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Vol. 31. Issue 3.
Pages 93-100 (May - June 2019)
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Vol. 31. Issue 3.
Pages 93-100 (May - June 2019)
Original article
DOI: 10.1016/j.artere.2019.05.001
A new rational approach to reach LDL-cholesterol concentration objectives after an acute coronary syndrome
Una nueva estrategia para alcanzar los niveles objetivos de colesterol LDL tras un síndrome coronario agudo
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Núria Ribasa,b,c,
Corresponding author
60055@parcdesalutmar.cat

Corresponding author.
, Lluís Recasensa,b, Silvia Pérezd,g, Víctor Bazána,f, Juan Pedro-Botete, Sonia Ruiza,b, Roberto Elosuad,g, Julio Martí-Almora,b
a Servicio de Cardiología, Hospital del Mar, Barcelona, Spain
b Grupo de Investigación Biomédica en Enfermedades del Corazón, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
c Departamento Medicina, Universidad Autónoma de Barcelona, Barcelona, Spain
d Grupo de Investigación Epidemiología y Genética Cardiovascular, Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, Spain
e Unidad de Lípidos y Riesgo Vascular, Hospital del Mar, Universidad Autónoma de Barcelona, Barcelona, Spain
f Hospital Universitari Germans Trias i Pujol, Badalona, Spain
g CIBER de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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Tables (5)
Table 1. Baseline characteristics of the study population distributed by gender.
Table 2. Achievement of the target LDL-C (LDL<70mg/dl) during follow-up by lipid-lowering therapy at discharge following an acute coronary syndrome.
Table 3. Factors associated with adherence to the Masana criteria in the prescription of lipid-lowering drugs following an acute coronary syndrome.
Table 4. Factors associated with the achievement of the LDL-C target<70mg/dl during follow-up.
Table 5. Factors associated with the achievement of the LDL cholesterol target<70mg/dl: Logistic regression model (multivariate analysis).
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Abstract
Introduction and objectives

Adequate LDL cholesterol (LDLc) control after an acute coronary syndrome (ACS) is a crucial secondary prevention strategy to minimise the incidence of recurrent myocardial infarction and cardiovascular death. There are tables that predict the necessary dosage of lipid-lowering treatment from the initial LDLc but have not been tested in ACS. Variables associated with optimal LDLc after an ACS were analysed and the therapeutic yield of the use of Masana's recommendations in this setting.

Methods

A total number of 326 ACS-patients were included between January-2015 and May-2016. Baseline LDLc concentration and prescribed hypolipemiant treatment at hospital discharge were registered. We analysed the variables associated with optimal LDLc levels (<70mg/dl) control during follow-up.

Results

Among our patient population (72% male, age 66±13 years), the hypolipemiant treatment at hospital discharge fulfilled the Masana's recommendations in 196 (60%) patients. After a follow-up period of 122 [66–184] days the targeted LDLc levels were achieved in 148 (45%) patients, being this percentage greater among those in whom the Masana's recommendations were fulfilled (109/196, 56%), as compared with the remaining (39/130, 30%; p<0.001). The male gender (p<0.001), the absence of prior history of dyslipemia (p<0.001) and the adherence to Masana's recommendations (p=0.007) were independent predictors for the achievement of targeted LDLc levels during follow-up.

Conclusions

In less than half of ACS-patients adequate mid-term LDLc control is obtained. The dosage of the lipid-lowering therapy according to Masana's recommendations helps to achieve this important therapeutic goal.

Keywords:
Dyslipemia
Acute coronary syndrome
Secondary prevention
LDL-cholesterol
Statins
Masana's recommendations
Resumen
Introducción y objetivos

El adecuado control lipídico tras un síndrome coronario agudo (SCA) es una estrategia de prevención secundaria crucial para disminuir el riesgo de reinfarto y muerte cardiovascular. Existen tablas que predicen la dosificación necesaria del tratamiento hipolipidemiante según el colesterol LDL (cLDL) inicial pero no han sido probadas en el SCA. Analizamos los factores asociados al control del cLDL tras un SCA y la utilidad de las tablas de Masana y Plana en este contexto.

Métodos

Entre enero de 2015 y mayo de 2016 se incluyeron 326 pacientes con SCA. Se registraron las concentraciones basales de cLDL y el tratamiento hipolipidemiante al alta. Se analizaron las variables asociadas a un adecuado control del cLDL (<70mg/dL) en el seguimiento.

Resultados

La edad media fue 66±13 años, el 72% varones. El tratamiento hipolipidemiante al alta se ajustó a las recomendaciones de Masana en 196 (60%) pacientes. Tras 122 [66-184] días, en 148 (45%) se alcanzó el objetivo de cLDL, siendo este porcentaje mayor (109/196 –56%– vs. 39/130 –30%– pacientes) cuando el tratamiento fue planificado según las tablas de Masana y Plana (p<0,001). En el análisis multivariante, el género masculino (p<0,001), la ausencia de dislipidemia previa (p<0,001) y la aplicación de las tablas de Masana y Plana (p=0,007) fueron predictores independientes para alcanzar el cLDL objetivo.

Conclusiones

El control lipídico adecuado tras un SCA se alcanza en menos de la mitad de casos. La dosificación de la terapia hipolipidemiante según las tablas de Masanay Plana mejora la consecución de este crucial objetivo terapéutico.

Palabras clave:
Dislipidemia
Síndrome coronario agudo
Prevención secundaria
Colesterol
Estatinas
Tablas de Masana y Plana

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