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Application of simple lipid treatment goals in patients with atherosclerotic disease
1Lipid Clinic, Rikshospitalet, Oslo, Norway.
Insights
A new guideline focusing on low-density lipoprotein cholesterol and triglycerides improved high-density lipoprotein cholesterol levels in patients with cardiovascular disease. This "3-1.5" criterion is recommended for secondary prevention, particularly for diabetic patients.
Area of Science:
- Cardiovascular Medicine
- Lipid Metabolism
- Preventive Cardiology
Background:
- Established atherosclerotic disease requires effective lipid management.
- Current guidelines for lipid-lowering therapy vary in their targets.
- Specific lipid parameters like triglycerides and HDL-cholesterol are crucial in secondary prevention.
Purpose of the Study:
- To compare the efficacy of three lipid management guidelines: "5-4-3-2-1", "5-3", and "3-1.5".
- To evaluate the "3-1.5" criterion (LDL-C < 3.0 mmol/L and TG < 1.5 mmol/L) for secondary cardiovascular prevention.
- To assess the impact of these guidelines on achieving desirable levels of HDL-cholesterol and total to HDL-cholesterol ratio.
Main Methods:
- A multicentre observational study involving 2134 patients on lipid-lowering therapy.
- Monitoring patient adherence to the "5-4-3-2-1", "5-3", and "3-1.5" lipid management guidelines.
- Analysis of lipid profiles, including total cholesterol, HDL-cholesterol, LDL-cholesterol, and triglycerides.
Main Results:
- Only 19.2% met the "5-4-3-2-1" guideline, while 36.2% met the "5-3" guideline.
- The "3-1.5" criterion was fulfilled by 22.5% of patients.
- A good conformity was observed between the "5-4-3-2-1" and "3-1.5" criteria.
- Patients meeting the "5-3" guideline often had unfavorable HDL-C and TG levels (approx. 50%), whereas only 15% of those meeting "3-1.5" had HDL-C < or = 1.0 mmol/L.
Conclusions:
- The "3-1.5" treatment goal significantly increased the proportion of patients with desirable HDL-cholesterol and total to HDL-cholesterol ratio.
- This guideline is particularly beneficial for secondary prevention in diabetic patients.
- The "3-1.5" criterion is recommended for optimizing lipid management in high-risk cardiovascular patients.
Background And Aim:
In this multicentre observational study the "5-4-3-2-1" guideline (total cholesterol < 5.0 mmol/L, the ratio of total to high-density lipoprotein cholesterol < 4, low-density lipoprotein cholesterol < 3.0 mmol/L, triglycerides < 2.0 mmol/L and high-density lipoprotein cholesterol > 1.0 mmol/L) was compared with the new European recommendations (total cholesterol < 5.0 mmol/L and low-density lipoprotein cholesterol < 3.0 mmol/L) ("5-3") and a treatment criterion of low-density lipoprotein cholesterol < 3.0 mmol/L and triglycerides < 1.5 mmol/L ("3-1.5"), as patients with triglycerides > 1.5 mmol/L may have an increased risk of premature cardiovascular disease.
Methods And Results:
In 1997/98, 2134 patients in general practice with established atherosclerotic disease on a lipid-lowering therapy were monitored. The "5-4-3-2-1" guideline was met in 19.2% and the "5-3" guideline in 36.2% and 22.5% fulfilled the "3-1.5" criterion. Our data showed a good conformity between the "5-4-3-2-1" guideline and the "3-1.5" criterion. Of the patients who achieved the "5-3" guideline approximately 50% still had unfavourable values of HDL-cholesterol and TG, while only 15% of those who fulfilled the "3-1.5" criterion had HDL-cholesterol < or = 1.0 mmol/L.
Conclusions:
A treatment goal of LDL-cholesterol < 3.0 mmol/L and fasting TG < 1.5 mmol/L markedly raised the proportion of patients with desirable levels of HDL-cholesterol and the ratio of total cholesterol to HDL-cholesterol and should be recommended in secondary prevention, especially in diabetic patients.