Abstract Background Secondary prevention of cardiovascular disease (CVD) is critical to reducing recurrent major adverse cardiovascular events (MACE) and long-term healthcare burden 1. Effective reductions in elevated LDL-cholesterol (LDL-C) has been consistently shown to improve MACE in patients with established atherosclerotic CVD (ASCVD) 2, 3. The UK National Institute for Clinical Care and Excellence (NICE) recommends secondary prevention LDL-C treatment target of 2. 0mmol/L (4) whereas the European Society of Cardiology Guidelines recommend a LDLC target of 1. 4 mmol/L and a ≥50% reduction from baseline 5. Initiatives designed to improve the delivery of secondary prevention of ASCVD can play a fundamental role in improving lipid lowering and patient outcomes 1, 6. Purpose We aimed to assess the efficacy of a novel secondary prevention nurse-led clinic to improve Lipid Lowering therapy regionally Methods This was a prospective examination of the efficacy of our regional nurse-led secondary prevention service. Consecutive patients with a history of established ASCVD and a baseline serum LDL-cholesterol (LDL-C) 1. 4 mmol/L at the index admission were included. ASCVD was defined as a history of confirmed acute coronary syndrome (ACS), previous coronary revascularisation for flow-limiting coronary artery disease (CAD), or with a stenosis of 70% in a major epicardial coronary artery. The primary outcome was the change in LDL-C from baseline to six months which was examined using a Repeated Measures Anova with a Tukey post-test. The secondary outcomes were the proportion of patients achieving the NICE LDL-C target of 2. 0 mmol/L and the ESC Target of 1. 4mmol/L (using Chi-Squared Test). Results We examined 201 consecutive patients. The mean (± standard deviation) age was 66. 30±10. 71 (range 32. 0-90. 0) years of which 132 (65. 67%) were men. In total 111 (55. 22%) patients had suffered an acute coronary syndrome. The mean ± standard deviation LDL-C was 3. 16 ±1. 91 mmol/l at the index hospital admission, 2. 31±0. 87 mmol/l at three months (baseline visit) and 1. 92±0. 73 mmol/l at six months (p0. 001) Figure 1). The mean LDL-C reduction from baseline to six months was 1. 24 (95% CI: 1. 04 -1. 44) mmol/L and a 38. 61% relative risk reduction. The proportion of patients at six months who achieved an LDL-C target of 2. 0mmol/l and 1. 4mmol/L was 65. 2% and 18. 4% respectively (P0. 001). Overall, 11/201 (5. 5%) were commenced on injectable lipid lowering therapy with PCSK9 inhibitors within six months of their index admission. Conclusions The introduction of a nurse-led secondary prevention service led to a significant reduction in LDL-C and improvements in regional lipid lowering performance. Whilst nearly two thirds of patients achieve the NICE lipid lowering target of 2. 0mmol/L at six months post index ASCVD event less than 1 in 5 achieve the ESC target of 1. 4mmol/L. Changes in LDL-CholesterolFor image description, please refer to the figure legend and surrounding text.
Young et al. (Mon,) studied this question.