Goal Attainment In Patients Research Articles

Efficacy of iGlarLixi, a fixed-ratio combination of insulin glargine and lixisenatide, in patients with type 2 diabetes stratified as at high or low risk according to HEDIS measurements.

The Healthcare Effectiveness Data and Information Set (HEDIS) measurements assess glycaemic goal attainment in patients with type 2 diabetes, incorporating factors including age and health status. Healthier patients are assigned a glycated haemoglobin (HbA1c) goal of <7% (low-risk [LR]) and individuals aged >65 years or with comorbidities are assigned a goal of <8% (high-risk [HR]). This post-hoc analysis assessed the safety and efficacy of iGlarLixi, a fixed-ratio combination of insulin glargine 100 U/mL (iGlar) and lixisenatide, in 1898 patients from the phase 3 LixiLan-L and LixiLan-O clinical trials, retrospectively classified as LR (n = 1181) or HR (n = 717). iGlarLixi was more effective in reducing HbA1c than comparators in both LR and HR patients across the LixiLan-L trial (change from baseline, 1.1% vs -0.6% for iGlar in both groups; P < 0.001) and the LixiLan-O trial (change from baseline, LR/HR -1.6%/-1.4% vs -1.3%/-1.2% for iGlar and -0.8%/-0.9% for lixisenatide; P < 0.01). iGlarLixi treatment significantly reduced postprandial glucose in both LR and HR patients (P < 0.001). The incidence of hypoglycaemia did not differ between risk categories in any treatment group.

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

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)

Utilization of lipid-modifying therapy and low-density lipoprotein cholesterol goal attainment in patients at high and very-high cardiovascular risk: Real-world evidence from Germany

Background and aimsElevated low-density lipoprotein cholesterol (LDL-C) is a causal risk factor for cardiovascular (CV) events. European guidelines recommend reducing LDL-C as the primary lipid target to reduce CV risk, using lifestyle modifications and lipid-lowering therapy (LLT). Many European patients do not achieve guideline-recommended LDL-C levels. The present database analysis aimed to assess LLT treatment patterns and LDL-C threshold attainment in Germany in a large, real-world cohort of patients. MethodsPatients from the Cegedim Longitudinal Practice Database in Germany who met selection criteria were included: (a) LDL-C measurement in 2013; (b) ≥20 years of age; (c) high or very-high CV risk conditions: recent acute coronary syndrome (ACS), other coronary heart disease (CHD), ischemic stroke, peripheral arterial disease (PAD) (atherosclerotic cardiovascular disease [ASCVD]) or diabetes mellitus (DM) (non-ASCVD). LDL-C threshold attainment was assessed based on LDL-C targets from 2011 European guidelines. Results42,767 patients met the inclusion criteria; 35% received current statin treatment, and 30% achieved guideline-recommended LDL-C targets. Attainment of LDL-C goals among ASCVD hierarchical categories was 46.7% for recent ACS, 35.8% for ischemic stroke, 34.9% for other CHD, and 26.9% for PAD. Among patients in the non-ASCVD group with DM, 23.6% achieved LDL-C goals. Similar results were observed when patients were grouped by prevalence (patients assigned to every risk group for which they qualified). ConclusionsIn this high/very-high CV risk population in Germany, statin utilization was low; suggesting that LLTs are not prescribed as per European guidelines. These results highlight the need to increase LLT use among high-risk patients.

Clinical meaningfulness of Alzheimer's Disease Assessment Scale–Cognitive subscale change in relation to goal attainment in patients on cholinesterase inhibitors

IntroductionThe clinical meaningfulness of Alzheimer's Disease Assessment Scale–Cognitive subscale (ADAS-Cog) subscale change is disputed. We compared 2- to 4-point ADAS-Cog changes with changes in Goal Attainment Scaling (GAS) and everyday function across initial ADAS-Cog scores and treatment responses. MethodsThis exploratory analysis evaluated mild-moderate Alzheimer's disease patients treated with donepezil (12 months) or galantamine (8 months). Clinical meaningfulness was defined as concomitant ADAS-Cog and GAS changes of ±3 points and/or functional improvement. ResultsPatients with ≥3-point ADAS-Cog improvement significantly improved on GAS but not on standard tests of everyday function. ADAS-Cog “no change” (≤±3 points) was seen with mean GAS improvement. Initial ADAS-Cog improvement made endpoint improvement (ADAS-Cog 3 points and GAS 1 point) more likely (odds ratio = 6.9; 95% confidence interval = 2.5–19.5). In contrast, initial deterioration made endpoint improvement unlikely (0.33; 0.14–0.64). DiscussionADAS-Cog improvement and no change were each associated with GAS improvement. Initial ADAS-Cog worsening was unlikely to result in later improvement. Clinical trial registration numberISRCTN26167328.

