In patients at high cardiovascular risk, a low-density lipoprotein cholesterol (LDL-C) reduction of ≥50% from baseline and an LDL-C goal of <70 mg/dL (or <55 mg/dL in very high-risk patients) are recommended. Multiple registry and retrospective studies have shown that patients with high atherosclerotic cardiovascular risk often do not reach the targets defined by the European Society of Cardiology guidelines as a result of suboptimal management of LDL-C. Here, we report the data on lipid-lowering therapy and lipid targets from the Survey on Risk FactOrs and CardiovascuLar secondary prEvention and drug strategieS (SOFOCLES), an observational, prospective study designed to collect data on patients with ischemic heart disease treated at cardiac outpatient clinics across the Italian national territory. We included patients with known coronary heart disease (CHD) who underwent follow-up visits at various outpatient cardiology clinics. A total of 2532 patients were included (mean age: 67±17 years, 80% male). Among patients with available laboratory data (n=1712), 995 (58%) had LDL-C<70 mg/dL, 717 (42%) had LDL-C≥70 mg/dL, and 470 (27%) had LDL-C<55 mg/dL. Patients who more frequently achieved the recommended LDL-C levels were male, had diabetes, had a higher educational level, and performed intense physical activity. Statins were used in 2339 (92%) patients, high-intensity statins (e.g., rosuvastatin 20/40 mg or atorvastatin 40/80 mg) in 1547 patients (61% of the whole population and 66% of patients on statins), and ezetimibe in 891 patients (35%). Patients receiving high-intensity statins tended to be younger, not to have diabetes, and to have been included in a cardiac rehabilitation program. In a real-world sample of Italian patients with CHD, adherence to lipid-lowering therapy fell markedly short of optimal levels. Many patients did not achieve the LDL-C target of 70 mg/dL, and even fewer reached the LDL-C target of 55 mg/dL. Notably, patients with a lower educational level had a greater likelihood of being undertreated. Strategies aimed at improving preventive interventions for CHD and overcoming social disparities should be evaluated and optimized.

Background/Objectives: Postoperative atrial fibrillation (POAF) is a common complication of coronary artery bypass grafting (CABG) and may recur during cardiac rehabilitation (CR); its long-term prognostic value remains unclear. We evaluated the impact of POAF on a composite endpoint of all-cause mortality and non-fatal stroke after isolated CABG and assessed POAF duration and timing, AF recurrence, and other predictors of adverse outcomes. Methods: This multicentre retrospective study enrolled 1139 patients who underwent CR after isolated CABG between 2011 and 2015 across 17 Italian centres. Clinical and outcome data were obtained from medical records and structured interviews; median follow-up was 5.78 years. Results: POAF occurred in 34.3% of patients and was associated with a higher incidence of the primary composite endpoint of all-cause mortality and non-fatal stroke in univariate analysis (15.4% vs. 10.0%, p = 0.008), particularly when lasting ≥48 h or occurring during both surgery and rehabilitation. However, in multivariate analysis POAF was not an independent predictor; instead, CHA₂DS₂-VASc score ≥3, reduced left ventricular ejection fraction, elevated urea, history of heart failure, and AF recurrence during follow-up predicted adverse outcomes. Conclusions: POAF reflects early vulnerability but does not independently predict long-term mortality or stroke. Conversely, AF recurrence and CHA₂DS₂-VASc score retain strong prognostic value, underscoring the need for long-term rhythm monitoring and individualised risk assessment post-CABG.