Lipid management in contemporary community practice: Results from the Provider Assessment of Lipid Management (PALM) Registry

Abstract

Background The latest cholesterol guidelines have shifted focus from achieving low-density lipoprotein cholesterol (LDL-C) targets towards statin use and intensity guided by atherosclerotic cardiovascular disease (ASCVD) risk. Methods Statin use and intensity were evaluated in 5,905 statin-eligible primary or secondary prevention patients from 138 PALM Registry practices. Results Overall, 74.7% of eligible adults were on statins; only 42.4% were on guideline-recommended intensity. Relative to primary prevention patients, ASCVD patients were more likely to be on a statin (83.6% vs. 63.4%, p<0.0001) and guideline-recommended intensity (47.3% vs. 36.0%, p<0.0001). Men were more likely than women to be prescribed recommended intensity for primary (OR 1.87, 95% CI 1.49–2.34) and secondary (OR 1.47, 95% CI 1.26–1.70) prevention. In primary prevention, increasing age, diabetes, obesity, hypertension, and lower 10-year ASCVD risk were associated with increased odds of receiving recommended intensity. Among ASCVD patients, those with coronary artery disease were more likely to be on recommended intensity than cerebrovascular or peripheral vascular disease patients (OR 1.71, 95% CI 1.41–2.09), as were those seen by cardiologists (OR 1.43, 95% CI 1.12–1.83). Median LDL-C levels were highest among patients not on statins (124.0 mg/dL), and slightly higher among those on lower-than-recommended intensity compared with recommended therapy recipients (88.0 mg/dL and 84.0 mg/dL, respectively, p≤0.0001). Conclusion In routine contemporary practice, one in four guideline-eligible patients were not on a statin; less than half were on the recommended statin intensity. Untreated and under-treated patients had significantly higher LDL-C levels than those receiving guideline-directed statin treatment.

Vascular Events and Carotid Atherosclerosis: A 5-Year Prospective Cohort Study in Patients with Type 2 Diabetes and a Contemporary Cardiovascular Prevention Treatment

“…Studies that observe real-life practice found similar results; 43 to 58% of patients at a high CV risk and 72 to 78% of patients at a very high risk were still above LDL-C target despite the use of statins [35][36][37]. In the same way, it was observed that a quarter of patients with an indication for treatment were not receiving statins and that the intensity of statin was not sufficient in nearly half of cases [38] underlining the need to be more aggressive in terms of CV risk factor control. However, as not all patients had optimal CV treatment, the rate of CV events could be further reduced in the population studied herein.…”

<p>Effectiveness and prescription pattern of lipid-lowering therapy and its associated factors among patients with type 2 diabetes mellitus in Malaysian primary care settings</p>

“…There are several reports of inadequate dyslipidemia treatment and the challenge of attaining LDL-C treatment goals in general practice 10,11. Moreover, it has been highlighted in previous research that a significant portion of the statin-eligible population is not receiving the treatment 12. Furthermore, it has been shown that the failure to reduce LDL-C with the recommended LLT has been related to an increased risk of cardiac events 13.…”

Achievement of LDL-C Targets Defined by ESC/EAS (2011) Guidelines in Risk-Stratified Korean Patients with Dyslipidemia Receiving Lipid-Modifying Treatments

“…Since a prerequisite for evidence-based management of dyslipidemia is appropriate risk stratification, the discordance in risk assessment could have a substantial bearing on the outcomes. For example, a recent study [ 35 ] showed that only 42.4% of the patients who were recommended for statin therapy were on the recommended statin intensity. In the study, untreated (25.3%) and undertreated (32.3%) patients had significantly higher LDL-C levels than the ones on recommended statin intensity.…”