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Risk Factors Associated with Failure to Achieve the Low Density Lipoprotein Cholesterol Therapeutic Target in Patients with Acute Coronary Syndrome: A Longitudinal, Single Centre Investigation

  • Mojgan Hajahmadi PourrafsanjaniEmail author
  • Ebrahim Khayati Shal
  • Sina Khezrpour
Original Article
  • 18 Downloads

Abstract

Introduction

Reducing low-density lipoprotein cholesterol (LDL-C) to target < 100 mg/dL is considered as a critical therapeutic goal after acute coronary syndrome (ACS).

Aim

To evaluate the factors associated with reaching or not this LDL-C target after 6 months of statin therapy.

Methods

Demographic features and other clinically relevant information from a cohort of patients enrolled from April 3, 2016 through March 20, 2017 were analyzed in the current investigation. All included cases had baseline LDL-C levels ≥ 100 mg/dL. LDL-C levels were determined once again after 6-month of statin therapy for each patient.

Results

Two hundred and thirty two participants were included in the final analysis. One third of patients (33.2%) with ACS with initially elevated LDL-C failed to attain LDL-C goal at 6 months. Spearman correlation test showed that the age, diabetes mellitus, lipid lowering therapy and statin daily dose were among the influential factors associated with LDL-C goal achievement. Furthermore, multiple logistic regression analysis revealed that diabetes mellitus and statin treatment before admission were the only independent predictors of achieving LDL-C goal.

Conclusions

According to our findings, the drug adherence and use of higher intensity as recommended in secondary prevention are needed to increase the achievement of LDL-C treatment targets.

Keywords

Acute coronary syndrome Dyslipidemia Lipid-lowering therapy Statins Low-density lipoprotein cholesterol 

Notes

Acknowledgements

We gratefully acknowledge all of the participants and entire staff involved at the Cardiology Ward of Seyyed-Alshohada Hospital for their help.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was conducted in accordance with the Declaration of Helsinki and was approved by the Ethics Committees of the Urmia University of Medical Sciences.

Informed consent

Written informed consent was obtained from all participants prior to enrollment.

