[A change of attitude in lipidology, achievement of target levels. What comes next?]

Complex lipid-lowering treatment options in patients with a history of acute coronary syndrome

Authors aimed to assess how target values in serum lipid concentrations (LDL- and HDL-cholesterol, triglyceride) can be achieved in patients with a history of acute coronary syndrome during follow up in an outpatient cardiology clinic. Methods: 201 patients with a history of acute coronary syndrome were included and were followed up between January 1 and May 31, 2007.Authors analyzed serum lipid parameters of the patients and the lipid-lowering medications at the time of the first meeting and during follow up lasting two years. Results: During the enrollment visit only 26.4% of the patients had serum LDL cholesterol at target level, whereas high triglycerides and low HDL cholesterol levels were observed in 40.3% and 33.3% of the patients, respectively. Only 22 patients (10.9%) achieved the target levels in all three lipid parameters. Of the 201 patients, 179 patients participated in the follow up, and data obtained from these patients were analyzed. There was a positive trend toward better lipid parameters; 42.5% of the patients reached the desired LDL-cholesterol target value and 17.3% of the patients had HDL-cholesterol and triglycerides target values. Conclusions: These findings are consistent with those published in the literature. Beside the currently used therapeutic options for achieving optimal LDL-cholesterol, efforts should be made to reduce the so-called “residual cardiovascular risk” with the use of a widespread application of combination therapy. Orv. Hetil., 2011, 152, 296–302.

[From lipid target values to the JUPITER study. Significance of achieving lipid levels specified by the guidelines and deficiencies in practice]

In Hungary the life expectancy have increased by 4.14 years between 1993 and 2006 and the improvement of cardiovascular mortality contributed to this with 1.85 years. Lipid lowering therapy and achievement of target lipid levels have become recently a crucial point of cardiovascular prevention. Despite the improving tendency the rate of achieving LDL-cholesterol goal is not higher than 1/3 and its main cause seems to be the fact that greater part of the physicians (56% of them in year 2007) - seeing the results with not convenient lipid levels - yield to it, do not modify the current treatment. However, there is growing evidence that the lower LDL-cholesterol level improves not only the clinical outcome but it is cost-effective as well. The most important trial performed recently using statin was the JUPITER study, in which patients with normal lipid levels and high hs-CRP level without known atherosclerotic disease were treated with 20 mg rosuvastatin or placebo. The primary endpoint (cardiovascular mortality, stroke, non fatal myocardial infarction, unstable angina and revascularization) decreased significantly by 44% and total mortality decreased by 20%. For the prevention of one primary event 23 patients for 5 years were necessary to be treated. The results raise the need for reconsidering principles and target levels of the primary prevention and warn that in the lipid lowering therapy a greater emphasis should be placed on the hs-CRP level.