Secondary prevention of Atherosclerotic Cardiovascular Disease: how close are we to the target in the management of dyslipidemia (results of the SURF CAD II study for Azerbaijan)?

doi:10.28942/acj.v23i1y2023.17

Abstract

Introduction: According to the WHO, about 17.9 million people die annually due to cardiovascular diseases (CVD). Azerbaijan belongs to a group of countries with a very high risk of cardiovascular diseases. Effective management of the main risk factors for cardiovascular diseases is of great importance for reducing the mortality rate from CVD. The Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II study is a clinical audit of the recording and management of CHD risk factors. It was developed in collaboration with the European Association of Preventive Cardiology (EAPC) and the European Society of Cardiology (ESC). The purpose of this study is a subgroup analysis of the results of the SURF CHD II study conducted in Azerbaijan, and, thus, to study the compliance of dyslipidemia management with secondary prevention of cardiovascular diseases in our country with the goals specified in the latest ESC recommendations. Material and methods: In 2019-2021, data of 687 patients (24.9% of women) aged over 18 years with confirmed atherosclerotic CVD who underwent outpatient examination in six hospitals in Baku (average age 59.6 ± 9.6 years) were collected through an electronic questionnaire survey. The survey noted demographic, clinical, and laboratory levels, including total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TG), as well as whether patients took drugs from the statin group. Dyslipidemia is defined as statin use or TC level ≥ 200 mg/dl, LDL-C level ≥ 130 mg/dl, TG level ≥ 150 mg/dl, and HDL-C level ≥ 40 mg/dl for men and ≥ 50 mg/dl for women. LDL-C levels ≥ 70 mg/dl were indicated as uncontrolled dyslipidemia in accordance with the recommendations of the ESC guidelines. Results: Among 687 patients during an outpatient visit, the blood lipid level was checked only in about 50% of patients. They noted that 73.9% of all patients used statins, and this number was higher among men (p=0.012), although there was no statistically honest difference between male and female patients in TC, LDL-C, HDL-C, and TG levels (p=0.012). It should be noted that 255 (37.1%) of the patients included in the study had a history (respectively, 60 (35.1%) women and 195 (37.8%) men) of dyslipidemia, in other words, already confirmed at previous visits. We found that in 86.8% of these patients, LDL-C levels did not reach their first target level. Conclusion: The results of the Survey of Risk Factors in Coronary Heart Disease (SURF CHD) II study conducted in Azerbaijan showed that compliance with the guidelines of the European Society of Cardiology for the prevention of CVD is still at an unsatisfactory level. For the effective management of cardiac patients, it is very important to strengthen primary and secondary prevention, the establishing of specialized cardiac rehabilitation centers, and their geographical location in strategic areas.