Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach

Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach

Öz:

Objective: The aim of this study is to analyze the low-density lipoprotein cholesterol-lowering therapies in secondary prevention patients by analyzing their plasma low-density lipoprotein cholesterol levels, current treatment, considering their inadequate response to medications (as defined in current guidelines), and the requirement for a protein convertase subtilisin/kexin type 9 inhibitor. Methods: Delphi panel is used to seek expert consensus of experienced 12 cardiologists. A questionnaire consisting of 6 main questions is used to reflect the opinion of the expert panelists on the practices of low-density lipoprotein cholesterol-lowering therapies of patients with high and very high cardiovascular risk. Patients with atherosclerotic cardiovascular disease are covered in this present analysis. Results: According to expert opinion data, 18.6% of the patient population with atherosclerotic cardiovascular disease is estimated to have experienced recurrent vascular events. The current treatment of the patient population is 39.7% on high dose, 36.9% on low/moderate dose of statin, 13.1% on maximum tolerated dose statin + ezetimibe, and 1.2% on maximum tolerated dose statin + ezetimibe + protein convertase subtilisin/kexin type 9 inhibitor. The percentage of atherosclerotic cardiovascular disease patients with inadequate treatment response is estimated to be 20.2% in those using “maximum tolerated dose statin + ezetimibe.” The proportion of patients who will need to be treated with a protein convertase subtilisin/kexin type 9 inhibitor increases as their low-density lipoprotein cholesterol levels rises from 9.1% in 70-99 mg/dL to 50.8% in ≥160 mg/dL for these patients. Conclusion: According to expert opinion, although a substantial proportion of patients with secondary prevention have not achieved low-density lipoprotein cholesterol goals, the use of protein convertase subtilisin/kexin type 9 inhibitors is very low. Since the questionnaire subject to panel discussion did not include any question elaborating the issue, the discrepancy between the recommendation of the related guidelines and Turkish practice needs further studies for the explanation.

Anahtar Kelime:

Sekonder Önlem Hastalarında Kardiyovasküler Riski Azaltmada PCSK9 İnhibitör Gereksinimine Özel Vurgu ile Lipit Modifikasyonu: Delphi Panel Yaklaşımına Dayalı Bir Analiz

Öz:

tedavilerini, plazma LDL-K düzeylerini, mevcut tedavilerini, ilaçlara yanıtlarının yetersizliğini (mevcut rehberlerde açıklandığı şekilde) ve protein konvertaz subtilisin/keksin tip 9 (PCSK9) inhibitörlerine ihtiyaçlarını dikkate alarak analiz etmek. Yöntemler: Delphi panel yaklaşımı kullanıldı. Panelde, deneyimli 12 kardiyolog yer aldı. Uzman panelistlerin yüksek ve çok yüksek KV riski olan hastaların tedavi uygulamaları ve bunların sonuçları ile ilgili ortak görüşlerini yansıtacak şekilde altı ana soru içeren bir anket hazırlandı. Bu çalışma aterosklerotik kardiyovasküler hastalığı (ASKVH) olan hastaların analizlerini kapsamaktadır. Bulgular: Uzman görüşü verilerine göre, ASKVH olanların %18,4’inde tekrarlayan vasküler olayların görüldüğü tahmin edilmektedir. Bu hastaların %39,7’si yüksek, %36,9’u düşük/ orta doz statin, %13,1 “maksimum tolere edilen doz (MTD) statin + ezetimib ve %1,2 MTD statin + ezetimib + PCSK9 inhibitörü ile tedavi edilmektedir. MTD statin + ezetimib” ile tedavi edilen hastaların %20.2’sinde tedavi yanıtının yetersiz olduğu tahmin edilmektedir. PCSK9 inhibitörü ile tedavi edilmesi gereken hastaların oranı, LDL-K seviyeleri yükseldikçe artmaktadır. Tekrarlayan vasküler olayı olan LDL-K düzeyleri 70-99 mg/dL aralığında olan hastalarda %9,1 iken LDL-K düzeyleri ≥160 mg/dL olanlarda %50,8 olduğu tahmin edilmektedir. Sonuç: Uzman görüşüne göre, sekonder koruma hastalarının önemli bir kısmı hedef LDL-K seviyelerinde olmasa da PCSK9 inhibitörlerinin kullanımı çok düşüktür. Panel tartışmasına konu olan ankette bu konuyu detaylandıran herhangi bir soru bulunmadığından, ilgili kılavuzların tavsiyesi ile Türkiye uygulaması arasındaki çelişkinin açıklanması için daha fazla araştırma yapılması gerekmektedir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