Treatment patterns and LDL-C goal attainment in patients with diabetes: Temporal trends analysis from National Health and Nutrition Examination Survey†

Treatment patterns and LDL-C goal attainment in patients with diabetes: Temporal trends analysis from National Health and Nutrition Examination Survey†

Suboptimal Control of Lipid Levels: Results from 29 Countries Participating in the Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS).

Five multicentre, cross-sectional Centralized Pan-Regional Surveys on the Undertreatment of Hypercholesterolaemia (CEPHEUS) were conducted in 29 countries across Asia, Western Europe, Eastern Europe, the Middle East, and Africa. The surveys assessed the current use and efficacy of lipid-lowering drugs (LLDs) worldwide and identified possible patient and physician characteristics associated with failure to attain low-density lipoprotein cholesterol (LDL-C) goals. The aim of this analysis was to consolidate the global results from these surveys. The surveys involved patients aged ≥18 years who had been prescribed LLDs for at least 3 months without dose changes for at least 6 weeks. A single visit was scheduled for data collection, including fasting plasma lipid and glucose levels. Cardiovascular risk profile and LDL-C goal attainment were assessed according to the 2004 updated US National Cholesterol Education Program Adult Treatment Panel III guidelines. In total, 35 121 patients (mean age: 60.4 years) were included, and 90.3% had been prescribed statin monotherapy. Overall, only 49.4% of patients reached their recommended LDL-C level. LDL-C goals were attained in 54.8% (5084/9273) and 22.8% (3287/14 429) of patients were at high and very high cardiovascular risk, respectively. Factors associated with an increased likelihood of LDL-C goal attainment were lower baseline cardiovascular risk; presence of diabetes mellitus, hypertension, or history of cardiovascular disease; and treatment with simvastatin, atorvastatin, or rosuvastatin (vs. all other LLDs). LDL-C goal attainment in patients taking LLDs is suboptimal worldwide, particularly in patients at high and very high cardiovascular risk.

Non–high-density lipoprotein cholesterol target achievement in patients on lipid-lowering drugs and stratified by triglyceride levels in the Arabian Gulf

Atherogenic dyslipidemia is highly prevalent in the Arabian Gulf. Non-high-density lipoprotein cholesterol (non-HDL-C) reduction has been proposed as an additional goal to low-density lipoprotein cholesterol (LDL-C) lowering to prevent atherosclerotic cardiovascular disease (ASCVD). Data on non-HDL-C goal attainment in patients with high triglycerides (TGs) on lipid-lowering drugs (LLDs) in the region is scarce. Evaluate non-HDL-C target attainment according to the National Lipid Association in patients on LLDs stratified by TG (<150 [1.69], 150-200 [1.69-2.26], >200 [2.26] mg/dL [mmol/L]) levels in the Arabian Gulf. Overall, 4383 patients on LLD treatment from 6 Middle Eastern countries participating in the Centralized Pan-Middle East Survey on the Undertreatment of Hypercholesterolemia study were evaluated. Patients were classified according to TG levels and ASCVD risk. The overall non-HDL-C goal attainment was 41% of the subjects. Non-HDL-C goal was less likely attained in patients with high TGs (12% vs 27% vs 55%; P < .001). Very high ASCVD risk patients with high TGs attained less their non-HDL-C targets compared with those with lower TG levels (8% vs 23% vs 51%; P < .001). Similarly, high ASCVD risk patients with high TGs also failed more in attaining non-HDL-C targets compared with those with lower TGs (26% vs 42% vs 69%; P < .001). In addition, those with high TG also succeeded less in attaining LDL-C and apolipoprotein B goals (P < .001). A large proportion of very high and high ASCVD patients on LLDs in the Arabian Gulf are not at recommended non-HDL-C targets and hence remain at a substantial residual risk.

