Lipid-lowering therapy: modern possibilities and real clinical practice

Aim. To monitor the scope and effectiveness of lipid-lowering therapy (LLT) in the out- and inpatient settings among people hospitalized at the National Medical Research Center for Therapy and Preventive Medicine.

Material and methods. Retrospective analysis of randomly selected case records for April-May 2012, 2015 and 2022 (n=658).

Results. From 2012 to 2022, the proportion of outpatients taking statins increased as follows: from 28,8 to 60,4% (from 22,2 to 73,3% for high cardiovascular risk (CVR) and from 34,8 to 91,7% for very high CVR). Patients with very high CVR were significantly more likely to be prescribed high-intensity statin therapy (from 3,8 to 45,8%). Inpatients with high CVR were prescribed statins less often (74,3%) than patients with very high CVR (93,6%). In 2022, compared to 2015, the proportion of inpatients who received combined LLT increased as follows — 8,9 vs 0,5% (p< 0,001). Target low-density lipoprotein cholesterol <1,4 mmol/l in 2022 was achieved in 18,2 and 13,6% of outpatients with high and very high CVR, respectively.

Conclusion. Despite increase in the frequency of prescribing and the intensity of statin therapy, by 2022 there remains a large proportion of patients with high and very high CVR who do not receive adequate LLT, which allows them to achieve the target low-density lipoprotein cholesterol. It is important to note that modern LLT provides great opportunities for the implementation of clinical guidelines in practice.

PCSK9 Inhibitors in Clinical Practice: Experience of a Specialized Lipid Center

Aim. To characterize patients receiving PCSK9 inhibitors, and assess the efficiency of their treatment in a specialized lipid center.

Material and methods. A retrospective analysis of the medical records of patients who visited the Lipid clinic of the National Medical Research Center for Therapy and Preventive Medicine (Moscow, Russia), receiving PCSK9 inhibitor and having lipid profile in dynamics, was carried out (n=77). Cardiovascular risk (CVR) and low-density lipoprotein cholesterol (LDL-C) target levels were evaluated in accordance with the Russian guidelines for the diagnostics and correction of dyslipidemias 2020.

Results. Of 77 patients taking PCSK9 inhibitors (44.2% males, the median of age 56 [47; 66] years), the majority (64.0%) had a probable or definite familial hypercholesterolemia (FH). The proportion of other lipid metabolism disorders, pure hypercholesterolemia and combined hyperlipidemia was 21% and 15%. More than half of the patients (68.8%) had a very high CVR, mainly due to the presence of coronary heart disease (84.9%). The proportion of patients receiving PCSK9 inhibitors as monotherapy was 7.8%, in combination with high-intensity statin therapy – 33.8%, as part of triple lipid-lowering therapy (high-intensity statin, ezetimibe, PCSK9 inhibitors) – 50.6%. Addition of PCSK9 inhibitors to combined lipid-lowering therapy enabled to reduce the LDL-C level to 1.02 [0.62; 1.39] mmol/l with its total decrease from the baseline by 87.3%. While taking PCSK9 inhibitors, LDL-C <1.8 mmol/l and <1.4 mmol/l achieved at 78.3% and 57.7% FH patients with high and very high CVR, respectively. Among patients with other hyperlipidemias, 74.1% of patients with very high CVR was achieved the target LDL-C level <1.4 mmol/l.

Conclusion: In a specialized lipid center, PCSK9 inhibitors are prescribed to patients with high or very high CVR, most of whom are FH patients. The effectiveness of the use of PCSK9 inhibitors in real-world practice is comparable to the results of clinical trials.