Prevalence and overlap of different lipid abnormalities in statin-treated patients at high cardiovascular risk in clinical practice in Germany

Abstract

BackgroundIn line with current guideline recommendations, patients at high cardiovascular risk are usually treated with statins for secondary as well as for primary prevention. While many studies investigated treatment goal achievement with regards to low-density lipoprotein (LDL-C) and total cholesterol (TC) there is paucity of data regarding high density lipoprotein (HDL-C), and/or triglycerides (TG).SettingProspective, cross-sectional study (Dyslipidemia International Survey, DYSIS) with data provided by 748 office-based physicians throughout Germany.MethodsConsecutive patients were eligible for participation, if they were at least 45 years old, currently treated with a statin and had had a documented lipid profile (at least 1 parameter) within the last 6 months. Besides descriptive analyses, logistic regression was performed with backward selection to assess predictors for lipid abnormalities (non-attainment of goals for TC, LDL-C, low HDL-C or elevated TG) classified according to current European Society of Cardiology guidelines.ResultsThe 4,282 documented patients (98.6% Caucasian, 56.4% male; 86.6% at high cardiovascular risk) were predominantly treated with simvastatin (83.9%), pravastatin (7.7%) or atorvastatin (3.9%), usually with doses equivalent to simvastatin 20–40 mg daily. Non-statins were used in at most 12% of patients. No lipid abnormalities were found in 21.0% of patients, one abnormality in 38.5%, two in 31.9%, and all three in 8.5%. LDL-C goals were not attained in 58.1%, elevated TC was found in 66.6%, low HDL-C in 22.7%, and elevated TG in 47.3%. In the multivariate logistic regression model, non-attainment of LDL-C levels was predicted by hypertension (odds ratio, OR 1.4), current smoking (OR 1.3), sedentary lifestyle (OR 1.3), and female gender (OR 1.3). On the other hand, a reduced risk for missing LDL-C targets was noted in the presence of ischemic heart disease (OR 0.6), diabetes (0.5), higher statin doses, ezetimibe treatment, or specialist care, respectively.ConclusionA substantial proportion of statin-treated patients not only missed targets for LDL-C, but also did not attain the normal levels for HDL-C and/or TG. There is a large disconnect between high prevalence of HDL and/or TG disorders, with or without elevated LDL-C, and utilization of therapies targeting these lipids. Particularly in high-risk patients, additional efforts should be made to improve their lipid profile.

Current state of cardiac rehabilitation in Germany: patient characteristics, risk factor management and control status, by education level

“…Similar findings on suboptimal control of lipids,28,29 diabetes mellitus,30 and hypertension31 have been reported in primary care, which is the setting in which most patients with coronary heart disease are managed after cardiac rehabilitation. Reasons may include the limited time period in which physicians have to initiate lifestyle modifications or drug treatment during rehabilitation (about 3–4 weeks).…”

Do acute coronary events affect lipid management and cholesterol goal attainment in Germany?

“…An analysis of the German 2L registry of patients with coronary heart disease (CHD) showed that most patients treated for dyslipidemia received low-intensity statin regimens [8]. Not surprisingly, the Dyslipidemia International Study (DYSIS) found that, among statin-treated patients in Germany, 58.1% failed to attain the LDL-C target value for high risk patients (<100 mg/dl; 2.6 mmol/l) [9], and a large German population-based cross-sectional study found that among statin-treated CHD patients, the estimated 10-year risk of a coronary event was 35.1%, well above the threshold for LLT [10]. …”

Lipid management in 13,000 high risk cardiovascular patients treated under daily practice conditions: LIMA Registry

“…According to an analysis of all prescriptions paid by the statutory health insurance in 2010, of the 1471 million defined daily doses of statins (which allow treatment of 4 million patients, at standard doses), 1277 million were for simvastatin, 91 million were for pravastatin, 62 million for fluvastatin, 18 million for atorvastatin, and 5 million were for lovastatin and rosuvastatin each. The simva statin 40 mg/day entry dose, used as the inclusion criterion in our study, is somewhat higher than in other studies documenting actual care: in the DYSIS cross-sectional study,13 84% of patients treated for lipid disorders received simvastatin, and the mean simvastatin dose (or in case of other statins, the equivalent dose) was 27 mg/day, with no major differences between high-risk patients and other patients.…”