References

  1. 1.
    Jones PH. Low-density lipoprotein cholesterol reduction and cardiovascular disease prevention: the search for superior treatment. Am J Med. 2004;116(Suppl 6A):17S–25S.  https://doi.org/10.1016/j.amjmed.2004.02.007.CrossRefPubMedGoogle Scholar
  2. 2.
    Karalis DG. Intensive lowering of low-density lipoprotein cholesterol levels for primary prevention of coronary artery disease. Mayo Clin Proc. 2009;84(4):345–52.  https://doi.org/10.1016/s0025-6196(11)60544-2.CrossRefPubMedGoogle Scholar
  3. 3.
    Stein EA. Low-density lipoprotein cholesterol reduction and prevention of cardiovascular disease. Mayo Clin Proc. 2009;84(4):307–9.  https://doi.org/10.1016/s0025-6196(11)60537-5.CrossRefPubMedGoogle Scholar
  4. 4.
    Cannon CP, Braunwald E, McCabe CH, Rader DJ, Rouleau JL, Belder R, Joyal SV, Hill KA, Pfeffer MA, Skene AM. Intensive versus moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med. 2004;350(15):1495–504.  https://doi.org/10.1056/NEJMoa040583.CrossRefPubMedGoogle Scholar
  5. 5.
    Lee KH, Jeong MH, Kim HM, Ahn Y, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi DH, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Rha SW, Bae JH, Cho JG, Park SJ. Benefit of early statin therapy in patients with acute myocardial infarction who have extremely low low-density lipoprotein cholesterol. J Am Coll Cardiol. 2011;58(16):1664–71.  https://doi.org/10.1016/j.jacc.2011.05.057.CrossRefPubMedGoogle Scholar
  6. 6.
    JCS. Guidelines for secondary prevention of myocardial infarction (JCS 2011). Circ J. 2013;77(1):231–48.CrossRefGoogle Scholar
  7. 7.
    O’Gara PT, Kushner FG, Ascheim DD, Casey DE Jr, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Stevenson WG, Yancy CW. 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;61(4):485–510.  https://doi.org/10.1016/j.jacc.2012.11.018.CrossRefPubMedGoogle Scholar
  8. 8.
    Steg PG, James SK, Atar D, Badano LP, Blomstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van ‘t Hof A, Widimsky P, Zahger D. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur Heart J. 2012;33(20):2569–619.  https://doi.org/10.1093/eurheartj/ehs215.CrossRefPubMedGoogle Scholar
  9. 9.
    NCEP. Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III). JAMA. 2001;285(19):2486–97.CrossRefGoogle Scholar
  10. 10.
    Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation. 2004;110(2):227–39.  https://doi.org/10.1161/01.CIR.0000133317.49796.0E.CrossRefPubMedGoogle Scholar
  11. 11.
    Davidson MH, Maki KC, Pearson TA, Pasternak RC, Deedwania PC, McKenney JM, Fonarow GC, Maron DJ, Ansell BJ, Clark LT, Ballantyne CM. Results of the National Cholesterol Education (NCEP) Program Evaluation ProjecT Utilizing Novel E-Technology (NEPTUNE) II survey and implications for treatment under the recent NCEP Writing Group recommendations. Am J Cardiol. 2005;96(4):556–63.  https://doi.org/10.1016/j.amjcard.2005.04.019.CrossRefPubMedGoogle Scholar
  12. 12.
    Melloni C, Shah BR, Ou FS, Roe MT, Smith SC Jr, Pollack CV Jr, Ohman M, Gibler WB, Peterson ED, Alexander KP. Lipid-lowering intensification and low-density lipoprotein cholesterol achievement from hospital admission to 1-year follow-up after an acute coronary syndrome event: results from the Medications ApplIed aNd SusTAINed Over Time (MAINTAIN) registry. Am Heart J. 2010;160(6):1121–1129, 9 e1.  https://doi.org/10.1016/j.ahj.2010.09.008.CrossRefPubMedGoogle Scholar
  13. 13.
    Santos RD, Waters DD, Tarasenko L, Messig M, Jukema JW, Ferrieres J, Verdejo J, Chiang CW. Low- and high-density lipoprotein cholesterol goal attainment in dyslipidemic women: the Lipid Treatment Assessment Project (L-TAP) 2. Am Heart J. 2009;158(5):860–6.  https://doi.org/10.1016/j.ahj.2009.08.009.CrossRefPubMedGoogle Scholar
  14. 14.
    Martin SS, Gosch K, Kulkarni KR, Spertus JA, Mathews R, Ho PM, Maddox TM, Newby LK, Alexander KP, Wang TY. Modifiable factors associated with failure to attain low-density lipoprotein cholesterol goal at 6 months after acute myocardial infarction. Am Heart J. 2013;165(1):26–33.  https://doi.org/10.1016/j.ahj.2012.10.005.CrossRefPubMedGoogle Scholar
  15. 15.
    Andrews TC, Ballantyne CM, Hsia JA, Kramer JH. Achieving and maintaining National Cholesterol Education Program low-density lipoprotein cholesterol goals with five statins. Am J Med. 2001;111(3):185–91.CrossRefPubMedGoogle Scholar
  16. 16.
    Smith SC Jr, Blair SN, Bonow RO, Brass LM, Cerqueira MD, Dracup K, Fuster V, Gotto A, Grundy SM, Miller NH, Jacobs A, Jones D, Krauss RM, Mosca L, Ockene I, Pasternak RC, Pearson T, Pfeffer MA, Starke RD, Taubert KA. AHA/ACC Scientific Statement: AHA/ACC guidelines for preventing heart attack and death in patients with atherosclerotic cardiovascular disease: 2001 update: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology. Circulation. 2001;104(13):1577–9.CrossRefPubMedGoogle Scholar
