Background: Guidelines of treatment of hypercholesterolemia in patients at very high cardiovascular (CV) risk have progressively lowered the target LDL-cholesterol (LDL-C). In real life LDL-C targets are difficult to reach.
Aim of this study was to evaluate the achievement of LDL-C targets and the prescription of lipid-lowering therapy (LLT) in a large cohort of outpatients at very high CV risk.
Methods: we considered 11350 patients at very high CV risk, mean age 70 years evaluated in Our Center from 2017 to 2020. The study population was divided in 3 groups according to the presence of one or more very high risk CV score components. For each group lipid-lowering therapy, LDL-C goal and prognosis were assessed.
Results: The very high CV risk population was composed maily by patients with coronary artery disease (CAD). We found an increse of LLT after the index cardiologic visit (from 50,5 to 75,8%) and high-efficacy (HE) LLT from 22% to 27,9%. Consequently we found an increase in the achievement of LDL-C target <55 mg/dl (1.4 mmol/l): from 3,2% to 8,3% 6 months after the visit. In the group with more CV risk components the LLT and HE LLT were more prescribed, the LDL-C target was more reached and the mortality rate were higher (22,3% vs 8,4% in patients with only one CV risk component).
Conclusions: in the very high CV risk population the target of LDL-C is rarely reached. We identificated patients with more CV risk components with worse prognosis and need of HE LLT.