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What is the main barrier to reach LDL target levels in patients with coronary artery disease?

Session Poster Session 2

Speaker Andrea Velez Salas

Event : ESC Preventive Cardiology (Formerly EuroPrevent) 2019

  • Topic : preventive cardiology
  • Sub-topic : Secondary Prevention
  • Session type : Poster Session

Authors : A Velez Salas (Madrid,ES), LA Martinez Marin (Madrid,ES), R Dalmau Gonzalez-Gallarza (Madrid,ES), A Rivas Perez (Madrid,ES), JM Garcia De Veas Marquez (Madrid,ES), L Rodriguez Sotelo (Madrid,ES), FJ Irazusta Cordoba (Madrid,ES), A Castro Conde (Madrid,ES), JL Lopez Sendon Herschel (Madrid,ES)

A Velez Salas1 , LA Martinez Marin1 , R Dalmau Gonzalez-Gallarza1 , A Rivas Perez1 , JM Garcia De Veas Marquez1 , L Rodriguez Sotelo1 , FJ Irazusta Cordoba1 , A Castro Conde1 , JL Lopez Sendon Herschel1 , 1University Hospital La Paz - Madrid - Spain ,


Introduction: statins are the cornerstone to reach LDL-cholesterol (LDL) goal in patients (pts) with coronary artery disease (CAD) recommended by the current guidelines (<70 mg/dl). This is not always achieved, mainly because of inadequate treatment adjustment during follow-up (therapeutic inertia), statin intolerance or poor adherence. The aim of this study is to analyse the causes of suboptimal achievement of LDL goals in pts with CAD. Methods: Retrospective study of pts with CAD included in a cardiac rehabilitation program (CRP) between September 2015 and April 2016. Baseline characteristics of the pts were analysed, as well as their lipid-lowering treatment, LDL levels and cardiovascular events during 18 months of follow up. Results: We analysed 200 pts, of which 37 were not on high dose statin at the end of the CRP. Among these, 17 pts had out-of-target levels during the follow up but only 5 (23.5%) received treatment adjustement and 3 of them had cardiovascular events at 18 months. Twenty-one pts reported statin-related symptoms (figure 1) that forced to lower or suspend the drug. LDL goal was only achieved in 6 of these pts (28.6%). In addition, 8 pts abandoned treatment for other reasons and all of them had poor LDL-C control. Ninety-one of the total of pts did not reach LDL target, and only 26.4% received ezetimibe or antiPCSK9. Conclusion: Therapeutic inertia and statin intolerance are important causes of failure in secondary prevention. Both are related, since pts that do not tolerate statins usually maintain the same treatment despite suboptimal LDL control. It is important to encourage the use of ezetimibe and antiPCSK9 to improve the achievement of LDL goals in secondary prevention.

Age (mean ±sd)

58.7 ±10.4

Sex (male)

166 (83%)


89 (44.5%)

Diabetes mellitus

47 (23.5%)


119 (59.5%)


99 (49.5%)


161 (80.5%)

Atorvastatin 80 mg

162 (81%)

Rosuvastatin 20 mg

1 (0.5%)

Other statin

34 (17%)


39 (19.5%)

LDL-c target achievement

89 (44.5%)

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