Patients' achievement of cholesterol targets: a cross-sectional evaluation

Despite incontrovertible evidence for the efficacy of cholesterol lowering, numerous studies suggest that patients are suboptimally treated. This study was conducted to determine the proportion of patients achieving recommended target lipid levels in a relatively unselected group of community-dwelling patients who were prescribed HMG-CoA reductase inhibitors (statins).

Community pharmacists identified participants who were receiving an HMG-CoA reductase inhibitor at the same dosage for a minimum of 6 weeks and enrolled them into the study. Participants had an interview to determine cardiovascular risk factors and level of cardiovascular risk as defined by Canadian dyslipidemia guidelines, and a fasting lipid profile was performed using a point-of-care cholesterol assessment device.

During 2000, a total of 404 participants were enrolled from 16 pharmacies. The highest proportion (96%) of participants achieving low-density lipoprotein targets was in the low-risk group, and the proportion progressively decreased as cardiac risk level increased: 80% in the moderate-risk group and 82% in the high-risk group. The very-high-risk group had the lowest proportion (37%) of participants who achieved their target.

Consistent with other studies, this study found that as cardiac risk increased, the proportion of patients achieving their target cholesterol values decreased, such that those at the greatest risk for cardiovascular disease (who had the most to gain from aggressive lipid-lowering interventions) were least likely to achieve their cholesterol targets. This suggests a need for more-aggressive approaches to the management of cholesterol, particularly in high-risk patients.