Impact of Adherence to Lipid-Lowering Guidelines on the Achievement of Lipid Profile Goals in Patients With Acute Coronary Syndrome: A Prospective Cohort Study

Document Type : Original Article

Authors

1 CHANGE Research Working Group, Carrera de Medicina Humana, Facultad de Ciencias de la Salud, Universidad Científica del Sur. Lima, Perú.

2 Instituto Nacional Cardiovascular “Carlos Alberto Peschiera Carrillo”, Cardiology Department, INCOR, Lima, Perú.

Abstract

Background: Acute coronary syndrome (ACS) is one of the main causes of mortality worldwide, and dyslipidemia is one of its important risk factors. Studies have shown that treatment with high-intensity statins protects against cardiovascular events; other investigations have noted that despite the potential effects of statins, 80% of patients with ACS fail to lower cholesterol levels. We conducted the present study to determine the association between medical compliance to clinical practice guidelines (CPG) and changes in low-density lipoprotein cholesterol (LDL-C) at follow-up among patients with ACS.
 
Methods: We performed a prospective cohort study on patients diagnosed with ACS. We enrolled 79 adult patients from August 2019 through March 2020. Data on patient characteristics at presentation, hospitalization, and 8 months of follow-up were collected. Adherence was established as a high-intensity statin prescription at discharge according to Peruvian, European Society of Cardiology (ESC) 2019, and American Heart Association (AHA) 2018 guidelines.
 
Results: Adherence to AHA and ESC guidelines showed a reduction in mean LDL-C values of 44.2 mg/dL (P = 0.14). In patients with dyslipidemia, mean LDL-C values were reduced by 60.6 mg/dL (P < 0.001). Only 27.8% of the patients did not achieve any goal in their LDL-C levels following the AHA or ESC guideline recommendations.
 
Conclusions: Due to the high prevalence of dyslipidemia, adequate primary prevention before an acute event occurs is essential. Compliance with CPG by healthcare personnel is related to a reduction in LDL-C levels at follow-up, and patient adherence is essential to achieve LDL-C targets. (Iranian Heart Journal 2023; 24(4): 54-62)

