A comparison of Canadian and American guidelines for lipid management using data from the National Cholesterol Education Program Evaluation ProjecT Utilizing Novel E-technology (NEPTUNE) II survey
“…This is despite the fact that 77% were receiving lipid‐lowering therapy. These findings are consistent with previous studies highlighting the low frequency of treatment success in high‐risk patients with established CHD or CHD risk equivalents and the substantial underachievement of treatment goals by patients at high risk under the NCEP/ATP III guidelines 2,3,25–29 . In a recent study carried out in Spain in which 5849 consecutive patients with type 2 diabetes or chronic ischemic heart disease were included, 75% of risk factors were not appropriately treated by general practitioners or specialists in accordance with current clinical practice guidelines 30 .…”
Section: Discussionsupporting
confidence: 89%
“…These findings are consistent with previous studies highlighting the low frequency of treatment success in high-risk patients with established CHD or CHD risk equivalents and the substantial underachievement of treatment goals by patients at high risk under the NCEP ⁄ ATP III guidelines. 2,3,[25][26][27][28][29] In a recent study carried out in Spain in which 5849 consecutive patients with type 2 diabetes or chronic ischemic heart disease were included, 75% of risk factors were not appropriately treated by general practitioners or specialists in accordance with current clinical practice guidelines. 30 Similarly, in a crosssectional study of 2264 ambulatory patients with an estimated CV risk of high or very high (10-year risk for CHD >20%; 74.6% hypertensive, 61% dyslipidemic, 59.8% type 2 diabetes, 31% smokers, 38% obese, and 36.7% in secondary prevention), only 6.9% of patients had all their principal risk factors under control and this was independently associated with an increased incidence of CV events.…”
The authors assessed a large cohort of patients with coronary heart disease (CHD) or at high risk for developing CHD in terms of lipid profile, lipid-lowering treatment, and attainment of National Cholesterol Education Program (NCEP) target low-density lipoprotein cholesterol (LDL-C) levels. The investigation was a cross-sectional study involving Spanish outpatients treated in primary or secondary care facilities. From a total of 26,598 attending patients, 12,128 with CHD or CHD risk equivalents were recruited by 1875 physicians; 49% had CHD and 69% had multiple risk factors. Only 25% of patients attained LDL-C values <100 mg/dL, 76.6% patients received lipid-lowering therapy (statins in 95.4% of cases), and 54% of physicians considered that a treatment change was required (the most frequent choice was the addition of ezetimibe to current statin therapy). In this large cohort of high-risk coronary patients, only 25% attained a target LDL-C of <100 mg/dL. These results highlight a need for improved patient care and physician awareness/training.
“…This is despite the fact that 77% were receiving lipid‐lowering therapy. These findings are consistent with previous studies highlighting the low frequency of treatment success in high‐risk patients with established CHD or CHD risk equivalents and the substantial underachievement of treatment goals by patients at high risk under the NCEP/ATP III guidelines 2,3,25–29 . In a recent study carried out in Spain in which 5849 consecutive patients with type 2 diabetes or chronic ischemic heart disease were included, 75% of risk factors were not appropriately treated by general practitioners or specialists in accordance with current clinical practice guidelines 30 .…”
Section: Discussionsupporting
confidence: 89%
“…These findings are consistent with previous studies highlighting the low frequency of treatment success in high-risk patients with established CHD or CHD risk equivalents and the substantial underachievement of treatment goals by patients at high risk under the NCEP ⁄ ATP III guidelines. 2,3,[25][26][27][28][29] In a recent study carried out in Spain in which 5849 consecutive patients with type 2 diabetes or chronic ischemic heart disease were included, 75% of risk factors were not appropriately treated by general practitioners or specialists in accordance with current clinical practice guidelines. 30 Similarly, in a crosssectional study of 2264 ambulatory patients with an estimated CV risk of high or very high (10-year risk for CHD >20%; 74.6% hypertensive, 61% dyslipidemic, 59.8% type 2 diabetes, 31% smokers, 38% obese, and 36.7% in secondary prevention), only 6.9% of patients had all their principal risk factors under control and this was independently associated with an increased incidence of CV events.…”
The authors assessed a large cohort of patients with coronary heart disease (CHD) or at high risk for developing CHD in terms of lipid profile, lipid-lowering treatment, and attainment of National Cholesterol Education Program (NCEP) target low-density lipoprotein cholesterol (LDL-C) levels. The investigation was a cross-sectional study involving Spanish outpatients treated in primary or secondary care facilities. From a total of 26,598 attending patients, 12,128 with CHD or CHD risk equivalents were recruited by 1875 physicians; 49% had CHD and 69% had multiple risk factors. Only 25% of patients attained LDL-C values <100 mg/dL, 76.6% patients received lipid-lowering therapy (statins in 95.4% of cases), and 54% of physicians considered that a treatment change was required (the most frequent choice was the addition of ezetimibe to current statin therapy). In this large cohort of high-risk coronary patients, only 25% attained a target LDL-C of <100 mg/dL. These results highlight a need for improved patient care and physician awareness/training.
