LDL-cholesterol Goal Attainment Research Articles

Abstract P162: Has LDL Cholesterol (LDL-C) and Non-HDL Cholesterol (Non-HDL-C) Goal Attainment Improved 7 Years After Adult Treatment Panel III (ATP III) Guidelines Were Published?

Background In coronary heart disease (CHD) patients, ATP III guidelines (2001) recommended LDL-C goal of <100 mg/dl, with optional goal of <70 in a 2004 update, and in patients with triglycerides (TG) ≥ 200mg/dl, non-HDL-C goal of <130 mg/dl with optional goal of <100. In a 2003 survey (NEPTUNE II), 62% of CHD patients achieved LDL-C goal of < 100 mg/dl but only 33% achieved both LDL-C and non-HDL-C goals. Methods To assess whether goal attainment has improved, we analyzed data from 7 Veterans Affairs (VA) medical centers. In patients with ICD-9 codes for CHD and a primary care visit in 2008, we assessed LDL-C and (in patients with TG ≥200 mg/dl) non-HDL-C (calculated as total cholesterol - HDL-C), to compare goal attainment for LDL-C and non-HDL-C in the VA system with NEPTUNE II. Results We analyzed 24,769 CHD patients. Significantly more VA patients ( table ) attained LDL-C goals per ATP III guidelines. Attainment of optional LDL-C goals per the 2004 update was statistically better than NEPTUNE II, but still low (34%). A major treatment gap was noted in patients with TG ≥ 200, with poor attainment for both LDL-C (primary goal) and non-HDL-C (secondary goal) per both ATP III (51%) and the update (12%), although goal attainment was better in the VA patients compared to NEPTUNE II. Controlling for facility clustering and patient's illness severity, non-physician providers (p=0.07), care at a teaching facility (p=0.09), patient's age > 55 years (p= 0.001) and diabetes (p=0.005) were positively associated with goal attainment, whereas African American patients were less likely to achieve lipid goals (p=0.04). Conclusion LDL-C goal attainment per ATP III guidelines has improved, but attainment of <70 mg/dl in CHD patients remains low. CHD patients with elevated TG continue to have poor attainment of non-HDL-C goals, which recent data indicate is as important as LDL-C goal attainment. We also identify factors associated with goal attainment which have implications for future interventions.

Clinical efficacy of rosuvastatin in lipid management in Chinese patients in Hong Kong.

BACKGROUND Rosuvastatin has been claimed to be more potent than other statins in its ability to lower the low-density lipoprotein (LDL) cholesterol levels. This study aimed to investigate the clinical efficacy of rosuvastatin in LDL cholesterol lowering therapy for new or switched hyperlipidaemic Chinese patients. METHODS This study was a retrospective one in patients who took rosuvastatin in the outpatient clinics of Prince of Wales Hospital during the period of July 1, 2004 to June 30, 2005. The prescribing pattern, the utilization pattern and the side effect profile were recorded. Attainment of lipid goals for each patient was assessed according to the National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III guidelines. RESULTS A total of 261 Chinese patients (mean age (64.8 +/- 12) years; 55.6% male) were recruited into the study. The mean LDL-cholesterol level was (3.50 +/- 1.29) mmol/L prior to Rosuvastatin and (2.30 +/- 1.73) mmol/L after Rosuvastatin treatment (P < 0.0001). Rosuvastatin raised the LDL-cholesterol goal achievement rate from 28.0% to 74.3% in all patients combined (P < 0.0001) and from 11.0% to 79.0% for statin naive patients (P < 0.0001). Approximately 4% of patients developed side effects including myalgia, elevated liver enzymes, and dizziness. CONCLUSION Rosuvastatin was effective in improving LDL-cholesterol goal attainment and lowering LDL-cholesterol and triglyceride (TG) levels in either newly started or switched patients.

