• Hrvoje Pintarić, Marijana Knezović Florijan, Ian Bridges, Robert Steiner, Luka Zaputović, and Davor Miličić.
• 1University of Zagreb, School of Dental Medicine, Zagreb, Croatia; 2Sestre milosrdnice University Hospital Centre, Department of Internal Medicine, Zagreb, Croatia; 3Amgen Ltd., Cambridge, United Kingdom; 4Osijek University Hospital Centre, Department of Cardiology, Osijek, Croatia; 5Rijeka University Hospital Centre, Rijeka, Croatia; 6University of Zagreb, School of Medicine, Department of Cardiovascular Diseases, Zagreb University Hospital Centre, Zagreb, Croatia.
• Acta Clin Croat. 2020 Dec 1; 59 (4): 641-649.

AbstractOur observational study evaluated current management of elevated low-density lipoprotein cholesterol (LDL-C) in adult secondary prevention patients (all very high risk (VHR) by European guidelines) attending specialist clinics across Croatia. Data were collected retrospectively from patient records for the preceding 12 months. The subset judged to be at extreme risk (ER; American Association of Clinical Endocrinologists (AACE) criteria; n=48) were compared with the remaining patients (VHR group; n=41). All patients were receiving statins (75.6% VHR/81.3% ER at high-intensity), with only a minority receiving concomitant lipid-lowering treatment (7.3% VHR/16.7% ER). Median (Q1, Q3) LDL-C levels at the last visit were 1.9 (1.6, 2.4) mmol/L for VHR and 2.1 (1.5, 3.1) mmol/L for ER, with only 41.5% (95% CI 26.3-57.9) of VHR patients and 27.1% (15.3-41.9) of ER patients attaining their LDL-C targets (<1.8 mmol/L and <1.42 mmol/L, respectively). Thus, we found that a substantial proportion of VHR and ER secondary prevention patients being treated across Croatia had LDL-C levels exceeding the targets recommended in the European and newer AACE guidelines, but not all were receiving high-intensity statins. Identification of ER patients and their lipid patterns may help optimize usage of high-intensity statin treatment, alone or along with newer treatments, for better control of elevated LDL-C.

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