(by Nicola Simonetti) Having a high rate of cholesterol in the blood (hypercholesterolemia) means risking strongly atherosclerosis, open door to the entrance of one or more serious cardiovascular events.
It is essential to identify hypercholesterolemics and treat them immediately, to prevent the consequences deriving from that unwelcome excess guest. “There is a considerable share of Italians exposed to a particularly high risk of acute cardiovascular events that it is urgent to identify and control without delay. In particular, they are the veterans of a first manifestation of a cardiovascular pathology and, that is, the veterans from a heart attack, those with a previous stroke. They are the favorite victims and re-heart attack or other event is just around the corner. Fundamental, for them, is a secondary prevention intervention based essentially on the control of risk factors ". Prof. Pasquale Perrone Filardi (Univ. Federico II, Naples), at the second edition of Meridiano Cardio promoted by The European House-Ambrosetti (“New perspectives in secondary cardiovascular prevention: focus on hypercholesterolemia”).
“Cardiovascular diseases represent the leading cause of death in Italy (220 a year), being responsible for 35% of total deaths. Ischemic diseases of the heart, cerebrovascular, hypertensive, other cardiovascular diseases occupy the first 5 positions. It is not surprising, therefore - said Francesco Saverio Mennini, professor of Health Economics, University of Rome Tor Vergata - if the health costs (direct and indirect) associated with these diseases reach 21 billion euros / year. In particular, direct healthcare costs, 84% attributable to hospitalizations, amount to 16 billion; almost 11% of the total health budget in Italy ”.
The prevention to be implemented is soon said: radical change of lifestyle, cessation of smoking, adoption of a correct diet and habitual practice of physical activity and, moreover, pharmacological intervention aimed at the correction of diabetes, hypertension and hypercholesterolemia .
On the bench of the defendants this last condition that, as noted by numerous studies and clinical practice, assumes a crucial role in the development of cardiovascular diseases. Galeotto, especially LDL cholesterol (C-LDL), universally recognized as the causal factor of atherosclerosis and the risk of serious cardiovascular events.
For example, it would be enough to lower it in the blood by only 39 mg / dL (1 mmol / L) to obtain an evident decrease in the relative risk of cardiovascular events of 10% in the first year, of 16% in the second year and of 20% after three years of treatment.
It would seem easy but the reality is different. Fifty percent of patients returning from an acute cardiovascular event are not taking cholesterol-controlling drugs and those being treated are not faithful to prescribed medications. Only 50% of patients at very high risk and 45,9% of those at medium cardiovascular risk are observed.
Moreover, the recommended rules of life are not always put into practice.
It is easy to understand the discrepancies between the realities demonstrated by science and clinical practice with the consequence that hypercholesterolemia continues to be the master and rage, undisturbed, aiming to provoke a second or further other cardiovascular event with its specific consequences.
"The scientific evidence today - points out Perrone Filardi - tells us that the ideal value of cholesterol, especially in subjects at very high risk, should even be much lower than the one currently recommended. This lower value offers an advantage for the patient, in terms of fewer strokes, fewer myocardial infarctions, fewer hospitalizations and fewer deaths.
Keep in mind that about 4-10% of patients in secondary prevention - says prof. Marcello Arca (Policlinico Umberto I, Rome) - is carrier of familial hypercholestetolemia, genetic disease, which makes them resistant to conventional therapies. They must be identified and subjected to more appropriate therapies.
Hypercholesterolemia is a preventable risk factor: "It will strike sooner or later / to avoid it, all you need to do is" (Venetian proverb).
"The results show - reiterates Mennini - how the share of patients not on target is very high, equal to 65,1% for users of low and moderate intensity statins and equal to 53,9% for users of high intensity, as demonstrated by our extensive research. This also depends on the fact that a proportion of these patients are treated in a "sub-optimal" manner. Even in the case of "optimal" treatment, more than half of the subjects do not reach the target levels of LDL-C defined by the guidelines ".
“New drugs are available - adds Perrone Filardi - that are extremely effective in controlling hypercholesterolemia, including PCSK9 inhibitors. These are monoclonal antibodies capable of determining a reduction in cholesterol levels of more than 50% with an excellent safety and tolerability profile. Their use translates into a significant reduction in cardiovascular risk, with a reduction of over 20% of heart attacks and strokes, alongside a reduction in the need to undergo coronary revascularization interventions in patients ".
“Although PCSK9 inhibitors represent a therapeutic opportunity of recognized importance, their use is still limited. Only 13-14% of patients to whom these drugs are indicated - underlines Federico Spandonaro, professor of health economics, University of Rome Tor Vergata; President, CREA Sanità - was actually subjected to this therapy ”.
The reasons for this underuse are to be found in a series of factors, due, for example, to the bureaucratic procedure linked to repayment plans.
The link between prescribing physicians and local health workers is recommended.
"It is considered essential - says Dr. Sabrina Nardi, Cittadinanzattiva - to simplify the bureaucratic implications, to give clear messages and to be close to the patient, to help him in adhering to therapies and other prescriptions, to recognize dignity to the citizen and timely, adequate, safe responses to his needs. Revisit the diagnostic-therapeutic paths, different areas, from the waiting to access controls, visits and specific examinations, to the difficulties for territorial assistance, for example on the rehabilitation side and for access to drugs. "