Evaluation of the effectiveness of the implementation of recommendations on lipid-lowering therapy in patients with very high cardiovascular risk in medical organizations of the North-Western federal district

Abstract

Cardiovascular pathology remains the leading cause of mortality in Russia, which determines the priority of correcting modifiable risk factors. According to the 2023 clinical guidelines on lipid metabolism disorders, patients at very high cardiovascular risk should be prescribed starting therapy with statin + ezetimibe combination. A study was conducted to assess the adequacy of dyslipidemia correction in the Northwestern Federal District in 2023; in 2025, a repeat study was initiated to evaluate the dynamics. Materials and methods. The study was conducted using a specially developed questionnaire: 165 patients in 2023 and 281 patients in 2025. The results were comparable with the ESSE-RF, ARGO-3, ICEBERG, ESSE-RF-2 studies. Statistical significance was assessed using two-sample Fisher’s z-test. The results and their discussion. There was a significant increase in the number of patients with grade 1-3 obesity (from 18.8 % to 39.9 %; z-criterion 4.62; p<0.00001), while the proportion of overweight patients decreased, approaching but not reaching significance (from 47.8 % to 38.4 %; z-criterion – 1.95; p<0.05). Patients with physical inactivity became significantly less common (60.0 % vs. 38.4 %; z-criterion 4.42; p<0.00001). The number of patients with postinfarction cardiosclerosis increased (9.6 % vs. 37.2 %; z-criterion 6.92; p<0.00001). In 2025, statin monotherapy was prescribed three times more often (94.7 % vs 36.9 %). There was a significant increase in the prescription of the statin + ezetimibe combination (53.6 % vs 0.0 %). Lipid profile monitoring was performed in 74.8 % of patients in 2025 and 78.1 % in 2023; outpatient therapy correction was carried out in 17.0 % and 16.3 %, respectively. The target level of LDL-C < 1.4 mmol/L was achieved in 34,9 % of causes in 2023 and 49,3 % in 2025 (p=0,007). Conclusion. The paper considers ways to address the discrepancy between prescribed lipid-lowering therapy and clinical guidelines: inclusion of eze-timibe and the fixed combination of statin + ezetimibe in the list of subsidized drug provision, and compliance with dispencary observation requirements.