Evaluation of lipid profile and statin therapy in patients with atrial fibrillation: Real-life data from a tertiary hospital
Öz
Aim: Dyslipidemia is a modifiable risk factor of atrial fibrillation (AF). However, the majority of patients either do not receive low-density lipoprotein cholesterol (LDL-C) lowering treatment or do not meet their LDL-C and non-high-density lipoprotein cholesterol (non-HDL-C) goal. We aimed to search whether patients with AF are being treated for dyslipidemia and/or are at target LDL-C and non-HDL-C levels if treated.
Materials and Methods: This cross-sectional analysis includes 725 AF patients and was performed between 20 May 2023 and 25 November 2023, in cardiology outpatient clinics of a tertiary hospital. The demographic and clinical features of the patients were recorded. Systemic coronary risk estimation-2 (SCORE2) and old person version algorithms were used for cardiovascular disease (CVD) risk estimation. Primary prevention (PP) group involved patients with low-to-moderate, high and very high CVD risk without established atherosclerotic cardiovascular disease (ASCVD) and secondary prevention (SP) group was consisted of patients with established ASCVD.
Results: The mean age of the participants was 71.98± 9.01 and 54.5% (n=368) of patients were females. 207 (30.7%) of patients were paroxysmal AF, and 468 (69.3%) were permanent AF. Prevalence of dyslipidemia and hypertriglyceridemia were 364 (53.9%) and 248 (36.7%) respectively. 9 (1.3%) and 152 (22.5%) of patients were on fibrate and statin treatment respectively. Mean LDL-C and non-HDL-C were 107.81±35.97 and 135.42±41.19 and their target attainment rates were 62 (9.2%) and 107 (15.9%), respectively.
Conclusion: Control of dyslipidemia in patients with atrial fibrillation was severely poor and the most common cause was physician negligence.
Anahtar Kelimeler
Atrial fibrillation Dyslipidemia Low-density lipoprotein cholesterol Statin therapy
Kaynakça
- 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation, European Heart Journal (2020) 00, 1_126 doi:10.1093/eurheartj/ehaa612.
- 2019 ESC-EAS Guidelines for the management of dyslipidemia. European Heart Journal (2019)00-,1-78, doi: :10.1093/eurheartj/ehz455
- 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal (2021) 00, 1_111, doi:10.1093/eurheartj/ehab484
- Flint AC, Conell C, Ren X et al. Statin adherence is associated with reduced recurrent stroke risk in patients with or without atrial fibrillation. Stroke. 2017;48:1788-94.
- Li ZZ, Du X, Guo XY et al. Association Between Blood Lipid Profiles and Atrial Fibrillation: A Case-Control Study. Med Sci Monit. 2018 Jun 9;24:3903-3908. doi: 10.12659/MSM.907580. PMID: 29885277; PMCID: PMC6024732
- Fauchier L, Pierre B, de Labriolle A, Grimard C, Zannad N, Babuty D. Antiarrhythmic effect of statin therapy and atrial fibrillation. A meta-analysis of randomized controlled trials.J Am Coll Cardiol. 2008;51:828-35.10
- Liu T, Li L, Korantzopoulos P, Liu E, Li G. Statin use and developmentof atrial fibrillation: a systematic review and meta-analysis ofrandomized clinical trials and observational studies. Int J Cardiol. 2008;126:160-70.
- Başaran Ö, Doğan V, Mert KU et al. How did the updated 2019 European Society of Cardiology/European Atherosclerosis Society risk categorization for patients with diabetes affect the risk perception and lipid goals? A simulated analysis of real-life data from EPHESUS study. Anatol J Cardiol. 2023;27(2):78-87. DOI:10.14744/AnatolJCardiol.2022.2012.
- Mert GÖ, Başaran Ö, Mert KU et al. The reasons of poor lipid target attainment for secondary prevention in real life practice: results from EPHESUS. Int J Clin Pract. 2019;73(9):1-9.
- SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 2021;42:24392454.
- SCORE2-OP working group and ESC Cardiovascular risk collaboration. SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. Eur Heart J 2021;42:24552467
- Kayıkçıoğlu M, Tokgözoğlu L, Kılıçkap M, et al. Türkiye’de dislipidemi sıklığı ve lipit verileri: Kardiyovasküler risk faktörlerine yönelik epidemiyolojik çalışmaların sistematik derleme ve meta-analizi [Data on prevalence of dyslipidemia and lipid values in Turkey: Systematic review and meta-analysis of epidemiological studies on cardiovascular risk factors]. Turk Kardiyol Dern Ars. 2018 Oct;46(7):556-74. Turkish. doi: 10.5543/tkda.2018.23450. PMID: 30391985.
- Hyun-Jung Lee, So-Ryoung Lee, Eue-Keun Choi, Kyung-Do Han, Seil Oh. Low cholesterol levels and high cholesterol variability were associated with a higher risk of AF development. (J Am Heart Assoc. 2019;8:e012771. DOI: 10.1161/JAHA.119.012771.)
