Dyslipidemia management improving in high-risk patients
MedWire News: Around six out of 10 dyslipidemia patients at high risk for coronary heart disease (CHD) are achieving their lipid targets, a study by US researchers suggests.
Danai Kitkungvan (Saint Vincent Hospital, Worcester, Massachusetts) and co-workers conducted a retrospective study to determine success in attaining cholesterol goals among high-risk patients.
From a database of patients referred for cardiac stress testing, they identified 765 who were at high or very high risk for CHD, based on a prior history of CHD, the presence of CHD risk equivalents, or a 10-year Framingham risk score of more than 20%.
Most patients were on treatment for dyslipidemia with at least one lipid-lowering agent, the team reports in the Journal of Clinical Lipidology. Overall, the mean low-density lipoprotein (LDL) cholesterol level was 96 mg/dl (2.5 mmol/l) and 62% of participants had achieved the LDL cholesterol goal of less than 100 mg/dl (2.7 mmol/l).
Among participants at very high risk for CHD, by contrast, the mean LDL cholesterol level was 79 mg/dl (2.0 mmol/l) and just 37% had attained the more stringent goal of less than 70 mg/dl (1.8 mmol/l).
Kitkungvan et al analyzed longitudinal data on the 293 patients who were not at goal at baseline. The mean LDL cholesterol level in this group was 131 mg/dl (3.4 mmol/l) at basement but declined to 100 mg/dl by 12 months. During the same period the percentage of patients taking lipid-lowering drugs increased from 49% to 71%.
Statins were the most commonly used lipid-lowering agents (64%). Among the 106 patients who did not achieve goal LDL cholesterol levels by month 12, 52% were being treated with at least one lipid-lowering drug.
Among the patients who were not receiving lipid-lowering therapy and who were not at goal at month 12, one-third were described as "intolerant" to medication, 12% had refused medication, and no explanation was given for 48%.
Kitkungvan and co-authors conclude: "These results confirm the trend toward substantially improved cholesterol control over the past decade."
They add: "Although the proportion [of patients who had achieved LDL goal] is higher than previous reports, it remains suboptimal and points toward the need for more aggressive management to lower the LDL cholesterol level in patients at greatest risk."
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By Joanna Lyford