Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany

März, Winfried; Dippel, FW; Theobald, Karlheinz; Gorcyca, Katherine; Iorga, Şerban R.; Ansell, David

doi:10.1016/j.atherosclerosis.2017.11.020

Cited by 63 publications

(46 citation statements)

References 25 publications

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“…Comparable results (for 2010) in this study showed LDL-C goal attainment rates of approximately 12 and 32%, in DM patients with or without additional high-risk disease, respectively. Low rates of LDL-C goal attainment have also been described consistently in other countries, including 58% of recent ACS patients in the Netherlands [38], 28.8% of ACS survivors in Hong Kong and Taiwan [39], 30% of German atherosclerotic CVD patients [40], 41% of patients with DM at very-high cardiovascular risk receiving statins in France [41] and 38% of DM patients with ischemic heart disease in a tertiary hospital in China [42]. In contrast, a higher attainment rate (68%) for Japan Atherosclerosis Society guideline-recommended LDL-C targets [43] was reported in high-risk patients for CVD in Japan [44].…”

Section: Discussionmentioning

confidence: 66%

Low-density lipoprotein cholesterol goal attainment rates in high-risk patients with cardiovascular diseases and diabetes mellitus in Korea: a retrospective cohort study

Yang

Kim

et al. 2020

Lipids Health Dis

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Background: Real-world evidence of low-density lipoprotein cholesterol (LDL-C) goal attainment rates for Asian patients is deficient. The objective of this study was to assess the status of dyslipidemia management, especially in high-risk patients with cardiovascular disease (CVD) including stroke and acute coronary syndrome (ACS). Methods: This was a retrospective cohort study of 514,866 subjects from the National Health Insurance Service-National Health Screening Cohort database in Korea. Participants were followed up from 2002 to 2015. Subjects with a high-risk of CVD prior to LDL-C measurement and subjects who were newly-diagnosed for high-risk of CVD following LDL-C measurement were defined as known high-risk patients (n = 224,837) and newly defined high-risk patients (n = 127,559), respectively. Data were analyzed by disease status: stroke, ACS, coronary heart disease (CHD), peripheral artery disease (PAD), diabetes mellitus (DM) and atherosclerotic artery disease (AAD). Results: Overall, less than 50% of patients in each disease category achieved LDL-C goals (LDL-C < 70 mg/dL in patients with stroke, ACS, CHD and PAD; and LDL-C < 100 mg/dL in patients with DM and AAD). Statin use was observed in relatively low proportions of subjects (21.5% [known high-risk], 34.4% [newly defined high-risk]). LDL-C goal attainment from 2009 to 2015 steadily increased but the goal-achiever proportion of newly defined high-risk patients with ACS remained reasonably constant (38.7% in 2009; 38.1% in 2015). Conclusions: LDL-C goal attainment rates in high-risk patients with CVD and DM in Korea demonstrate unmet medical needs. Proactive management is necessary to bridge the gap between the recommendations of clinical guidelines and actual clinical practice.

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Section: Discussionmentioning

confidence: 66%

Low-density lipoprotein cholesterol goal attainment rates in high-risk patients with cardiovascular diseases and diabetes mellitus in Korea: a retrospective cohort study

Yang

Kim

et al. 2020

Lipids Health Dis

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“…Data from the international, observational, cross-sectional DYSIS II study showed that fewer than onethird of patients with stable CHD achieved an LDL-C level <70 mg/dL, despite all patients being at very high CV risk [21], and these findings were replicated within Asian DYSIS II cohorts [8,9,22]. Other cross-sectional and real-world evidence clearly demonstrates that many CHD patients with dyslipidemia remain inadequately treated with most patients on statin therapy not achieving treatment targets [23][24][25][26][27][28]. Collectively, these findings indicate huge potential to improve cardiovascular outcomes using more intensive lipid-lowering therapy.…”

Section: Discussionmentioning

confidence: 97%

A Retrospective Study of LDL-Cholesterol in Koreans on Atorvastatin/Ezetimibe or Atorvastatin Monotherapy