Obesity, ultrasound indexes of fat depots and lipid goal attainment in patients with high and very high cardiovascular risk: A novel approach towards better risk reduction

AimOur aim was to assess the attainment of primary (low density lipoprotein cholesterol; LDL-C) and secondary (non-high density lipoprotein cholesterol; non-HDL-C) lipid therapeutic goals in relation to obesity, clinical measures of adiposity and ultrasound indexes of fat depots, including the novel index of periarterial adipose tissue (PAT): carotid artery extra media thickness (EMT). Methods and ResultsHigh and very high cardiovascular (CV) risk patients (n = 420; F/M: 34/66%; age: 61.2 ± 7years) with prior statin treatment (≥18 months) were enrolled into this cross-sectional study. All patients had a detailed assessment with several anthropometric measures and ultrasound indexes of fat depots indexed to BMI: abdominal (Intra-abdominal Fat Thickness; IAT and Pre-peritoneal Fat Thickness; PreFT), paracardial (Epicardial Fat Thickness; EFT and Pericardial Fat Thickness; PFT) and the new index corresponding to PAT (carotid EMT). Lipid goals attainment in the study group was as follows: 34% (LDL-C goal), 39% (non-HDL-C goal) and 35% (both LDL and non-HDL-C goals). Among ultrasound indexes, patients with both lipid goals attainment revealed significantly lower carotid EMT/BMI (LDL-C goal: 25.2 ± 4.2 vs 27.5 ± 4.1, p < 0.01 and non-HDL-C goal: 26.1 ± 4 vs 27.7 ± 4.2, p < 0.01) and IAT/BMI (LDL-C goal: 2.35 ± 0.66 vs 2.51 ± 0.71, p = 0.02 and non-HDL-C goal: p = ns) compared to individuals without goals achievement. Moreover, lipid goals attainment was associated with both measures: carotid EMT/BMI (LDL-C goal: r = −0.2, p < 0.05 and non-HDL-C goal: r = −0.2, p < 0.05) and IAT/BMI (LDL-C goal: r = −0.2, p < 0.05 and non-HDL-C goal: r = −0.2, p < 0.05). Multivariable regression analysis showed also independent association between carotid EMT/BMI and both goals achievement: LDL-C (p = 0.01) and non-HDL-C goal (p = 0.01). Other fat depots indexes (EFT, PFT and PreFT) failed to provide additional data. ConclusionContrary to overall obesity and most clinical measures of adiposity, carotid EMT and abdominal IAT, but not other ultrasound indexes of fat depots revealed associations independent from BMI with lipid goal attainment and may help identify patients requiring more aggressive lipid management.

Patient and physician factors influence decision-making in hypercholesterolemia: a questionnaire-based survey.

BackgroundGoal attainment of guideline-recommended low-density lipoprotein cholesterol (LDL-C) is suboptimal. Little is known about how patient factors influence physicians’ treatment decision-making in hypercholesterolemia. We examined physicians’ treatment recommendations in high-risk patients whose LDL-C remained uncontrolled despite statin monotherapy.MethodsPhysicians completed a questionnaire prior to randomization into period I of a two-period randomized controlled trial evaluating LDL-C goal attainment in patients whose LDL-C remained ≥100 mg/dL after 5 weeks’ treatment with atorvastatin 10 mg/day (NCT01154036). Physicians’ treatment recommendations were surveyed for two hypothetical and one real scenario: (1) LDL-C presumed near goal (between 100–105 mg/dL), (2) LDL-C presumed far from goal (~120 mg/dL), and (3) observed baseline LDL-C of enrolled patients. Prognostic factors considered during decision-making were identified by regression analysis. Observed lipid outcomes at the end of period I (following 6 weeks’ treatment with ezetimibe 10 mg plus atorvastatin 10 mg, atorvastatin 20 mg, or rosuvastatin 10 mg) were compared with estimated LDL-C outcomes for physicians’ treatment recommendations after 6 weeks (based on individual patients’ pre-randomization LDL-C and expected incremental change).ResultsQuestionnaires were completed for 1,534 patients. No change in therapy, or double atorvastatin dose, were frequently recommended, even when LDL-C was far from goal (6.5% and 52.2% of patients, respectively). Double atorvastatin dose was commonly recommended in all scenarios (43–52% of patients). More intensive LDL-C-lowering regimens were recommended infrequently e.g. double atorvastatin dose and add ezetimibe only <12% in all scenarios. Overall, cardiovascular risk factors and desire to achieve a more aggressive LDL-C goal were prominent factors in decision-making for treatment. Comparison of observed and estimated LDL-C levels showed that physicians tended to overestimate the effectiveness of their recommendations.ConclusionsThis study provides insight into physicians’ perspectives on clinical management of hypercholesterolemia and highlights a gap in knowledge translation from guidelines to clinical practice. The need for lower LDL-C and cardiovascular risk were key drivers in clinical decision-making, but physicians’ treatment choices were more conservative than guideline recommendations, potentially resulting in poorer LDL-C reduction. When compared with actual outcomes, projected LDL-C control was better if physicians used more comprehensive strategies rather than simply doubling the statin dose.Trial registrationClinicaltrials.gov: NCT01154036Electronic supplementary materialThe online version of this article (doi:10.1186/s12944-015-0037-y) contains supplementary material, which is available to authorized users.

