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Undertreatment of hypercholesterolaemia: a population-based study
A K Mantel-Teeuwisse1, W M M Verschuren, O H Klungel
1Department of Pharmacoepidemiology and Pharmacotherapy, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, PO Box 80082, 3508 TB Utrecht, the Netherlands. A.K.Mantel-Teeuwisse@pharm.uu.nl
British Journal of Clinical Pharmacology
|April 19, 2003
Summary
Over 95% of eligible individuals with high cholesterol were untreated or uncontrolled. Identifying high-risk patients and using statins more aggressively can reduce undertreatment.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Hypercholesterolaemia is a significant risk factor for cardiovascular disease.
- Undertreatment of high cholesterol levels contributes to preventable morbidity and mortality.
- Assessing undertreatment requires considering variations in serum cholesterol measurements.
Purpose of the Study:
- To evaluate the extent of hypercholesterolaemia undertreatment in the general population.
- To identify factors influencing undertreatment of high cholesterol.
- To account for intra-person variability in serum cholesterol concentrations.
Main Methods:
- Cross-sectional study utilizing data from two Dutch cardiovascular disease risk factor surveys (1987-1997).
- Inclusion of 64,757 respondents aged 20-59 years.
- Eligibility for lipid-lowering drug therapy determined by the Dutch Cholesterol Consensus and absolute coronary heart disease risk; determinants of undertreatment analyzed using multivariate logistic models.
Main Results:
- 56.8% of the population had undesirable cholesterol levels (serum total cholesterol > 5 mmol/l).
- 5.5% of the total population were eligible for pharmacological treatment based on absolute coronary heart disease risk.
- Only 16.3% of eligible individuals received treatment, and 19.6% of those treated achieved controlled cholesterol levels, resulting in only 3.2% being both treated and controlled.
- Determinants of undertreatment varied by prevention type (e.g., younger males for primary, older females for secondary prevention).
- Slight improvements in treatment rates were observed in more recent years.
Conclusions:
- Over 95% of individuals eligible for pharmacological treatment for hypercholesterolaemia remain undertreated or uncontrolled.
- Enhanced identification of high-risk patients is crucial to decrease undertreatment.
- Patients on lipid-lowering medication, particularly statins, could benefit from more aggressive treatment strategies to achieve better control.