Abstract
BackgroundIn hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). However, LDL-C control remains generally insufficient, also in patients with hypertension. We analyzed Electronic Health Record (EHR) data of 7117 hypertensive patients to find the most potential age and sex subgroups in greatest need for improvement in real life dyslipidemia treatment. Taking into account the current discussion on lifetime CVD risk, we focused on the age dependence in LDL-C control.MethodsIn this observational cross-sectional study, based on routine electronic health record (EHR) data, we investigated LDL-C control of hypertensive, non-diabetic patients without renal dysfunction or CVD, aged 30 years or more in Finnish primary care setting.ResultsMore than half (54% of women and 53% of men) of untreated patients did not meet the LDL-C target of < 3 mmol/l and one third (35% of women and 33% of men) of patients did not reach the target even with the lipid-lowering medication (LLM). Furthermore, higher age was strongly associated with better LDL-C control (p < 0.001) and lower LDL-C level (p < 0.001) in individuals with and without LLM. Higher age was also strongly associated with LLM prescription (p < 0.001). In total, about half of the patients were on LLM (53% of women and 51% of men).ConclusionsOur findings indicate that dyslipidemia treatment among Finnish primary care hypertensive patients is generally insufficient, particularly in younger age groups who might benefit the most from CVD risk reduction over time. Clinicians should probably rely more on the lifetime risk of CVD, especially when treating working age hypertensive patients.
Highlights
In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD)
The relationship between dyslipidemia and CVD is strong with plasma low-density lipoprotein cholesterol level (LDL-C) as every 1 mmol/L increase in Low-density lipoprotein (LDL-C) is associated with 28% risk increase in coronary heart disease mortality [3]
65% of hypertensive women and 67% of hypertensive men treated with lipidlowering medication (LLM) reached the LDL-C target < 3 mmol/l
Summary
In hypertensive patients, reducing plasma low-density lipoprotein cholesterol level (LDL-C) is one of the main interventions for preventing chronic cardiovascular diseases (CVD). The relationship between dyslipidemia and CVD is strong with plasma low-density lipoprotein cholesterol level (LDL-C) as every 1 mmol/L increase in LDL-C is associated with 28% risk increase in coronary heart disease mortality [3]. Reducing LDL-C is one of the central focuses in preventing CVD, in hypertensive patients. According to the 2016 European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) Guidelines for the Management of Dyslipidaemias, the target for individuals at low or moderate total CVD risk for treatment is LDL-C < 3 mmol/l [3]. Lifestyle changes are essential as a first approach but with hypertensive patients, who have moderate-high CV risk, lipid-lowering therapy is justified [4,5,6,7,8,9]
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