Factors influencing goal attainment in patients with post-stroke upper limb spasticity following treatment with botulinum toxin A in real-life clinical practice: sub-analyses from the Upper Limb International Spasticity (ULIS)-II Study.

In this post-hoc analysis of the ULIS-II study, we investigated factors influencing person-centred goal setting and achievement following botulinum toxin-A (BoNT-A) treatment in 456 adults with post-stroke upper limb spasticity (ULS). Patients with primary goals categorised as passive function had greater motor impairment (p < 0.001), contractures (soft tissue shortening [STS]) (p = 0.006) and spasticity (p = 0.02) than those setting other goal types. Patients with goals categorised as active function had less motor impairment (0.0001), contracture (p < 0.0001), spasticity (p < 0.001) and shorter time since stroke (p = 0.001). Patients setting goals for pain were older (p = 0.01) with more contractures (p = 0.008). The proportion of patients achieving their primary goal was not impacted by timing of first-ever BoNT-A injection (medium-term (≤1 year) vs. longer-term (>1 year)) post-stroke (80.0% vs. 79.2%) or presence or absence of severe contractures (76.7% vs. 80.6%), although goal types differed. Earlier BoNT-A intervention was associated with greater achievement of active function goals. Severe contractures impacted negatively on goal achievement except in pain and passive function. Goal setting by patients with ULS is influenced by impairment severity, age and time since stroke. Our findings resonate with clinical experience and may assist patients and clinicians in selecting realistic, achievable goals for treatment.

110. Factors influencing goal attainment in patients with poststroke upper limb spasticity following treatment with botulinum neurotoxin A in real-life clinical practice: subanalyses from the Upper Limb International Spasticity (ULIS)-II Study

110. Factors influencing goal attainment in patients with poststroke upper limb spasticity following treatment with botulinum neurotoxin A in real-life clinical practice: subanalyses from the Upper Limb International Spasticity (ULIS)-II Study

Ldl-C Goal Attainment In Patients With Hyperlipidemia - Estimates From Population-Based Register Data In Sweden.

LDL-C Goal Attainment in Patients with Hyperlipidemia - Estimates from Population-Based Register Data in Sweden

GW25-e0873 Lipid-lowering therapy and lipid goal attainment in patients with metabolic syndrome in China: subgroup analysis of the Dyslipidemia International Study-China (DYSIS-China)

GW25-e0873 Lipid-lowering therapy and lipid goal attainment in patients with metabolic syndrome in China: subgroup analysis of the Dyslipidemia International Study-China (DYSIS-China)

Lipid-lowering therapy and lipid goal attainment in patients with metabolic syndrome in China: Subgroup analysis of the Dyslipidemia International Study-China (DYSIS-China)

