IJCS | Volume 33, Nº4, July and August 2020

374 Figure 1 - Response rate (improvement of lipid profile) in Ecuadorian patients after treatment for dyslipidemia. Total-C: total cholesterol; LDL-c: low-density lipoprotein cholesterol; HDL-c: high-density lipoprotein cholesterol. doses is low. 7 It is also to be noted that fibrates have been prescribed to high-risk patients, given that recent trials have shown that these medications have failed to achieve a statistically significant reduction in lipid levels and, when combined with statins, have shown an increase in side effects. 8 Moreover, the use of ezetimibe, particularly in association with statins, was found to be reduced. This may be explained by the fact that ezetimibe is not included in the National Essential Medicines List, which is a mandatory reference in public institutions. In private institutions, however, we could not find a clear explanation other than a misinterpretation of ATP III therapeutic goals by physicians. In 2013, a new set of recommendations for the management of dyslipidemia were released by the American College of Cardiology (ACC) in collaboration with the American Heart Association (AHA). These guidelines refer to overall atherosclerotic cardiovascular disease and differ significantly from the previous ATP III guidelines by the fact that LDL-c and non-HDL-c goals were completely abolished. 9 In addition, ATP III and subsequent updates state that the decrease in the lipid profile solely is not enough to reduce cardiovascular risk. 10 Our analysis shows that the achievement of ATPIII treatment goals by patients at high risk was no different between statin therapies, i.e. 22% atorvastatin at 40 mg, 18.2% simvastatin at 40 mg and 18.8% rosuvastatin at 20 mg. Atorvastatin in higher doses allowed an additional 15%while no increase was found with higher doses of simvastatin or rosuvastatin. In patients at very high-risk, the ATPIII LDL-C goals were achieved by 18.4% of patients taking atorvastatin at 40 mg, 7.6% of patients taking simvastatin and 3.6% of patients taking rosuvastatin. The use of higher doses did not result in a difference in success rates for LDL-c goal achievement. We also analyzed our results based on the 2013 ACC/ AHA guidelines as reference, and found that although 94% of the patients required a high-intensity statin therapy (atorvastatin at 40/80 mg or rosuvastatin at 20/40 mg), only 35.4% of patients actually received it, and from these, only 10.7% reached the expected goal of 50% reduction LDL-c. 9 Our results are comparable to those reported in a study conducted in Mexico, which showed that therapeutic Hernández et al. Dyslipidemia treatment in Ecuadorian population Int J Cardiovasc Sci. 2020; 33(4):371-376 Original Article