Suboptimal control of lipid levels: results from the non-interventional Centralized Pan-Russian Survey of the Undertreatment of Hypercholesterolemia II (CEPHEUS II)

S А Boytsov ,Наталья Анатольевна Логунова ,Yunona Khomitskaya

doi:10.1186/s12933-017-0641-4

S А Boytsov , Наталья Анатольевна Логунова + Show 1 more

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https://doi.org/10.1186/s12933-017-0641-4

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Abstract

BackgroundElevated levels of low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) are risk factors for cardiovascular complications. This study evaluated LDL-C goal attainment in Russian clinical practice among patients with moderate to very high cardiovascular risk. The study also assessed LDL-C goal attainment in patients prescribed lipid-lowering therapy for primary compared with secondary cardiovascular disease (CVD) prevention, predictors of LDL-C goal attainment, and the proportion of individuals with diabetes mellitus who achieved HbA1c < 7%.MethodsThe Centralized Pan-Russian Survey on the Undertreatment of Hypercholesterolemia in Russia II (CEPHEUS II) was a multicenter, non-interventional, cross-sectional study conducted in the Russian Federation from September 2014 to November 2015. Participants were aged ≥ 18 years, were receiving a stable dose of lipid-lowering medication and had a moderate to very high cardiovascular risk. The primary variable was the proportion of patients reaching LDL-C goals established by the Fifth Joint European Task Force guidelines. Secondary analyses used McNemar and χ2 tests.ResultsData from 2703 patients were analyzed; 91.2% had a very high cardiovascular risk and 24.0% had been diagnosed with diabetes mellitus. Overall, 17.4% of patients (95% confidence interval [CI] 15.9–18.8%) achieved LDL-C goals. Investigators estimated this proportion at 21.8% (95% CI 20.3–23.4%). LDL-C goals were achieved by more patients in the primary CVD prevention subgroup than in the secondary CVD prevention subgroup (19.7% vs 16.1%, p = 0.017). Patient-related factors associated with a decreased likelihood of achieving LDL-C goals included having ischemic heart disease or a family history of premature coronary heart disease, forgetting to take hypercholesterolemia treatment or considering it acceptable to miss prescribed doses more than once per week, and dissatisfaction with or concern about lipid-lowering therapy. Overall, 367/593 (61.9%) patients with diabetes mellitus and interpretable HbA1c results achieved HbA1c < 7%.ConclusionsHypercholesterolemia management is suboptimal in patients with moderate to very high cardiovascular risk in Russian clinical practice. Substantial opportunity remains to improve treatment target attainment and reduce the risk of cardiovascular complications. Lipid-modifying strategies may need to be intensified to reduce CVD risk in this setting.Trial registration ClinicalTrials.gov: NCT02230241 (registered 26 August 2014)

Highlights

Elevated levels of low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) are risk factors for cardiovascular complications
The results showed that just under half (48.2%) of the participants who received lipid-lowering therapy achieved LDL-C target levels recommended by the 2007 Fourth Joint European Task Force guidelines [11], and 34.5% achieved LDL-C targets set by the 2007 Russian Society of Cardiology (RSC) guidelines [12]
Most of the patients had a history of cardiovascular disease (CVD) or had CV risk factors, and 91.2% were categorized as being at very high CV risk

Summary

Introduction

Elevated levels of low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) are risk factors for cardiovascular complications. A Cochrane review of trials in which ≤ 10% of participants had a history of CVD showed reductions in all-cause mortality and the risk of CVD events in individuals treated with statins compared with those receiving placebo or usual care for primary CVD prevention, over a minimum follow-up duration of 6 months [7]. Treatment with statins reduced the odds of all-cause death during the observation period by 14% relative to placebo or usual care (odds ratio [OR] 0.86; 95% confidence interval [CI] 0.79–0.94), lowered the risk of CVD (relative risk [RR] 0.75; 95% CI 0.70–0.81), coronary heart disease (CHD) events (RR 0.73; 95% CI 0.67–0.80), and stroke (RR 0.78; 95% CI 0.68–0.89), and decreased the rate of revascularization (RR 0.62; 95% CI 0.54–0.72) [7]. Statins were observed to be effective in the prevention of any CV event in a metaanalysis of trials evaluating secondary prevention of CVD (RR vs placebo: 0.81; 95% CI 0.78–0.85) [8]

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