Keywords

References

  1. Chacón-Piñero A, Nogales-Asensio JM, Martínez-Carapeto A, Lledó-Gómez M, Merchán-Cuenda M, Bengla-Limpo B. Current Management of Hyperlipidemia in Patients Discharged With a Diagnosis of Acute Coronary Syndrome. Rev Esp Cardiol Engl Ed. 2016 Jan; 69(1):83–4.
  2. Hu H, Zhu J, Zhong Y, Geng R, Ji Y, Guan Q, et al. PIK3CA mutation confers resistance to chemotherapy in triple-negative breast cancer by inhibiting apoptosis and activating the PI3K/AKT/mTOR signaling pathway. Ann Transl Med. 2021 Mar; 9(5):410–410.
  3. Kumar N, Kumar S, Kumar A, Shakoor T, Rizwan A. Lipid Profile of Patients with Acute Myocardial Infarction (AMI). Cureus [Internet]. 2019 Mar 18 [cited 2022 Oct 23]; Available from: https://www.cureus.com/articles/18555-lipid-profile-of-patients-with-acute-myocardial-infarction-ami
  4. Li M, Wang X, Li X, Chen H, Hu Y, Zhang X, et al. Statins for the Primary Prevention of Coronary Heart Disease. BioMed Res Int. 2019 Jan 29; 2019:1–15.
  5. Adhyaru BB, Jacobson TA. Safety and efficacy of statin therapy. Nat Rev Cardiol. 2018 Dec; 15(12):757–69.
  6. Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Circulation [Internet]. 2019 Jun 18 [cited 2022 Oct 23]; 139(25). Available from: https://www.ahajournals.org/doi/10.1161/CIR.0000000000000625
  7. Schiele F, Farnier M, Krempf M, Bruckert E, Ferrières J, Angoulvant D, et al. A consensus statement on lipid management after acute coronary syndrome. Eur Heart J Acute Cardiovasc Care. 2018 Sep; 7(6):532–43.
  8. Álvarez, Patricia. GUÍA DE PRÁCTICA CLÍNICA DE SÍNDROME CORONARIO AGUDO. INSTITUTO DE EVALUACIÓN DE TECNOLOGÍAS EN SALUD E INVESTIGACIÓN; 2017.
  9. Bansilal S, Castellano JM, Garrido E, Wei HG, Freeman A, Spettell C, et al. Assessing the Impact of Medication Adherence on Long-Term Cardiovascular Outcomes. J Am Coll Cardiol. 2016 Aug; 68(8):789–801.
  10. Liu YB, Wu CC, Lee CM, Chen WJ, Wang TD, Chen PS, et al. Dyslipidemia is associated with ventricular tachyarrhythmia in patients with acute ST-segment elevation myocardial infarction. J Formos Med Assoc Taiwan Yi Zhi. 2006 Jan; 105(1):17–24.
  11. Coimbra S, Reis F, Nunes S, Viana S, Valente MJ, Rocha S, et al. The Protective Role of Adiponectin for Lipoproteins in End-Stage Renal Disease Patients: Relationship with Diabetes and Body Mass Index. Oxid Med Cell Longev. 2019; 2019:3021785.
  12. Oshunbade AA, Yimer WK, Valle KA, Clark D, Kamimura D, White WB, et al. Cigarette Smoking and Incident Stroke in Blacks of the Jackson Heart Study. J Am Heart Assoc. 2020 Jun 16; 9(12):e014990.
  13. Morisky DE, Ang A, Krousel-Wood M, Ward HJ. Predictive validity of a medication adherence measure in an outpatient setting. J Clin Hypertens Greenwich Conn. 2008 May; 10(5):348–54.
  14. Hurtado Noblecilla E, Bartra Aguinaga A, Osada Liy J, León Jiménez F, Ochoa Medina M. Frecuencia de factores de riesgo cardiovascular en pacientes con síndrome isquémico coronario agudo, Chiclayo. Rev Medica Hered. 2020 Jan 13; 30(4):224–31.
  15. Nakahashi T, Tada H, Sakata K, Yakuta Y, Tanaka Y, Nomura A, et al. Paradoxical impact of decreased low-density lipoprotein cholesterol level at baseline on the long-term prognosis in patients with acute coronary syndrome. Heart Vessels. 2018 Jul; 33(7):695–705.
  16. Guerrero-Díaz DV, Hernández-Vásquez A, Montoya-Rivera WC, Rojas-Roque C, Chacón Díaz MA, Bendezu-Quispe G. Undiagnosed hypertension in Peru: analysis of associated factors and socioeconomic inequalities, 2019. Heliyon. 2021 Jul; 7(7):e07516.
  17. Stacy TA, Egger A. Results of retrospective chart review to determine improvement in lipid goal attainment in patients treated by high-volume prescribers of lipid-modifying drugs. J. Manag. Care Pharm. 2006; 12(9):745–751. doi:10.18553/jmcp.2006.12.9.745
  18. Aghasizadeh M, Bizhaem SK, Baniasadi M, Khazdair MR, Kazemi T. Evaluation of LDL goal achievement in statin consumption, south east of Iran. Sci Rep. 2021 May 24; 11(1):10786. doi:10.1038/s41598-021-90228-0.
  19. Oesterle A, Laufs U, Liao JK. Pleiotropic effects of statins on the cardiovascular system. Circ Res. 2017; 120:229–243
  20. Buonvino C, Chopard R, Guillon B, Puymirat E, Farnier M, Ferrières J, et al. An innovative lipid-lowering approach to enhance attainment of low-density lipoprotein cholesterol goals. Eur Heart J Acute Cardiovasc Care. 2020 Dec 1; 9(8):879–87.
  21. Castañeda-Amado Z. Medical compliance to evidence-based clinical guidelines on secondary prevention of coronary heart disease in a hospital from Lima, Peru: a retrospective study. Medwave. 2017; https://doi.org/10.5867/medwave.2017.05.6989
  22. Zhang W, Ji F, Yu X, Wang X. Factors associated with unattained LDL-cholesterol goals in Chinese patients with acute coronary syndrome one year after percutaneous coronary intervention. Medicine (Baltimore). 2017 Jan; 96(1):e5469.
  23. Hajahmadi Pourrafsanjani M, Khayati Shal E, Khezrpour S. Risk Factors Associated with Failure to Achieve the Low Density Lipoprotein Cholesterol Therapeutic Target in Patients with Acute Coronary Syndrome: A Longitudinal, Single Centre Investigation. High Blood Press Cardiovasc Prev. 2019.26:37–43. DOI:1007/s40292-019-00298-5
Iranian Heart Journal
Volume 24, Issue 4
October 2023
Pages 54-62

Files

Share

How to cite

Statistics