LDL cholesterol treatment ‘not satisfactory’
MedWire News: Lipid-lowering treatment for patients at high risk for coronary heart disease (CHD) has improved, but is still not satisfactory, German researchers say.
In the journal Clinical Research in Cardiology, they report that only 43.8% of high-risk patients achieved the target low-density lipoprotein (LDL) cholesterol level of <100 mg/dl, as defined by the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III guidelines.
Kurt Bestehorn (MSD Sharp and Dohme, Haar, Germany) and colleagues analyzed data from a 2005-2006 internet-based registry, to investigate the attainment of LDL cholesterol treatment goals in patients before and after cardiologist intervention.
They included 3131 patients with CHD and/or CHD risk equivalents (CE; diabetes mellitus, peripheral arterial disease, or a 10-year CHD risk >20%) who were receiving chronic statin treatment and were assessed on a single visit by cardiologists from 42 hospitals.
Patients were separated into three prespecified subgroups, CHD plus CE (n=1458; 46.6%), CHD-only (n=1104; 35.3%), and CE-only (n=569; 18.2%).
For every patient, the cardiologists documented individual LDL cholesterol target values and planned changes to lipid therapy. They received instant feedback on the estimated effects of their treatment decisions, as calculated by NCEP ATP III algorithms.
At admission, LDL cholesterol levels of <100 mg/dl (2.6 mmol/l) were observed in 43.1% of patients with CHD plus CE, 44.8% of CHD-only patients, and 37.9% of CE-only patients. The majority of these patients were receiving low to intermediate statin doses (eg, simvastatin 10-20 mg/day).
Following the intervention, overall, same-drug dosage was increased in 22.9% of patients, while 14.6% switched to another statin, and 11.6% received an additional cholesterol absorption inhibitor.
The researchers say: "By intensifying lipid-lowering treatment, cardiologists were able to increase the number of patients at LDL cholesterol target, considerably."
However, the LDL cholesterol target of <100 mg/dl was still only reached in 49.0% of CHD plus CE patients, 48.5% of CHD-only, and 42.9% of CE-only patients.
Besterhorn's team concludes that target achievement rates for LDL cholesterol are not optimal in high-risk patients with CHD and/or CE.
They suggest that treatment needs to be further optimized in the future, particularly in the earlier course of cardiovascular disease, so that the target attainment rates for high-risk patients can be achieved.
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By Nikki Withers