ObjectiveTo objectively evaluate lipid-lowering therapy and low-density lipoprotein cholesterol (LDL-C) and non-high-density lipoprotein cholesterol (non-HDL-C) goal attainment in metabolic syndrome (MetS) patients in China. MethodsData regarding patient demographics, lipid-lowering agents, lipid parameters, and cardiovascular risk profiles were analyzed for 25,317 patients of the Dyslipidemia International Study-China. MetS was defined according to criteria of the NCEP-ATP III and the 2007 Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. ResultsThe prevalence of MetS was 39.9% and 37.4% according to the NCEP-ATP III and 2007 Chinese Guidelines, respectively. LDL-C goal attainment occurred less frequently among MetS patients than in those without MetS (NCEP-ATP III: 46.9% vs 68.6%; 2007 Chinese Guidelines: 52.2% vs 67.1%; p < 0.001). Similar results were obtained for non-HDL-C goal attainment (2007 Chinese Guidelines: 51.0% vs 72.0%; p < 0.001). As the risk class increased, LDL-C and non-HDL-C goal attainment decreased. In multivariate logistic regression analysis, DM, CHD, ischemic cerebrovascular disease, and higher SBP were independently associated with failure to achieve LDL-C and non-HDL-C goal attainment. The type of lipid-lowering agent was not significantly correlated with LDL-C not at goal attainment but was correlated with non-HDL-C not at goal attainment. ConclusionGoal attainment for both LDL-C and non-HDL-C occurs less frequently in MetS patients than in those without MetS. The residual risk due to elevated non-HDL-C levels should be considered in MetS patients. Strategies for controlling multiple risk factors in order to decrease the residual risk related to dyslipidemia in MetS patients should be recommended in future guidelines.

Determinants of glycaemic control in a practice setting: the role of weight loss and treatment adherence (The DELTA Study).

AimsExamine the association between weight loss and adherence with glycaemic goal attainment in patients with inadequately controlled T2DM.Materials and methodsPatients ≥ 18 years with T2DM from a US integrated health system starting a new class of diabetes medication between 11/1/10 and 4/30/11 (index date) with baseline HbA1c ≥ 7.0% were included in this cohort study. Target HbA1c and weight change were defined at 6-months as HbA1c < 7.0% and ≥ 3% loss in body weight. Patient-reported medication adherence was assessed per the Medication Adherence Reporting Scale. Structural equation modelling was used to describe simultaneous associations between adherence, weight loss and HbA1c goal attainment.ResultsInclusion criteria were met by 477 patients; mean (SD) age 59.1 (11.6) years; 50.9% were female; 30.4% were treatment naïve; baseline HbA1c 8.6% (1.6); weight 102.0 kg (23.0). Most patients (67.9%) reported being adherent to the index diabetes medication. At 6 months mean weight change was −1.3 (5.1) kg (p = 0.39); 28.1% had weight loss of ≥ 3%. Mean HbA1c change was −1.2% (1.8) (p< 0.001); 42.8% attained HbA1c goal. Adherent patients (OR 1.70; p = 0.02) and diabetes therapies that lead to weight loss (metformin, GLP-1) were associated with weight loss ≥ 3% (OR 2.96; p< 0.001). Weight loss (OR 3.60; p < 0.001) and adherence (OR 1.59; p < 0.001) were associated with HbA1c goal attainment.ConclusionsWeight loss ≥ 3% and medication adherence were associated with HbA1c goal attainment in T2DM; weight loss was a stronger predictor of goal attainment than medication adherence in this study population. It is important to consider weight-effect properties, in addition to patient-centric adherence counselling, when prescribing diabetes therapy.

Impact of time to treatment intensification on glycemic goal attainment among patients with type 2 diabetes failing metformin monotherapy

