Epidemiology of atherosclerotic cardiovascular diseases in some regions of the Russian Federation, clinical characteristics of patients and estimation of the efficacy of lipid-lowing therapy: study of real clinical practice

Atherosclerotic cardiovascular diseases (ASCVD) are traditionally leading in the structure of mortality in the world and in Russia.

The aim of the research is estimation of the incidence of ASCVD from 2016 to 2021 in the general population and by strata (acute/chronic ASCVD, age, gender), prevalence of these diseases by years; comparison of demographic and clinical characteristics of patients with and without ASCVD; study of applied lipid-lowering therapy regimens and its efficacy in clinical practice.

Material and methods. The source of data for the study were anonymized medical records from the EHR of patients in healthcare facilities for the period from 01/01/2016 to 02/28/2022 in 10 territorial entities of the Russian Federation. ICD-10 codes were used to identify patient subgroups (acute/chronic ASCVD). Epidemiological part of the research for study the incidence and prevalence of ASCVD in the Russian Federation for the period 2016–2021 included 1,591,126 patients from the Kirov region; clinical part of the research for study the efficacy of lipid-lowering therapy regimens for ASCVD included 293,803 patients from 10 territorial entities of the Russian Federation.

Results. Among all patients included in the epidemiological part of the study, only 14,1% were diagnosed with ASCVD. The group of ASCVD patients differed significantly from the group without ASCVD in age parameters: 68,5±12,1 versus 41,9±23,9 years old. The initial level of LDL cholesterol on statin monotherapy was 3,27±1,18 mmol/l. No significant dynamics of this index was found in patients with ASCVD during lipid-lowering therapy after 3–6 (2,93±1,16 mmol/l) and 6–12 (2,96±1,08 mmol/l) months. In the statin monotherapy group, the proportion of patients who did not achieve the target LDL cholesterol level <1,4 mmol/l after 3–6 months was 95,83%, and after 6–12 months – 96,06%. At the same time, the frequency of failure to achieve LDL cholesterol levels in the range of 1,4–1,8 mmol/l was slightly lower and after 3–6 months was 90,22%, and after 6–12 months – 91,63%. Combined lipid-lowering therapy statin + ezetimibe was prescribed in total to 52 patients with ASCVD.

Conclusion. Currently, in real clinical practice in 10 subjects of the Russian Federation, a clinical inertia in achieving target LDL cholesterol levels in ASCVD patients takes place, which requires more active implementation of innovative lipid-lowering medicaments use.