MANAGEMENT OF SECONDARY PREVENTION PATIENTS WITH LDL-CHOLESTEROL LEVELS < 70MG/DL (1.8MMOL/L): AN ANALYSIS BASED ON DELPHI PANEL APPROACH

Background and Aims : Current guidelines recommend at least 50% LDL-C reduction from baseline levels in patients with atherosclerotic cardiovascular disease in addition to getting the LDL-C goal of <55 mg/dL. We sought to determine how secondary prevention patients with LDL-C levels <70 mg/dL (1.8 mmol/L) are managed.Methods: Delphi Panel Methodology was used to figure out the approach to patients with LDL-C <70mg/dL. Nine expert cardiologists replied to the questionnaire to generate a consensus on how high-risk patients were treated in Turkey.Results: Treatment-naïve secondary prevention patients with LDL-C<55mg/dL are left untreated in 75.6%, only 18.3% are considered for low to moderate doses of statins and 6.1% for high doses of statins. For those with LDL-C levels of 55-69mg/dL, are left untreated in 50.9%, considered for low-moderate dose statin therapy in 40%, and 29.4% high doses of statins. For patients with recurrent cardiovascular events and LDL-C<55mg/dL these proportions were 75.6%, 18.3%, and 6.1%, respectively. For those with recurrent events but LDL-C levels ranging 55-69mg/dL were 50.9%, 32.2%, and 9.1%, respectively.Conclusions: According to expert cardiologists’ consensus, only one-fourth of secondary prevention patients with LDL-C levels <55mg/dL or 55-69mg/dL will be considered for antilipid therapy in Turkey. However, patients should be targeted to at least 50% LDL-C reduction from baseline levels on top of getting to LDL-C goals according to current guidelines. Our results may imply that awareness of current guideline recommendation of at least 50% LDL-C reduction in secondary prevention is extremely low among cardiologists. Background and Aims : Current guidelines recommend at least 50% LDL-C reduction from baseline levels in patients with atherosclerotic cardiovascular disease in addition to getting the LDL-C goal of <55 mg/dL. We sought to determine how secondary prevention patients with LDL-C levels <70 mg/dL (1.8 mmol/L) are managed. Methods: Delphi Panel Methodology was used to figure out the approach to patients with LDL-C <70mg/dL. Nine expert cardiologists replied to the questionnaire to generate a consensus on how high-risk patients were treated in Turkey. Results: Treatment-naïve secondary prevention patients with LDL-C<55mg/dL are left untreated in 75.6%, only 18.3% are considered for low to moderate doses of statins and 6.1% for high doses of statins. For those with LDL-C levels of 55-69mg/dL, are left untreated in 50.9%, considered for low-moderate dose statin therapy in 40%, and 29.4% high doses of statins. For patients with recurrent cardiovascular events and LDL-C<55mg/dL these proportions were 75.6%, 18.3%, and 6.1%, respectively. For those with recurrent events but LDL-C levels ranging 55-69mg/dL were 50.9%, 32.2%, and 9.1%, respectively. Conclusions: According to expert cardiologists’ consensus, only one-fourth of secondary prevention patients with LDL-C levels <55mg/dL or 55-69mg/dL will be considered for antilipid therapy in Turkey. However, patients should be targeted to at least 50% LDL-C reduction from baseline levels on top of getting to LDL-C goals according to current guidelines. Our results may imply that awareness of current guideline recommendation of at least 50% LDL-C reduction in secondary prevention is extremely low among cardiologists.