Focused therapy may improve attainment of target lipid levels
MedWire News: Swedish researchers report that focusing dyslipidemia therapy on reducing levels of low-density lipoprotein (LDL) cholesterol enables a significant number of patients to achieve target LDL cholesterol levels.
Billie Pettersson (Linköping University, Sweden) and colleagues say that after treatment with lipid-lowering therapy (mostly statins), approximately 40% of all patients attained Swedish lipid goal levels.
However, 60% of patients had persistently elevated high-density lipoprotein (HDL) cholesterol and triglycerides, irrespective of LDL cholesterol, and the team suggests that such patients should be considered for additional treatment that targets multiple lipid disorders.
The researchers analyzed data collected from 1994 to 2007 on 5424 patients (aged >35 years) who had been treated with lipid-modifying therapy and had at least one lipid abnormality.
Lipid levels were measured at baseline and after 12 months of treatment, and attainment of normal and target lipid levels was assessed.
The researchers report in the journal BMC Public Health that, following treatment, the prevalence of dyslipidemia (≥1 lipid abnormality) was reduced by 18%.
Targets for total cholesterol (<4.5 mmol/l [174.0 mg/dl] for patients at high risk and <5 mmol/l [193.4 mg/dl] for non-high risk) were attained by 30% of the population and LDL cholesterol goals (<2.5 mmol/l [96.7 mg/dl] for high risk and <3.0 mmol/l [116.0 mg/dl] for non high risk) were attained by 40% of the population.
Rates of elevated total and LDL cholesterol decreased from 95% to 68% and 93% to 61%, respectively.
In contrast, there was little improvement in HDL cholesterol (target >1.0 mmol/l [38.7 mg/dl] for men and >1.3 mmol/l [50.3 mg/dl] for women) and/or triglyceride abnormalities (target <1.7 mmol/l [68.7 mg/dl]), independent of LDL cholesterol.
This was particularly evident in the high-risk population, in whom low HDL cholesterol and/or elevated triglyceride levels at baseline remained at 69% for patients with Type 2 diabetes, 50% among patients with CHD, and 66% among patients with 10-year CHD risk >20% at follow-up.
The researchers suggest that high lipid levels at baseline are strong predictors of failing to reach goal/normal levels after treatment; each 0.1-mmol/l (3.9-mg/dl) increase in total or LDL cholesterol resulted in a 7% decrease in the likelihood of attaining target lipid levels.
Furthermore, baseline levels of HDL cholesterol were positively associated with attainment of normal levels at follow-up.
Pettersson's team concludes that despite low HDL cholesterol being a known risk factor for CHD, it appears to be largely ignored. They suggest that high-risk patients with abnormal lipid levels should, in addition to statins, be considered for treatment that targets multiple lipid disorders, especially those with Type 2 diabetes.
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By Nikki Withers