Background: The prevalence of persistent lipid abnormalities in patients receiving statins in primary and secondary care is needed to formulate recommendations for future treatment. Studies associating cardiovascular risk factors with lipid target goal achievement are lacking.
Design: A cross-sectional, observational study that assessed the prevalence of persistent dyslipidemia in patients treated with statins and analyzed predictors of lipid target achievement.
Methods: Serum lipid values of 22,063 statin-treated patients were studied in the context of their cardiovascular risk factors, and the potency and composition of their lipid-lowering treatment. European Society of Cardiology recommendations were used to classify patient risk, and to define LDL-cholesterol goal and normal levels for HDL-cholesterol and triglycerides.
Results: Overall, 48.2% of patients did not achieve the therapeutic goal for LDL-cholesterol, either as a single lipid anomaly or associated with low HDL-cholesterol, elevated triglycerides, or both. Lack of goal achievement was more prevalent among low-risk patients (55.8%) than high-risk patients (46.8%). Serum LDL-cholesterol levels were lower in high-risk patients. Predictors associated with LDL-cholesterol goal achievement were higher statin dose (odds ratio (OR): 0.35), specialist treatment (OR: 0.74), or combined lipid-lowering therapy (OR: 0.80).
Conclusions: Nearly half of statin-treated patients missed their therapeutic LDL-cholesterol goal, highlighting a gap between recommendations and clinical practice. Better achievement of LDL-cholesterol therapeutic goal was found among patients at high cardiovascular risk, those on high statin doses or using combination therapy, and patients managed by specialists. Results suggest that residual dyslipidemia in statin-treated patients at low cardiovascular risk may be reduced by increasing statin dose.
World Health Report 2004. The changing history. Geneva: World Health Organization, 2004.
2.
LealJLuengo-FernándezRGrayAPetersenSRaynerM. Economic burden of cardiovascular diseases in the enlarged European Union. Eur Heart J2006; 27: 1610–1619.
3.
WildSRoglicGGreenASicreeRKingH. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care2004; 27: 1047–1053.
4.
PoirierPGilesTDBrayGAHongYSternJSPi-SunyerFX. American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation2006; 113: 898–918.
5.
BaigentCKeechAKearneyPMBlackwellLBuckGPollicinoC. Cholesterol Treatment Trialists' (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet2005; 366: 1267–1278.
6.
Cholesterol Treatment Trialists' (CTT) CollaboratorsKearneyPMBlackwellLCollinsRKeechASimesJPetoR. Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet2008; 371: 117–125.
7.
GrundySMCleemanJIMerzCNBrewerHBJrClarkLTHunninghakeDB. National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation2004; 110: 227–239. Erratum in: Circulation 2004; 110: 763.
8.
Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice. European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J2007; 28: 2375–2414.
9.
ShahPKKaulSNilssonJCercekB. Exploiting the vascular protective effects of high-density lipoprotein and its apolipoproteins: an idea whose time for testing is coming, part I. Circulation2001; 104: 2376–2383.
10.
GottoAMJr. High-density lipoprotein cholesterol and triglycerides as therapeutic targets for preventing and treating coronary artery disease. Am Heart J2002; 144(Suppl): S33–S42.
11.
BarterPJPuranikRRyeKA. New insights into the role of HDL as an anti-inflammatory agent in the prevention of cardiovascular disease. Curr Cardiol Rep2007; 9: 493–498.
12.
McBrideP. Triglycerides and risk for coronary artery disease. Curr Atheroscler Rep2008; 10: 386–390.
13.
KotsevaKWoodDDe BackerGDe BacquerDPyöräläKKeilU. (EUROASPIRE Study Group). Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet2009; 373: 929–940.
14.
Van GanseELaforestLBurkeTPhatakHSouchetT. Mixed dyslipidemia among patients using lipid-lowering therapy in French general practice: an observational study. Clin Ther2007; 29: 1671–1681.
15.
PhatakHWentworthCSazonovVBurkeT. Prevalence and predictors of lipid abnormalities in patients treated with statins in the UK general practice. Atherosclerosis2009; 202: 225–233.
16.
