Management of atherogenic dyslipidemia according to current treatment guidelines: DESPEGA study in real clinical practice

Abstract

Studies in patients with dyslipidemia have revealed that, despite guideline recommendations, treatment remains unchanged even when therapeutic goals are not achieved. Our objective was to determine the degree to which primary care (PC) and specialty care (SC) physicians adhere to clinical guidelines for the management of atherogenic dyslipidemia (AD). This was an observational, descriptive, cross-sectional study. Physicians working in the Spanish Health System completed an electronic questionnaire comprising 24 items organized into three blocks: clinical guidelines, adherence to clinical guidelines, and other issues in the management of AD. The questions were formulated with closed polytomous or categorized responses. Adherence to guidelines, in terms of treatment, was assessed according to physicians’ responses to six patient profiles. Absolute and relative frequencies (qualitative variables), central tendency and dispersion (quantitative variables) were calculated. In total, 980 physicians (88.5% PC) participated in the study; 77.3% used guidelines in their routine clinical practice, with the most used being the Spanish SEMERGEN (73.8%) and the European Society of Cardiology/European Atherosclerosis Society guidelines (41.2%). A total of 83% adhered to guideline recommendations in more than four of the six profiles proposed, 26.2% adhered to the SEMERGEN definition of AD, 66.6% combined all lipoprotein ratios to diagnose AD, and > 60% used non-high-density lipoprotein cholesterol (HDL-C) to diagnose patients with AD at high cardiovascular risk. In total, 99.0% prescribed a fibrate to reduce triglyceride levels, 47.4% to increase HDL-C levels and 40.2% to reduce small, dense low-density lipoprotein cholesterol particles. Since adherence to clinical guidelines improves both the quality of care and health outcomes, greater adherence to and satisfaction with clinical guidelines for the management of AD may contribute to improvements in and optimization of the management of patients with AD in the Spanish health system.