Abstract 1183: Longitudinal Assessment of Dyslipidemia in a Representative Sample of US Adults: Prevalence and Attainment of Goal/Recommended Levels

Abstract

Elevated low density lipoprotein cholesterol (LDL-C), low high density lipoprotein cholesterol (HDL-C) and elevated triglycerides (TG) are cardiovascular (CV) risk factors. The objective of this study was to evaluate attainment of goal/recommended lipid levels and predictors thereof post initiation of lipid modifying therapy (LMT) in a representative sample of US adults with commercial and government health insurance. Among 111,623 patients age >35 from GE Centricity Electronic Medical Records with ≥1 abnormal lipid value (before June 2004), we extracted 51,891 patients who initiated LMT between June 2004 and December 2006 (index date), continued therapy for 1 year, and had full lipid panels (LDL-C, HDL-C and TG) pre and post index date. LDL-C goals were defined according to NCEP ATP III guidelines. Recommended level for TG was <200 mg/dL, and for HDL-C >40mg/dL for men and >50mg/dL for women. Patients with history of coronary heart disease (CHD), diabetes and 10 year CHD risk>20% were classified as high CV risk. Multiple logistic regressions evaluated predictors of lipid level attainment (individual and ≥2). Among 51,891 patients, 53% had elevated LDL-C, 60% had low HDL-C, 37% had elevated TG and 73% had low HDL-C and/or elevated TG prior to LMT initiation. Despite 1 year therapy - with over 80% initiating statin therapy - 34% had elevated LDL-C (29% for high risk), 56% had low HDL-C (67% for high risk), 30% had elevated TG (32% for high risk) and 65% had low HDL-C and/or elevated TG (75% for high risk). CHD and diabetes were associated with better attainment of LDL-C goal and TG recommended levels. Females (Odds Ratio=0.24, 95% Confidence Interval [0.16 – 0.34]), patients with 10 year CHD risk>20% (OR=0.22, 95% CI [0.12– 0.40]) and those with higher baseline total cholesterol (OR=0.98, 95% CI [0.97– 0.99]) were less likely to attain ≥2 recommended lipid levels. In this cohort of insured US adults, additional 19% attained LDL-C goal following LMT for 1 year but few improved in terms of HDL-C (4%), TG (7%) and HDL-C and/or TG (8%). Additionally, dyslipidemia persisted among high risk patients despite higher likelihood of reaching LDL-C goal with presence of CHD or diabetes. Control of multiple lipid parameters remained poor.