Cardiologist-guided lipid-lowering therapy improved expected LDL-C levels by a mean of 9.0 mg/dl, but the <100 mg/dl target was only reached in 51.3% (95% CI 50.0-52.5) of the total cohort.
Observational (n=6,711)
Yes
What is the rate of guideline-recommended LDL-C target achievement in high-risk patients on chronic statin therapy in ambulatory clinical practice?
Despite improvements in lipid-lowering therapy by cardiologists, nearly half of high-risk patients in ambulatory care still fail to reach the guideline-recommended LDL-C target of <100 mg/dl.
BACKGROUND: Lipid-lowering treatment has been proven to decrease the rate of cardiovascular events in high-risk patients with manifest coronary artery disease (CAD) or CAD equivalent risk profile. Current treatment guidelines recommend low-density lipoprotein-cholesterol (LDL-C) less than 100 mg/dl (optional <70 mg/dl) as the target level for this high-risk population. Little is known about the ambulatory treatment of high-risk patients in clinical practice and the achievement of guideline recommended target values. METHODS AND RESULTS: In the '2L cardio' registry in Germany, 295 cardiologists enrolled 6711 consecutive patients with known CAD, and/or diabetes mellitus, peripheral arterial disease (summarized as 'coronary risk equivalent', CE), on chronic statin treatment. They recorded actual LDL-C values at entry, probable changes in therapy, and the expected LDL-C values using a lipid calculator based on an earlier observational study in a similar setting. The three groups comprised 2618 patients with CAD plus CE (39.0%; median LDL-C 112 mg/dl), 3436 patients with CAD only (51.2%; median LDL-C 108 mg/dl), and 657 with CE only (9.8%; median LDL-C 124 mg/dl). They had LDL-C levels less than 100 mg/dl in 36.2% 95% confidence intervals (CI): 34.3-38.1, 39.7% (CI: 38.0-41.4), and 27.2% (CI: 23.7-30.7), respectively. Statin doses at entry were usually in the lower to intermediate range (e.g. simvastatin median 25 mg/day). Cardiologists switched to another statin in 10.1% (9.4-10.8), increased the dose of statins (if same drug) in 22.2% (CI: 21.1-23.2) and/or added a cholesterol absorption inhibitor in 23.7% (CI: 22.7-24.7) of the patients. The cardiologists' intervention improved expected LDL-C levels in the total cohort by a mean of 9.0 mg/dl, but the 100 mg/dl LDL-C target was only reached in 51.3% (CI: 50.0-52.5) of the total cohort. CE patients appeared undertreated in terms of antiplatelet drugs. DISCUSSION: Through infrequent increases in statin doses and mainly through add-on of a cholesterol absorption inhibitor, cardiologists improved target level attainment. Compared with earlier studies in the outpatient setting, the treatment to target for LDL-C of high-risk CAD patients has improved, but is not satisfactory.
Gitt et al. (2009) conducted an observational in Coronary artery disease or coronary risk equivalent (n=6,711). Cardiologist-guided lipid-lowering therapy was evaluated on Expected achievement of LDL-C target <100 mg/dl (95% CI 50.0-52.5). Cardiologist-guided lipid-lowering therapy improved expected LDL-C levels by a mean of 9.0 mg/dl, but the <100 mg/dl target was only reached in 51.3% (95% CI 50.0-52.5) of the total cohort.