CV4 Patients with Hypercholesterolaemia or MIXED Dyslipidaemia and High or VERY High Cardiovascular Risk According to ESC/EAS Guidelines – a Population-Based CROSS–Sectional Study from the Netherlands

Abstract

To describe the proportion, clinical characteristics, treatment patterns and healthcare utilization of patients with hypercholesterolaemia/mixed dyslipidaemia and high or very high cardiovascular (CV) risk according to the 2016 ESC/EAS guidelines, in the Netherlands. The analysis was done using the PHARMO Database Network, which combines anonymous data linked on a patient level from different primary and secondary healthcare settings in Netherlands. A cross-sectional cohort was constructed, including patients with a diagnosis of hypercholesterolaemia/mixed dyslipidaemia or ever treated with lipid lowering treatment (LLT) in the period 2009-2018. Included were those that in 2018 were classified as high or very high CV risk based on the 2016 ESC/EAS guidelines or were classified as statin intolerant and had a recorded Low Density Lipoprotein-Cholesterol (LDL-C). We identified 173,321 patients with hypercholesterolaemia/mixed dyslipideamia based on a recorded diagnosis or a history of LLT, of which 54,346 met the inclusion criteria. Out of those, 30% were of high risk and 70% of very high CV risk. The mean age was 70.9 (standard deviation 10.3) and the proportion of female was 46%. 66% of the patients had an atherosclerotic CV disease, with myocardial infarction (25%) and angina pectoris (32%) being the most frequently recorded diagnoses. Documented statin intolerance was reported in 3% of the patients. Only 35% of the patients had an LDL-C <1.8 mmol/L (70 mg/dl), while 25% had an LDL-C >2.6 mmol/L (100 mg/dL). Statin alone is the most common LLT (93%) administered mostly at moderate intensity (73%). 5% of the patients received ezetimibe as monotherapy or with statins. Ongoing analysis will cover also the healthcare utilization. Despite current LLT, LDL-C levels remain high in patients who are at CV risk, suggesting that additional therapies and strategies are needed.