  17. 17.
    Chin CW, Gao F, Le T, Tan R. Lipid goal attainment and prescription behavior in asian patients with acute coronary syndromes: experience from a tertiary hospital. Clin Med Insights Cardiol. 2013;7:51–7.  https://doi.org/10.4137/CMC.S11488.CrossRefPubMedGoogle Scholar
  18. 18.
    Chinwong D, Patumanond J, Chinwong S, Siriwattana K, Gunaparn S, Hall JJ, Phrommintikul A. Statin therapy in patients with acute coronary syndrome: low-density lipoprotein cholesterol goal attainment and effect of statin potency. Ther Clin Risk Manag. 2015;11:127–36.  https://doi.org/10.2147/TCRM.S75608.PubMedGoogle Scholar
  19. 19.
    Manurung D. Lipid profiles of acute coronary syndrome patients hospitalized in ICCU of Cipto Mangunkusumo Hospital. Acta Med Indones. 2006;38(4):196–201.PubMedGoogle Scholar
  20. 20.
    Rasmussen JN, Chong A, Alter DA. Relationship between adherence to evidence-based pharmacotherapy and long-term mortality after acute myocardial infarction. JAMA. 2007;297(2):177–86.  https://doi.org/10.1001/jama.297.2.177.CrossRefPubMedGoogle Scholar
  21. 21.
    Tungsubutra W, Phongtuntakul B. Achievement of LDL-cholesterol goal with statins after an st segment elevation myocardial infarction. J Med Assoc Thai. 2015;98(2):129–36.PubMedGoogle Scholar
  22. 22.
    MRC/BHF. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002;360(9326):7–22.  https://doi.org/10.1016/s0140-6736(02)09327-3.CrossRefGoogle Scholar
  23. 23.
    LaRosa JC, Grundy SM, Waters DD, Shear C, Barter P, Fruchart JC, Gotto AM, Greten H, Kastelein JJ, Shepherd J, Wenger NK. Intensive lipid lowering with atorvastatin in patients with stable coronary disease. N Engl J Med. 2005;352(14):1425–35.  https://doi.org/10.1056/nejmoa050461.CrossRefPubMedGoogle Scholar
  24. 24.
    Sever PS, Dahlof B, Poulter NR, Wedel H, Beevers G, Caulfield M, Collins R, Kjeldsen SE, Kristinsson A, McInnes GT, Mehlsen J, Nieminen M, O’Brien E, Ostergren J. Prevention of coronary and stroke events with atorvastatin in hypertensive patients who have average or lower-than-average cholesterol concentrations, in the Anglo-Scandinavian Cardiac Outcomes Trial-Lipid Lowering Arm (ASCOT-LLA): a multicentre randomised controlled trial. Lancet. 2003;361(9364):1149–58.  https://doi.org/10.1016/s0140-6736(03)12948-0.CrossRefPubMedGoogle Scholar
  25. 25.
    de Lemos JA, Blazing MA, Wiviott SD, Lewis EF, Fox KA, White HD, Rouleau JL, Pedersen TR, Gardner LH, Mukherjee R, Ramsey KE, Palmisano J, Bilheimer DW, Pfeffer MA, Califf RM, Braunwald E. Early intensive vs a delayed conservative simvastatin strategy in patients with acute coronary syndromes: phase Z of the A to Z trial. JAMA. 2004;292(11):1307–16.  https://doi.org/10.1001/jama.292.11.1307.CrossRefPubMedGoogle Scholar
  26. 26.
    Khovidhunkit W, Silaruks S, Chaithiraphan V, Ongphiphadhanakul B, Sritara P, Nimitphong H, Benjanuwattra T, Ambegaonkar BM. Prevalence of dyslipidemia and goal attainment after initiating lipid-modifying therapy: a Thai multicenter study. Angiology. 2012;63(7):528–34.  https://doi.org/10.1177/0003319711432451.CrossRefPubMedGoogle Scholar
  27. 27.
    American Diabetes Association. American Diabetes Association: clinical practice recommendations 2002. Diabetes Care. 2002;25(Suppl 1):S1–147.Google Scholar
  28. 28.
    Brunzell JD, Davidson M, Furberg CD, Goldberg RB, Howard BV, Stein JH, Witztum JL. Lipoprotein management in patients with cardiometabolic risk: consensus conference report from the American Diabetes Association and the American College of Cardiology Foundation. J Am Coll Cardiol. 2008;51(15):1512–24.  https://doi.org/10.1016/j.jacc.2008.02.034.CrossRefPubMedGoogle Scholar
  29. 29.
    Fruchart JC, Sacks F, Hermans MP, Assmann G, Brown WV, Ceska R, Chapman MJ, Dodson PM, Fioretto P, Ginsberg HN, Kadowaki T, Lablanche JM, Marx N, Plutzky J, Reiner Z, Rosenson RS, Staels B, Stock JK, Sy R, Wanner C, Zambon A, Zimmet P. The Residual Risk Reduction Initiative: a call to action to reduce residual vascular risk in patients with dyslipidemia. Am J Cardiol. 2008;102(10 Suppl):1K–34K.  https://doi.org/10.1016/s0002-9149(08)01833-x.CrossRefPubMedGoogle Scholar
  30. 30.
    Schramm TK, Gislason GH, Kober L, Rasmussen S, Rasmussen JN, Abildstrom SZ, Hansen ML, Folke F, Buch P, Madsen M, Vaag A, Torp-Pedersen C. Diabetes patients requiring glucose-lowering therapy and nondiabetics with a prior myocardial infarction carry the same cardiovascular risk: a population study of 3.3 million people. Circulation. 2008;117(15):1945–54.CrossRefPubMedGoogle Scholar

Copyright information

© Italian Society of Hypertension 2019

Authors and Affiliations

  1. 1.Cardiology DepartmentUrmia University of Medical SciencesUrmiaIran

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