Monitoring and treatment of dyslipidemia in patients with high, very high and extreme cardiovascular risk in the North Caucasus Federal District

Aim. To assess lipid metabolism parameters, their changes with lipid-lowering therapy and the achievement rate of low-density lipoprotein cholesterol (LDL-C) target levels in patients with high, very high and extreme cardiovascular risk who are outpatiently monitored in real-world practice.

Material and methods. A multicenter retrospective-prospective observational study was conducted in health facilities of the North Caucasus Federal District. The study included 1006 patients over 18 years of age with high (n=357), very high (n=601) and extreme (n=42) cardiovascular risk. Electronic individual registration cards were used, including demographic and clinical characteristics, lipid profile dynamics, treatment regimens and tolerability. Lipid parameters were monitored at least twice with an interval of 8±4 weeks. Descriptive and comparative statistics methods were used using SPSS Statistics 25 and R. Differences were considered significant at p<0,05.

Results. At the time of inclusion in the study, 84% of patients had dyslipidemia, but only 69,2% received lipid-lowering therapy. After inclusion, the proportion of those receiving treatment increased to 98,8%. MLDL-C level decreased from 3,7 to 2,7 mmol/l, and total cholesterol — from 5,7 to 4,8 mmol/l. Target LDL-C values were achieved in 8,9% of patients. The most pronounced reduction was observed in very high-risk patients and with the use of combination therapy (statins + ezetimibe). High individual variability in treatment response was established. In some cases, a paradoxical increase in LDL-C levels was recorded, requiring further analysis.

Conclusion. Systemic monitoring and treatment of lipid-lowering therapy allows achieving a significant reduction in atherogenic lipids, especially in the very high-risk group. However, achieving target LDL-C levels remains difficult. Early and broader initiation of combination therapy, regular assessment of adherence and personalized approach are necessary, especially in extreme-risk patients. The data obtained emphasize the importance of implementing modern clinical guidelines in primary health care practice.

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