Highlights
- •The virtual lipid visits model led to an early optimization of lipid-lowering therapy.
- •Intensive lipid-lowering therapy included high use of ezetimibe and PCSK9i.
- •Lipid targets were achieved in most patients within the first 3 months post-ACS.
- •LDL-C levels <70 and <55 mg/dL were reached in 95.4% and 81.5% of patients.
- •High LDL-c control rates meant better outcomes with low MACE and mortality rates.
Background
Atherosclerotic cardiovascular disease is a very common condition in routine practice
and a leading cause of morbidity and mortality all around the world.
Objetive
To determine the impact of a strategy based on strict control and close follow-up
for patients with acute coronary syndrome (ACS) through the use of “post-ACS virtual
lipid visits” on lipid-lowering therapy, low-density lipoprotein cholesterol (LDL-c),
and outcomes.
Methods
Prospective study that consecutively included patients with ACS during 2020. All patients
were discharged with high-intensity statins, and the lipid profile was determined
after 1 month. At this time, patients were contacted by phone, and treatment was adjusted
following the therapeutic algorithm of the Spanish Society of Cardiology. These visits
were repeated every month until LDL-c reached <55 mg/dL. Patients were then transferred
to scheduled conventional outpatient visits.
Results
A total of 346 patients (67.3±2.3 years; 68.2% men) were included. Follow-up was 12-24
months (mean, 17.7±3.8; median, 17.3). Definitive lipid-lowering therapy (mean uptitration
time, 3.2±2.1 months) consisted of high-intensity statins alone (32.4%), high-intensity
statins plus ezetimibe (56.9%), and PCSK9 inhibitors (10.7%). LDL-c decreased from
108.4±40.6 to 48.7±14.4 mg/dL. At baseline, LDL-c was <100 mg/dL, 70 mg/dL, and 55
mg/dL in 44.5%, 17.6%, and 7.2% of patients, respectively. At study end, these percentages
were 100%, 95.4%, and 81.5%, respectively. After one year of follow-up, 3-P MACE,
4-P MACE, and cardiovascular mortality were recorded in 3.5%, 4.0% and 1.5% of patients,
respectively. At study end, these percentages were 4.0%, 5.2%, and 1.7%, respectively.
Conclusions
The implementation of a post-ACS virtual lipid visit model led to early optimization
of lipid-lowering therapy, which led to marked improvements in LDL-c control rates
and low MACE and mortality rates.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Clinical LipidologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Heart disease and stroke statistics-2021 update: a report from the American heart association.Circulation. 2021; 143: e254-e743https://doi.org/10.1161/CIR.0000000000000950
- Long-term mortality and hospital readmission after acute myocardials infarction: an eight-year follow-up study.Rev Esp Cardiol. 2012; 65: 414-420https://doi.org/10.1016/j.recesp.2011.09.009
- Early and late benefits of high-dose atorvastatin in patients with acute coronary syndromes: results from the PROVE IT-TIMI 22 Trial.J Am Coll Cardiol. 2005; 46: 1405-1410https://doi.org/10.1016/j.jacc.2005.03.077
- ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice.Eur Heart J. 2021; 42: 3227-3337https://doi.org/10.1093/eurheartj/ehab484
- ESC/EASCES. 2019 ESC/EAS guidelines for the management of dyslipidaemia: lipid modification to reduce cardiovascular risk.Eur Heart J. 2020. 2019; 41: 111-188https://doi.org/10.1093/eurheartj/ehz455
- Cholesterol Treatment Trialists (CTT) Collaboration. Efficacy and safety of more intensive lowering of LDL cholesterol: A meta-analysis of data from 170,000 participants in 26 randomised trials.Lancet. 2010; 376: 1670-1681https://doi.org/10.1016/S0140-6736(10)61350-5
- Efficacy and safety of statin therapy in older people: A meta-analysis of individual participant data from 28 randomised controlled trials.Lancet. 2019; 393: 407-415https://doi.org/10.1016/S0140-6736(18)31942-1
