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Lifetime risk assessment in cholesterol management among hypertensive patients: observational cross-sectional study
Aapo Tahkola1,2, Päivi Korhonen3, Hannu Kautiainen4
1University of Eastern Finland, Institute of Public Health and Clinical Nutrition, Kuopio, Finland. aapo.tahkola@jkl.fi.
Insights
Low-density lipoprotein cholesterol (LDL-C) control is insufficient in Finnish hypertensive patients, especially younger individuals. Improved management is crucial for preventing cardiovascular diseases (CVD) over a lifetime.
Area of Science:
- Cardiology
- Public Health
- Pharmacology
Background:
- Cardiovascular disease (CVD) prevention in hypertensive patients relies on reducing low-density lipoprotein cholesterol (LDL-C).
- Despite its importance, LDL-C control is often inadequate in hypertensive populations.
- Electronic Health Record (EHR) data analysis is used to identify subgroups needing improved dyslipidemia treatment.
Purpose of the Study:
- To investigate LDL-C control in hypertensive, non-diabetic patients without renal dysfunction or CVD.
- To identify age and sex-specific disparities in LDL-C management within Finnish primary care.
- To assess the association between age and LDL-C control and lipid-lowering medication (LLM) use.
Main Methods:
- Observational, cross-sectional study utilizing routine EHR data.
- Inclusion criteria: hypertensive, non-diabetic, aged 30+, no renal dysfunction or CVD.
- Analysis focused on LDL-C levels, achievement of targets (<3 mmol/l), and LLM prescription rates.
Main Results:
- Over half of untreated patients (53-54%) and one-third of treated patients (33-35%) did not meet LDL-C targets.
- Higher age was significantly associated with better LDL-C control and lower LDL-C levels (p<0.001).
- Older age also correlated strongly with LLM prescription (p<0.001); approximately 51-53% of patients were on LLM.
Conclusions:
- Dyslipidemia treatment in Finnish hypertensive patients is generally insufficient.
- Younger hypertensive patients require more attention for effective CVD risk reduction.
- Clinicians should consider lifetime CVD risk, particularly for working-age hypertensive individuals.
Background:
In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control.
Methods:
In this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting.
Results:
More than half (54% of women and 53% of men) of untreated patients did not meet the LDL-C target of < 3 mmol/l and one third (35% of women and 33% of men) of patients did not reach the target even with the lipid-lowering medication (LLM). Furthermore, higher age was strongly associated with better LDL-C control (p < 0.001) and lower LDL-C level (p < 0.001) in individuals with and without LLM. Higher age was also strongly associated with LLM prescription (p < 0.001). In total, about half of the patients were on LLM (53% of women and 51% of men).
Conclusions:
Our findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.
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