Prevalence and types of persistent dyslipidemia in patients treated with statins

To determine the prevalence and types of persistent dyslipidemia in patients treated with different statins to reduce cardiovascular disease (CVD) risk, as well as to determine the proportion of high risk patients who did not reach the lipid target values and assess cardiologists' further treatment advice for these patients.

This cross-sectional, observational study recruited 1849 outpatients from all parts of Croatia between January and September 2011 (44.6% women), 19 to 90 years old (average age 63.13) treated with statins for at least 6 months. We analyzed how the potency and type of lipid-lowering treatment were correlated with CVD risk level and achieving treatment goals according to 2007 Joint European Guidelines on CVD prevention.

Most patients (81.3%) were at high risk for CVD. The most frequently used statin was atorvastatin (42.8%), followed by simvastatin (27.6%) and rosuvastatin (22.8%). Only 35.5% patients achieved low density lipoprotein-cholesterol treatment target. Patients treated with more potent statins had better results. A total of 22.3% of patients had high density lipoprotein-cholesterol below 1.0 mmol/L (~40 mg/dL) for men and below 1.2 (~45 mg/dL) for women and 46.4% had triglycerides above 1.7 mmol/L (~150 mg/dL) but there were no significant differences between statins in improving these parameters. Most of the patients on more potent statins were not advised by their cardiologists to change the type or dosage of statin, which was more common in patients on less potent statins.

A considerable number of patients treated with statins did not achieve the treatment goal values. The results were better in patients treated with more potent statins and cardiologists advised them much less frequently to change the type and dosage of statin. There is a need for more intensive treatment, especially for high-risk patients. This could be accomplished by optimizing patients' adherence, using more potent statins, titrating current statin therapy to higher doses, or using a combined lipid-lowering treatment.