An attempt to make lipid-lowering therapy more effective in Hungary. The results of MULTI GAP 2010 and the Plus Program

Abstract

IntroductionThe primary goal of lipid-lowering therapy is the attainment of low-density lipoprotein cholesterol (LDL-C) target levels.Material and methodsThe MULTI GAP (MULTI Goal Attainment Problem) 2010 is a part of surveys started a few years ago, in which the lipid results of 1540 patients treated by general practitioners (GPs) and specialists were measured. The data were compared to the results of similar studies involving 15,580 patients between 2004 and 2009.ResultsIn 2010 the mean LDL-C level (± SD) of patients treated by GPs was found to be 3.01 ±1.0 mmol/l. The target of 2.50 mmol/l was achieved by 32%, with a mean LDL-C level of 2.84 ±1.0 mmol/l and an achievement rate of 39% in patients treated by specialists. The results of comparisons starting from 2004 showed a marked improvement every year in the beginning, but in the last 3 years stagnation was observed. In 2010 in addition to the MULTI GAP main study, a group of physicians took part in special training called the Plus Program. As a result of this, the LDL-C level was 0.18 mmol/l lower in 114 of the GPs’ patients (p = 0.088) and 0.27 mmol/l (p < 0.0001) lower in 313 of the specialists’ patients, with a significantly better, 42% (p = 0.045) and 50% (p = 0.001), goal attainment rate, respectively.ConclusionsThe 2010 MULTI GAP study shows that the quality of lipid-lowering therapy in Hungary seems to be in stagnation. The results of the PLUS Program suggest that continuous training of doctors is the key to further improvement.

Non-HDL cholesterol goal attainment and its relationship with triglyceride concentrations among diabetic subjects with cardiovascular disease: A nationwide survey of 2674 individuals in Hungary

“…These findings are in general agreement with previous data from Hungary [8,9,12]. By comparison, data from the EUROASPIRE surveys among patients with CHD showed a substantial 51% reduction in raised TC levels (4.5 mmol/l) from 1995 to 2007.…”

“…This is important given the fact that although widespread implementation of lipid guidelines (combined with physician-and patient-education, changes to health care policy, and wider use of statins), may partly account for modest improvements in lipid goals attainment seen more recently [13,14], other counterbalancing influences (such as adverse lifestyle choices, increasing rates of obesity [13], clinical inertia [8], patient non-compliance [9] and/or lack of risk perception) still significantly undermine the strides made in public health and preventative policy.…”

Lipid, blood pressure and kidney update 2013

“…Considering the complicated mechanisms and signals involved in atherosclerosis, research is now focused on novel lipid biomarkers that can be introduced as routine diagnostic tests. It is important to determine whether adding information on apolipoprotein B (apoB) and apolipoprotein A1 (apoA1), lipoprotein (a) or lipoprotein-associated phospholipase A2 to total cholesterol (TC), LDL-C and HDL-C improves cardiovascular disease (CVD) risk prediction [ 12 – 14 ]. It is known that in selected individuals at high CV risk, despite LDL-C, triglycerides (TG) should be targeted, but HDL-C, Lp(a) and ratios such as LDL-C/HDL-C or apoB/apoA1 are not recommended as treatment targets [ 15 ].…”

How can we further improve the LDL-cholesterol target level achievement rate based on the Hungarian MULTI GAP 2011 study results and considering the new European dyslipidemia guidelines?

“…The trends in lipid lowering treatment were studied using the data of 17 420 patients in total from different surveys (CEL Program 2004 and 2005, KONSZENZUS-CEL Program 2006, REALITY 2004 and 2007 studies, MULTI GAP 2008, 2009 and 2010) performed on high cardiovascular risk patients of GPs and specialists in Hungary [ 17 , 18 ].…”