RESUMO
BACKGROUND: This real-world study examined clinical characteristics and dyslipidemia management among patients initiating evolocumab across 12 European countries. Austrian data are reported. METHODS: Data of consenting adults were collected for ≤â¯6 months prior to evolocumab initiation (baseline) and ≤â¯30 months post-initiation. Patient characteristics, lipid lowering therapy (LLT, i.e. statin and/or ezetimibe) and lipid values were collected from medical records. RESULTS: In Austria, 363 patients were enrolled. At baseline, 52% of patients initiated evolocumab without background LLT; the median (Q1, Q3) initial low-density lipoprotein cholesterol (LDL-C) level was 142 (111, 187) mg/dL. Within 3 months of evolocumab treatment, median LDLC decreased by 59% to 58 (37, 91) mg/dL. This reduction was maintained over time, despite consistently infrequent use of background LLT. LDL-Câ¯< 55â¯mg/dL was attained by 65% of patients (76% with, 55% without background LLT). Evolocumab persistence was ≥â¯90% at month 12 and month 30. CONCLUSION: In Austria, patients were initiated on evolocumab at LDLC levels almost 3times higher than the guideline-recommended clinical goal (<â¯55â¯mg/dL). Persistence with evolocumab was very high. Evolocumab led to a rapid and sustained LDLC reduction with 65% attaining the LDLC goal. Patients using evolocumab in combination with statins and/or ezetimibe were more likely to attain their LDLC goal and thus decrease cardiovascular risk.
Assuntos
Anticorpos Monoclonais Humanizados , Anticolesterolemiantes , Inibidores de Hidroximetilglutaril-CoA Redutases , Adulto , Humanos , Anticorpos Monoclonais/uso terapêutico , Anticolesterolemiantes/uso terapêutico , Áustria/epidemiologia , LDL-Colesterol , Ezetimiba/uso terapêutico , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Resultado do TratamentoRESUMO
BACKGROUND: Cardiovascular disease (CVD) is the most frequent cause of death in Austria. The European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines recommend intensive lipid lowering therapy (LLT) in patients at high or very high CV risk. Lipid management and achievement of low-density lipoprotein cholesterol (LDL-C) goals in Austria have not recently been assessed. METHODS: Subgroup analysis for Austria of a European 18 country, cross-sectional, observational study. Patients received LLT for primary (PP) or secondary prevention (SP). Data including LLT in the preceding 12 months and most recent LDLC were collected during a single visit between June 2017 and November 2018. Achievement of the risk-based 2016 and 2019 ESC/EAS LDLC goal while receiving stabilized LLT was assessed. RESULTS: A total of 293 patients were enrolled from 8 Austrian sites, of which 200 (PPâ¯= 104, SPâ¯= 96) received stabilized LLT at the LDLC measurement date. Overall, 58% (71% PP, 43% SP) and 38% (52% PP, 23% SP) achieved the risk-based 2016 and 2019 goals, respectively. Most patients received moderate-intensity statin monotherapy (46%), while 34% used high-intensity statin monotherapy. Combination therapy of moderate/high-intensity statin with ezetimibe (12%), or proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors with statin⯱ ezetimibe (1%), was used infrequently. CONCLUSION: The current Austrian routine lipid management using mainly moderate-intensity or high-intensity statin monotherapy is insufficient to attain ESC/EAS guideline goals, in particular the more stringent 2019 recommendations, a situation comparable to other participating European countries. In addition to switching to and optimizing doses of high-intensity statins, a combination with ezetimibe or PCSK9 inhibitors will be needed in many cases.