Suboptimal lipid levels in clinical practice among Portuguese adults with dyslipidemia under lipid-lowering therapy: Data from the DISGEN-LIPID study

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. 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. 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). 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. A doença cardiovascular (DCV) é a principal causa de morbimortalidade em Portugal. Hipercolesterolemia é um reconhecido fator causal na DCV aterosclerótica. As recomendações aconselham a individualização da redução do risco cardiovascular (CV) e da identificação dos objetivos terapêuticos. O LDL-C é o principal alvo do tratamento. O DISGEN-LIPID foi um estudo transversal, observacional, com 24 centros em Portugal, que incluiu doentes ≥40 anos e dislipidemia, com tratamento antidislipidémico havia pelo menos três meses e perfil lipídico nos últimos seis meses. Foram analisados 368 pacientes: 48,9% homens e 51,1% mulheres (93,9% na pós-menopausa); 73% dos doentes tinham um risco CV alto ou muito alto. Um quarto tinha história familiar de DCV prematura; 31% DMT2, 26% DC; 9,5% doença vascular cerebral; e 4,1% DAP. O perfil lipídico basal médio era CT de 189 mg/dl, LDL-C de 116 mg/dl, HDL-C de 53,5 mg/dl e TG de 135 mg/dl. As mulheres apresentavam um CT (p<0,001), LDL-C (não significativo), HDL-C (p<0,001) mais elevado do que os homens e níveis mais baixos de TG (p=0,002); 57% dos homens e 63% das mulheres tinham um LDL-C>100 mg/dl (p=0,28) e 58% dos homens e 47% das mulheres apresentavam um valor de LDL-C>70 mg/dl (p=0,933). Os dados mostram que mais de metade dos doentes, homens e mulheres, não alcançou o alvo de LDL-C e um grande número tinha valores indesejáveis de HDL-C e/ou TG. Esta é uma oportunidade para melhorar a prática clínica em prevenção CV.