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  • Article
  • Source: Campus Sanofi

Dyslipaedemia: Unmet needs

Author : Sanofi
Editorial Team

Cardiovascular disease (CVD) is a leading cause of death in Ireland, but most of these deaths could be prevented1

  • CVD claims the lives of almost 9,000 people in Ireland each year, but it is estimated that 80% of premature CVD is preventable.

  • Greater prioritisation of CVD and preventive action across the disease continuum are urgently needed to slow, or even halt, disease progression and ultimately save thousands of lives.

Key opportunities for CVD prevention include -

  • Early identification and management of risk factors (high blood pressure, raised cholesterol, smoking, obesity and diabetes) is essential to improving outcomes
  • Timely diagnosis and treatment of established CVD
  • Initiation or escalation of prevention in the acute setting
  • Multidisciplinary care and prevention models post-discharge

Significant lipid level abnormalities in Ireland2a

In 2017, 60% of those studied had some form of lipid abnormality

aThis study was part of a cholesterol awareness campaign, during which a pilot study of current lipid levels to preliminarily assess the extent and pattern of lipid abnormalities in Ireland was carried out. Volunteers responded to adverts in local newspaper. Non-fasting, full lipid profiles and glucose measurements were performed in 259 people (32 on lipid-lowering medication and 225 untreated) using a validated Cholestech LDX machine.

 

Attainment of secondary prevention goals in Ireland:

The iASPIRE Study3b

87% of heart attack survivors didn’t reach the 2019 ESC/EAS goal of reducing their LDL-C to below 1.4 mmol/L

A gap exists between what the 2019 ESC/EAS guidelines recommend and actual practice in the area of lipid-lowering therapy in Ireland

  1. Letterkenny University Hospital (n=38)
  2. Sligo University Hospital (n=59)
  3. University College Hospital Galway (n=299)
  4. Limerick University Hospital (n=60)
  5. Cork University Hospital (n=80)
  6. Midlands Regional Hospital (n=46)
  7. Connolly Hospital Blanchardstown (n=48)
  8. Tallaght University Hospital (n=40)
  9. St James’ Hospital (n=51)

b The iASPIRE study was a cross-sectional survey coordinated by the Irish National Institute for Prevention and Cardiovascular Health (NIPC) and was conducted during 2017–2019. 721 outpatients were enrolled at nine Irish study sites who had an index CHD event in the preceding 6–24 months.

 

Optimising lipid management is still important

The DA VINCI studyc :

Is Ireland achieving ESC/EAS guideline–directed LDL‑C goals?4

2016/2019 goal attainment5,6 among patients with ASCVD

  • In total, 198 patients from Ireland were enrolled from three primary care and three secondary care centres. 
  • Most patients were receiving moderate- or high-intensity statin therapy (most frequently atorvastatin or rosuvastatin). 
  • Few patients (< 10%) were receiving combination therapy of statin and ezetimibe. 
  • Approximately half of secondary prevention patients achieved their 2016 ESC/EAS goals and only 20% of secondary prevention patients achieved their 2019 ESC/EAS goals.

Images created from Offiah et al (2022)4

c DA VINCI was a cross-sectional study planned to enrol 6000 adults receiving LLT at primary and secondary care clinics across 18 European countries (including Ireland) between June 2017 and November 2018

ESC/EAS 2016/2019 risk-based LDL-C targets: Very high risk: 2016, <1.8 mmol/L 5; 2019, <1.4 mmol/L 6

 

There is a disparity between dyslipidaemia management in clinical practice in Ireland and guideline recommendations

  1. NIPC/National CVD Prevention Council Position Paper - Morris T, Harding E, Handcock M. 2023. Advancing a prevention agenda for cardiovascular care in Ireland: position paper. London: The Health Policy Partnership. Available at https://nipc.ie/national-prevention-council-report-2023/. Published February 2023. Accessed May 2024.
  2. Agar R, et al. A snapshot of lipid levels in the Republic of Ireland in 2017. Ir J Med Sci. 2019; 188:241–247.
  3. Curneen JMG, et al. Interhospital and interindividual variability in secondary prevention: a comparison of outpatients with a history of chronic coronary syndrome versus outpatients with a history of acute coronary syndrome (the iASPIRE Study). Open Heart. 2021 Jun;8(1):e001659
  4. Offiah G et al. The DA VINCI study: is Ireland achieving ESC/EAS guideline–directed LDL‑C goals? Ir J Med Sci. 2022; https://doi.org/10.1007/s11845-022-03050-6.
  5. Catapano AL, et al and the ESC Scientific Document Group. 2016 ESC/EAS Guidelines for the management of dyslipidaemias. Eur Heart J. 2016;37:2999–3058.
  6. Mach F, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk. Eur Heart J. 2020;41:111–188.

ACS, acute coronary syndrome; CHD, coronary heart disease; CV, cardiovascular; CVD, cardiovascular disease; EAS, European Atherosclerosis Society; ESC, European Society of Cardiology; LDL-C, low-density lipoprotein cholesterol; LLT, lipid lowering therapy

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MAT-IE-2300173 (v3.0)
Date of preparation: April 2024

MAT-IE-2300203 (v2.0) Date of Preparation: May 2024