- Qi Jiang, Ling Yang, Ming-Long Chen, Fei Hua, Jian-Jun Li. Lipid Profile and Atrial Fibrillation: Is There Any Link?. Rev. Cardiovasc. Med. 2022, 23(8), 272. https://doi.org/10.31083/j.rcm2308272
- Li F, Du X, He L et al. Relationship between serum lipid levels and ischemic stroke in patients with atrial fibrillation: a nested case–control study based on the China Atrial Fibrillation Registry. BMC Cardiovasc Disord. 21, 424 (2021). https://doi.org/10.1186/s12872-021-02237-6
- Harrison SL, Lane DA, Banach M et al. Lipid levels, atrial fibrillation and the impact of age: Results from the LIPIDOGRAM2015 study. Atherosclerosis. 2020; 312: 16–22.
- Fauchier L, Pierre B, de Labriolle A, Grimard C, Zannad N, Babuty D. Antiarrhythmic effect of statin therapy and atrial fibrillation. A metaanalysis of randomized controlled trials. J Am Coll Cardiol. 2008;51: 828-35.
- Faruk Ertaş, Hasan Kaya, Zekeriya Kaya, Serkan Bulur, Nuri Köse, Mehmet Gül. Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER∗ study. Türk Kardiyol Dern Arş- Arch Turk Soc Cardiol. 2013;41(2):99-104 doi: 10.5543/tkda.2013.18488
- Hanna IR, Heeke B, Bush H et al. Lipid-lowering drug use is associated with reduced prevalence of atrial fibrillation in patients with left ventricular systolic dysfunction. Heart Rhythm. 2006 Aug;3(8):881-6. doi: 10.1016/j.hrthm.2006.05.010. Epub 2006 May 9. PMID: 16876733; PMCID: PMC3164215.
Atriyal Fibrilasyonlu Hastalarda Lipid Profilinin ve Statin Tedavisinin Değerlendirilmesi: Üçüncü Basamak Bir Hastaneden Gerçek Hayat Verileri
Öz
Amaç: Dislipidemi, atriyal fibrilasyonun (AF) değiştirilebilir bir risk faktörüdür. Ancak hastaların büyük çoğunluğu ya düşük yoğunluklu lipoprotein kolesterol (LDL-C) düşürücü tedavi almıyor ya da LDL-C ve yüksek yoğunluklu olmayan lipoprotein kolesterol (non-HDL-C) hedeflerine ulaşamıyor. AF'li hastaların dislipidemi için tedavi edilip edilmediğini ve/veya tedavi edilirlerse hedef LDL-C ve non-HDL-C düzeylerinde olup olmadıklarını araştırmayı amaçladık.
Gereç ve Yöntem: Bu kesitsel analiz 725 AF hastasını içermektedir ve 20 Mayıs 2023 ile 25 Kasım 2023 tarihleri arasında üçüncü basamak bir hastanenin kardiyoloji polikliniklerinde gerçekleştirildi. Hastaların demografik ve klinik özellikleri kaydedildi. Kardiyovasküler hastalık (CVD) risk tahmini için sistemik koroner risk tahmini-2 (SCORE2) ve yaşlı kişi versiyonu algoritmaları kullanıldı. Birincil koruma (PP) grubu, belirlenmiş aterosklerotik kardiyovasküler hastalığı (ASCVD) olmayan düşük-orta, yüksek ve çok yüksek CVD riski olan hastaları içermektedir ve ikincil önleme (SP) grubu, belirlenmiş ASCVD'si olan hastalardan oluşmaktadır.
Bulgular: Katılımcıların yaş ortalaması 71,98± 9,01 olup hastaların %54,5'i (n=368) kadındı. Hastaların 207'si (%30,7) paroksismal AF, 468'i (%69,3) kalıcı AF idi. Dislipidemi ve hipertrigliseridemi prevalansı sırasıyla 364 (%53,9) ve 248 (%36,7) idi. Hastaların 9'u (%1,3) fibrat, 152'si (%22,5) ise statin tedavisi görüyordu. Ortalama LDL-C ve non-HDL-C sırasıyla 107,81±35,97 ve 135,42±41,19 olup, hedeflenen oranlara ulaşma oranları sırasıyla 62 (%9,2) ve 107 (%15,9) idi.
Sonuç: Atriyal fibrilasyonu olan hastalarda dislipideminin kontrolü oldukça zayıftı ve en yaygın neden doktor ihmaliydi.
Anahtar Kelimeler
Atriyal fibrilasyon Dislipidemi Düşük yoğunluklu lipoprotein kolesterol Statin tedavisi
Kaynakça
- 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation, European Heart Journal (2020) 00, 1_126 doi:10.1093/eurheartj/ehaa612.
- 2019 ESC-EAS Guidelines for the management of dyslipidemia. European Heart Journal (2019)00-,1-78, doi: :10.1093/eurheartj/ehz455
- 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal (2021) 00, 1_111, doi:10.1093/eurheartj/ehab484
- Flint AC, Conell C, Ren X et al. Statin adherence is associated with reduced recurrent stroke risk in patients with or without atrial fibrillation. Stroke. 2017;48:1788-94.
