IJCS | Volume 33, Nº4, July and August 2020

372 Ministry of Public Health showed that dyslipidemia is present in 19.9% of people below 60 years old while hypertriglyceridemia reaches 38.7% nationwide. 4 For more than a decade, treatment of dyslipidemia by the medical community has been based on the National Cholesterol Education Program (NCEP)Adult Treatment Panel III guidelines (ATP III and subsequent updates). 5 This approach relied heavily on the Framingham Heart Risk Score as a predictor of 10-year risk of coronary heart disease (CHD) events, specifically myocardial infarction and CHD-related death. Moreover, ATPIII provides therapy guidelines for low-density lipoprotein cholesterol (LDL-c) and non-high-density lipoprotein cholesterol (non-HDL-c) established based on patients’ predicted risk and related comorbidities. In general, these guidelines recommend aggressive treatment of LDL-c of patients at higher risk, with specific LDL-c targets for each risk category. 5 Since the late 1980s, 3-hydroxy-3-methylglutaryl- coenzyme A (HMG-CoA) reductase inhibitors (‘statins’) has been used as the primary treatment of hypercholesterolemia.Apooled analysis of theCholesterol Treatment Trialists’ Collaboration (CTTC) showed that every 1 mmol/L (38.67 mg/ dL) reduction in LDL-c with statin therapywas associatedwith a reduction in anymajor cardiovascular event by 21% to 28%. 6 The present study analyzes different lipid-lowering regimens in Ecuadorian patients at high and very high cardiovascular risk, to determine if ATPIII guidelines achieve their treatment goals. Materials and methods This was a retrospective study approved by the institutional reviewboard of the Universidad San Francisco de Quito (2015-044IN). A sample of patients’ medical records was calculated (5% precision, 95% confidence interval and 50% variability) and obtained from six hospitals in the two main cities of Ecuador assuming a rate of 2:1 between public and private institutions. In Quito city, the hospitals that participated in the study “Hospital de Especialidades Eugenio Espejo” (public hospital, run by theMinistry of Public Health), “Hospital Carlos Andrade Marín” (public hospital, run by the social security administration), and “Hospital de Los Valles” (private hospital). In Guayaquil, the hospitals included were “Hospital Luis Vernaza” (public hospital, run by the Junta Beneficencia – Charity Board), “Hospital Teodoro Maldonado Carbo” (public hospital, run by the social security administration), and “Clinica Kennedy” (private hospital). Medical records of subjects that met the following criteria were included in our analysis: (a) subjects that attended an internal medicine, cardiology or endocrinology outpatient clinics, (b) subjects older than 30 years (c) patients with a diagnosis of dyslipidemia evidenced by laboratory tests (d) subjects undergoing pharmacological treatment at one of the mentioned hospitals for at least three months. Subjects that met the above criteria were selected per institution using a random number generator (www.random.org ) and data from the medical records were collected using forms specially designed for this study. According to theATP III algorithm, subjects are placed in one of three risk categories: (1) established CHD and CHD risk equivalents, (2) multiple (2+) risk factors, and (3) zero to one (0–1) risk factor. CHD risk equivalents include noncoronary forms of clinical atherosclerotic disease, diabetes, and multiple (2+) CHD risk factors with 10-year risk for CHD > 20%. Subjects with CHD or CHD risk equivalents can be categorized as high risk. The goal for LDL-lowering therapy in high-risk patients is an LDL-c level < 100 mg/dL. According to ATP III, for a baseline or on-treatment LDL-c < 100 mg/dL, no further LDL-lowering therapy is recommended. For all high-risk patients with LDL-c levels > 100 mg/dL, LDL-lowering dietary therapy should be initiated. 5 Other factors that place subjects in the category of very high risk are the presence of established CVD plus (1) multiple major risk factors (especially diabetes), (2) severe and poorly controlled risk factors (especially continued cigarette smoking), (3) multiple risk factors of the metabolic syndrome (especially high triglycerides > 200 mg/dL plus non-HDL-C > 130 mg/dL with low HDL-C [< 40 mg/dL]), and (4) patients with acute coronary syndromes. 5 Statistical analysis Continuous variables with a normal distribution, assessed by the Shapiro-Wilk test, were described asmean and standard deviation while categorical variables were presented as frequencies. Data were analyzed using the SPSS, using the chi-square test for categorical variables and the paired t-test for the continuous variables. A p-value less than 0.05 was considered as significant. Hernández et al. Dyslipidemia treatment in Ecuadorian population Int J Cardiovasc Sci. 2020; 33(4):371-376 Original Article