Ineffectiveness of lipid‐lowering therapy in primary care

Abstract

Background Evidence confirms the positive effects of lipid-lowering agents on the risk of cardio-vascular disease. Local guidelines in France (AFSSAPS) have defined therapeutic objectives for LDL-cholesterol. These objectives vary with the number of cardiovas-cular risk factors in addition to dyslipidaemia. We determined the proportions of patients at therapeutic objective in different classes of cardiovascular risk to test the hypothesis that compliance with guidelines varies across the levels of risk. Comparison with international guidelines (ANDEM) was also performed. Methods A group of 3173 dyslipidaemic patients treated with lipid-lowering agents and managed by general practitioners was randomly selected from B KL-Thales panel, a French computerized database. For each patient, history of coronary heart disease and the number of cardiovascular risk factors were documented. Compliance with guidelines was assessed from achievement of therapeutic objective. Results The study population included 79% primary prevention patients (1.6, 25.5, 31.7 and 20.1%, with 1, 2, 3, and > 3 risk factors, respectively) and 21.0% secondary prevention patients. Applying AFSSAPS guidelines, the proportions of primary prevention patients not at LDL-cholesterol objectives varied across risk categories (P < 0.0001), from 3.9% for patients with one risk factor to 46.5% for patients with > 3 risk factors, and therapeutic failure reached 39.9% in secondary prevention. Only 26% of patients who were at high cardiovascular risk (> 3 risk factors or prior coronary heart disease) and not at therapeutic objective received high doses (> standard recommended doses) of lipid-lowering agents in monotherapy. Applying ANDEM guidelines, 74% of secondary prevention patients were not at treatment goal. Conclusion Compliance with guidelines varied inversely with the level of cardiovascular risk. Besides, most patients not at therapeutic objective were not up-titrated. The use of lipid-lowering agents is inadequate, depriving many patients of an effective protection against cardiovascular diseases.

Mixed dyslipidemias in primary care patients in France

“…The data source was the 2006 BKL-Thales database 22,33–38. Physicians in the Thales panel compose a nationally representative sample, based on criteria of age, gender, and area of practice.…”

Exploring patient demographic and clinical characteristics associated with lipid-lowering pharmacotherapy use in primary care

“…Even though the methods for recruiting the patient population and gathering data were different between our study and the CALIPSO study, the results for LDL-C target achievement are comparable. On the other hand, the present study has demonstrated a significantly higher attainment of target LDL-C concentrations compared to studies from European countries [13][14][15] and the United States. 16 Several issues may contribute to these differences, including different guidelines used to determine the risk strata for the patients 15 , different region-specific clinical practices and different time frames.…”

Diagnostic indicators of restless legs syndrome in primary care consultations: The DESYR study

“…Participants were members of the Thalès network, a representative panel of general practitioners in France who contribute exhaustive anonymous data on patient consultations and treatment to a centralized electronic database, allowing subsequent follow‐up of outcome. The Thalès database has been used widely in previous epidemiological studies 14–18. All 1,010 general practitioners belonging to the network were invited to participate in the study.…”