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Impact of a virtual lipid clinic on lipid-lowering therapy, LDL cholesterol levels, and outcomes in patients with acute coronary syndrome

  • Rafael Vázquez García
    Correspondence
    Corresponding author: Rafael Vázquez García, Jefe de Servicio de Cardiología, Hospital Universitario Puerta del Mar, Avenida Ana de Viya 21, 11009, Cádiz. Spain
    Affiliations
    Servicio de Cardiología, Hospital Universitario Puerta del Mar. Departamento de Medicina, Universidad de Cádiz. Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA). Cádiz, Spain.
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  • Juan Enrique Puche García
    Affiliations
    Servicio de Cardiología, Hospital Universitario Puerta del Mar. Departamento de Medicina, Universidad de Cádiz. Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA). Cádiz, Spain.
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  • William Delgado Navas
    Affiliations
    Servicio de Cardiología, Hospital Universitario Puerta del Mar. Departamento de Medicina, Universidad de Cádiz. Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA). Cádiz, Spain.
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  • Diego Mialdea Salmerón
    Affiliations
    Servicio de Cardiología, Hospital Universitario Puerta del Mar. Departamento de Medicina, Universidad de Cádiz. Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA). Cádiz, Spain.
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  • Daniel Bartolomé Mateos
    Affiliations
    Servicio de Cardiología, Hospital Universitario Puerta del Mar. Departamento de Medicina, Universidad de Cádiz. Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA). Cádiz, Spain.
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      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

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