Keywords: LDL-cholesterol, secondary prevention, risk assessment

Background:

Despite significant progress in the identification of high-risk individuals and their treatment, there are few real-world data focusing on the dynamics of LDL cholesterol levels and the subsequent major coronary events after successful coronary revascularization.

Research questions:

How frequently after successful revascularization the actual LDL-C targets are reached in practice

Method:

The study provides real-world data for patients with a history of coronary revascularization from 20 heart centers in Bulgaria, selected through the period of 01.04.2021 - 31.03.2022, and followed for dynamics in LDL-C, mortality and major cardiovascular events from 01.04.2020 to 31.03.2023.

Results:

A total of 8272 patients with coronary revascularizations were included in Real World Evidence of Arterial Hypertension and Lipids Evaluation Dynamics (REVEALED) observational study. During three – year follow-up there were 2451 (29.6%) repeated revascularizations (n=2 in 1898 and n>2 in 553 patients with a mean number of 2.3 revascularizations per patient). Overall LDL-C levels decrease from 3.2 mmol/l (IQR 2.2-4.06) to 2.3 mmol/l (1.6-2.8) during the second and 2.2 mmol/l (1.5-2.6) during the last revascularization. The results were mainly driven by the reduction of LDL-C in the group of patients with baseline LDL-C>2.6 mmol/l (65.3%, delta of LDL-C – 37.5%) and to a lesser degree in the group of baseline LDL-C 1.8-2.6 mmol/l (19.9%, delta of LDL-C – 5.8%). In contrast, in the groups with baseline LDL-C < 1.4 mmol/l (6.26%) and 1.4-1.8 mmol/l (8.6%), an increase of subsequent LDL-C was noticed (delta of LDL-C 32.5% and 10.3% respectively) mainly related with therapy discontinuation or de-escalation.

Conclusions:

The speed of achievement of LDL-C targets and the success of their sustained long-term maintenance had an impact on prognosis. The main problems arise from the lack of sufficient emphasis on therapy maintenance and adherence monitoring in patients with near-target levels, as well as insufficient intensification in the remaining patients.

Points for discussion: