Metabolic syndrome, ischemic heart disease, and heart failure: insights from the Colombian Heart Failure Registry (RECOLFACA)

Background

Ischemic heart disease (IHD) is still a leading cause of morbidity and mortality worldwide, with major implications for healthcare systems, especially in low- and middle-income countries. Effective metabolic control and risk factor management, including evidence-based pharmacological therapies such as statins, ACE inhibitors (ACEIs), and angiotensin receptor-neprilysin inhibitors (ARNIs), are essential for reducing adverse outcomes. However, gaps persist in the implementation of these therapies, particularly in resource-limited regions.

Objective

To evaluate metabolic control and the use of evidence-based therapies in patients with IHD enrolled in the Colombian Heart Failure Registry (RECOLFACA), and to identify barriers to optimal treatment implementation.

Methods

This cross-sectional study analyzed demographic, clinical, and biochemical data, as well as medication usage, from patients with confirmed IHD. Descriptive and inferential statistical analyses were performed to identify treatment patterns and associated factors.

Results

Among 2,528 patients with heart failure (HF), 1,123 had IHD. Statins were prescribed to 73.6% (827), antiplatelets to 66.3% (745), and ARNIs to only 10.1% (114), despite guideline recommendations. Statin use was notably low among patients with chronic kidney disease (CKD) (18.1%), diabetes mellitus type 2 (15.8%), and both conditions combined (3.2%).

Conclusions

Despite robust evidence supporting their efficacy, the use of statins, ACEIs, and ARNIs remains suboptimal in Colombia. Addressing barriers to access, adherence, and healthcare delivery is crucial to improve outcomes and align clinical practices with international standards. These findings highlight the need for targeted interventions and future studies to evaluate strategies that enhance access to and adherence with guideline-directed therapies.