Determinants for Achieving the LDL-C Target of Lipid Control for Secondary Prevention of Cardiovascular Events in Taiwan

Abstract

BackgroundEpidemiological and clinical studies have clearly established the link between low-density lipoprotein cholesterol (LDL-C) and atherosclerosis-related cardiovascular consequences. Although it has been a common practice for physicians to prescribe lipid-lowering therapy for patients with dyslipidemia, the achievement rate is still not satisfied in Taiwan. Therefore, the determinants for achieving the LDL-C target needed to be clarified for better healthcare of the patients with dyslipidemia.MethodThis registry-type prospective observational study enrolled the patients with cardiovascular diseases (coronary artery disease (CAD) and cerebrovascular disease (CVD)) from 18 medical centers across Taiwan, and clinically followed them for five years. At every clinical visit, vital signs, clinical endpoints, adverse events, concurrent medications and laboratory specimens were obtained as thoroughly as possible. The lipid profile (total cholesterol, high-density lipoprotein cholesterol, LDL-C, triglyceride), liver enzymes, and creatinine phosphokinase were evaluated at baseline, and every year thereafter. The cross sectional observational data was analyzed for this report.ResultAmong the 3,486 registered patients, 54% had their LDL-C < 100 mg/dL. By univariate analysis, the patients achieving the LDL-C target were associated with older age, more male sex, taller height, lower blood pressure, more under lipid-lowering therapy, more smoking cessation, more history of CAD, DM, physical activity, but less history of CVD. The multivariate analysis showed statin therapy was the most significant independent determinant for achieving the treatment target, followed by age, history of CAD, diabetes, blood pressure, and sex. However, most patients were on regimens of very-low to low equipotent doses of statins.ConclusionAlthough the lipid treatment guideline adherence is improving in recent years, only 54% of the patients with cardiovascular diseases have achieved their LDL-C target in Taiwan, and the most significant determinant for this was statin therapy.

Ezetimibe-Simvastatin Therapy Reduce Recurrent Ischemic Stroke Risks in Type 2 Diabetic Patients

“…Despite these disadvantages, our real-world nationwide data remains valuable for answering uncertain questions and guiding experimental studies. We wish this could help to improve the lower target-achieved rate in IS patients in the future (9,10).…”

“…However, the target achievement of LLT in stroke is not as good as in coronary artery disease (CAD) patients (9,10). Fewer trials have focused on the secondary preventive effects of LLT in stroke patients (11)(12)(13), and most supporting data comes from post hoc analyses or meta-analysis of studies that initially enrolled CAD patients (2, 14 -16).…”

The effect of the intensity of lipid-lowering medications on the LDL cholesterol treatment goals of Asian patients with dyslipidaemia in primary care

“…The results showed that senior patients aged 60 years and older were more likely to achieve treatment goals in both MR and HR groups. Likewise, in a recently published Taiwanese study, older Chinese patients were more likely to attain LDL‐C treatment goal for secondary prevention of cardiovascular disease . It alluded to the patients' perceived risk of further complications with rising age, prompting them to be proactive in taking measures to attain treatment control …”

“…LI and MI levels of LLT were used to manage over 90% of the three risk groups (Table ). The Taiwanese study also showed that most patients were on regimens of very low to low equipotent doses of statins …”

“…Likewise, in a recently published Taiwanese study, older Chinese patients were more likely to attain LDL-C treatment goal for secondary prevention of cardiovascular disease. 11 It alluded to the patients' perceived risk of further complications with rising age, prompting them to be proactive in taking measures to attain treatment control. 11 A common factor in both studies was the use of statin therapy, which was the most significant determinant in achieving LDL-C treatment goal.…”