First-line treatment patterns and lipid target levels attainment in very high cardiovascular risk outpatients
Ioanna Xanthopoulou, Periklis Davlouros, Simos Siahos
1From the Department of Cardiology, Patras University Hospital, Patras, Rion 26500, Greece. dalex@med.upatras.gr.
Insights
Lipid management for high-risk cardiovascular patients in Greece is inadequate, with most failing to meet low-density lipoprotein-cholesterol (LDL-C) and non-HDL-C targets. This highlights the need for more intensive statin therapy to improve outcomes.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Previous research indicates suboptimal achievement of low-density lipoprotein-cholesterol (LDL-C) goals in very high cardiovascular risk populations.
- Understanding current lipid management practices and target attainment rates is crucial for improving patient outcomes.
Purpose of the Study:
- To evaluate lipid treatment patterns and assess the achievement of lipid targets in very high cardiovascular risk outpatients in Western Greece.
- To identify predictors of successful lipid target attainment in this patient cohort.
Main Methods:
- A prospective observational study involving 712 patients from 19 outpatient clinics in Western Greece.
- Patients had established cardiovascular disease (CVD) and/or diabetes mellitus (DM), untreated with lipid-lowering medication for at least 3 months prior.
- Lipid profiles were assessed at baseline and follow-up; treatment choices were physician-determined and maintained.
Main Results:
- Only 10.0% of patients achieved the primary LDL-C target (<70 mg/dL), and 11.6% achieved the secondary non-HDL-C target (<100 mg/dL).
- High or very high efficacy LDL-C lowering regimens were prescribed in 33.3% of cases, often involving statin and ezetimibe combinations (47.7%).
- Independent predictors for LDL-C goal attainment included male gender, smoking, baseline LDL-C levels, and the use of very high potency LDL-C lowering regimens.
Conclusions:
- First-line dyslipidemia management in very high cardiovascular risk outpatients in Western Greece is unsatisfactory, with low rates of LDL-C and non-HDL-C target achievement.
- The findings underscore the necessity for intensifying statin treatment strategies in this patient group to enhance lipid goal attainment.
Objectives:
Previous studies have demonstrated gaps in achievement of low-density lipoprotein-cholesterol (LDL-C) goals among patients at very high cardiovascular risk. We aimed to investigate lipid treatment patterns, rates and predictors of lipid targets attainment, in such outpatients in an urban area of Greece.
Methods:
This was a prospective observational study, conducted in 19 outpatient clinics of Western Greece. We recruited patients with established cardiovascular disease (CVD) and/or diabetes mellitus (DM), previously (at least 3 months before baseline assessment) untreated with any lipid lowering medication. Lipid profile assessment was performed at baseline (prior to lipid-lowering treatment initiation) and at follow-up. Lipid lowering treatment choice was at physicians' discretion and was kept constant until follow-up.
Results:
We recruited 712 patients with a mean age 61.4 ± 10.4 years, 68.0% males, 43.0% with DM, 64.7% with prior coronary artery disease-CAD. In total, 237/712 (33.3%) of prescribed regimens were of high or very high LDL-C lowering efficacy and out of them 113/237 (47.7%) comprised a combination of statin and ezetimibe. At follow-up the primary target of LDL-C < 70 mg/dL (1.8 mmol/L) was achieved in 71(10.0%) patients. The secondary target of non-HDL-C < 100 mg/dL (2.6 mmol/L) in the subgroup of patients with DM or increased triglycerides levels (>150 mg/dl or 1.7 mmol/L) was achieved in 45(11.6%) of patients. In multivariate logistic regression analysis (AUC = 0.71, 95% CIs 0.65-0.77, p < 0.001) male gender, smoking, baseline LDL-C and very high potency LDL-C lowering regimen emerged as independent predictors of LDL-C goal attainment (OR = 1.88, 95% CIs 1.03-3.44, p = 0.04, OR = 0.57, 95% CIs 0.33-0.96, p = 0.04, OR = 0.98, 95% CIs 0.98-0.99, p < 0.001 and OR = 2.21, 95% CIs 1.15-4.24, p = 0.02 respectively).
Conclusions:
First-line management of dyslipidemia among very-high cardiovascular risk outpatients in Western Greece is unsatisfactory, with the majority of treated individuals failing to attain the LDL-C and non-HDL-C targets. This finding points out the need for intensification of statin treatment in such patients.
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