BackgroundThe aim of this study was to examine recommended target levels of low-density lipoprotein cholesterol (LDL-C) for hyperlipidaemia patients at high risk (i.e., with two or more risk factors or coronary heart disease or its risk equivalents) for cardiovascular disease (CVD); to determine LDL-C targets recommended by guidelines, and to examine the proportions of patients who do not achieve targeted LDL-C levels in real-world studies.MethodsElectronic databases were searched: Medline, Medline In-Process, Embase, BIOSIS, and the Cochrane Library (1 January 2005 to 31 December 2013). Guideline searches were limited to publications in the last 5 years. There were no geographical or language restrictions.ResultsSeventeen guidelines and 42 observational studies that reported on high-risk hyperlipidaemia patients were identified. The National Cholesterol Education Program–Adult Treatment Panel III’s LDL-C target levels were the most common guidelines used for patients with very high hyperlipidaemia. However, between 68 and 96 % of patients in the studies did not achieve an LDL-C goal <70 mg/dL, except in one study conducted in China (16.9 %). In high-risk patients, 61.8 to 93.8 % did not achieve a target of <100 mg/dL. Regarding common comorbidities, patients with concomitant CVD or diabetes were least likely to reach their target LDL-C goals.ConclusionIn patients with high risk for CVD, the majority of patients do not attain recommended LDL-C goals, highlighting worldwide suboptimal hyperlipidaemia management and missed opportunities for reduction of the patients CVD risk. Lipid-modifying management strategies need to be intensified.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0241-3) contains supplementary material, which is available to authorized users.
objeCtives: To evaluate the management of Chronic Thromboembolic Pulmonary Hypertension (CTEPH) in a referral hospital by assessing clinical variables, patientreported outcomes and caregivers' burden. Methods: An observational, retrospective study was conducted. All patients (aged > 18 years) attending the specialised unit on CTEPH at the 12 de Octubre Hospital (Spain), between January 2010 and November 2012, were offered to participate. Clinical variables were recorded at the clinical session for treatment decision (Pulmonary endarterectomy -PEA-if operability was confirmed or medication therapy -MT-if inoperable), and after one year. Outcomes considered: The New York Heart Association Functional Class (FC), 6-Minute Walking Distance, pulmonary arterial pressure, pulmonary vascular resistance and pro-brain natriuretic peptide. Participants completed the EQ-5D and caregivers' fulfilled the Zarit Burden Interview. Differences between groups were studied (Chi-squared, Mann-Whitney U and ANCOVA). Results: A total of 64 CTEPH cases (57.8% males) were included. Mean (SD) age at diagnosis was 55.8 (14.9) and 67.2% had an III-IV FC at diagnosis. At the moment of treatment prescription, differences in clinical variables were not found (all p> 0.4) between PEA (n= 35-54.7%-) and MT groups (n= 29-45.3%-). After 12 months, 8 patients died (2 in PEA group and 6 in MT). Among survivors, FC was significantly better in PEA group (93.9% improved at least one level). Regarding EQ-5D, patients undergoing PEA showed significant higher utilities (0.83-0.17-vs. 0.53-0.31-p= 0.007) and VAS values (80.22-14.24-vs. 49.47-20.68-p< 0.001). Furthermore, mean VAS values in PEA group were comparable to general population (adjusted by sex and age). Finally, formal care was needed by just 4.8% of patients in PEA versus 33.3% in MT. Reported caregivers' burden were relatively low in both groups (p= 0.87). ConClusions: The positive outcomes obtained, especially in those patients undergoing PEA, suggest the experienced management of CTEPH by this referral hospital and highlights the importance of detecting candidates for PEA. PCV22 the 3.
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