Integrazione sistematica delle

conoscenze per la gestione dei

pazienti con ipercolesterolemia:

il progetto SKIM LEAN

Laura Calabresi

Professore Ordinario di Farmacologia

Coordinatore Scientifico del Centro E. Grossi Paoletti

Dipartimento di Scienze Farmacologiche e

Biomolecolari, Università degli Studi di Milano

HYPERCHOLESTEROLEMIA as RISK FACTOR

LDL, HDL and CHD The PROCAM Study

CH

D E

vents

(ra

te/1

00

6y)

6-year Follow-Up of 4559 middle-aged males

0

2

4

6

8

<132 132-162 >162

LDL Cholesterol (mg/dl)

0

2

4

6

8

<39 39-48 >48

HDL Cholesterol (mg/dl)

Eve

nt

Ra

te (

%)

30

25

20

15

10

5

0

0 70 90 110 130 150 170 190

Statin

Placebo

4S

4S

LIPID LIPID

CARE CARE

HPS HPS

TNT (less-intense LDL-C management)

TNT (intense LDL-C management)

Mean LDL-C (mg/dL)

LDL-C is a major contributor to CV risk

LaRosa JC, et al. N Engl J Med 2005;352:1425–35.

LDL-C levels and event rates in secondary prevention statin studies

Lower LDL-C is associated with increased risk reduction

Ference et al. J Am Coll Cardiol 2015;65:1552.

LDL-C reduction and CV risk

Can

no

n C

P,

et a

l. N

En

gl J M

ed

20

15

;372:2

387

–9

7.

• .

Rischio basso

Punteggio secondo le carte del rischio SCORE <1%.

Rischio moderato

Punteggio secondo le carte del rischio SCORE <5%.

Rischio alto

Pazienti con dislipidemie familiari o

ipertensione severa, diabetici senza fattori di rischio

cardiovascolare e senza danno d’organo e pazienti

con insufficienza renale cronica moderata (GFR 30-

59 ml/min/1.73 m2).

Punteggio secondo le carte del rischio SCORE <10%.

Rischio molto alto

Pazienti con malattia cardiovascolare documentata

Punteggio secondo le carte del rischio SCORE >10%.

LDL-C targets

<115 mg/dl

<115 mg/dl

<100mg/dl

< 70mg/dl

Documento di consenso Intersocietario - G ITAL CARDIOL vol 17, SUPPL 1 AL N 6 2016

Rischio basso

Punteggio secondo le carte del rischio SCORE <1%.

Rischio moderato

Punteggio secondo le carte del rischio SCORE <5%.

Rischio alto

Pazienti con dislipidemie familiari o

ipertensione severa, diabetici senza fattori di rischio

cardiovascolare e senza danno d’organo e pazienti

con insufficienza renale cronica moderata (GFR 30-

59 ml/min/1.73 m2).

Punteggio secondo le carte del rischio SCORE <10%.

Rischio molto alto

Pazienti con malattia cardiovascolare documentata

Punteggio secondo le carte del rischio SCORE >10%.

LDL-C targets

<115 mg/dl

<115 mg/dl

<100mg/dl

< 70mg/dl

Documento di consenso Intersocietario - G ITAL CARDIOL vol 17, SUPPL 1 AL N 6 2016

Nord

estg

aa

rd e

t a

l, E

ur

Hea

rt J

3

4:3

478; 2

01

3

DIAGNOSIS of HeFH

A significant percentage of HeFH patients

do not achieve their LDL-C goal

Pijlman AH, et al. Atherosclerosis 2010;209:189–94.

(100mg/dl)

Only 1 in 5 MI patients achieve LDL-C target <70 mg/dL

despite high statin prescription rate and good

adherence

EUROASPIRE IV: 7998 patients <80 years old with established CHD

On lipid-lowering treatment

SKIM LEAN

Systematic lab Knowledge Integration for

Management of Lipid Excess in high-risk

pAtieNts

Pfizer Independent Grants for Learning & Change

(IGLC) – Grant ID 24028955

Università degli Studi di Milano, Centro Grossi Paoletti

Laura Calabresi, Franco Pazzucconi, Chiara Pavanello

CNR – Istituto di Fisiologia Clinica

M. Giovanna Trivella, Renata de Maria, Marina Parolini

Ospedale Niguarda – ICT

Gianni Origgi, Federica Orsi, Stefano Gatti, Ilaria Barbieri

Ospedale Niguarda – Cardio 5

Antonia Alberti, Fabio Drago, Tiziana Pupilella

NoemaLife-Dedalus

Michele Carenini, Gianpiero Camilli, Paolo Maino

Key Objectives - To assess prevalence of uncontrolled hypercholesterolemia in

Niguarda Hospital catchment area among patients discharged

from hospital after CV events or interventional/surgical

procedures and community-dwelling outpatients who are

otherwise at high risk.

- To improve clinical competence and patient empowerment

through a two-tiered educational website for GPs and patients.

- To scan laboratory data for clues to comorbidities, causes of

secondary hypercholesterolemia, side effects and/or interference

with cholesterol-lowering agents. To streamline referral of

uncontrolled high-risk or very high-risk patients from GP to

specialist outpatient management through a shared care

pathway.

- To increase proportion of patients at high- or very-high CV risk

who achieve target LDL-C levels.

SKIM LEAN – Overall Project Strategy

SKIM LEAN – The numbers

Jan-Dec 2016 - 25250 patients >18 y with at least one LDL-C measurment

LDL-C distribution (mg/dl)

11%

<=70 26%

71-100

31%

101-130

21%

131-160

8%

161-190

3%

>190

SKIM LEAN – The numbers

LDL-C distribution in Females (n=11043) and Males (n=14207)

0

500

1000

1500

2000

2500

3000

3500

4000

4500

<=70 71-100 101-130 131-160 161-190 >190

Females

Males

SKIM LEAN – The numbers

Patients with LDL-C>190 mg/dl – Suspected Heterozygote FH

(1:200 to 1:500)

758

Secondary prevention patients: 2920

LDL>70: 2253

Jan-Dec 2016 - 25250 patients >18 y with at least one LDL-C measurment

SKIM LEAN – Overall Project Strategy

www.ospedaleniguarda.it