- Li ZZ, Du X, Guo XY et al. Association Between Blood Lipid Profiles and Atrial Fibrillation: A Case-Control Study. Med Sci Monit. 2018 Jun 9;24:3903-3908. doi: 10.12659/MSM.907580. PMID: 29885277; PMCID: PMC6024732
- Fauchier L, Pierre B, de Labriolle A, Grimard C, Zannad N, Babuty D. Antiarrhythmic effect of statin therapy and atrial fibrillation. A meta-analysis of randomized controlled trials.J Am Coll Cardiol. 2008;51:828-35.10
- Liu T, Li L, Korantzopoulos P, Liu E, Li G. Statin use and developmentof atrial fibrillation: a systematic review and meta-analysis ofrandomized clinical trials and observational studies. Int J Cardiol. 2008;126:160-70.
- Başaran Ö, Doğan V, Mert KU et al. How did the updated 2019 European Society of Cardiology/European Atherosclerosis Society risk categorization for patients with diabetes affect the risk perception and lipid goals? A simulated analysis of real-life data from EPHESUS study. Anatol J Cardiol. 2023;27(2):78-87. DOI:10.14744/AnatolJCardiol.2022.2012.
- Mert GÖ, Başaran Ö, Mert KU et al. The reasons of poor lipid target attainment for secondary prevention in real life practice: results from EPHESUS. Int J Clin Pract. 2019;73(9):1-9.
- SCORE2 working group and ESC Cardiovascular risk collaboration. SCORE2 risk prediction algorithms: new models to estimate 10-year risk of cardiovascular disease in Europe. Eur Heart J 2021;42:24392454.
- SCORE2-OP working group and ESC Cardiovascular risk collaboration. SCORE2-OP risk prediction algorithms: estimating incident cardiovascular event risk in older persons in four geographical risk regions. Eur Heart J 2021;42:24552467
- Kayıkçıoğlu M, Tokgözoğlu L, Kılıçkap M, et al. Türkiye’de dislipidemi sıklığı ve lipit verileri: Kardiyovasküler risk faktörlerine yönelik epidemiyolojik çalışmaların sistematik derleme ve meta-analizi [Data on prevalence of dyslipidemia and lipid values in Turkey: Systematic review and meta-analysis of epidemiological studies on cardiovascular risk factors]. Turk Kardiyol Dern Ars. 2018 Oct;46(7):556-74. Turkish. doi: 10.5543/tkda.2018.23450. PMID: 30391985.
- Hyun-Jung Lee, So-Ryoung Lee, Eue-Keun Choi, Kyung-Do Han, Seil Oh. Low cholesterol levels and high cholesterol variability were associated with a higher risk of AF development. (J Am Heart Assoc. 2019;8:e012771. DOI: 10.1161/JAHA.119.012771.)
- Qi Jiang, Ling Yang, Ming-Long Chen, Fei Hua, Jian-Jun Li. Lipid Profile and Atrial Fibrillation: Is There Any Link?. Rev. Cardiovasc. Med. 2022, 23(8), 272. https://doi.org/10.31083/j.rcm2308272
- Li F, Du X, He L et al. Relationship between serum lipid levels and ischemic stroke in patients with atrial fibrillation: a nested case–control study based on the China Atrial Fibrillation Registry. BMC Cardiovasc Disord. 21, 424 (2021). https://doi.org/10.1186/s12872-021-02237-6
- Harrison SL, Lane DA, Banach M et al. Lipid levels, atrial fibrillation and the impact of age: Results from the LIPIDOGRAM2015 study. Atherosclerosis. 2020; 312: 16–22.
- Fauchier L, Pierre B, de Labriolle A, Grimard C, Zannad N, Babuty D. Antiarrhythmic effect of statin therapy and atrial fibrillation. A metaanalysis of randomized controlled trials. J Am Coll Cardiol. 2008;51: 828-35.
- Faruk Ertaş, Hasan Kaya, Zekeriya Kaya, Serkan Bulur, Nuri Köse, Mehmet Gül. Epidemiology of atrial fibrillation in Turkey: preliminary results of the multicenter AFTER∗ study. Türk Kardiyol Dern Arş- Arch Turk Soc Cardiol. 2013;41(2):99-104 doi: 10.5543/tkda.2013.18488
- Hanna IR, Heeke B, Bush H et al. Lipid-lowering drug use is associated with reduced prevalence of atrial fibrillation in patients with left ventricular systolic dysfunction. Heart Rhythm. 2006 Aug;3(8):881-6. doi: 10.1016/j.hrthm.2006.05.010. Epub 2006 May 9. PMID: 16876733; PMCID: PMC3164215.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kardiyoloji |
| Bölüm | Araştırma Makaleleri |
| Yazarlar | |
| Yayımlanma Tarihi | 9 Aralık 2024 |
| Gönderilme Tarihi | 24 Ocak 2024 |
| Kabul Tarihi | 5 Eylül 2024 |
| Yayımlandığı Sayı | Yıl 2024 |