Cargando…

Landscape of Lipid Management Following an Acute Coronary Syndrome Event: Survey of Canadian Specialists

BACKGROUND: Following the occurrence of an acute coronary syndrome (ACS), patients are at high risk for subsequent cardiovascular events. Therapies to lower the level of low-density lipoprotein (LDL) cholesterol remain a pillar in secondary prevention approaches following ACS. Significant variabilit...

Descripción completa

Detalles Bibliográficos
Autores principales: Gouda, Pishoy, Welsh, Robert C., Padarath, Michelle, Grégoire, Jean C., Hegele, Robert A., Gupta, Milan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710998/
https://www.ncbi.nlm.nih.gov/pubmed/33305223
http://dx.doi.org/10.1016/j.cjco.2020.08.009
_version_ 1783618051043753984
author Gouda, Pishoy
Welsh, Robert C.
Padarath, Michelle
Grégoire, Jean C.
Hegele, Robert A.
Gupta, Milan
author_facet Gouda, Pishoy
Welsh, Robert C.
Padarath, Michelle
Grégoire, Jean C.
Hegele, Robert A.
Gupta, Milan
author_sort Gouda, Pishoy
collection PubMed
description BACKGROUND: Following the occurrence of an acute coronary syndrome (ACS), patients are at high risk for subsequent cardiovascular events. Therapies to lower the level of low-density lipoprotein (LDL) cholesterol remain a pillar in secondary prevention approaches following ACS. Significant variability remains in the application of therapies to lower cholesterol level in clinical practice. METHODS: A cross-sectional, online survey was conducted of 200 cardiovascular and lipid specialists across Canada who routinely care for patients following the occurrence of ACSs. The survey consisted of 50 multiple-choice questions with opportunities for free-text entry exploring knowledge of lipid guidelines and recent clinical trials, and in-hospital and outpatient management of lipids and familial hypercholesterolemia. RESULTS: A total of 67.5% (n = 135) of participants stated that a lipid panel would routinely be obtained during the first 24 hours of an admission for an ACS, and 68.5% (n = 137) stated that their hospitals had standing orders for statin initiation at ACS presentation. In high-risk patients, the majority (75.5%; n = 151) of participants indicated that they target an LDL cholesterol level of <1.8 mmol/L. However, a subset (22%; n = 44) would target lower LDL cholesterol levels ranging from 0.5 to 1.7 mmol/L. Only 32.0% (n = 64) of participants stated that >70% of their ACS patients were at or below guideline-recommended LDL cholesterol levels. Respondents generally underappreciated the prevalence of familial hypercholesterolemia in both the general population and ACS patients. CONCLUSIONS: There is significant variation in practice patterns involving therapies to lower LDL cholesterol level in the post–ACS onset period. To improve management of lipids in this high-risk population, changes to institutional policies, shared responsibility of lipid management across multiple disciplines, and physician education are required.
format Online
Article
Text
id pubmed-7710998
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Elsevier
record_format MEDLINE/PubMed
spelling pubmed-77109982020-12-09 Landscape of Lipid Management Following an Acute Coronary Syndrome Event: Survey of Canadian Specialists Gouda, Pishoy Welsh, Robert C. Padarath, Michelle Grégoire, Jean C. Hegele, Robert A. Gupta, Milan CJC Open Original Article BACKGROUND: Following the occurrence of an acute coronary syndrome (ACS), patients are at high risk for subsequent cardiovascular events. Therapies to lower the level of low-density lipoprotein (LDL) cholesterol remain a pillar in secondary prevention approaches following ACS. Significant variability remains in the application of therapies to lower cholesterol level in clinical practice. METHODS: A cross-sectional, online survey was conducted of 200 cardiovascular and lipid specialists across Canada who routinely care for patients following the occurrence of ACSs. The survey consisted of 50 multiple-choice questions with opportunities for free-text entry exploring knowledge of lipid guidelines and recent clinical trials, and in-hospital and outpatient management of lipids and familial hypercholesterolemia. RESULTS: A total of 67.5% (n = 135) of participants stated that a lipid panel would routinely be obtained during the first 24 hours of an admission for an ACS, and 68.5% (n = 137) stated that their hospitals had standing orders for statin initiation at ACS presentation. In high-risk patients, the majority (75.5%; n = 151) of participants indicated that they target an LDL cholesterol level of <1.8 mmol/L. However, a subset (22%; n = 44) would target lower LDL cholesterol levels ranging from 0.5 to 1.7 mmol/L. Only 32.0% (n = 64) of participants stated that >70% of their ACS patients were at or below guideline-recommended LDL cholesterol levels. Respondents generally underappreciated the prevalence of familial hypercholesterolemia in both the general population and ACS patients. CONCLUSIONS: There is significant variation in practice patterns involving therapies to lower LDL cholesterol level in the post–ACS onset period. To improve management of lipids in this high-risk population, changes to institutional policies, shared responsibility of lipid management across multiple disciplines, and physician education are required. Elsevier 2020-08-31 /pmc/articles/PMC7710998/ /pubmed/33305223 http://dx.doi.org/10.1016/j.cjco.2020.08.009 Text en © 2020 Canadian Cardiovascular Society. Published by Elsevier Inc. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Article
Gouda, Pishoy
Welsh, Robert C.
Padarath, Michelle
Grégoire, Jean C.
Hegele, Robert A.
Gupta, Milan
Landscape of Lipid Management Following an Acute Coronary Syndrome Event: Survey of Canadian Specialists
title Landscape of Lipid Management Following an Acute Coronary Syndrome Event: Survey of Canadian Specialists
title_full Landscape of Lipid Management Following an Acute Coronary Syndrome Event: Survey of Canadian Specialists
title_fullStr Landscape of Lipid Management Following an Acute Coronary Syndrome Event: Survey of Canadian Specialists
title_full_unstemmed Landscape of Lipid Management Following an Acute Coronary Syndrome Event: Survey of Canadian Specialists
title_short Landscape of Lipid Management Following an Acute Coronary Syndrome Event: Survey of Canadian Specialists
title_sort landscape of lipid management following an acute coronary syndrome event: survey of canadian specialists
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7710998/
https://www.ncbi.nlm.nih.gov/pubmed/33305223
http://dx.doi.org/10.1016/j.cjco.2020.08.009
work_keys_str_mv AT goudapishoy landscapeoflipidmanagementfollowinganacutecoronarysyndromeeventsurveyofcanadianspecialists
AT welshrobertc landscapeoflipidmanagementfollowinganacutecoronarysyndromeeventsurveyofcanadianspecialists
AT padarathmichelle landscapeoflipidmanagementfollowinganacutecoronarysyndromeeventsurveyofcanadianspecialists
AT gregoirejeanc landscapeoflipidmanagementfollowinganacutecoronarysyndromeeventsurveyofcanadianspecialists
AT hegeleroberta landscapeoflipidmanagementfollowinganacutecoronarysyndromeeventsurveyofcanadianspecialists
AT guptamilan landscapeoflipidmanagementfollowinganacutecoronarysyndromeeventsurveyofcanadianspecialists