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Compliance With Dyslipidemia Guidelines in Daily Practice: How Effective Is Cardiovascular Risk Prevention?
Ünal Güntekin1, Hasan Ali Gümrükçüoğlu2, Mehmet Yaman3
1Department of Cardiology, Faculty of Medicine, Akdeniz University, Antalya, Turkey.
Insights
Adherence to European dyslipidemia guidelines for cardiovascular disease (CVD) risk is low in clinical practice. Many patients, especially those at very-high/high risk, do not achieve their LDL-C goals.
Area of Science:
- Cardiology
- Preventive Medicine
- Clinical Practice Guidelines
Background:
- Atherosclerosis-related cardiovascular disease (CVD) is a primary cause of premature mortality.
- Current guidelines from Europe (SCORE system) and the US (pooled cohort equations) assess atherosclerotic CVD risk.
- Dyslipidemia management is crucial for CVD prevention.
Purpose of the Study:
- To evaluate compliance with dyslipidemia guidelines in daily practice for patients with dyslipidemia or CVD risk factors.
- To compare the achievement of LDL-C targets based on European and American guidelines.
- To analyze factors influencing the achievement of LDL-C goals.
Main Methods:
- A study of 500 outpatients with dyslipidemia or CVD risk factors.
- Risk stratification using European and American Heart Association guidelines.
- Comparison of achieved LDL-C levels with guideline-recommended targets, considering statin dosage.
Main Results:
- Under European guidelines, 231 patients were very-high/high risk, with only 45.9% achieving the LDL-C target (<100 mg/dL).
- Moderate-risk patients (n=210) had 74.3% goal achievement (<115 mg/dL), and low-risk patients (n=59) had 93.2% goal achievement (<155 mg/dL).
- Lower LDL-C levels and absence of coronary artery disease were associated with achieving LDL-C goals (P < 0.001).
Conclusions:
- The majority of patients in daily practice fall into very-high/high-risk categories for CVD.
- Despite the frequent use of European dyslipidemia guidelines, goal achievement for LDL-C is suboptimal.
- Improved adherence to and implementation of guidelines are necessary for effective CVD risk reduction.
Purpose:
Cardiovascular disease (CVD) due to atherosclerosis is the leading cause of early mortality and morbidity. The current European guidelines on CVD prevention in clinical practice recommend the use of the Systematic Coronary Risk Estimation (SCORE) system. The current American Heart Association guidelines recommend the use of the new pooled cohort risk assessment equations to estimate the 10-year atherosclerotic CVD risk. The purpose of this article was to investigate the compliance of dyslipidemia guidelines in daily practice in patients with dyslipidemia or who have risk factors for CVD.
Methods:
The study group consisted of 500 outpatients who had dyslipidemia or risk factors for CVD. The risk level was computed according to the European and American Heart Association guidelines. Therapeutic LDL-C targets were identified based on the calculated risk level. Therapeutic target levels were compared based on the dosage of statins used and achievement of the LDL-C goal in daily practice according to the risk levels.
Findings:
According to the European dyslipidemia guidelines, 231 patients were in the very-high/high-risk group, and 106 patients (45.9%) achieved the LDL-C target (<100 mg/dL); 210 patients were in the moderate-risk group, and 156 (74.3%) patients achieved the LDL-C target (<115 mg/dL); and 59 patients were in the low-risk group, and 55 (93.2%) patients achieved the LDL-C target (<155 mg/dL). Univariate and multivariate logistic regression analyses revealed that the LDL-C level and presence of coronary artery disease were significantly reverse associated with achievement of the LDL-C goal (both, P < 0.001).
Implications:
Our results showed that the majority of patients were in the very-high/high-risk group in daily practice. Although the European dyslipidemia guidelines are more likely to be used in daily practice, achievement of the guidelines-recommended treatment goals was low.
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