Real vs perceived LDL cholesterol control in clinical practice in Spain: Which factors are related to real control?

Abstract

Abstract Background/Introduction According to ESC Guidelines, low-density lipoprotein cholesterol (LDLc) reduction is essential for the control of dyslipidaemia. Frequently, the physicians’ perception of LDLc control in patients (pts) is higher than the actual control, potentially leading to a suboptimal management of these pts. Purpose To understand the impact of physicians’ perception on LDLc control using a multivariate analysis and identify other potential predictive factors in the management of pts with dyslipidaemia in Spain. Methods Cross-sectional and multicentre study that included 435 healthcare professionals (34% cardiologists, 28% General Practitioners [GPs], 24% internists, and 14% endocrinologists) from 145 healthcare areas in Spain. Qualitative and quantitative information related to the management of pts with dyslipidaemia in clinical practice was collected. Additionally, aggregated anonymized data of the last 10 pts with dyslipidaemia attended by each physician were collected. With these data, a multivariate analysis was performed to estimate the impact of different variables on real LDLc control, including: age, gender and speciality of the physician, category of prevention, presence of comorbidities, lipid-lowing therapy (LLT) used, and whether the physician accurately perceived the real LDLc control. Results 4,010 pts (8%, 13%, 16% and 61% with low, moderate, high, and very high CV risk) were included. Physicians’ perception was that 62% of the pts achieved LDLc goals, but in actual clinical practice only 31% of pts did (p<0.01) (Figure 1). In the multivariate analysis it was found that physicians’ age and gender had little to no effect on LDLc control of pts, while their speciality did: cardiologists were twice as likely to control patients with dyslipidaemia than GPs. Likewise, pts with comorbidities or on secondary prevention were statistically associated with lower chance of appropriate LDLc control. Regarding the treatment used, data showed that the proportion of pts achieving LDLc goals increased as higher potency LLT was used. Precisely, LLT was found to have an significant impact on LDLc control: when compared to low intensity statins, pts treated with the combination of statin + ezetimibe had twice as many chances of achieving LDLc goals, reaching up to almost 15 times more possibilities for pts using PCSK9i. Lastly, control perception also mattered, with physicians who accurately perceived the real control having a probability two times higher to control their pts than physicians with poor LDLc control perception. Conclusions In Spain, most pts with dyslipidemia do not achieve the recommended LDLc goals mainly because of an insufficient intensification of LLT. The multivariate analysis showed that both LLT intensity and physicians’ perception had a major effect on LDLc control. These data highlight the need to further intensify LLT and raise awareness among physicians of the importance of achieving LDLc targets.Perceived vs real LDLc control by riskMultivariate analysis results