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Marie Hauguel-Moreau, Maryam Kavousi, Lipid management in patients with atherosclerotic cardiovascular disease: it is time to apply the guidelines!, European Journal of Preventive Cardiology, Volume 31, Issue 15, October 2024, Pages 1790–1791, https://doi.org/10.1093/eurjpc/zwae335
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This editorial refers to ‘Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales’, by D.E. Harris et al., https://doi.org/10.1093/eurjpc/zwae233.
European guidelines recommend that patients with atherosclerotic cardiovascular disease (ASCVD), including ischaemic heart disease (IHD), stroke, and peripheral artery disease (PAD), are prescribed lipid-lowering treatment (LLT) and treated to target LDL cholesterol (LDL-C) levels.1 However, to what extent these guidelines are applied in routine practice and across the full ASCVD spectrum remains unknown.
In this issue of the journal, Harris et al.2 used routinelly-collected linked community and hospital health data from the population of Wales, UK, between 2010 and 2022 to document population-scale trends in the incidence and prevalence of ASCVD, prescribing LLT, monitoring lipid levels, and achieving European Society of Cardiology and European Atherosclerosis Society (ESC/EAS)-recommended LDL-C targets. Of great interest is that the authors examined the trends across the full ASCVD spectrum. The authors reported that the prescription of LLT, including high-intensity statin therapy, documentation of LDL-C, and achievement of target LDL-C levels (<1.8 mmol/L in this study), was relatively low, especially in PAD patients. While both the prevalence and incidence of ASCVD increased during the study period, the proportion of prevalent and incident patients prescribed LLT decreased from 75.3% in 2010 to 67.1% in 2022 and from 70.6% in 2010 to 69.1% in 2021, respectively. Over the same period, high-intensity LLT increased from 9.4% in 2010 to 25.2% in 2022 for prevalent cases and from 10.0% in 2010 to 37.7% in 2021for incident cases. The proportion of prevalent and incident cases achieving ESC/EAS LDL-C target levels improved during the study period, most notably in those with IHD. However, the overall proportion of achieving target levels remained low, in particular in patients with PAD. Male sex and diabetes mellitus were independently associated with a greater likelihood of a prescription for high-intensity LLT, a LDL-C test within the first year of diagnosis, and a LDL-C < 1.8 mmol/L in the incident year.
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