Clinical and genetic factors associated with mismanagement of dyslipidemia. Multiple cross-sectional analysis

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Aims Identify the clinical and genetic factors associated with poor control of high cholesterol in the Swiss population. Methods Data from three waves [baseline, N = 617; first, N = 844 and second, N = 798 follow-ups] of a population-based, prospective study conducted in Lausanne, Switzerland. Inadequate management of dyslipidemia was assessed according to the most common Swiss guideline. Genetic scores for lipid levels were computed based on the existing literature. Results Prevalence of inadequately managed dyslipidemia was 30%, 31.5% and 17.4% in the baseline, first and second follow-up. On multivariable analysis, participants at high risk of CVD had a lower likelihood of being adequately managed: odds ratio (OR) and (95% confidence interval) for high-risk relative to low-risk: 0.10 (0.06-0.18), 0.11 (0.07-0.17) and 0.15 (0.09-0.27) for the baseline, first and second follow-up (p for trend < 0.001). Use of more potent statins increased the likelihood of adequate management, OR and (95% CI) for third vs. first level: 2.89 (1.76-4.74) and 5.17 (2.51-10.6) in the first and second follow-up (p for trend < 0.001). No differences in total cholesterol, LDL and HDL genetic scores were found between adequately and inadequately managed participants: for the total cholesterol, -3.7 ± 9.6 vs. -2.7 ± 9.4; -3.5 ± 8.9 vs. -3.7 ± 9.5 and -3.8 ± 8.9 vs. -3.3 ± 9.4 in the baseline, first and second follow-up, p = NS. Those findings were replicated when the thresholds for adequate control were relaxed. Conclusion Management of dyslipidemia is suboptimal in Switzerland. Use of newer, more potent statins in high-risk patients could improve this status. The use of genetic scores appears to be of little interest. Multivariate Analysis First FUOR (95% CI) p-value Second FUOR (95% CI) p-value CVD risk Intermediate 0.18 (0.10 - 0.32) <0.001 0.22 (0.09 - 0.55) 0.001 High 0.07 (0.04 - 0.12) <0.001 0.09 (0.04 - 0.2) <0.001 p-value for trend <0.001 <0.001 Swiss vs Non-Swiss 1.34 (0.87 - 2.05) 0.181 0.79 (0.43 - 1.43) 0.428 FH dyslipidemia (yes/no) 1.02 (0.63 - 1.63) 0.948 0.55 (0.29 - 1.03) 0.060 Statins potency First 1 (ref.) 1 (ref.) Second 2.00 (1.22 - 3.27) 0.006 2.59 (1.23 - 5.44) 0.012 Third 2.89 (1.76 - 4.74) <0.001 5.17 (2.51 - 10.6) <0.001 p-value for trend <0.001 <0.001