in 45 (34,9%), in 2025 - 113 (49,3%) cases. The significance of the obtained results is confirmed by the z-criterion 2,7 and the level p = 0,007. Conclusion . The paper considers ways to solve the problem of non-compliance of prescribed lipid-lowering therapy with clinical recommendations: the inclusion of ezetimibe and a fixed combination of statin + ezetimibe in the list of preferential drug provision, compliance with the requirements of follow-up of patients.