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Suboptimal lipid levels in clinical practice among Portuguese adults with dyslipidemia under lipid-lowering therapy:
Pedro Marques da Silva1, Carlos Aguiar2, João Morais3
1Centro Hospitalar de Lisboa Central, EPE, Hospital de Santa Marta, Arterial Investigation Unit, Lisboa, Portugal.
Insights
Many Portuguese patients with high cardiovascular risk on lipid-lowering therapy do not reach recommended LDL-C goals. This highlights a need to optimize treatment for better cardiovascular disease prevention.
Area of Science:
- Cardiology
- Public Health
- Lipidology
Background:
- Cardiovascular disease (CVD) is a leading cause of death in Portugal.
- Hypercholesterolemia is a key factor in atherosclerotic CVD.
- Individualized cardiovascular risk assessment and treatment targets are recommended.
Purpose of the Study:
- To evaluate the achievement of lipid-lowering treatment goals in dyslipidemic patients in Portugal.
- To assess the effectiveness of current lipid-lowering therapies in a real-world setting.
Main Methods:
- A cross-sectional, observational study (DISGEN-LIPID) was conducted in 24 Portuguese centers.
- 368 dyslipidemic patients aged ≥40 years on lipid-lowering therapy for ≥3 months were analyzed.
- Patient data included lipid profiles, cardiovascular risk scores, and comorbidities.
Main Results:
- 73% of patients had a high or very high cardiovascular risk (SCORE).
- Over half of patients, both men and women, did not achieve recommended low-density lipoprotein cholesterol (LDL-C) target levels.
- A significant proportion also presented with abnormal high-density lipoprotein cholesterol (HDL-C) and/or triglycerides (TG).
Conclusions:
- Despite high cardiovascular risk and lipid-lowering therapy, many patients do not meet LDL-C targets.
- Abnormal HDL-C and TG levels are also prevalent.
- There is a need for improved clinical practice in cardiovascular prevention to optimize lipid management.
Introduction:
Cardiovascular disease (CVD) is the leading cause of morbidity and mortality in Portugal. Hypercholesterolemia has a causal role in atherosclerotic CVD. Guidelines recommend that cardiovascular (CV) risk reduction should be individualized and treatment goals identified. Low-density lipoprotein cholesterol (LDL-C) is the primary treatment target.
Methods:
DISGEN-LIPID was a cross-sectional observational study conducted in 24 centers in Portugal in dyslipidemic patients aged ≥40 years, on lipid-lowering therapy (LLT) for at least three months and with an available lipid profile in the previous six months.
Results:
A total of 368 patients were analyzed: 48.9% men and 51.1% women (93.9% postmenopausal), of whom 73% had a SCORE of high or very high CV risk. One quarter had a family history of premature CVD; 31% had diabetes; 26% coronary heart disease; 9.5% cerebrovascular disease; and 4.1% peripheral arterial disease. Mean baseline lipid values were total cholesterol (TC) 189 mg/dl, LDL-C 116 mg/dl, high-density lipoprotein cholesterol (HDL-C) 53.5 mg/dl, and triglycerides (TG) 135 mg/dl. Women had higher TC (p<0.001), LDL-C (non-significant) and HDL-C (p<0.001), and lower TG (p=0.002); 57% of men and 63% of women had LDL-C>100 mg/dl (p=0.28), and 58% of men and 47% of women had LDL-C>70 mg/dl (p=0.933).
Conclusion:
These observational data show that, despite their high-risk profile, more than half of patients under LLT, both men and women, did not achieve the recommended target levels for LDL-C, and a large proportion also had abnormal HDL-C and/or TG. This is a renewed opportunity to improve clinical practice in CV prevention.
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