From Valencia, a team from the University Clinical Hospital and the INCLIVA Health Research Institute is analyzing how fine-tune lipid control The research focuses on patients following a heart attack to prevent further coronary events. The study aims to translate the findings into clinical practice.
The studies explore three complementary fronts: the actual impact of the lifestyle changes and medications on LDL cholesterol, the evolution of HDL cholesterol during rehabilitation and screening of familial hypercholesterolemia in survivors of acute myocardial infarction.
Lines of research in lipid control after a heart attack
The clinical-research team, led by Victor Marcos Garces along with Carlos Bertolín Boronat y Hector Merenciano Gonzalez, is part of the Translational Research Group in Ischemic Heart Disease of INCLIVA and CIBER CB16 / 11/00486, coordinated by the professor Vicente Bodí PerisThe lines of research address both the biological response to lipid-lowering drugs and strategies for personalized medicine in secondary prevention.
To achieve this, they have relied on the involvement of the Cardiology and Rehabilitation Services of the hospital itself, the INCLIVA Biobank, and the collaboration of the CIBER group. CB16 / 11/00360Directed by Manuel Francisco Jiménez Navarro, Together with the FIMABIS and the Virgen de la Victoria University Hospital in Malaga, thus reinforcing a working network with a focus multicenter.
LDL: When lifestyle isn't enough
In the study published in the Journal of Clinical Medicine, with 179 post-infarction patients After completing phase 2 of rehabilitation, it was found that, despite good adherence to heart-healthy diet and exercise, around a third does not reach the expected LDL reduction with the prescribed treatment.
The authors emphasize that this profile may reflect variability in response to lipid-lowering drugs and baseline LDL levels that are difficult to modulate through lifestyle alone. In these situations, they recommend avoiding blaming the patient and intensify treatment when indicated, given that, even with adjustments, the LDL target is achieved less frequently in this subgroup.
HDL during cardiac rehabilitation
A second study, published in Reviews in Cardiovascular Medicine, followed 121 patients and described a noticeable improvement in HDL cholesterol throughout the Cardiac Rehabilitation Program. The increase was most notable in exfumadores and in those who reduced total cholesterol and LDL cholesterol the most.
According to the results, HDL, although considered a secondary control target, can benefit from the combination of physical training and behavioral changes. However, people with higher baseline HDL levels and elevated figures of lipoprotein(a) showed a lower probability of relative improvement.
Screening for familial hypercholesterolemia after a heart attack
The third study, published in Cardiogenetics, assessed the diagnostic probability of familial hypercholesterolemia in 245 heart attack survivors treated in rehabilitation. Two-thirds presented a low probability, but in the rest the diagnosis was "possible" or "probable" following the Dutch Lipid Clinic Network (DLCN) criteria.
Nevertheless, they were carried out very few genetic studiesThis indicates clear room for improvement. The team proposes standardizing the use of the DLCN criteriaReview/estimate baseline LDL levels and prioritize genetic testing in patients with a high probability of developing the condition, to optimize treatment and facilitate the prevention in family members.
Publication and funding
The findings have been recorded in Journal of Clinical Medicine, Reviews in Cardiovascular Medicine y CardiogeneticsAmong the signatories are Víctor Marcos Garcés, Carlos Bertolín Boronat, and Héctor Merenciano González, within the framework of the INCLIVA ischemic heart disease group and the structure CIBERCV led by Vicente Bodí Peris at the University of Valencia.
The projects have received support from Carlos III Health Institute, the Funds SPRING and the ESF +: aid PI20/00637, PI23/01150, CIBERCV16/11/00486, as well as CM23/00246 granted to Hector Merenciano Gonzalez and CM21/00175 and JR23/00032 to Victor Marcos Garces.
Implications for patients and the healthcare system
In a scenario of increasingly demanding LDL targets in Europe, this data supports an approach proactive and personalized After a heart attack: combine lifestyle interventions with pharmacological intensification when necessary and take advantage of cardiac rehabilitation to monitor and adjust.
Improved screening for familial hypercholesterolemia can drive strategies for cascade detection and more effective treatments, with an impact on relapses and healthcare burden. Integrating these measures into rehabilitation pathways facilitates a more effective approach. coordinated and equitable for post-heart attack patients.
The three studies reinforce that LDL control requires therapeutic escalation without stigmathat HDL can improve with rehabilitation and that genetic screening should be systematized; a useful roadmap for cardiology and public health services seeking to reduce heart attacks and complications in Spain.