- Association between lowering LDL-C and cardiovascular risk reduction among different therapeutic interventions: a systematic review and meta-analysis.JAMA. 2016; 316: 1289-1297https://doi.org/10.1001/jama.2016.13985
- Analyzing the coronary heart disease mortality decline in a Mediterranean population: Spain 1988-2005.Rev Esp Cardiol. 2011; 64: 988-996https://doi.org/10.1016/j.recesp.2011.05.033
- Control of LDL-C levels after an acute coronary syndrome in Spain. Are the available treatments adequately used?.Rev Esp Cardiol (Engl Ed). 2021; 74: 194-196https://doi.org/10.1016/j.rec.2020.06.027
- Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries.Atherosclerosis. 2019; 285: 135-146https://doi.org/10.1016/j.atherosclerosis.2019.03.014
- EU-wide cross-sectional observational study of lipid-modifying therapy use in secondary and primary care: the DA VINCI study.Eur J Prev Cardiol. 2021; 28: 1279-1289https://doi.org/10.1093/eurjpc/zwaa047
- Management of patients with dyslipidaemia in Spain. The cardio right care control of cardiovascular risk project.Semergen. 2021; 47: 28-37https://doi.org/10.1016/j.semerg.2020.08.007
- Recommendations to improve lipid control. Consensus document of the Spanish society of cardiology.Rev Esp Cardiol. 2020; 73: 161-167https://doi.org/10.1016/j.rec.2019.08.012
- Virtual lipid clinic after acute coronary syndrome.Rev Esp Cardiol (Engl Ed). 2022; 75: 91-92https://doi.org/10.1016/j.rec.2021.07.008
- ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: a report of the American College of Cardiology/American heart association task force on practice guidelines.Circulation. 2013; 2014: S1-45https://doi.org/10.1161/01.cir.0000437738.63853.7a
- 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA guideline on the management of blood cholesterol: executive summary: a report of the American college of cardiology/American heart association task force on clinical practice guidelines.J Am Coll Cardiol. 2019; 73: 3168-3209https://doi.org/10.1016/j.jacc.2018.11.002
- 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC).Eur Heart J. 2018; 39: 119-177https://doi.org/10.1093/eurheartj/ehx393
- 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation.Eur Heart J. 2021; 42: 1289-1367https://doi.org/10.1093/eurheartj/ehaa575
- Statin intolerance - an attempt at a unified definition. Position paper from an international lipid expert panel.Arch Med Sci. 2015; 11: 1-23https://doi.org/10.5114/aoms.2015.49807
- Prognostic significance of presenting blood pressure in patients with ST-elevation myocardial infarction undergoing percutaneous coronary intervention.Am J Hypertens. 2015; 28: 797-805https://doi.org/10.1093/ajh/hpu230
- Ezetimibe added to statin therapy after acute coronary syndromes.N Engl J Med. 2015; 372: 2387-2397https://doi.org/10.1056/NEJMoa1410489
- Clinical impact of the cardio-ankle vascular index for predicting cardiovascular events after acute coronary syndrome.Circ J. 2016; 80: 1420-1426https://doi.org/10.1253/circj.CJ-15-1257
- Efficacy of high-intensity atorvastatin for asian patients undergoing percutaneous coronary intervention.Ann Pharmacother. 2016; 50: 725-733https://doi.org/10.1177/1060028016654722
- Residual dyslipidemia leads to unfavorable outcomes in patients with acute coronary syndrome after percutaneous coronary intervention.Stem Cells Int. 2016; 20166175948https://doi.org/10.1155/2016/6175948
- Real-world study of low-density lipoprotein cholesterol levels and cardiovascular outcomes in Chinese: a retrospective cohort study in post-percutaneous coronary intervention acute coronary syndrome patients.Int J Cardiol. 2017; 249: 18-24https://doi.org/10.1016/j.ijcard.2017.07.016
- Gender is not a predictor of mortality or major adverse cardiovascular events in patients undergoing percutaneous coronary intervention for acute coronary syndromes.Heart Lung Circ. 2019; 28: 727-734https://doi.org/10.1016/j.hlc.2018.03.020