SuárezCMaiquesAAmbegaonkarBMMeleroMNoceaGZhangQ. Attainment of multiple recommended lipid levels following lipid modifying treatment in high-risk patients. PRIMULA Study, Spain. In: ISPOR 11th Annual European Congress, Athens, Greece, 8–11 November, 2008 (Abstr).
17.
RobertsWC. The rule of 5 and the rule of 7 in lipid-lowering by statin drugs. Am J Cardiol1997; 80: 106–107.
18.
MaronDJFazioSLintonMF. Current perspectives on statins. Circulation2000; 101: 207–213.
19.
McPhersonRFrolichJFodorGGenestJCanadian Cardiovascular Society. Canadian Cardiovascular Society position statement—recommendations for the diagnosis and treatment of dyslipidemia and the prevention of cardiovascular disease. Can J Cardiol2006; 22: 913–927. Erratum in: Can J Cardiol 2006; 22: 1077.
20.
LucGBardJMFerrièresJEvansAAmouyelPArveilerD. Value of HDL cholesterol, apolipoprotein A-I, lipoprotein A-I, and lipoprotein A-I/A-II in prediction of coronary heart disease: The PRIME Study. Prospective Epidemiological Study of Myocardial Infarction. Arterioscler Thromb Vasc Biol2002; 22: 1155–1161.
21.
BourgaultCDavignonJFodorGGagnéCGaudetDGenestJ. Statin therapy in Canadian patients with hypercholesterolemia: The Canadian Lipid Study—Observational (CALIPSO). Can J Cardiol2005; 21: 1187–1193.
22.
BruckertEBaccara-DinetMEschwegeE. Low HDL-cholesterol is common in European Type 2 diabetic patients receiving treatment for dyslipidemia: data from a pan-European survey. Diabet Med2007; 24: 388–391.
23.
AssmannGBeneckeHNeissACullenPSchulteHBestehornK. Gap between guidelines and practice: attainment of treatment targets in patients with primary hypercholesterolemia starting statin therapy. Results of the 4E-Registry (Efficacy Calculation and Measurement of Cardiovascular and Cerebrovascular Events Including Physicians’ Experience and Evaluation). Eur J Cardiovasc Prev Rehabil2006; 13: 776–783.
24.
GoffDCJrBertoniAGKramerHBondsDBlumenthalRSTsaiMY. Dyslipidemia prevalence, treatment, and control in the Multi-Ethnic Study of Atherosclerosis (MESA): gender, ethnicity, and coronary artery calcium. Circulation2006; 113: 647–656.
25.
YanATYanRTTanMHackamDGLeblancKLKertlandH. Vascular Protection (VP) and Guidelines Oriented Approach to Lipid Lowering (GOALL) Registries Investigators. Contemporary management of dyslipidemia in high-risk patients: targets still not met. Am J Med2006; 119: 676–683.
26.
GrantRWMeigsJB. Prevalence and treatment of low HDL cholesterol among primary care patients with type 2 diabetes: an unmet challenge for cardiovascular risk reduction. Diabetes Care2007; 30: 479–484.
27.
WatersDDBrotonsCChiangCWFerrièresJFoodyJJukemaJW. Lipid Treatment Assessment Project 2 Investigators. Lipid treatment assessment project 2: a multinational survey to evaluate the proportion of patients achieving low-density lipoprotein cholesterol goals. Circulation2009; 120: 28–34.
28.
WalleyTFolino-GalloPStephensPVan GanseE. Trends in prescribing and utilization of statins and other lipid lowering drugs across Europe 1997–2003. Br J Clin Pharmacol2005; 60: 543–551.
29.
ManninenVTenkanenLKoskinenPHuttunenJKMänttäriMHeinonenOP. Joint effects of serum triglyceride and LDL cholesterol and HDL cholesterol concentrations on coronary heart disease risk in the Helsinki Heart Study: implications for treatment. Circulation1992; 85: 37–45.
30.
BIP Study Group. Secondary prevention by raising HDL cholesterol and reducing triglycerides in patients with coronary artery disease: The Bezafibrate Infarction Prevention (BIP) Study. Circulation2000; 102: 21–27.