“…Three studies that followed the Canadian Working Group guidelines, using a target of <97 mg/dL (2.5 mmol/L), reported that between 38.0 and 42.3 % of high-risk patients did not achieve this goal [ 26 – 28 ]. A further five studies also used a target of <97 mg/dL (<2.5 mmol/L), as recommended by the Third Joint European Task Force guidelines, the European Society of Cardiology, and guidelines from Brazil and Hungary; 41.7 to 89.7 % patients did not achieve this goal [ 29 – 33 ].…”
BackgroundThe aim of this study was to examine recommended target levels of low-density lipoprotein cholesterol (LDL-C) for hyperlipidaemia patients at high risk (i.e., with two or more risk factors or coronary heart disease or its risk equivalents) for cardiovascular disease (CVD); to determine LDL-C targets recommended by guidelines, and to examine the proportions of patients who do not achieve targeted LDL-C levels in real-world studies.MethodsElectronic databases were searched: Medline, Medline In-Process, Embase, BIOSIS, and the Cochrane Library (1 January 2005 to 31 December 2013). Guideline searches were limited to publications in the last 5 years. There were no geographical or language restrictions.ResultsSeventeen guidelines and 42 observational studies that reported on high-risk hyperlipidaemia patients were identified. The National Cholesterol Education Program–Adult Treatment Panel III’s LDL-C target levels were the most common guidelines used for patients with very high hyperlipidaemia. However, between 68 and 96 % of patients in the studies did not achieve an LDL-C goal <70 mg/dL, except in one study conducted in China (16.9 %). In high-risk patients, 61.8 to 93.8 % did not achieve a target of <100 mg/dL. Regarding common comorbidities, patients with concomitant CVD or diabetes were least likely to reach their target LDL-C goals.ConclusionIn patients with high risk for CVD, the majority of patients do not attain recommended LDL-C goals, highlighting worldwide suboptimal hyperlipidaemia management and missed opportunities for reduction of the patients CVD risk. Lipid-modifying management strategies need to be intensified.Electronic supplementary materialThe online version of this article (doi:10.1186/s12872-016-0241-3) contains supplementary material, which is available to authorized users.
“…This might partially explain the poor goal attainment rates in our study. Sub-optional LDL-C goal attainment can also be found in the study of Canadian patients based on the Canadian and American guidelines for lipid management [32].…”
ObjectiveTo compare use of statins and target-goal achievement in patients with type 2 diabetes mellitus (T2DM), with or without stable coronary artery disease (CAD), between cardiology and endocrinology departments at a tertiary hospital.MethodsA total of 966 patients with T2DM were enrolled, including 553 with stable CAD, from the departments of endocrinology and cardiology. Baseline characteristics, prescription of statins, and target-goal achievement of low-density lipoprotein cholesterol (LDL-C) during a 6-month follow-up period were analyzed.ResultsThere was lower ratio of statin use in patients with T2DM, with or without CAD, in the department of endocrinology than in the department of cardiology (all P<0.05). At the 6-month follow-up, compared to patients with T2DM in the endocrinology department, target-goal achievement among patients with T2DM in the department of cardiology was higher (52.90% vs. 41.46%, P<0.01), indicating a significant improvement among patients in the department of cardiology but not for those in the department of endocrinology when compared to baseline. According to the new Chinese guidelines, the goal attainment rate was higher among patients with T2DM combined with CAD in the department of cardiology than in the department of endocrinology (27.62% vs. 19.05%, P<0.05). However, with regard to ATP III 2004, the goal attainment rate was similar for patients with T2DM combined with CAD in both departments during the 6-month follow-up (9.21% vs. 8.84%, P>0.05), with no apparent improvement compared to baseline.ConclusionsThere was differential and sub-optimal use of statins as well as low target-goal achievement among patients with T2DM, with or without CAD, in the departments of cardiology and endocrinology at the same tertiary hospital, with a lower rate of statin prescription and target-goal achievement of LDL-C in the department of endocrinology.
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