0186: Are coronary patients on lipid-lowering therapy in Europe achieving the recommended LDL-C target? Results from the Dyslipidemia International Study (DYSIS) II Europe

Abstract

Current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) target of <1.8mmol/l for coronary patients and the administration of high potency statin therapy. Our study documents real world lipid target achievement, including distance to target, among patients with stable coronary heart disease (CHD) and patients surviving an acute coronary syndrome (ACS) event in Europe. DYSIS II is a multicountry, observational cross-sectional chart review conducted in 257 sites throughout Belgium, France, Germany, Greece, Ireland, Italy, and Russia. Two distinct patient cohorts were enrolled: patients surviving an ACS event and patients diagnosed with stable CHD. Full lipid profiles were available within 24 hours of hospital admission for ACS patients and 0-12 months prior to enrollment for CHD patients. Patients were on lipid-lowering therapy (LLT) ≥3 months and not participating in clinical trials involving medication. Patient characteristics, risk factors, treatment patterns, and laboratory values were collected. LDL-C target achievement was assessed based on ESC/EAS guidelines. 880 ACS and 2778 CHD patients currently on LLT were enrolled in Europe from 2012 to 2014. Only 23.2% (n=204) ACS and 29.6% (n=821) CHD patients achieved and LDL-C<1.8mmol/l, with median distance to LDLC target in patients not a goal being 0.9mmol/l (IQR 0.4, 1.5) in ACS and 0.6mmol/l (IQR 0.3, 1.1) in CHD patients. Three out of four coronary patients did not achieve the recommended LDL-C target, even while being treated with LLT, primarily statin monotherapy. Low potency statin treatment was found in both patient cohorts, despite the high risk of our patient population and the need for more intense LLT (as stressed by our distance to target findings). Abstract 0186 – Table: Mean Lipid Values and LLT ACS Patients N=880 CHD Patients N=2778 Total cholesterol (mmol/l) 4.4±1.2 4.1±1.0 LDL-C (mmol/l) 2.6±1.0 2.3±0.8 Triglycerides (mmol/l) 1.6±0.9 1.5±0.8 HDL-C (mmol/l) 1.1±0.3 1.2±0.4 Non-HDL-C (mmol/l) 3.3±1.2 2.9±0.9 Atorvastatin equivalent dose (mg/day) 22±17 27±20 Statin monotherapy 87.2% 79.8% Statin + ezetimibe 6.4% 11.6% Statin + other non-statin (fibrates, omega 3 fatty acids) 2.4% 6.7% Non-statin monotherapy 3.8% 2.0%