Achievement of LDL-Cholesterol Targets in a Reference Service of the Brazilian Public Health System
Roberto Ramos Barbosa, Glícia Chierici Baptista, Layla Pasolini Lott, Valentin Trevizani Neto, Eduardo Gomes Vieira, Pedro Henrique Paiva Faria Faleiro, Carolina Bravim Ferraço Vetorazi, Ana Beatriz Parma Marçal, Priscila Cabral Gomes Coelho Lima, Nickolas Fraga Perin da Cruz, Fabio Casagrande Coelho Costa, João Paulo
Introduction: Guidelines recommend that physicians reduce levels of low-density lipoprotein cholesterol (LDL-c) in patients with high cardiovascular risk. However, the achievement of these targets is low. It is paramount to know the success rate of lipid control to improve therapy and reduce cardiovascular events.
Objective: To assess the efficacy of lipid-lowering therapy in the achievement of LDL-c goals for each cardiovascular risk group in public outpatient ambulatory in Brazil.
Methods: Cross-sectional, observational, retrospective study in the Cardiology outpatient clinic of a referral hospital in Brazil. We included all patients with a history of dyslipidemia who were attended between May and June 2022. We excluded patients who had their first consultation at the time of recruitment. Data were obtained from medical records and the success rates for LDL-c goals were analyzed across cardiovascular risk groups. Statistical analyses were made by Pearson’s chi-square test, unpaired Student’s T-test and ANOVA One-Way test. Differences among groups were considered to be statistically significant if p-values were lower than .05.
Results: We included 431 patients; 207 (48.0%) were classified as very high risk, 159 (36.9%) as high risk, 46 (10.7%) as intermediate risk and 19 (4.4%) as low risk. 82.8% received statins, 30.4% received high-intensity statin therapy (HIST), 6.7% received ezetimibe and none received PCSK9 inhibitor. The LDL-c goal had been reached in different proportions among risk groups: 15.9% of very high risk patients, 31.4% of high risk patients, 54.3% of intermediate risk patients and 73.7% of low risk patients (p=.0001 for comparison among groups).
Conclusions: Our study showed poor success rates in achieving LDL-c goals, with the lowest success rate in the very-high risk group, despite the more frequent use of HIST and ezetimibe. These results demonstrate challenges in achieving LDL-c targets in real world.
View pdf