BackgroundPatients with type 2 diabetes on metformin monotherapy frequently require treatment intensification with another anti-hyperglycemic medication over time. Previous studies have indicated that a high proportion of patients with diabetes have a significant delay in the initiation of oral add-on therapy after metformin alone fails to achieve targeted glycemic control. In this study, we evaluated the impact of the timing of treatment intensification with oral add-on drug on glycemic goal attainment among diabetic patients failing metformin monotherapy. Research design and methodsUsing the General Electric (GE) Centricity Electronic Medical Record database (January 2004 through December 2009), we identified 5,870 patients with type 2 diabetes with treatment failure on metformin monotherapy - defined by a glycosylated hemoglobin (HbA1c) of ≥7.5% (index date). This cut-off of ≥7.5% (trigger HbA1c) was chosen rather than that of >7.0% to ensure that selected patients were more likely to be indicated for treatment intensification with add-on drug. Continuous enrollment of one year prior and two years after index date was required to be included in the study. Add-on treatment was defined as prescription of second oral agent from any available therapeutic classes while continuing metformin. Early treatment intensification was defined as initiation of oral add-on therapy within 3months (n=1,012) of index date while late intensification was defined as add-on initiation between 10 and 15months after index date (n=461). The study outcome was defined as glycemic goal attainment (HbA1c<7%), which was evaluated between 18 and 24months after index date. ResultsOur results suggested that at the end of the follow-up period, 47.2% of patients in the early add-on group were at glycemic goal compared to 41.7% in the late add-on group (p=0.039). In a multivariable logistic regression model that accounted for age, gender, trigger HbA1c level, Charlson comorbidity index, anti-hypertensive and anti-hyperlipidemic drug use and history of cardiovascular disease, the adjusted odds ratio (OR) for glycemic goal attainment was 1.36 (95% confidence intervals [CI]: 1.09–1.72) comparing early add-on to late add-on treatment. This association was stronger among patients with higher trigger HbA1c at baseline; ORs of 1.53 (95% CI: 1.08–2.19) for HbA1c ≥8% and 2.63 (95% CI: 1.40–5.27) for HbA1c ≥9%. ConclusionThese results suggest that earlier use of oral add-on drug in treatment regimen helps better achieve glycemic goal attainment in patients with metformin failure. Future studies should evaluate whether earlier treatment intensification is also associated with longer term health outcomes such as risk of microvascular and macrovascular complications.

Factors Associated With Therapeutic Goal Attainment in Patients With Concomitant Hypertension and Dyslipidemia

Background: Hypertension and dyslipidemia are the most prevalent cardiovascular risk factors, with approximately 30 million patients in the United States having these concomitant conditions. Further, the presence of high body mass index (BMI) has a negative effect on the achievement of blood pressure (BP) and low-density lipoprotein cholesterol (LDL-C) targets. Objective: This study evaluates the demographic, diagnostic, and medication-related factors associated with BP and LDL-C goal attainment in patients with concomitant hypertension and dyslipidemia stratified by BMI. Methods: This retrospective study utilized the GE Centricity Electronic Medical Records database (2004–2011) of a primary care physician group. Patients aged ≥ 18 years with concomitant hypertension and dyslipidemia were included. The attainment of BP and LDL-C targets were assessed based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7) and National Cholesterol Education Program Adult Treatment Panel III (NCEP ATP III) guidelines. Patients were classified into 3 cohorts based on their BMI: normal weight (≤ 24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥ 30.0 kg/m2). Multivariate logistic regression analysis was conducted to identify the predictors of goal attainment. Results: A total of 9086 patients with concomitant hypertension and dyslipidemia were identified, of which 7723, 6724, and 5824 patients did not attain BP, LDL-C, and dual BP and LDL-C goals, respectively. Age was a significant predictor of BP and LDL-C goal attainment in those who were of normal weight or overweight, and obese women had a decreased likelihood of achieving these goals (P < 0.05). Failure to attain BP and LDL-C goals was more likely in patients with diabetes across all BMI groups (P < 0.001). Further, patients with stage 1 hypertension and higher baseline total cholesterol levels were less successful in attaining BP and LDL-C goals, respectively (P < 0.001). Conclusions: These variations in therapeutic goal attainment in patients with concomitant hypertension and dyslipidemia across different BMI groups suggest that future research is needed to determine the underlying reasons for these disparities.

Household income and LDL-C goal attainment in patients with diabetes and dyslipidemia in a Canadian dataset

