The Lipid Treatment Assessment Project (L-TAP)

Abstract

Objective: To determine the percentage of patients in the multicenter Lipid Treatment Assessment Project receiving lipid-lowering therapy who are achieving lowdensity lipoprotein cholesterol (LDL-C) goals as defined by National Cholesterol Education Program (NCEP) guidelines.Methods: Adult patients with dyslipidemia, who had been receiving the same lipid-lowering therapy for at least 3 months, were assessed at investigation sites. Lipid levels were determined once in each patient at the time of enrollment. The primary end point was the success rate, defined as the proportion of patients who achieved their LDL-C target level as specified by NCEP guidelines.Results: A total of 4888 patients from 5 regions of the United States were studied. Of these, 23% had fewer than 2 risk factors for coronary heart disease (CHD) and no evidence of CHD (low-risk group), 47% had 2 or more risk factors and no evidence of CHD (high-risk group), and 30% had established CHD. Overall, only 38% of patients achieved NCEP-specified LDL-C target levels; success rates were 68% among low-risk patients, 37% among high-risk patents, and 18% among patients with CHD. Drug therapy was significantly (PՅ.001) more effective than nondrug therapy in all patient risk groups. However, many patients treated with lipid-lowering drugs did not achieve LDL-C target levels.Conclusions: Large proportions of dyslipidemic patients receiving lipid-lowering therapy are not achieving NCEP LDL-C target levels. These findings indicate that more aggressive treatment of dyslipidemia is needed to attain goals established by NCEP guidelines.

The Status of Lipid Management in 1,836 Patients with Coronary Artery Disease: A multicenter survey to evaluate the percentage of Japanese coronary artery disease patients achieving the target low-density lipoprotein cholesterol level specified by the Japan Atherosclerosis Society

“…The success rate for achieving the target LDL-C level was only 29.9%, indicating that lipid management was not being performed optimally at the time of this survey. This huge treatment gap between the JAS guidelines and clinical practice in Japan is almost the same as that in the United States as demonstrated in the L-TAP survey (12). The gap may be explained by the use of low dosages of drugs, limited drug effectiveness, inappropriate choice of drug, drug tolerability, or poor compliance of patients with recommended treatments.…”

“…Available data indicate that a significant gap exists between the levels of LDL-C recommended by the NCEP and those achieved in clinical practice in the United States (10)(11)(12). However, in Japan, little is known about the extent to which physicians or cardiologists actually follow the JAS guideline.…”

Trends in Lipid Management Among Patients With Coronary Artery Disease

“…Given their elevated risk and similar lipid management goals, one would expect CAD patients with diabetes to be treated at least as aggressively as those without diabetes. Nevertheless, CAD patients, in general, continue to receive less than optimal lipid management, and those with diabetes may be relatively under-treated compared with those without diabetes (15)(16)(17)(18)(19). Hopefully, widespread dissemination and implementation of lipid management guidelines have resulted in improved outpatient lipid management over time (20,21).…”

Lipid‐lowering treatment patterns in patients with new cardiovascular events – estimates from population‐based register data in Sweden

“…The notion that there is a gap between evidence‐based medicine and real‐world clinical practice has been established in prior studies 35, 36, 37. Studies based on real‐world evidence are therefore important to establish the actual treatment of patients in different clinical practices.…”