IJCS | Volume 33, Nº4, July and August 2020

373 Table 1 - Lipid values (mg/dL) in Ecuadorian subjects categorized by cardiovascular risk before and after pharmacological treatment for dyslipidemia Age %Female Total-c LDL-c Triglycerides HDL-c High risk (n = 125) 54.1 ± 14.3 48.0 235 ± 60 151 ± 62 271 ± 195 49 ± 26 212 ± 55 135 ± 52 204 ± 156 48 ± 26 0.018 0.03 0.003 0.76 Very high risk (n = 264) 62.6 ± 11.7 57.2 228 ± 54 140 ± 50 268 ± 285 43 ± 13 197 ± 51 123 ± 45 208 ± 152 44 ± 13 < 0.0001 < 0.0001 0.003 0.37 Total-c: total cholesterol; LDL-c: low-density lipoprotein cholesterol; HDL-c: high-density lipoprotein cholesterol. Results A total of 385 patients were recruited, with an average age of 59.8 ± 13.2 years; 46% (n = 178) were male and 68% of themwere at a very high risk of cardiovascular disease. Analysis of baseline lipid profile showed total cholesterol levels higher than the desirable (< 200 mg/dL) in 75% of subjects and LDL-c near optimal/above optimal (129mg/dL) in 83%of subjects. HDL cholesterol was lower than 40 mg/dL in 43% of patients, and triglycerides were above normal (< 150mg/dL) in 79%of patients. Therewere no differences in lipid values between subjects at high or very high cardiovascular risk (Table 1). Very high cardiovascular risk was significantly more frequent in women (57%; p = 0.02). Treatment resulted in a significant reduction of total and LDL cholesterol as well as triglycerides both in high and very high-risk subjects (Table 1). However, the response rate to treatment ranged from 50% to 75%, with no difference between high and very high-risk subjects (Figure 1). Interestingly, all three parameters (total-c, LDL-c, and triglycerides) were seen to lower in 40% and 47% in high and very high-risk patients, respectively, with no statistical difference between the groups. Finally, improvement in the lipid profile – total-c, LDL-c and triglyceride reductions plus HDL-c increase – was evidenced in only 21% and 28%, respectively, with no statistical difference between the groups. Regarding the LDL-c goal attainment (NCEP-ATP III therapy guidelines), only 24 (19%) high-risk subjects achieved an LDL-c < 100 mg/dL, while a significantly lower percentage (p = 0.04) of subjects at very high cardiovascular risk reached an LDL-c < 70mg/dL (11%; n = 30). Additionally, ATP III goals were attained in a larger percentage by men (20.7%) than women (12.6%), although this difference was not statistically significant. The most common pharmacological treatment was statin-based therapy, i.e. simvastatin at an initial dose of 20 mg in 35% (n = 68) of patients, or atorvastatin at an initial dose of 40mg in 56% (n = 110) of the subjects. Ezetimibe alone or in combination with simvastatin was used in 11 subjects (5.6%). Lastly, fibrates, i.e. gemfibrozil (600 mg) or fenofibrate (160 mg) was the treatment prescribed to only 3% (n = 5) of the patients. In very-high risk patients, statins were used in 95.8%of the cases (n = 253) and in those, atorvastatin corresponded to 50%, simvastatin 34.8% and rosuvastatin 11% (Table 2). The 30 patients who reached the ATP III LDL-c goal were prescribed high doses of statins either alone or in combination. Discussion A reduction of lipid values – total-c, LDL cholesterol and/or triglycerides – in patients at high and very high cardiovascular risk was 56% and 53%, respectively. Therefore, we conclude that regardless of the treatment option or its duration, approximately half of the patients did not show an improvement in lipid profile. It was not surprising that pharmacological treatment for dyslipidemia was mainly based on statins and particularly on atorvastatin. What is surprising is that low doses have been prescribed for high-risk patients, even though it is known that the success rate of such Hernández et al. Dyslipidemia treatment in Ecuadorian population Int J Cardiovasc Sci. 2020; 33(4):371-376 Original Article