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Vol. 55. Issue 1.
Pages 23-29 (January - March 2020)
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Vol. 55. Issue 1.
Pages 23-29 (January - March 2020)
Original article
DOI: 10.1016/j.rccl.2019.10.001
Individual trends in LDL-C control in patients with previous myocardial infarction
Tendencias individuales en el control del cLDL en pacientes con infarto de miocardio previo
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Eduardo Ródenasa, Roxana Escalonaa, Ivana Pariggianob, Gerard Oristrella,c,d,e, Berta Mirandaa,c,d,e, Yassin Belahnecha, Toni Sorianoa,c,d,e, Pau Relloa,c,d,e, Blanca Gordona,c,d,e, José A. Barrabésa,c,d,e, David García-Doradoa,c,d,e, Jordi Bañerasa,c,d,e,
Corresponding author
jbaneras@vhebron.net

Corresponding author.
a Servicio de Cardiología, Hospital Universitari Vall d’Hebron, Barcelona, Spain
b Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, Naples, Italy
c Vall d’Hebron Institut de Recerca (VHIR), Barcelona, Spain
d Facultad de Medicina, Universitat Autònoma de Barcelona, Barcelona, Spain
e Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Barcelona, Spain
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Tables (3)
Table 1. Baseline characteristics are shown on the left column as mean±standard deviation for continuous variables or, when categorical, as absolute frequencies with its relative frequencies. For every clinical variable, an odds ratio (95% confidence interval) for predicting an LDL-C < 70mg/dL in each year is provided in the univariate analysis.
Table 2. Odds ratio (95%CI) for the capacity of each clinical variable to predict an LDL-C < 70mg/dL in each year in a multivariate analysis.
Table 3. On the left, absolute and relative frequencies of each clinical predictor are shown for patients with all 3 assessed LDL-C < 70mg/dL (N=65), and for patients with any LDL-C ≥ 70mg/dL. On the right column, odds ratio (95%CI) to predict all LDL-C < 70mg/dL is provided for each clinical variable in a multivariate analysis.
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Abstract
Introduction and objectives

In patients with previous myocardial infarction (MI) guidelines recommend a low-density lipoprotein cholesterol (LDL-C) < 70mg/dL (ACC/AHA) or < 55mg/dL (European Society of Cardiology). Current data on individual variation of LDL-C in this population is limited. We aimed to assess the percentage of patients who achieved an LDL-C below target, the variation from 2013 to 2018 and to evaluate clinical predictors of good LDL-C control.

Methods

A retrospective cohort study was conducted. All Cardiology outpatients with previous MI with available LDL-C measurements after MI in 2013, 2016 and 2018 were included. We estimated the prevalence of patients with LDL-C below target for each year, individual trends and performed multivariate analysis for assessing clinical predictors.

Results

Of 650 patients, an LDL-C < 70mg/dL was attained in 24.8% and 34.0% in 2013 and 2018, respectively, with a median reduction in LDL-C of 6mg/dL (P<.001). LDL-C < 55mg/dL was observed in 8.0% and 11.7% in the same years. Only 10.0% and 1.4% of patients presented 3 LDL-C measurements < 70mg/dL and 55mg/dL, respectively, whereas 78.8% and 47.4% did not have any LDL-C < 55mg/dL or < 70mg/dL. Male sex and diabetes were constant predictors of achieving an LDL-C below target.

Conclusions

There has been an improvement in LDL-C control in recent years, but only one-third of the outpatients with previous MI are currently on LDL-C < 70mg/dL and even less on LDL-C < 55mg/dL. Male sex and diabetes predicted better LDL-C control.

Keywords:
Myocardial infarction
LDL cholesterol
Cardiovascular risk
Secondary prevention
Goal attainment
Abbreviations:
ESC
LDL-C
MACE
MI
Resumen
Introducción y objetivos

En pacientes con infarto de miocardio (IM) previo, se recomienda un colesterol unido a lipoproteínas de baja densidad (cLDL) <70mg/dl (ACC/AHA) o <55mg/dl (European Society of Cardiology). Los datos actuales sobre la variación individual de cLDL en esta población son limitados. Nuestro objetivo fue evaluar el porcentaje de pacientes que alcanzaron el objetivo de cLDL, la variación de 2013 a 2018 y evaluar predictores clínicos para el buen control de cLDL.

Métodos

Se realizó un estudio de cohorte retrospectivo que incluyó a los pacientes ambulatorios de cardiología con IM previo con mediciones de cLDL disponibles después del IM en 2013, 2016 y 2018. Se estimó la prevalencia de pacientes con cLDL por debajo del objetivo para cada año, las tendencias individuales y realizamos un análisis multivariado para evaluar predictores clínicos.

Resultados

De 650 pacientes, el 24,8 y 34,0% alcanzaron un cLDL <70mg/dl en 2013 y 2018, respectivamente, con una reducción media de 6mg/dl (p<0,001). Se observó un cLDL <55mg/dl en el 8,0 y 11,7% en los mismos años. El 10,0 y el 1,4% de los pacientes presentaron las 3 mediciones de cLDL <70mg/dl y <55mg/dl, respectivamente. El sexo masculino y la diabetes fueron predictores de lograr el objetivo de cLDL.

Conclusiones

Ha habido una mejora en el control de cLDL en los últimos años, pero un tercio de los pacientes ambulatorios con IM previo presentan actualmente un cLDL <70mg/dl, y un porcentaje menor aún un cLDL <55mg/dl. El sexo masculino y la diabetes predijeron un mejor control de cLDL.

Palabras clave:
Infarto de miocardio
Colesterol LDL
Riesgo cardiovascular
Prevención secundaria
Logro de objetivos

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