High-dose of potent statins may not be sufficient to achieve therapeutic goals of ldlc and non-hdl cholesterol in patients at very high cardiovascular risk

ABSTRACT

INTRODUCTION High-dose of potente statins are first-line and mandatory therapy to reduce LDL-c among very high cardiovascular risk patients. The Brazilian Guideline on Dyslipidemia and Prevention of Atherosclerosis of the Brazilian Society of Cardiology (SBC) recommends a target of LDL-c below 50mg/dL or non-HDL cholesterol (NHDLc) <80mg/dL. OBJECTIVE Evaluate the amount of very high-risk patients using the initial treatment recommended by the brazilian guideline that achieved the LDL-c and NHDLc therapeutic goals. METHODS This is a crosssectional observational study that included 1122 very high cardiovascular risk patients (significant atherosclerotic disease with or without clinical events or obstruction ≥ 50% in any arterial territory), treated in outpatients clinics between January and March of 2022, in a tertiary care hospital in Brazil, using atorvastatin 40 mg or 80 mg daily. Exclusion criteria were use of atorvastatin in a dose lower than 40mg/daily or use of other statins. Data from the electronic medical record were collected regarding lipid profile, such as LDL-c and NHDLc, age and sex. RESULTS A total of 1122 patients were evaluated and 1012 were included. Mean age was 68.8 years (SD 9.2), 634 (62.4%) were men. Regarding statin use, 613 (60.6%) patients used atorvastatin 80mg/daily and 399 (39.4%) used atorvastatin 40mg/daily. Average LDL-c was 83.1mg/dL (SD 29.5) and NHDLc was 113.5mg/dL (SD 35). The mean TC was 152 mg/dL (SD 29.5), HDL-c was 39.5 (SD 11.8) and of TG was 154.9 (SD 85.6). Ninety two (9%) patients had LDL-c <50 mg/dL and 133 (13.14%) patients had NHDLc <80mg/dL. CONCLUSION The low amount of patients in this population that achieved LDL-c and NHDLc target shows that with high-intensity statins monotherapy may not be sufficient. These data suggest that in very high-risk patients, combined lipid-lowering therapy, in the initial phase, should be considered.