Assessment of lipid levels and cholesterol lowering treatment in patients with acute coronary syndrome at the invasive center of Gyula during the COVID period
█ Original article
DOI: 10.26430/CHUNGARICA.2023.53.3.273
Authors:
Márk László1, Tajtiné Fazekas Krisztina2, Dani Győző3, Ruzsa János1, Thury Attila1
1Békés Megyei Központi Kórház, Pándy Kálmán Tagkórháza, Kardiológia Osztály, Gyula
2Békés Megyei Központi Kórház, Pándy Kálmán Tagkórháza, Központi Laboratórium, Gyula
3Városi Kórház, Orosháza
Levelezési cím:
Dr. Márk László, Békés Megyei Központi Kórház Pándy Kálmán Tagkórház, Kardiológia Osztály
5700 Gyula, Semmelweis u. 1. E-mail: dr.mark.laszlo@gmail.com
Summary
Introduction: Acute coronary syndrome (ACS) patients are a large and one of the most vulnerable groups of patients in cardiology. We should pay more attention to their lipid lowering treatment values based on the principle that the greater the risk, the greater the benefit.
Objective: The investigation of the lipid values of patients treated with ACS during the year of the COVID period in a county hospital operating as an invasive center assessed at 1 and 2 years after the index event. Furthermore, we aimed to compare the results with one-year lipid values of patients treated in the same center with the same diagnosis in 2015 and 2017.
Method: Unlike our two previous surveys, the lipid results found in hospital and outpatient databases were collected retrospectively, we did not investigate the treatment data.
Results: At the beginning of the COVID epidemic, during a one-year period (between 1 April 2020 and 31 March 2021) we treated 531 patients with ACS, 312 men and 219 women. In the county databases lipid results were found in 35% of the patients at 6 months and 42% at one year. The rates decreased gradually: in 2015 73%, and in 2017 54% had lipid results available. Similar to our previous studies, the median LDL-cholesterol (LDL-C) and IQ range calculated using the Friedewald formula were 1.64 (1.09–2.30) mmol/l at six months, and 1.60 (1.19–2.27) mmol/l at one year, and with the Martin-Hopkins method, which is more recommended today, they were 1.92 (1.33–2.27) and 1.73 (1.36–2.43) mmol/l, respectively. Compared to the latter, the Friedewald formula gave a significantly lower value at both times (by 15% at six months, p=0.044, by 8% at one year, p=0.014). Compared to our previous studies, the LDL-C calculated according to Friedewald reached the “old” target value of 1.8 mmol/l during the COVID epidemic in a smaller proportion (32% at half a year, 36% at one year), the 1.4 mmol/l value had been attained at both times in 22% of patients.
Conclusions: In patients treated for ACS during the COVID period we found a significantly lower proportion of lipid results available than in our surveys performed 5 and 7 years earlier, and the rate of the target level attainment also decreased. At hospital discharge, patients with ACS giving a laboratory referral for a blood test before the next control and scheduling them to a fixed time, as well as paying more attention to the possibility of prescribing ezetimibe, and increasing the involvement of general practitioners can help improve the quality of lipid-lowering treatment. Taking into account the differences in LDL-C calculated according to the Friedewald and Martin-Hopkins method, it would be advisable to use the more accepted latter, and it would be even better to use more widely the direct LDL-C measurement with health insurance support.
ISSUE: CARDIOLOGIA HUNGARICA | 2023 | VOLUME 53, ISSUE 3
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