Your browser doesn't support javascript.
loading
Optimal implementation of the 2019 ESC/EAS dyslipidaemia guidelines in patients with and without atherosclerotic cardiovascular disease across Europe: a simulation based on the DA VINCI study.
Brandts, Julia; Bray, Sarah; Villa, Guillermo; Catapano, Alberico L; Poulter, Neil R; Vallejo-Vaz, Antonio J; Ray, Kausik K.
Afiliación
  • Brandts J; Department of Primary Care and Public Health, Imperial Centre for Cardiovascular Disease Prevention, School of Public Health, Imperial College London, London, UK.
  • Bray S; Department of Internal Medicine, University Hospital RWTH Aachen, Aachen, Germany.
  • Villa G; Global Biostatistical Science, Amgen Ltd, Cambridge, UK.
  • Catapano AL; Health Economics & Outcomes Research, Amgen (Europe) GmbH, Risch-Rotkreuz, Switzerland.
  • Poulter NR; IRCCS MultiMedica, Milan, Italy.
  • Vallejo-Vaz AJ; Department of Pharmacological and Biomolecular Sciences, University of Milan, Milan, Italy.
  • Ray KK; Imperial Clinical Trials Unit, Imperial College London, London, UK.
Lancet Reg Health Eur ; 31: 100665, 2023 Aug.
Article en En | MEDLINE | ID: mdl-37547279
Background: The impact of the stepwise implementation of the 2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) treatment algorithm on low-density lipoprotein cholesterol (LDL-C) goal attainment was simulated in patients from the DA VINCI study. Methods: Monte Carlo simulation was used to evaluate treatment optimisation scenarios, based on a patient's risk category: statin intensification (step 1), addition of ezetimibe (step 2), and addition of a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor (step 3). Residual cardiovascular risk and predicted relative and absolute risk reduction (RRR and ARR) in cardiovascular events were assessed. Findings: In DA VINCI, 2482 patients did not achieve their 2019 ESC/EAS LDL-C goals and were included in the simulation. In patients without atherosclerotic cardiovascular disease (ASCVD) (n = 962), 27.0% (n = 259) and 57.0% (n = 548) are likely to achieve their LDL-C goals at step 1 and step 2, respectively. Of those at very high risk without ASCVD (n = 74), 88.1% (n = 65) are likely to achieve their LDL-C goals at step 3. In patients with ASCVD (n = 1520), 12.0% (n = 183), 42.1% (n = 641) and 93.2% (n = 1416) are likely to achieve their LDL-C goals at steps 1, 2 and 3, respectively. In patients with and without ASCVD, treatment optimisation may result in mean simulated RRR of 24.0% and 17.7%, respectively, and ARR of 8.1% and 2.6%, respectively. Interpretation: Most patients at high cardiovascular risk are unlikely to achieve LDL-C goals through statin optimisation and ezetimibe, and will require a PCSK9 inhibitor, leading to greater reduction in cardiovascular risk. Funding: Amgen.
Palabras clave

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Guideline / Prognostic_studies Idioma: En Revista: Lancet Reg Health Eur Año: 2023 Tipo del documento: Article Pais de publicación: Reino Unido

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Tipo de estudio: Guideline / Prognostic_studies Idioma: En Revista: Lancet Reg Health Eur Año: 2023 Tipo del documento: Article Pais de publicación: Reino Unido