Lipid Lowering Treatment and Eligibility for PCSK9 Inhibition in Post-Myocardial Infarction Patients in Italy: Insights from Two Contemporary Nationwide Registries

Author:

Colivicchi Furio1,Massimo Gulizia Michele2,Arca Marcello3,Luigi Temporelli Pier4,Gonzini Lucio5,Venturelli Vanessa6,Morici Nuccia7,Indolfi Ciro8ORCID,Gabrielli Domenico9,De Luca Leonardo10ORCID

Affiliation:

1. Division of Cardiology, S. Filippo Neri Hospital, Roma, Italy

2. Division of Cardiology, Garibaldi-Nesima Hospital, Catania, Italy

3. Department of Internal Medicine and Medical Specialties, Sapienza University of Roma, Italy

4. Division of Cardiology, Istituti Clinici Scientifici Maugeri, IRCCS, Veruno (Novara), Italy

5. ANMCO Research Center, Fondazione per il Tuo cuore, Firenze, Italy

6. Division of Cardiology, S. Pertini Hospital, Roma, Italy

7. Division of Cardiology, Niguarda Ca’Grande Hospital, Milano, Italy

8. Cardiology Unit, Università degli Studi Magna Graecia, Catanzaro, Italy

9. Division of Cardiology, Augusto Murri Hospital, Fermo, Italy

10. Division of Cardiology, S. Giovanni Evangelista Hospital, Tivoli (Roma), Italy

Abstract

Introduction. The current use of lipid lowering therapies and the eligibility for proprotein convertase subtilisin/kexin-9 (PCSK9) inhibitors of patients surviving a myocardial infarction (MI) is poorly known. Methods. Using the data from two contemporary, nationwide, prospective, real-world registries of patients with stable coronary artery disease, we sought to describe the lipid lowering therapies prescribed by cardiologists in patients with a prior MI and the resulting eligibility for PCSK9 inhibitors according to the European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) and the Italian regulatory agency (Agenzia Italiana del Farmaco; AIFA) criteria. The study cohort was stratified according to the following low-density lipoprotein cholesterol (LDL-C) levels at the time of enrolment: <70 mg/dl; 70–99 mg/dl and ≥100 mg/dl. Results. Among the 3074 post-MI patients with LDL-C levels available, a target level of LDL-C < 70 mg/dl was present in 1186 (38.6%), while 1150 (37.4%) had LDL-C levels ranging from 70 to 99 mg/dl and the remaining 738 (24.0%) an LDL-C ≥ 100 mg/dl. A statin was prescribed more frequently in post-MI patients with LDL-C levels <70 mg/dl (97.1%) compared to the other LDL-C groups (p<0.0001). A low dose of statin was prescribed in 9.3%, while a high dose in 61.4% of patients. Statin plus ezetimibe association therapy was used in less than 18% of cases. In the overall cohort, 293 (9.8%) and 450 (22.2%) resulted eligible for PCSK9 inhibitors, according to ESC/EAS and AIFA criteria, respectively. Conclusions. Post-MI patients are undertreated with conventional lipid lowering therapies. A minority of post-MI patients would be eligible to PCSK9 inhibitors according to ESC/EAS guidelines and Italian regulatory agency criteria.

Funder

AstraZeneca

Publisher

Hindawi Limited

Subject

Pharmacology (medical),Cardiology and Cardiovascular Medicine,Pharmacology,General Medicine

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