- Prescription of statins at discharge and 1-year risk of major clinical outcomes among acute coronary syndromes patients with extremely low LDL-cholesterol in clinical pathways for acute coronary syndromes studies.Clin Cardiol. 2018; 41: 1192-1200https://doi.org/10.1002/clc.23040
- Assessment of the LDL-C/HDL-C ratio as a predictor of one year clinical outcomes in patients with acute coronary syndromes after percutaneous coronary intervention and drug-eluting stent implantation.Lipids Health Dis. 2019; 18: 40https://doi.org/10.1186/s12944-019-0979-6
- Impact of sex on long-term cardiovascular outcomes of patients undergoing percutaneous coronary intervention for acute coronary syndromes.Catheter Cardiovasc Interv. 2021; 98: E494-E500https://doi.org/10.1002/ccd.29754
- The predictive value of Lp(a) for adverse cardiovascular event in ACS patients with an achieved LDL-C target at follow up after PCI.J Cardiovasc Transl Res. 2021 Jun 21; (Online ahead of print)https://doi.org/10.1007/s12265-021-10148-2
- Low hemoglobin predicts high-platelet reactivity and major cardiovascular ischemic events at long-term follow-up among ACS patients receiving dual antiplatelet therapy with ticagrelor.Catheter Cardiovasc Interv. 2021; 98: 1309-1316https://doi.org/10.1002/ccd.29512
- Influence of sex, age and race on coronary and heart failure events in patients with diabetes and post-acute coronary syndrome.Clin Res Cardiol. 2021; 110: 1612-1624https://doi.org/10.1007/s00392-021-01859-2
- Prevalence and impact of metabolic syndrome in patients with multivessel coronary artery disease and acute coronary syndrome.Nutr Metab Cardiovasc Dis. 2021; 31: 2693-2699https://doi.org/10.1016/j.numecd.2021.05.029
- Efficacy of evolocumab on cardiovascular outcomes in patients with recent myocardial infarction: a prespecified secondary analysis from the FOURIER trial.JAMA Cardiol. 2020; 5: 952-957https://doi.org/10.1001/jamacardio.2020.0882
- Fixed-dose combination of rosuvastatin and ezetimibe: treating hypercholesteremia according to cardiovascular risk.Expert Rev Clin Pharmacol. 2021; 14: 793-806https://doi.org/10.1080/17512433.2021.1925539
- Analysis of the prescription process of PCSK9 inhibitors in the cardiology departments of Spanish hospitals and optimization proposal. The IKIGAI study.Clin Investig Arterioscler. 2021; 33: 296-305https://doi.org/10.1016/j.arteri.2021.05.003
- Factors associated with time to initiation of a PCSK9 inhibitor after hospital discharge for acute myocardial infarction.J Clin Lipidol. 2021 Nov 7; (S1933-2874-9Epub ahead of printPMID34848176): 00257https://doi.org/10.1016/j.jacl.2021.11.001
- Use of bempedoic acid in patients with dyslipidemia. A practical approach.Rev Esp Cardiol Supl. 2021; 21 (Supl C): 1-7https://doi.org/10.1016/S1131-3587(21)00005-4
- ACS EuroPath Central & South European countries project. Optimal use of lipid-lowering therapy after acute coronary syndromes: a position paper endorsed by the international lipid expert panel (ILEP).Pharmacol Res. 2021; 166105499
Article info
Publication history
Published online: July 27, 2022
Accepted:
July 17,
2022
Received:
February 8,
2022
Footnotes
Author contributions: We confirm that each of the authors has contributed to the study design, data collection, statistical process, and manuscript preparation.
Conflict of interest: None.
Sources of Funding: This study was partially funded by the project (PI-0057-2017) subsidized under the Framework of the Integrated Territorial Initiative (ITI) 2014-2020 for the province of Cádiz, by the Regional Ministry of Health of the Government of Andalusia, and by the European Regional Development Fund (ERDF). Project 80% co-financed by funds from the Andalusian ERDF Operational Program 2014-2020.
Identification
Copyright
© 2022 National Lipid Association. Published by Elsevier Inc. All rights reserved.
