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30-01-2011 | Cardiometabolic | Article

More ‘aggressive’ treatment needed to achieve optimal lipid targets


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MedWire News: Most patients with coronary artery disease (CAD) are achieving the minimal recommended low-density lipoprotein (LDL) cholesterol goal, but many still have elevated levels of triglycerides or low levels of high-density lipoprotein (HDL) cholesterol despite treatment, say researchers.

In addition, few high-risk patients are achieving more aggressive LDL cholesterol goals recommended by the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III criteria.

"There exists a significant opportunity for physicians to more aggressively treat lipids to achieve the levels recommended by clinical guidelines," say Dean Karalis (Drexel University College of Medicine, Philadelphia, Pennsylvania, USA) and colleagues.

Using the electronic medical records of over 10,000 patients with histories of CAD, the researchers reviewed the percentage of patients achieving NCEP ATP III lipid goals between September 2008 and 2009.

Overall, 79% of patients achieved the minimal LDL cholesterol goal of <100 mg/dl (2.59 mmol/l), while only 35% achieved the more aggressive target of <70 mg/dl (1.81 mmol/l). Success rates were higher in men than in women for reaching LDL cholesterol levels <100 mg/dl and <70 mg/dl, at 83% versus 73%, and 38% versus 31%, respectively.

Furthermore, only 69% of patients achieved normal triglyceride levels (<150 mg/dl [1.69 mmol/l]) and only 63% of men and 56% of women achieved normal HDL cholesterol levels (<40 mg/dl [1.04 mmol/l] for men and <50 mg/dl [1.30 mmol/l] for women).

In addition, non-HDL cholesterol goals of <130 mg/dl (3.37 mmol/l) and <100 mg/dl (2.59 mmol/l) were achieved in only 79% and 44% of patients, respectively.

The researchers say that normal lipid levels were less likely to be achieved by women, compared with men, and that obesity (body mass index ≥30 kg/m2) and younger age (<65 years) were additional predictors for non-achievement of LDL and HDL cholesterol targets.

Writing in The American Journal of Cardiology, Karalis and team note that more than half of patients not achieving the LDL cholesterol goal of <70 mg/dl were not prescribed atorvastatin and rosuvastatin, the more "potent" statins, and in patients who were receiving them, the average dose prescribed was below the maximal dose.

They suggest more intensive treatment is needed for CAD patients who are not achieving the more aggressive lipid target levels.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2011

By Nikki Withers