IJCS | Volume 33, Nº4, July and August 2020

375 Table 2 - Distribution of pharmacological therapy for dyslipidemia in Ecuadorian patients at very high cardiovascular risk (n = 253) 10 mg 20 mg 40 mg 80 mg Atorvastatin (n = 132) 2 (0.8%) 23 (9.1%) 78 (30.8%) 29 (11.5%) Simvastatin (n = 92) 2 (0.8%) 47 (18.6%) 39 (15.4%) 4 (1.6%) Rosuvastatin (n = 29) 9 (3.5%) 8 (3.2%) 12 (4.7%) -- 100 mg 160 mg 300 mg 600 mg Gemfibrozil (n = 26) -- -- 1 (1.9%) 25 (46.3%) Fenofibrate (n = 28) 1 (1.9%) 2 (3.7%) 2 (3.7%) 23 (42.6%) 10 mg Ezetimibe (n = 6) 6 (75.0%) Ezetimibe 10 mg + simvastatin (n = 2) 2 (25.0%) is highly dependent on educational and motivational interventions. 14 Previous studies on adherence to statin treatment showed that in longer periods of time (6 months), around 50-60% patients continue on treatment. 15,16 Treatment adherence was not considered in the present study, but we previously reported that one out of four patients (25%) stated to have forgotten at least one dose of their treatment, regardless of disease and duration of treatment. 17 Although the retrospective design of the study and the lack of a stratified sampling constitute limitations to the analysis of the results, we conclude that there is a very low rate of ATP III therapy goal achievement among patients with dyslipidemia categorized as high and very high cardiovascular risk, independently of the treatment option or its duration. This can be attributed to the prescription of low doses of statins and to potential confounders like the simplistic evaluation of isolated lipid fractions rather than the complete lipid profile. Author contributions Conception and design of the research: Hernández I, Estrella A, Salazar J, Duarte Y, Torres E, López C, Terán S, Mendoza A, Terán E. Acquisition of data: Salazar J, Duarte Y, Torres E, López C, Terán S, Mendoza A. Analysis and interpretation of the data: Hernández I, Estrella A, Salazar J, Duarte Y, Torres E, López C, Terán S, Terán E. Statistical analysis: Terán S, Mendoza A, Terán E. Obtaining financing: Estrella A. Writing of the manuscript: Hernández I, Estrella A, Terán E. Critical revision of the manuscript for intellectual content: Hernández I, Estrella A, Salazar J, Duarte Y, Torres E, López C, Terán S, Mendoza A, Terán E. Potential Conflict of Interest No potential conflict of interest relevant to this article was reported. Sources of Funding This study was funded by Pontificia Universidad Catolica del Ecuador. Study Association This study is not associated with any thesis or dissertation work. goals were attained by 29% of subjects taking initial dose of statin therapy and and after statin dosage adjustment 42% of the subjects reach the goal at the end of the study. ATPIII therapy goals were better attained in groups at a lower risk. 11 As we described in the preliminary analysis of the results, previously published by our group, 12 physicians are probably not evaluating the total lipid profile when selecting and monitoring the therapy. Evidence of this is: a) nearly half of the subjects had a total cholesterol reduction and showed a 60% reduction in triglycerides; b) all three parameters (total-c, LDL-c and triglycerides) were reduced in almost 43% of the subjects; and c) 70% of the study population had mixed hyperlipidemia. In this sense, although it may be appropriate to adhere to treatment guidelines that recommend addressing LDL-C levels as the first step, it is important to deeper evaluate and treat these patients. 13 Adherence to treatment is an important factor that affects the success of reaching the proposed target and Hernández et al. Dyslipidemia treatment in Ecuadorian population Int J Cardiovasc Sci. 2020; 33(4):371-376 Original Article