Chang¹,

Ihm²,

Kim³

et al. 2019

JED

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Purpose: To investigate low-density lipoprotein cholesterol (LDL-C) goal attainment rates in patients with hypercholesterolemia treated with atorvastatin/ezetimibe or atorvastatin monotherapy. Methods: This was a multicenter, noninterventional, retrospective, chart review study of Korean patients with hypercholesterolemia who were statin-naïve and prescribed atorvastatin/ezetimibe or atorvastatin monotherapy during an observational period, from January 2014 to July 2017, and followed up for 12-18 weeks. Patients were propensity score matched to reduce treatment selection bias. Outcomes included LDL-C goal attainment rate at week 12, defined by risk groups according to Korean Society of Lipidology and Atherosclerosis guidelines; and change in lipid parameters from the index date to week 12. Results: A total of 969 patients were enrolled in the study: atorvastatin/ezetimibe, n = 349; atorvastatin monotherapy, n = 620. Following propensity matching (n = 316 in each group), respective LDL-C goal attainment rates for atorvastatin/ezetimibe and atorvastatin monotherapy groups were 86% and 75%, respectively (p = 0.0004). Atorvastatin/ezetimibe produced significantly larger reductions at week 12 in mean LDL-C (−50.3% vs −42.7%), total cholesterol (−36.8% vs −30.7%) and non-high-density lipoprotein cholesterol (non-HDL-C; −47.3% vs −39.8%) levels compared to atorvastatin monotherapy (all p < 0.0001). Conclusion: More patients achieved LDL-C goal attainment with atorvastatin/ezetimibe than with atorvastatin monotherapy, and atorvastatin/ ezetimibe was associated with significantly larger reductions in mean LDL-C, total cholesterol and non-HDL-C levels than atorvastatin monotherapy, in Korean patients with hypercholesterolemia in a real-world clinical practice.

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“…Despite these recommendations, several observational studies reported poor control rates of LDL-C in this clinical setting [4,5,[12][13][14]. This problem becomes more relevant if we consider that achievement of LDL-C goals was associated with better health outcomes among patients with diabetes [15].…”

Section: Discussionmentioning

confidence: 99%

Impact of the 2019 European Guidelines on Diabetes in Clinical Practice: Real and Simulated Analyses of Lipid Goals

Masson

Huerín²,

Lobo

et al. 2020

JCDD

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Background: Recent European guidelines on diabetes, prediabetes, and cardiovascular disease developed for the European Society of Cardiology (ESC) in collaboration with the European Association for the Study of Diabetes (EASD) significantly changed some concepts on risk stratification, lipid goals, and recommendations for the use of lipid-lowering drugs. The objectives of this work were to describe the lipid-lowering treatment prescribed for patients with diabetes and to determine the percentage of patients that achieved the lipid goals recommended by the 2019 ESC/EASD Guidelines on Diabetes in real and simulated scenarios. Methods: A multicenter, cross-sectional study was performed. Subjects >18 years with type 2 diabetes were included. The recommendations of the 2019 ESC/EASD Guidelines were followed. The real and simulated (ideal setting using adequate doses of statins ± ezetimibe) scenarios were analyzed. Results: Overall, 528 patients were included. In total, 62.5% of patients received statins (17.1% high intensity). Most patients were stratified as “very high risk” (54.2%) or “high risk” (43.4%). Only 13.3% achieved the double lipid goal (LDL-C and non-HDL-C goals according to the risk categories). In the simulation analysis, the proportion of subjects that did not reach the therapeutic objective decreased in all risk strata, although a considerable proportion of subjects persisted outside the target. Conclusion: The difficulty of achieving lipid goals in diabetic patients was considerable when applying the new guidelines. The situation would improve if we optimized treatment, but the prescription of new lipid-lowering drugs could be limited by their high cost.

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Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany

Abstract: In this high/very-high CV risk population in Germany, statin utilization was low; suggesting that LLTs are not prescribed as per European guidelines. These results highlight the need to increase LLT use among high-risk patients.

Cited by 63 publications

References 25 publications

Low-density lipoprotein cholesterol goal attainment rates in high-risk patients with cardiovascular diseases and diabetes mellitus in Korea: a retrospective cohort study

Low-density lipoprotein cholesterol goal attainment rates in high-risk patients with cardiovascular diseases and diabetes mellitus in Korea: a retrospective cohort study

A Retrospective Study of LDL-Cholesterol in Koreans on Atorvastatin/Ezetimibe or Atorvastatin Monotherapy

Impact of the 2019 European Guidelines on Diabetes in Clinical Practice: Real and Simulated Analyses of Lipid Goals

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