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Abstract Background Even though the ESC guidelines tend to be more demanding towards the lipid management and recommend lower LDL-C targets, studies have consistently shown very low rates of achieving dyslipidemia treatment goals and a large gap between clinical practice and guideline-recommended practice. Aim of the study To investigate the implementation of guidelines and the achievement of LDL-C target in secondary prevention (according to ESC 2019 guidelines), in a group of patients 6 months after an acute coronary syndrome (ACS); identification of barriers for not achieving the target: assessment of adherence, and optimization of lipid lowering therapy. Materials and methods We enrolled patients with ACS admitted in the cardiology unit of a university hospital during the period February-June 2022, and collected the data from medical records. Follow-up of patients was carried out through phone calls 6 months after discharge from the hospital, evaluating changes in the lipid profile and therapy. For analysis purpose, we divided the patients in two groups according the achievement of treatment goal. Results We enrolled 571 patients in the study, but were able to reach only 435 patients for a phone interview after six months, and only 257 of these patients performed the required lipid profile. At discharge, 95.7% of patients were prescribed statin monotherapy (84% high-intensity statin); 3.9% of patients were prescribed the statin + ezetimibe combination. In 0.4%, lipid lowering therapy was not prescribed. At the 6-month follow-up, fewer patients were being treated with statins (91.05% of patients were receiving statin monotherapy) and even fewer with high-intensity statins (62.3%); 4.7% of patients were taking the statin + ezetimibe combination; 4.25% of patients were not receiving lipid-lowering therapy (LLT). In 257 patients included in the study, only 55 of them (21.4%) reached LDL-C target after 6 months. Overall adherence to treatment was 94.2%, 100% in the group that reached the LDL-C target compared to 92.6% in the group that didn't reach the treatment goal. Optimization of LLT was performed in 14% of the cases. 58.2% of the patients in the group that reached the treatment goal had the LLT optimized after being discharged, compared to only 2% in the group that didn’t reach the target. Of the 36 patients who had the therapy optimized, 88.9% reached the LDL-C target. Optimization increases the likelihood of achieving the LDL-C goal by 14 times. Conclusions The results of our study show that most coronary patients have a less than optimal management of LDL-C, with only a small part of them achieving treatment goals. Lack of intensification of statin therapy and underutilization of combination therapy suggest gaps between real-world practices and guideline recommendations. Strategies directed at both the health care system and providers are needed to attain secondary prevention goals.
Rrapo et al. (Sat,) studied this question.