Lipid Treatment Assessment Project 2

Abstract

Background-Information about physicians' adherence to cholesterol management guidelines remains scant. The present survey updates our knowledge of lipid management worldwide. Methods and Results-Lipid levels were determined at enrollment in dyslipidemic adult patients on stable lipid-lowering therapy in 9 countries. The primary end point was the success rate, defined as the proportion of patients achieving appropriate low-density lipoprotein cholesterol (LDL-C) goals for their given risk. The mean age of the 9955 evaluable patients was 62Ϯ12 years; 54% were male. Coronary disease and diabetes mellitus had been diagnosed in 30% and 31%, respectively, and 14% were current smokers. Current treatment consisted of a statin in 75%. The proportion of patients achieving LDL-C goals according to relevant national guidelines ranged from 47% to 84% across countries. In low-, moderate-, and high-risk groups, mean LDL-C was 119, 109, and 91 mg/dL and mean high-density lipoprotein cholesterol was 62, 49, and 50 mg/dL, respectively. The success rate for LDL-C goal achievement was 86% in low-, 74% in moderate-, and 67% in high-risk patients (73% overall). However, among coronary heart disease patients with Ն2 risk factors, only 30% attained the optional LDL-C goal of Ͻ70 mg/dL. In the entire cohort, high-density lipoprotein cholesterol was Ͻ40 mg/dL in 19%, 40 to 60 mg/dL in 55%, and Ͼ60 mg/dL in 26% of patients. Conclusions-Although there is room for improvement, particularly in very-high-risk patients, these results indicate that lipid-lowering therapy is being applied much more successfully than it was a decade ago. (Circulation. 2009;120:28-34.)

Prevalence of persistent lipid abnormalities in statin‐treated patients: Belgian results of the Dyslipidaemia International Study ( DYSIS )

“…A number of cross-sectional epidemiologic studies have also investigated the prevalence of lipid abnormalities and statin use 12,15,16,19–24. These studies, however, were limited to specific populations, focused on specific lipid parameters such as LDL-C or HDL-C, or had mixed patients with different lipid-lowering therapies.…”

Effect of Switching From Statin Monotherapy to Ezetimibe/Simvastatin Combination Therapy Compared With Other Intensified Lipid‐Lowering Strategies on Lipoprotein Subclasses in Diabetic Patients With Symptomatic Cardiovascular Disease

“…Statin therapy is the recommended first‐line therapeutic approach for lipid management of high‐risk patients; however, many patients with diabetic dyslipidemia do not achieve adequate low‐density lipoprotein (LDL) cholesterol (LDL‐C) lowering on statin monotherapy 7, 8, 9, 10, 11. This residual risk may be attributed in part to atherogenic dyslipidemia, characterized by high levels of triglycerides, low levels of high‐density lipoprotein (HDL) cholesterol (HDL‐C), and high LDL‐particle (LDL‐P) numbers in these patients 1.…”

LDL-C Goal Attainment in Patients who Remain on Atorvastatin or Switch to Equivalent or Non-equivalent Doses of Simvastatin: A Retrospective Matched Cohort Study in Clinical Practice

“…3,4 Against this background, surveys of routine clinical practice show that management of lipid levels has improved but many patients, especially those at highest risk, are still not successfully treated to recommended targets. 5,6 In the environment of evolving LDL-C targets, health care payers worldwide have come under increasing pressure to contain costs. Over the past few years, switching patients from high-potency branded statins to lower-potency generic statins has been encouraged to reduce prescription costs, leaving many physicians uncertain as to whether this should take priority over keeping patients at their NCEP ATP guideline LDL-C levels.…”