Research articles: PreventionAvailable oral lipid-lowering agents could bring most high-risk patients to target: an estimate based on the Dyslipidemia International Study II-ItalyDe Ferrari, Gaetano M.a,b; Perna, Gian P.c; Nicosia, Antoninod; Guasti, Luiginae; Casu, Gavinof; Cuccia, Claudiog; Picco, Francescah; Strazzella, Caterinaa,b; Totaro, Rossanaa,b; Cercone, Stefaniai; Canullo, Laurai; Horack, Martinj,k; Lautsch, Dominikl; Gitt, Anselm K.j,k; Di Biase, MatteomAuthor Information aCoronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo bDipartimento di Medicina Molecolare, Università degli Studi di Pavia, Pavia cAzienda Ospedaliera Universitaria, Ospedali Riuniti di Ancona, Ancona dOspedale Maria Paternò Arezzo, Ragusa eCentro di Ricerca delle Dislipidemie, Università dell’Insubria, Varese fOspedale San Francesco, Nuoro gFondazione Poliambulanza Istituto Ospedaliero, Brescia hAzienda Ospedaliero-Universitaria di Udine, Udine iMSD, Rome, Italy jHerzzentrum Ludwigshafen, Medizinische Klinik B kStiftung Institut für Herzinfarktforschung Ludwigshafen, Ludwigshafen, Germany lMerck and Co Inc, Kenilworth, New Jersey, USA mAzienda Ospedaliera Universitaria Ospedali Riuniti di Foggia, Foggia, Italy Correspondence to Gaetano M. De Ferrari, MD, Coronary Care Unit and Laboratory of Clinical and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Viale Golgi, 19, 27100 Pavia, Italy Tel: +39 0382 503715; fax: +39 0382 503161; e-mail: [email protected] Received 18 August, 2017 Revised 26 April, 2018 Accepted 8 May, 2018 Journal of Cardiovascular Medicine: September 2018 - Volume 19 - Issue 9 - p 485-490 doi: 10.2459/JCM.0000000000000680 Buy Metrics Abstract Aims The analysis evaluated the contemporary percentage of patients with established coronary heart disease (CHD) reaching the European guidelines recommended LDL-cholesterol (LDL-C) levels of less than 70 mg/dl and the threshold required for proprotein convertase subtlisin/kexin type 9 reimbursement in Italy (100 mg/dl). It also assessed how these percentages would change in case of diffuse use of ezetimibe. Methods The Dyslipidemia International Study II enrolled CHD patients aged at least 18 either on lipid-lowering therapy (LLT) for at least 3 months or not on LLT at the time of the lipid profile. Distribution of LLTs and LDL-C target attainment were assessed. Multivariate logistic regression evaluated predictors of LDL-C target attainment. A 24% LDL-C lowering was modeled in patients not taking ezetimibe to assess its potential effects. Results Among 676 Italian CHD patients enrolled, LDL-C concentrations were lower among the 631 patients (93.3%) who were on LLT (82 versus 118 mg/dl; P < 0.001). The LDL-C target was attained by 35.4% of patients. Statin dose (median atorvastatin dose 40 mg/day) was the sole significant predictor of LDL-C target attainment. The simple addition of ezetimibe in the model reduced the percentage of patients more than 70 and 100 mg/dl from 64.6 to 37.9% and from 25.1 to 11.8%, respectively. Conclusion Despite treatment in more than 90%, only one-third of Italian stable CHD patients attained the recommended LDL-C target. Statin dose was the sole predictor of the target achievement. The addition of ezetimibe would almost double patients at target and halve the potential candidates for reimbursement of more expensive agents such as proprotein convertase subtlisin/kexin type 9 inhibitors. © 2018 Italian Federation of Cardiology. All rights reserved.