First-line treatment patterns and lipid target levels attainment in very high cardiovascular risk outpatients

Abstract

ObjectivesPrevious studies have demonstrated gaps in achievement of low-density lipoprotein-cholesterol (LDL-C) goals among patients at very high cardiovascular risk. We aimed to investigate lipid treatment patterns, rates and predictors of lipid targets attainment, in such outpatients in an urban area of Greece.MethodsThis was a prospective observational study, conducted in 19 outpatient clinics of Western Greece. We recruited patients with established cardiovascular disease (CVD) and/or diabetes mellitus (DM), previously (at least 3 months before baseline assessment) untreated with any lipid lowering medication. Lipid profile assessment was performed at baseline (prior to lipid-lowering treatment initiation) and at follow-up. Lipid lowering treatment choice was at physicians’ discretion and was kept constant until follow-up.ResultsWe recruited 712 patients with a mean age 61.4 ± 10.4 years, 68.0% males, 43.0% with DM, 64.7% with prior coronary artery disease-CAD. In total, 237/712 (33.3%) of prescribed regimens were of high or very high LDL-C lowering efficacy and out of them 113/237 (47.7%) comprised a combination of statin and ezetimibe. At follow-up the primary target of LDL-C < 70 mg/dL (1.8 mmol/L) was achieved in 71(10.0%) patients. The secondary target of non-HDL-C < 100 mg/dL (2.6 mmol/L) in the subgroup of patients with DM or increased triglycerides levels (>150 mg/dl or 1.7 mmol/L) was achieved in 45(11.6%) of patients. In multivariate logistic regression analysis (AUC = 0.71, 95% CIs 0.65-0.77, p < 0.001) male gender, smoking, baseline LDL-C and very high potency LDL-C lowering regimen emerged as independent predictors of LDL-C goal attainment (OR = 1.88, 95% CIs 1.03-3.44, p = 0.04, OR = 0.57, 95% CIs 0.33-0.96, p = 0.04, OR = 0.98, 95% CIs 0.98-0.99, p < 0.001 and OR = 2.21, 95% CIs 1.15-4.24, p = 0.02 respectively).ConclusionsFirst-line management of dyslipidemia among very-high cardiovascular risk outpatients in Western Greece is unsatisfactory, with the majority of treated individuals failing to attain the LDL-C and non-HDL-C targets. This finding points out the need for intensification of statin treatment in such patients.

Attainment of cholesterol target values in Greece: results from the Dyslipidemia International Study II

“…In a recent study of high or very high cardiovascular risk patients visiting a Greek university lipid treatment clinic, 95% were on any lipid-lowering treatment (LLT) and 92% were on statins, but only 25% among very high risk adult outpatients reached recommended LDL-C levels [14]. In another study involving 19 outpatient cardiology clinics in 2011–2012, it was found that, among patients with CVD or diabetes and initiating a LLT, only 25.9% received a high-efficacy regimen [15]. Thus, the question remains whether LLT in Greece is producing sufficient reductions in LDL-C.…”

Ezetimibe prescriptions in older Canadian adults after an acute myocardial infarction: a population-based cohort study

“…Further, cholesterol management in general has been reported to be suboptimal in high-risk patients [ 33 – 35 ], especially in older adults [ 33 ]. In a previous study of 396, 077 older adults (median age 75) with cardiovascular disease or diabetes in Ontario, only a small proportion were prescribed statins ( n = 75, 617 patients, 19.1%) [ 33 ].…”

Management of atherosclerosis risk factors for patients at high cardiovascular risk in real-world practice: a multicentre study

“…Several potential factors may contribute to suboptimal risk factor control, including physicians' discretion to use low-potency medications as the first-line treatment, (5,39) their inertia to adjust treatment plans, (26) drug accessibility, the adverse effects of medications (27) and patients' adherence to treatment regimens. Another factor related to physicians may be adherence to older guidelines, while in patients, the fear of adverse effects from medication and lack of knowledge about the results of undertreatment may lead to poor compliance to treatment plans.…”