Clinical Management of High and Very High Risk Patients with Hyperlipidaemia in Central and Eastern Europe: An Observational Study

Abstract

IntroductionA retrospective/prospective observational study was conducted to explore the current management of hyperlipidaemia in high-risk (HR) and very high risk (VHR) patients in central/eastern Europe and Israel.MethodsThe study enrolled adult patients who were receiving lipid-lowering therapy and attending a specialist (cardiologist/diabetologist/lipidologist) or internist for a routine visit at 57 sites (including academic/specialist/internal medicine centres) across Bulgaria, Croatia, Czech Republic, Israel, Poland, Romania and Slovakia. Data were collected from medical records, for the 12 months before enrolment, with/without ≤ 6 months’ additional prospective follow-up.ResultsA total of 1244 patients, mean (SD) age 63.3 (11.3) years were included (307 with familial hypercholesterolaemia (FH), 943 secondary prevention patients). Almost all patients (98.1%) were receiving statins (76.7% monotherapy/21.4% combined therapy), with 53.1% receiving high-intensity statin therapy: 127 patients (10.2%) had adverse events attributed to statin intolerance. Mean (SD) low density lipoprotein cholesterol (LDL-C) levels were 3.3 (1.7) mmol/L at the first, and 2.7 (1.3) mmol/L at the last, visit of the retrospective phase of observation, with little change during the prospective phase. Less than one-quarter (23.8%; 95% CI 17.29–31.45%) of HR patients and less than half (42.0%; 39.05–44.98%) of VHR patients achieved their risk-based LDL-C targets of < 2.5 and < 1.8 mmol/L, respectively. Less than 15% of FH patients reached these targets (10.9% (5.6–18.7%) of HR and 12.1% (8.0–17.4%) of VHR patients). The revised 2016 ESC/EAS target for HR patients (2.6 mmol/L) was met by 28.5% (21.44–36.38%) of HR patients overall. Almost one-half of patients (42.1%) experienced one or more cardiovascular events during observation.ConclusionOur findings confirm that, despite widespread statin use, a substantial proportion of patients treated for hyperlipidaemia in central/eastern Europe and Israel, particularly those with FH, do not reach recommended LDL-C targets, thus remaining at risk of cardiovascular events.FundingAmgen (Europe) GmbH.Electronic supplementary materialThe online version of this article (10.1007/s12325-019-0879-1) contains supplementary material, which is available to authorized users.

Familial Hypercholesterolemia Identification Algorithm in Patients with Acute Cardiovascular Events in A Large Hospital Electronic Database in Bulgaria: A Call for Implementation

“…Multiple issues may potentially contribute to the lack of LDL-C reduction. Under-dosing and statin discontinuation/poor adherence to therapy are acknowledged as key contributors, and have been linked to poorer clinical outcomes [1,10,20]. The healthcare system in Bulgaria is based on the reference principle and therefore restrictive, waiting for larger markets to introduce new products and deliver data showing results from the change in therapy.…”

Hyperlipidemia management in Slovakia: observational study

“…Retrospektívna/prospektívna observačná štúdia sa uskutočnila s cieľom preskúmať manažment hyperlipid émie a dosahovanie cieľových hodnôt LDL-C naprieč krajinami strednej, východnej Európy a v Izraeli [14]. V mnohých krajinách v regióne sú k dispozícii obmedzené údaje o používaní hypolipidemickej liečby (lipid-lowering therapy -LLT) a o kontrole hladín lipidov kvôli nedostatočnému počtu pacientskych registrov a nedostatočnému prístupu k verejným informáciám a k údajom zdravotných poisťovní.…”

“…Regionálna štúdia bola retrospektívna/prospektívna neintervenčná, observačná štúdia, do ktorej boli zaradení pacienti s diagnostikovanou hyperlipidémiou (HR alebo VHR, ako je definované v odporúčaniach ESC/EAS) [7], ktorí dostávali LLT a chodili na bežné kontroly k špecialistovi (kardiológ, diabetológ a/alebo internista) [14] Pacienti, ktorí podstupovali liečbu hyperlipidémie v rámci intervenčného klinického skúšania, boli z účasti na štúdii vylúčení. Údaje boli získané zo zdravotných záznamov jednotlivých pacientov a týkali sa obdobia 12 mesiacov pred zaradením do štúdie (retrospektívna fáza: všetky krajiny) a až 6 mesiacov po zaradení do štúdie (prospektívna fáza: iba Rumunsko, Poľsko a Česká republika).…”

“…Naša observačná štúdia zaoberajúca sa manažmentom hyperlipidémie a dosahovaním cieľových hodnôt LDL-C u HR a VHR pacientov v Slovenskej republike zistila, že počas sledovaného obdobia sa odporúčané cieľové hodnoty LDL-C dosiahli u menej ako tretiny našich pacientov, pričom hladinu LDL-C < 2,5 mmol/l dosiahlo iba 12,5 % HR pacientov (95% IS: 1,638,4 %) a hladinu LDL-C < 1,8 mmol/l dosiahlo 29,9 % VHR pacientov (95% IS: 22,338,4 %). Uvedené percentá pacientov sú nižšie ako percentá pacientov, ktorí dosiahli cieľové hodnoty v hlavnej regionálnej štúdii HR pacien-tov (23,8 %; 95% IS: 17,2931,45 %) a 42,0 % VHR pacientov (39,145,0 %) [14]. Zahrnuté centrá a pacienti sa medzi 7 krajinami participujúcimi na regionálnej štúdii značne líšili, a to mohlo prispieť k rozdielom vo výsledkoch.…”

The Burden of Associated Comorbidities in Patients with Obstructive Sleep Apnea—Regional Differences in Two Central–Eastern European Sleep Centers

“…A population-based study performed in the region of Pomerania, northeastern Germany, investigated the risk factors and clinical diseases in a German cohort and reported a significant positive association of anthropometric measurements and self-reported cardiovascular diseases with obstructive sleep apnea [10]. Petrov I et al conducted an observational study to explore the management of hyperlipidemia in high-and very high-risk patients from Central/Eastern Europe and Israel and found suboptimal levels of LDL-cholesterol in a significant proportion of treated patients [11]. Close collaboration across Europe is important, as learning from each other seems crucial to reducing health inequalities within Europe [12].…”