Primary prevention in high-risk dyslipidemic patients without an established cardiovascular disease: Undertreatment and rationale for lipid-lowering therapy

Abstract

Background Recent updated guidelines expand the usage of lipid-lowering therapy for primary prevention in high-risk individuals without an established cardiovascular disease (CVD). In contrast to secondary prevention, the extent of the target population and the utilization of lipid-lowering drugs are insufficiently clear. We examine the implementation of statin therapy as primary prevention in high-risk patients without a known CVD and discuss the rationale for the management of dyslipidemia in this population. Methods Records of 371 consecutive patients without an established CVD who were hospitalized in an internal medicine department between January and June 2005 were evaluated for CVD-equivalent high-risk factors (diabetes mellitus, stroke of carotid origin, peripheral vascular disease, abdominal aortic aneurysm, or Framingham 10-year risk score ≥ 20%). Demographic and clinical data, in addition to lipid profile and usage of statin drugs prior to and during hospitalization, were analyzed. Results Of the 371 non-cardiovascular patients, 88 (24%) were defined as high-risk individuals eligible for statin therapy as primary prevention of CVD. Their mean age was 71 ± 11 years and their mean LDL-C level was 132 ± 30 mg/dL. Seventeen patients (19%) were treated with statin drugs prior to admission and only two more patients (19/88, 22%) received statins in addition during hospitalization. Patients treated with statins had non-significantly higher LDL-C levels. Conclusions There is considerable undertreatment of high-risk patients without an established CVD with lipid-lowering drugs. There is also sub-optimal implementation of guidelines in clinical practice, despite well-established evidence of the benefits of statins in the primary prevention of CVD for high-risk individuals with average cholesterol levels, diabetes mellitus, and in elderly patients, as represented by our study population.