There is evidence of a social disparity pertaining to the epidemiology and burden of illness of diabetes. The purpose of this study was to assess the association between household income strata and therapeutic goal achievement rates for LDL-cholesterol (LDL-C) (< 2.5 mmol/L) in Canadian diabetic patients. Data (household income, cardiovascular risk factors, drug profile, clinical and laboratory variables) were obtained from a previous cross-sectional study of diabetic patients who filled a prescription for a lipid-lowering drug in selected pharmacies across Canada. Telephone interviews were conducted. Physicians, identified by the participating patients, were requested to complete a short questionnaire for clinical data. Achievement of LDL-C goals according to the Canadian diabetes guidelines were assessed and incorporated into regression models corresponding to household income strata. Seven household income strata were defined in the cohort (from less than 20,000 CDN$, up to 70,000 CDN$ by increments of 10,000 CDN$). LDL-C goals were attained in 34% of patients in the total cohort. There were no significant differences amongst household income strata for LDL-C goal achievement (p = 0.80). There were no significant differences in patient characteristics (age, sex, BMI) and cardiovascular risks according to the household income strata in this cohort, except age more than 65 in the lower income strata. This study demonstrates that household income was not a factor to achieve therapeutic goals for LDL-C for patients with diabetes in this dataset, although goal attainment was less than ideal overall. Future studies should address limitations of this work including small sample size, recruitment bias and lack of data on third party insurance coverage.

Association between Obesity and Therapeutic Goal Attainment in Patients with Concomitant Hypertension and Dyslipidemia

Background: Obesity is associated with cardiovascular risk factors such as hypertension, dyslipidemia, and diabetes mellitus, as well as cardiovascular diseases. Objectives: To evaluate demographic, diagnostic, and treatment characteristics of patients with concomitant hypertension and dyslipidemia, stratified by body mass index and the attainment of blood pressure (BP) and lipid targets in obese versus nonobese patients. Methods: This retrospective study used data from GE Centricity Electronic Medical Records database (2004–2011) of a primary care physician group. Patients aged ≥ 18 years and having concomitant hypertension and dyslipidemia were categorized based on their body mass index: normal weight (≤ 24.9 kg/m2), overweight (25.0–29.9 kg/m2), and obese (≥ 30.0 kg/m2). Blood pressure and lipid goal attainments were based on Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and National Cholesterol Education Program Adult Treatment Panel III guidelines, respectively. Results: A total of 9086 patients with concomitant hypertension and dyslipidemia were identified and categorized as normal weight (n = 1256), overweight (n = 3058) and obese (n = 4772). Patients who were obese were younger (< 65 years); were more likely to have diabetes mellitus (P < 0.001); had higher baseline BP and triglyceride levels and lower levels of high–density lipoprotein cholesterol (P < 0.05); and were more likely to be prescribed antihypertensives and antilipemic agents (P < 0.001). In multivariate analyses, obese patients were significantly more likely to fail to attain BP (odds ratio = 1.562, P < 0.001) and dual BP and low–density lipoprotein cholesterol (odds ratio = 1.193, P = 0.023) goals. Conclusions: Obesity appears to be an independent risk factor for the failure to attain BP and dual BP and low–density lipoprotein cholesterol goals in patients with concomitant hypertension and dyslipidemia. These findings suggest that future research is needed to determine the underlying link between obesity and failure to attain these goals.

The impact of chronic kidney disease on lipid management and goal attainment in patients with atherosclerosis diseases in Taiwan.

Background: Patients with chronic kidney disease (CKD) is a very high risk cardiovascular disease population and should be treated aggressively. We investigated lipid management in CKD patients with atherosclerosis in Taiwan.Methods: 3057 patients were enrolled in a multi-center study (T-SPARCLE). Lipid goal are defined as total cholesterol (TC) < 160mg/dl, low-density lipoprotein (LDL) <100 mg/dl, high-density lipoprotein (HDL) > 40 mg/dl in men, HDL > 50 mg/dl in women, non-HDL cholesterol < 130mg/dl, and triglyceride < 150 mg/dl.Results: Compared with those without CKD (n=2239), patients with CKD (n=818) had more co-morbidities (hypertension, glucose intolerance, stroke and heart failure) and lower HDL but higher triglyceride levels. Overall 2168 (70.5%) patients received lipid-lowering agents. There was similar equivalent statin potency between CKD and non-CKD groups. The goal attainment is lower in HDL and TG in the CKD group as compared with non-CKD subjects (47.1 vs. 51.9% and 63.2 vs. 68.9% respectively, both p < 0.02). Analysis of sex and CKD interaction on goals attainment showed female CKD subjects had lower non-HDL and TG goals attainment compared with non-CKD males (both p < 0.019).Conclusion: Although presenting with more comorbidities, the CKD population had suboptimal lipid goal attainment rate as compared with the non-CKD population. Further efforts may be required for better lipid control especially on the female CKD subjects.