10-YEAR RISK ESTIMATION OF ATHEROSCLEROTIC CARDIOVASCULAR DISEASE IN HYPERTENSIVE PATIENTS.

lipoprotein cholesterol goal levels with next lipid profile assessment 8 (± 4) weeks.


Introduction/Вступ
Arterial hypertension (AH) is the major preventable cause of cardiovascular disease (CVD) and all-cause death globally in Europe [1]. Substantial progress has been made in understanding the epidemiology, pathophysiology, and risk associated with hypertension [2].
Atherosclerotic cardiovascular disease (ASCVD) defined as coronary heart disease, cerebrovascular disease, or peripheral arterial disease presumed to be of atherosclerotic origin [3]. It is the leading cause of morbidity and mortality globally. In the United States, hypertension accounts for more ASCVD deaths than any other modifiable ASCVD risk factor [4].
AH is the major risk factor for both ASCVD and microvascular complications. Moreover, numerous studies have shown that antihypertensive therapy reduces ASCVD events, heart failure, and microvascular complications [3].
Еstimating an individual's 10-year absolute ASCVD risk is used to guide decision making for many preventive interventions, including lipid management [5] and blood pressure management [6].
It should be the start of a conversation with the patient about risk-reducing strategies (the "clinician-patient discussion") and not the sole decision factor for the initiation of pharmacotherapy [4].
Ideally, risk charts should be based on countryspecific cohort data [7].
Materials and Methods. We observed 61 patients with AH. AH was confirmed when the level of systolic and diastolic blood pressure was more than 140 mmHg and 90 mmHg, respectively.
Patients may have AH of stage 1 or 2. The classification of AH was assessed according to 2020 International Society of Hypertension Global Hypertension Practice Guidelines, in which stage 3 of AH is absent and stage 2 is determined for all persons, when the levels of systolic and diastolic blood pressure is more than 160/100 mmHg, respectively. Furthermore, the sorting of stages is not defined according to these latest guidelines [8].
Participants were treated by dual antihypertensive therapy, which included reninangiotensin-aldosterone system inhibitors (lisinopril 10-20 mg or telmisartan 40-80 mg once daily in the morning) and calcium channel blocker (amlodipine 10 mg once daily in the evening). Additionally, for improvement of lipid profile disorders confirmed before the examination all of them had been treated with atorvastatin (10-20 mg once daily in the evening) previously.
Results and discussion. For five persons (8 %) it was not possible to calculate ASCVD Risk on online-calculator. In all other 56 patients we evaluated this risk. Three of them had 1.7 mmol/l of LDL-C. The online calculators is invalid for low density lipoprotein cholesterol LDL-C which is less than 1.8 mmol/l. In two persons total cholesterol was too low (3.2 mmol/l) to calculate risk score.
In all other 56 patients we determined this risk. Low ASCVD 10-year risk was confirmed in 30 (53.6 %), borderline -2 (3.6 %), intermediate -11 (19.6 %), high -13 (23.2 %). The results of ASCVD 10-year risk was imaged in Figure 1. recommended to emphasizing of lifestyle for risk factors reduction. In the case of our study the risk factors connected with lipid profile disorders are persistently elevated LDL-C (> 4.1 mmol/l) and triglycerides (> 2.0 mmol/l). In addition, in adults with AH, including those requiring antihypertensive medications weight loss is recommended to reduce BP [4]. The levels of LDL-C in our participants with low ASCVD 10-year risk did not exceed 4.1 mmol/l. Among 30 (53.6 %) patients with low ASCVD 10-year risk the levels of triglycerides were more than 2 mmol/l in 7 persons for which it is recommended to continue lipid lowering therapy.
That is why for further management of 23 participants with low ASCVD 10-year risk and normal triglycerides we decided to analyze additionally the total cardiovascular risk categories with next determination of LDL-C goal levels according to 2019 ESC/EAS Guidelines for the management of dyslipidaemias [7]. For patients without goal levels it is recommended to continue treatment with statins.
Among the 23 patients, 14 had low total cardiovascular risk and 9moderate. The goal levels of LDL-C were not determined in 1 person with low and in 5 with moderate total cardiovascular risk. The absence of high and very high total cardiovascular risk was connected with the sex (all these 23 persons are female), absence of smoking, age (from 44 till 65 years old).
As a result, it was recommended to continue treatment with moderate doses of atorvastatin in 13 patients with low ASCVD 10-year risk with next assessment of lipid profile in 8 (± 4) weeks.
For persons with the presence of LDL-C goal levels according to 2019 ESC/EAS Guidelines for the management of dyslipidaemias [7] annually checking of lipid profile was advisable.
According to 2019 ACC/AHA Guideline on the Primary Prevention of Cardiovascular Disease lowdose aspirin (75-100 mg orally daily) might be considered for the primary prevention of ASCVD among select adults 40 to 70 years of age who are at higher ASCVD risk but not at increased bleeding risk [4].
2. Atherosclerotic cardiovascular disease absolute 10-year risk is recommended for hypertensive adults in the case of further treatment improvement.
3. If the atherosclerotic cardiovascular disease absolute 10-year risk is borderline, intermediate it is reasonable to continua therapy which must include moderate-intensity statin (atorvastatin include 10-20 mg daily).
4. If the atherosclerotic cardiovascular disease absolute 10-year risk is low it is reasonable to determine additionally total cardiovascular risk categories and continua moderate intensity statin (atorvastatin include 10-20 mg daily) in the case of absence low density lipoprotein cholesterol goal level with further assessment of lipid profile in 8 (± 4) weeks.
5. For hypertensive patients with high risk high-intensity statin therapy (atorvastatin 40-80 mg daily) can be recommended and low-dose aspirin (75-100 mg orally daily) might be considered among persons who are not at increased bleeding risk.

Prospects for future research/Перспективи подальших досліджень
Perspectives for future research include assessment of lipid profile spectrum and ASCVD 10-year risk in persons with AH secondly in 6 months for determination of possible reduction of it on the background of moderate-intensity and high-intensity statin therapy.