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Vol. 69. Issue 10.
Pages 996-997 (October 2016)
Vol. 69. Issue 10.
Pages 996-997 (October 2016)
Letters to the Editor
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Insufficient Lipid Control in Patients With Coronary Artery Disease: An Unresolved Problem
Insuficiente control de parámetros lipídicos en pacientes con enfermedad coronaria: un problema por resolver
Alfredo Renilla
Corresponding author

Corresponding author:
, Sergio Hevia, Vicente Barriales
Unidad de Rehabilitación Cardiaca y Prevención Secundaria, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
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Enrique Galve, Alberto Cordero, Angel Cequier, Emilio Ruiz, José Ramón González-Juanatey
Enrique Galve, Alberto Cordero, Ángel Cequier, José Ramón González-Juanatey
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To the Editor,

We have read with interest the article published by Galve et al.1 in Revista Española de Cardiología concerning the degree of lipid control in patients with coronary artery disease. The authors report an observational study in which they found that poor control of low-density lipoprotein cholesterol (LDL-C) levels has been reported constantly in recent years, a situation that we believe should prompt reflection. There is a great deal of scientific evidence that associates LDL-C levels with the development of new cardiovascular events in patients with coronary artery disease. This evidence has led the current clinical practice guidelines2 to consider the achievement of LDL-C levels < 70 mg/dL in these patients to be a class Ia recommendation. However, barely 1 in 4 patients achieves that therapeutic target, even with lipid-lowering therapy.1,3,4 In the treatment of patients with coronary artery disease, other therapeutic strategies with a class I recommendation—primary angioplasty or the use of dual antiplatelet therapy—reach much higher rates of compliance with therapeutic goals. We believe this could be due to the difference in the time it takes for the benefit to be observed; whereas the benefit observed with percutaneous treatment is practically immediate, lipid control requires proper treatment adherence for its beneficial effect on mortality and morbidity to become apparent. Although the achievement of optimal LDL-C levels reduces cardiovascular mortality by an additional 20%,5 Galve et al.1 found that lipid-lowering therapy was modified in only 26% of patients with poor LDL-C control. This finding suggests that, in general, scant attention is paid to this very important parameter of secondary prevention. In addition, another factor associated with poor LDL-C control may be individual variation in the response to lipid-lowering therapy. A recent communication reported that at least half of the patients treated with high-intensity statin therapy achieve a reduction in LDL-C > 50%, but that 10% of those patients show no change or even an increase in LDL-C levels.6 Given the resulting prognostic benefit, it is essential to optimize LDL-C concentrations in most patients with coronary artery disease, a fact that has been reflected in the recent document of the Spanish Society of Cardiology dealing with quality indicators in cardiology.7 On the other hand, subtilisin/kexin 9 inhibitors, with a presumed lower variation among the responses of the different groups and a reduction in LDL-C > 60% compared with baseline,8 could help to improve lipid control. The inclusion of these patients in cardiac rehabilitation programs helps to optimize secondary prevention parameters and, thus, to reduce morbidity and mortality rates. This strategy is categorized as a class Ia recommendation in recent guidelines on cardiovascular disease prevention.2 For this reason, it should be applied in most of our patients.

E. Galve, A. Cordero, A. Cequier, E. Ruiz, J.R. González-Juanatey.
Grado de control lipídico en pacientes coronarios y medidas adoptadas por los médicos. Estudio REPAR.
Rev Esp Cardiol., (2016),
[Epub ahead of print]. Available at:
M. Piepoli, A. Hoes, S. Agewall, C. Albus, C. Brotons, A. Catapano, et al.
2016 European Guidelines on cardiovascular disease prevention in clinical practice.
[Epub ahead of print]. Available at:
J.R. González-Juanatey, J. Millán, E. Alegría, C. Guijarro, J.V. Lozano, G.C. Vitale.
Prevalencia y características de la dislipemia en pacientes en prevención primaria y secundaria tratados con estatinas en España. Estudio DYSIS-España.
Rev Esp Cardiol., 64 (2011), pp. 286-294
K. Kotseva, D. Wood, D. De Bacquer, G. De Backer, L. Rydén, C. Jennings, et al.
EUROASPIRE IV: A European Society of Cardiology survey on the lifestyle, risk factor and therapeutic management of coronary patients from 24 European countries.
Eur J Prev Cardiol., 23 (2016), pp. 636-648
C. Baigent, L. Blackwell, J. Emberson, L.E. Holland, C. Reith, N. Bhala, et al.
Efficacy and safety of more intensive lowering of LDL cholesterol: a meta-analysis of data from 170,000 participants in 26 randomised trials.
Lancet., 376 (2010), pp. 1670-1681
P.M. Ridker, S. Mora, L. Rose, JUPITER Trial Study Group.
Percent reduction in LDL cholesterol following high-intensity statin therapy: potential implications for guidelines and for the prescription of emerging lipid-lowering agents.
Eur Heart J., 37 (2016), pp. 1373-1379
J. López-Sendón, J.R. González-Juanatey, F. Pinto, J. Cuenca, L. Badimon, R. Dalmau, et al.
Indicadores de calidad en cardiología. Principales indicadores para medir la calidad de los resultados (indicadores de resultados) y parámetros de calidad relacionados con mejores resultados en la práctica clínica (indicadores de práctica asistencial). INCARDIO (Indicadores de Calidad en Unidades Asistenciales del Área del Corazón): Declaración de posicionamiento de consenso de SEC/SECTCV.
Rev Esp Cardiol., 68 (2015), pp. 976-1005
J.G. Robinson, M. Farnier, M. Krempf, J. Bergeron, G. Luc, M. Averna, et al.
Efficacy and safety of alirocumab in reducing lipids and cardiovascular events.
N Engl J Med., 372 (2015), pp. 1489-1499
Copyright © 2016. Sociedad Española de Cardiología
Revista Española de Cardiología (English Edition)

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