CCCardiol CroatCardiologia CroaticaCardiol. Croat.1848-543X1848-5448Croatian Cardiac SocietyCC_13(11-12)_43010.15836/ccar2018.430Extended AbstractManagement of hyperlipidemia in very high and extremely high-risk patients in CroatiaLiječenje hiperlipidemije u bolesnika s vrlo visokim i ekstremno visokim rizikom u Hrvatskojhttps://orcid.org/0000-0002-7741-4194PintarićHrvoje12*https://orcid.org/0000-0002-7915-2562Knezović FlorijanMarijana2https://orcid.org/0000-0002-3317-3528BridgesIan3https://orcid.org/0000-0003-2250-9855SteinerRobert4https://orcid.org/0000-0001-9415-9618ZaputovićLuka5https://orcid.org/0000-0001-9101-1570MiličićDavor6Sveučilište u Zagrebu, Stomatološki fakultet, Zagreb, HrvatskaKlinički bolnički centar Sestre milosrdnice, Zagreb, HrvatskaAmgen Ltd; Cambridge, Velika BritanijaKlinički bolnički centar Osijek, Osijek, HrvatskaKlinički bolnički centar Rijeka, Rijeka, HrvatskaKlinički bolnički centar Zagreb, Zagreb, HrvatskaUniversity of Zagreb, Faculty of Dentistry, Zagreb, CroatiaUniversity Hospital Centre “Sestre milosrdnice” Zagreb, CroatiaAmgen Ltd; Cambridge, United KingdomUniversity Hospital Centre Osijek, Osijek, CroatiaUniversityHospital Centre Rijeka, Rijeka, CroatiaUniversity Hospital Centre Zagreb, Zagreb, CroatiaADDRESS FOR CORRESPONDENCE: Hrvoje Pintarić, Klinički bolnički centar Sestre milosrdnice, Vinogradska 29, HR-10000 Grad Zagreb, Croatia. / Phone: +385-91-378-7148 / E-mail: pintaric.hrvoje@gmail.com1120181311-1243043125102018051120182018Croatian Cardiac SocietyKLJUČNE RIJEČI: hiperlipidemijasekudarna prevencijakardiovaskularni događajiKEYWORDS: hyperlipidemiasecondary preventioncardiovascular events
Aim: An observational study was conducted to evaluate current management of elevated low-density lipoprotein cholesterol (LDL-C) in patients being treated for hyperlipidemia across central/eastern Europe and Israel. Information from this region is somewhat limited at present. Here we present data from the Croatian subpopulation.
Patients and Methods: We enrolled adult patients who were receiving lipid-lowering therapy (LLT) and attending a specialist (cardiologist/diabetologist/lipidologist) or general practitioner (GP) for a routine visit at a participating academic/specialist/GP centre in Croatia. Data were collected retrospectively from patients’ records for the preceding 12 months. Patients were classified by cardiovascular risk category: Very High Risk (VHR), according to European guidelines, (1, 2) or Extremely High Risk (EHR) according to recent American Association of Clinical Endocrinologists (AACE) criteria. (3)
Results: 89 patients (all secondary prevention: VHR 41/EHR 48) were enrolled at 4 sites (Table 1). All were receiving statins, as monotherapy (VHR 92.7%/EHR 83.3%) or combined with fibrates (VHR 4.9%/EHR 14.6%) or ezetimibe (VHR 2.4%/EHR 2.1%). Approximately 70% of patients in both subgroups were taking high-intensity statins (atorvastatin 40-80mg or rosuvastatin 20-40mg/day). Median (Q1, Q3) LDL-C levels were 2.5 (2.0, 3.8) mmol/L at the first, and 1.9 (1.6, 2.4) mmol/L at the last, visit of observation for VHR. Corresponding levels were 2.4 (1.7, 3.7) mmol/L and 2.1 (1.5, 3.1) mmol/L for EHR. Only 17 (41.5%; 95% CI 26.3-57.9) VHR patients and 13 (27.1%; 15.3-41.9) EHR patients had LDL-C levels within target (<1.8 mmol/L and <1.42 mmol/L, respectively). In general, the EHR group had lower median HDL-C (P <0.05) than the VHR group (e.g. 1.0 vs. 1.1 mmol/L at last visit; Table 1).
Patient population. Values are shown as n (%) unless otherwise indicated.
Very High Risk (n=41)
Extreme High Risk (n=48)a
Male/female
35 (85.4%)/6 (14.6%)
34 (70.8%)/14 (29.2%)
Age (mean, range), years
66.1 (56-78)
64.3 (46-82)
Weight (mean, range), kg
88.9 (57-173)[n=32]
85.0 (49-125)[n=38]
Current Smoker
9 (22.0%)
10 (20.8%)
Diabetes
6 (14.6%)
24 (50.0%)
STEMI
12 (29.3%)
13 (27.1%)
Statin-intolerantb
1 (2.4%)
2 (4.2%)
Time from diagnosisc
< 1 Year
9 (22.0%)
13 (27.1%)
≥1 to <2 Years
2 (4.9%)
2 (4.2%)
≥2 to <3 Years
1 (2.4%)
1 (2.1%)
≥3 to <4 Years
0 (0%)
1 (2.1%)
≥4 to <5 Years
1 (2.4%)
1 (2.1%)
≥5 Years
8 (19.5%)
12 (25.0%)
Missing
20 (48.8%)
18 (37.5%)
HDL-C (mmol/L)d
1.1 (1.0, 1.3)
1.0 (0.8, 1.2)
Triglycerides (mmol/L)d
1.3 (1.1, 1.5)
1.5 (1.0, 2.4)
Total cholesterol (mmol/L)d
3.5 (3.2, 3.9)
3.7 (3.3, 4.8)
a. Progressive ASCVD after achieving LDL-C <1.8 mmol/l; established clinical CV disease in patients with diabetes mellitus, CKD stage 3/4, or heterozygous FH; history of premature ASCVD (aged <55 years male, <65 years female); b. Symptoms of statin intolerance; c. Time from diagnosis of hyperlipidemia to study enrolment; d. Median (Q1, Q3) values at the last visit.
Conclusion: Our findings indicate that a substantial proportion of VHR and EHR secondary prevention patients being treated across Croatia have LDL-C levels exceeding targets recommended in European and newer AACE guidelines. (1-3) Despite this, not all patients are receiving high intensity statins as recommended. Identification of EHR patients and their lipid patterns may help to optimize usage of high-intensity statin treatment, alone or in combination with newer treatments, for better control of elevated LDL-C.
LITERATUREEuropean Association for Cardiovascular Prevention & RehabilitationReinerZCatapanoALDe BackerGGrahamITaskinenMR. ESC Committee for Practice Guidelines (CPG) 2008-2010 and 2010-2012 Committees. ESC/EAS Guidelines for the management of dyslipidaemias: the Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS).Eur Heart J. 2011 Jul;32(14):1769–818.21712404CatapanoALGrahamIDe BackerGWiklundOChapmanMJDrexelH2016 ESC/EAS Guidelines for the Management of Dyslipidaemias: The Task Force for the Management of Dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS) Developed with the special contribution of the European Assocciation for Cardiovascular Prevention & Rehabilitation (EACPR).Atherosclerosis. 2016 Oct;253:281–344. 10.1016/j.atherosclerosis.2016.08.01827594540JellingerPSHandelsmanYRosenblitPDBloomgardenZTFonsecaVAGarberAJAmerican Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease.Endocr Pract. 2017 Apr;23Suppl 2:1–87. 10.4158/EP171764.APPGL28437620