How effective are the ESC/EAS and 2013 ACC/AHA guidelines in treating dyslipidemia? Lessons from a lipid clinic

Abstract

The application of the ACC/AHA guidelines may be associated with undertreatment of high risk patients due to suboptimal LDL-C response to high-intensity statins in clinical practice. Adding ezetimibe substantially increases the rate of the ESC/EAS LDL-C target achievement together with the rate of LDL-C lowering response suggested by the ACC/AHA.

Similarities and differences between European and United States guidelines for the management of dyslipidaemias

“…Indeed, recently a retrospective (from 1999 to 2013) observational study including 1,000 consecutive adults treated for hyperlipidaemia and followed up for ≥ 3 years compared the applicability of current European and US guidelines and concluded that the application of the US guidelines may be associated with undertreatment of high-risk patients due to suboptimal LDL-C response to high-intensity statins in clinical practice. This study also found that adding ezetimibe to a statin substantially increased the rate of the European guidelines LDL-C target achievement together with the rate of LDL-C lowering response suggested by the US guidelines [45].…”

Statin therapy with or without ezetimibe and the progression to diabetes

“…23 We have previously shown that the use of ezetimibe in addition to statins improves LDL-C target attainment proposed by the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines, a target difficult to achieve even in the setting of specialized lipid clinics. 12 Moreover, the achievement of LDL-C reduction by $50%, as proposed for high-risk individuals by the American College of Cardiology/American Heart Association (ACC/AHA) guidelines, is more frequently accomplished with the combination of statin plus ezetimibe, rather than with the use of high-intensity statin monotherapy. 12 Although ezetimibe is a commonly prescribed hypolipidemic agent, there are no adequate data regarding the effect of ezetimibe on glucose metabolism.…”

“…12 Briefly, we included dyslipidemic adults attending the Outpatient Lipid Clinic of the University Hospital of Ioannina in Greece and followed-up for at least 3 years. All participants had a complete assessment of concomitant diseases and their treatment.…”

Attainment of multifactorial treatment targets among elderly in a lipid clinic

“…[4][5][6] We have previously reported that even in the setting of a lipid clinic, only one out of four very high risk patients achieved the optimal LDL-C target < 70 mg/dL and 42% of those at high CV risk had LDL-C < 100 mg/dL. [4,7] In the US, 31% of the hypertensive individuals and 36% of those with diabetes do not reach the BP and glycemic targets, respectively. [5,6] Data are limited regarding the rates of goal achievement of lipid-lowering, antihypertensive and antidiabetic treatment in the elderly.…”

“…[8,9] In two previous publications, we presented data for the lipid goal achievement of patients attending a Lipid Clinic of a University Hospital. [4,7] In this report, we studied only the older outpatients and present data for LDL-C target attainment, but also for BP and glycemic control. In addition, the rates of the less strict BP and glycemic target achievement, recently recommended in the elderly, [2,10] were recorded along with the incidence of treatment side effects.…”