ABSTRACT
INTRODUCTION AND OBJECTIVES: Lifestyle changes are frequently insufficient to reduce cardiovascular (CV) risk in patients with dyslipidemia. This study aims to characterize the long-term evolution of lipid profile and CV risk of patients under primary prevention. METHODS: A retrospective study was performed of outpatients at a Portuguese cardiovascular risk clinic with ≥2 CV risk factors, followed for ≥2 years between 1995 and 2015. Statin therapy had been initiated early, in accordance with the clinic's practice. After written informed consent was obtained, sociodemographic and clinical characteristics were collected from medical charts, at baseline and last visit. Changes in lipid profile and CV risk scores were estimated. Associations between HDL-C or LDL-C changes and gender, age, observation time and treatments were assessed through bivariate analysis and multiple linear regression models. RESULTS: Out of 516 participants with mean follow-up of 11.4±4.3 years, 56.6% were female and 91.5% received statins. Lipid profile showed statistically significant improvement, including median changes in LDL-C and HDL-C of -77.0 mg/dl and +19 mg/dl, respectively. CV risk also showed statistically significant improvements according to all scores. Statin therapy resulted in a mean HDL-C increase of 7.4 mg/dl (independently of gender and other treatments) and a mean LDL-C reduction of 51.8 mg/dl (irrespective of age and other treatments). CONCLUSION: Results from this long-term real-life study indicate that primary prevention, specifically early and continuous therapy with intermediate-intensity statins as an add-on to lifestyle interventions, was important in obtaining consistent and adequate metabolic correction in patients with additional risk factors.
ABSTRACT
INTRODUCTION: High values of lipoprotein(a), related to atherosclerosis progression, are often considered a marker of thrombosis. We assessed the lipoprotein(a) profile in a group of patients with high vascular risk and no cardiovascular events, established its correlation with other cardiovascular risk factors and inferred the results for patients with metabolic disorders and, at least, two risk factors. MATERIAL AND METHODS: This longitudinal observational study included 516 patients, who had at least two cardiovascular risk factors and regularly attended, for at least two years, the outpatient consultations at a clinic of metabolism and vascular risk for primary prevention. Sociodemographic, clinical and anthropometric parameters were obtained at the baseline visit. Hepatic morphology was assessed in 509 patients (98.6%) by ultrasonography. The 10-year vascular risk was estimated using Framingham risk score, atherosclerotic cardiovascular disease and systematic coronary risk evaluation tables. RESULTS: Significant correlations were found between lipoprotein(a) levels and the addressed vascular risk factors, as well as between lipoprotein(a), and Framingham risk score, atherosclerotic cardiovascular disease and systematic coronary risk evaluation charts. Lipoprotein(a) values were also considerably higher in patients with steatosis. DISCUSSION: Increased lipoprotein(a) values were directly associated with all markers of cardiovascular risk and with non-alcoholic hepatic steatosis. CONCLUSION: Due to its high availability and low cost, lipoprotein(a) should become part of the routine evaluation of patients at vascular risk.
Introdução: Valores elevados de lipoproteína(a), relacionados com a progressão da aterosclerose, são frequentemente considerados marcadores de trombose. O perfil de lipoproteína(a) foi avaliado num grupo de doentes sem eventos cardiovasculares mas com elevado risco vascular, estabelecendo-se a correlação com outros fatores de risco cardiovascular e inferindo-se os resultados para doentes com alterações metabólicas e, pelo menos, dois fatores de risco vascular. Material e Métodos: Este estudo observacional longitudinal incluiu 516 doentes com, pelo menos, dois fatores de risco cardiovascular e que frequentavam, regularmente e há pelo menos dois anos, a consulta ambulatória de metabolismo e risco vascular para prevenção primária. Os parâmetros sociodemográficos, clínicos e antropométricos foram recolhidos na primeira visita. A morfologia hepática foi avaliada por ultrassonografia em 509 doentes (98,6%). O risco vascular a 10 anos foi estimado através de tabelas de cálculo de risco de Framingham, doença cardiovascular e risco coronário sistemático. Resultados: Foram encontradas correlações significativas entre os níveis de lipoproteína(a) e os fatores de risco vasculares analisados, assim como entre lipoproteína(a) e as escalas de risco de Framingham, doença cardiovascular e risco coronário sistemático. Os valores de lipoproteína(a) apresentaram-se mais elevados em doentes com esteatose. Discussão: Os valores elevados de lipoproteína(a) estão diretamente associados com todos os marcadores de risco cardiovascular e com esteatose hepática não alcoólica. Conclusão: Como tal, considerando a sua elevada acessibilidade e custo reduzido, o marcador lipoproteína(a) deverá ser integrado na avaliação de rotina de doentes com risco vascular.