Physicians fail to assess LDL cholesterol targets correctly for many patients
MedWire News: Only about half of all high-risk patients are assigned the correct low-density lipoprotein (LDL) targets by their primary care physicians, report researchers.
“In our study we observed an average difference in LDL target levels of just over 17 mg/dl [0.44 mmol/l] between physicians with the least and best guideline knowledge, and this difference will certainly lead to a sizeable difference in major heart-related problems,” said study author Heribert Schunkert (Universitätsklinik Schleswig Holstein, Lübeck, Germany).
As reported in the European Heart Journal, the investigators surveyed 907 doctors who treated 25,250 patients for dyslipidemia.
According to guideline criteria (National Cholesterol Education Program - Adult Treatment Panel III), 68.0%, 21.9%, and 10.1% of the patients should have been allocated LDL targets of below 100, below 130, and below 160 mg/dl (2.59, 3.36, and 4.14 mmol/l), respectively.
However, the participating physicians allocated only 52.4% of the patients to the correct LDL cholesterol target. When divided by gender, significantly more men were assigned to the correct LDL cholesterol target than women, at 55.1% versus 49.1%.
Schunkert commented: “I am afraid to say that women are simply overlooked by their physicians, when it comes to cardiovascular risk.”
The researchers found that the group most often given the correct assessment was men with a history of myocardial infarction (MI). In comparison with this group, patients with coronary artery disease (CAD) but no prior MI, CAD-equivalent conditions, or a 10-year cardiovascular disease risk of more than 20% were 2.08-, 2.30-, and 2.69-fold, respectively, more likely to be assigned to an incorrect LDL cholesterol target group by their physician.
When physicians were grouped into quartiles of guideline knowledge, based on how many correct assessments they gave, LDL cholesterol levels were significantly lower in the first than in the second, third, and fourth quartiles ranging from 134.3 mg/dl (3.47 mmol/l) in the first to 151.4 mg/dl (3.92 mmol/l) in the fourth quartile.
“We believe efforts should be made to make guidelines simpler and easier to understand and follow; instruments to identify high-risk patients more easily should be developed; and special attention should be paid to women and patients without known cardiovascular disease, but with an accumulation of risk factors, since both groups appear frequently to escape the notice of doctors for aggressive cholesterol-lowering treatment,” summarized Schunkert.
Speaking on behalf of the International Menopause Society, Amos Pines (Tel Aviv University, Israel) said: “This paper rightly emphasizes a deficiency in therapy in higher risk subjects who have developed or who have an elevated risk of coronary artery disease. This is as relevant to women as it is to men.”
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By Helen Albert