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APA	Kızılırmak P, Ongen Z, Gulec S, Kayikcioglu M, KILICKAP M, ABACI A, Özer N, Aydogdu S, Temizhan A, YILMAZ M, Bozkurt E, Dölek B, Tokgozoglu L (2022). Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. , 554 - 560. 10.5543/tkda.2022.22367
Chicago	Kızılırmak Pınar,Ongen Zeki,Gulec Sadi,Kayikcioglu Meral,KILICKAP MUSTAFA,ABACI ADNAN,Özer Necla,Aydogdu Sinan,Temizhan Ahmet,YILMAZ MEHMET BIRHAN,Bozkurt Engin,Dölek Bilgen,Tokgozoglu Lale Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. (2022): 554 - 560. 10.5543/tkda.2022.22367
MLA	Kızılırmak Pınar,Ongen Zeki,Gulec Sadi,Kayikcioglu Meral,KILICKAP MUSTAFA,ABACI ADNAN,Özer Necla,Aydogdu Sinan,Temizhan Ahmet,YILMAZ MEHMET BIRHAN,Bozkurt Engin,Dölek Bilgen,Tokgozoglu Lale Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. , 2022, ss.554 - 560. 10.5543/tkda.2022.22367
AMA	Kızılırmak P,Ongen Z,Gulec S,Kayikcioglu M,KILICKAP M,ABACI A,Özer N,Aydogdu S,Temizhan A,YILMAZ M,Bozkurt E,Dölek B,Tokgozoglu L Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. . 2022; 554 - 560. 10.5543/tkda.2022.22367
Vancouver	Kızılırmak P,Ongen Z,Gulec S,Kayikcioglu M,KILICKAP M,ABACI A,Özer N,Aydogdu S,Temizhan A,YILMAZ M,Bozkurt E,Dölek B,Tokgozoglu L Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. . 2022; 554 - 560. 10.5543/tkda.2022.22367
IEEE	Kızılırmak P,Ongen Z,Gulec S,Kayikcioglu M,KILICKAP M,ABACI A,Özer N,Aydogdu S,Temizhan A,YILMAZ M,Bozkurt E,Dölek B,Tokgozoglu L "Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach." , ss.554 - 560, 2022. 10.5543/tkda.2022.22367
ISNAD	Kızılırmak, Pınar vd. "Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach". (2022), 554-560. https://doi.org/10.5543/tkda.2022.22367

APA	Kızılırmak P, Ongen Z, Gulec S, Kayikcioglu M, KILICKAP M, ABACI A, Özer N, Aydogdu S, Temizhan A, YILMAZ M, Bozkurt E, Dölek B, Tokgozoglu L (2022). Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. Türk Kardiyoloji Derneği Arşivi, 50(8), 554 - 560. 10.5543/tkda.2022.22367
Chicago	Kızılırmak Pınar,Ongen Zeki,Gulec Sadi,Kayikcioglu Meral,KILICKAP MUSTAFA,ABACI ADNAN,Özer Necla,Aydogdu Sinan,Temizhan Ahmet,YILMAZ MEHMET BIRHAN,Bozkurt Engin,Dölek Bilgen,Tokgozoglu Lale Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. Türk Kardiyoloji Derneği Arşivi 50, no.8 (2022): 554 - 560. 10.5543/tkda.2022.22367
MLA	Kızılırmak Pınar,Ongen Zeki,Gulec Sadi,Kayikcioglu Meral,KILICKAP MUSTAFA,ABACI ADNAN,Özer Necla,Aydogdu Sinan,Temizhan Ahmet,YILMAZ MEHMET BIRHAN,Bozkurt Engin,Dölek Bilgen,Tokgozoglu Lale Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. Türk Kardiyoloji Derneği Arşivi, vol.50, no.8, 2022, ss.554 - 560. 10.5543/tkda.2022.22367
AMA	Kızılırmak P,Ongen Z,Gulec S,Kayikcioglu M,KILICKAP M,ABACI A,Özer N,Aydogdu S,Temizhan A,YILMAZ M,Bozkurt E,Dölek B,Tokgozoglu L Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. Türk Kardiyoloji Derneği Arşivi. 2022; 50(8): 554 - 560. 10.5543/tkda.2022.22367
Vancouver	Kızılırmak P,Ongen Z,Gulec S,Kayikcioglu M,KILICKAP M,ABACI A,Özer N,Aydogdu S,Temizhan A,YILMAZ M,Bozkurt E,Dölek B,Tokgozoglu L Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach. Türk Kardiyoloji Derneği Arşivi. 2022; 50(8): 554 - 560. 10.5543/tkda.2022.22367
IEEE	Kızılırmak P,Ongen Z,Gulec S,Kayikcioglu M,KILICKAP M,ABACI A,Özer N,Aydogdu S,Temizhan A,YILMAZ M,Bozkurt E,Dölek B,Tokgozoglu L "Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach." Türk Kardiyoloji Derneği Arşivi, 50, ss.554 - 560, 2022. 10.5543/tkda.2022.22367
ISNAD	Kızılırmak, Pınar vd. "Lipid Modification to Reduce Cardiovascular Risk in Secondary Prevention Patients with Special Emphasis on PCSK9 Inhibitor Requirement: An Analysis Based on Delphi Panel Approach". Türk Kardiyoloji Derneği Arşivi 50/8 (2022), 554-560. https://doi.org/10.5543/tkda.2022.22367