Effects of Rosuvastatin and Atorvastatin on LDL and HDL Particle Concentrations in Patients With Metabolic Syndrome

OBJECTIVEThe purpose of this study was to examine the effects of statin therapy on lipoprotein particle concentrations in patients with the metabolic syndrome. Changes in lipoprotein particle concentration may predict the risk of coronary heart disease more accurately than lipoprotein cholesterol levels.RESEARCH DESIGN AND METHODSPatients with dyslipidemia and the metabolic syndrome (n = 318) were randomly assigned in a double-blind study comparing 10 mg rosuvastatin (RSV), 10 mg atorvastatin, or placebo daily for 6 weeks. From weeks 6 to 12, patients in the RSV and placebo groups received 20 mg RSV, whereas the ATV group increased their dose to 20 mg daily. Lipoprotein particle concentrations were measured by nuclear magnetic resonance spectroscopy, LDL cholesterol was measured by β-quantification, and other lipoproteins were measured by standard methods at baseline, 6 weeks, and 12 weeks. Lipoprotein levels were compared by analysis of covariance.RESULTSStatins reduced LDL particle concentration less than LDL cholesterol (−30 to −38 vs. −38 to −51%). Reductions were greater with RSV than with ATV (P < 0.05 for LDL particle concentration and P < 0.001 for LDL cholesterol). Most patients attained LDL cholesterol <2.59 mmol/l (100 mg/dl) at 12 weeks (80% with RSV and 59% with ATV; P = 0.003), but only 27% of patients receiving RSV and 19% receiving ATV attained the goal of LDL particle concentration <1,000 nmol/l (P = 0.07).CONCLUSIONSIn patients with the metabolic syndrome, statin-induced changes in LDL cholesterol do not accurately reflect changes in LDL particle concentration. Consequently, despite attainment of LDL cholesterol goals, these patients may retain considerable residual coronary heart disease risk.

LDL-C reductions and goal attainment among naive statin users in the Netherlands: real life results

ABSTRACTObjective: The effectiveness of statin therapy in a real life setting may differ from that in clinical trials, as physicians make non-randomised treatment decisions for patients with less uniform and possibly different characteristics. We therefore performed a study to compare the effectiveness of different statins and doses in routine clinical practice with respect to total serum cholesterol and LDL-cholesterol (LDL-C) reduction and goal attainment according to European guidelines on the prevention of cardiovascular disease (CVD).Research design and methods: Naive statin users starting treatment in 2003 and 2004 with LDL-C measurements at baseline and between 30 and 365 days after start of treatment were extracted from the PHARMO database. During treatment with their initial statin dose LDL-C reduction and attainment of cholesterol goals were compared between different statins and doses.Results: Of 2303 identified naive patients, approximately 30% were allocated to the high CVD-risk group. Average LDL-C reductions were 48%, 42%, 39%, and 32% at mean doses of 11 mg rosuvastatin, 17 mg atorvastatin, 22 mg simvastatin and 35 mg pravastatin, respectively. The proportion of patients attaining cholesterol goals was 75% for rosuvastatin, 68% for atorvastatin, 56% for simvastatin, and 42% for pravastatin. Dose comparisons showed greater LDL-C reduction and increased goal attainment for rosuvastatin 10 mg compared to other statins at most doses (adjusted p < 0.05).Conclusions: In a real life setting, both LDL-C reduction and the proportion of patients attaining cholesterol goals appear to be significantly increased among users of rosuvastatin compared to other statins. These results confirm and extend reported clinical trial results to a real world setting.

Correlates of LDL-cholesterol goal attainment in patients under lipid lowering therapy

Background LDL-cholesterol therapeutic objectives attainment under lipid lowering therapy remains inadequate. The correlates of LDL-cholesterol therapeutic objective attainment have not been thoroughly explored in an observational setting. Methods Patients under lipid lowering therapy and managed by general practitioners were included. LDL-cholesterol therapeutic objective was defined according to the number of cardiovascular risk factors associated with dyslipidemia (AFSSAPS-2005 guidelines). Results Most of the 2727 patients (mean age: 64.7 ± 11.0) received a statin (70.0%) or a fibrate (24.3%) in monotherapy. 58.5% of patients at high cardiovascular risk did not reach therapeutic objective. Compared to simvastatin, patients receiving fibrates were less likely to be at therapeutic objective (OR = 0.38, 95% CI = [0.26–0.54]). So were patients receiving fluvastatin (OR = 0.41, IC95% = [0.26–0.64]) or pravastatin (OR = 0.49, IC95% = [0.35–0.70]) at the dosages used by GPs. No significant difference appeared with atorvastatin (OR = 0.99, 95% CI = [0.71–1.39]) or rosuvastatin (OR = 1.25, CI95% = [0.77–2.02]). Patients with LDL-cholesterol levels < 0.7 g/L tended to be prescribed high doses of lipid lowering therapy. Conclusions In real conditions of lipid lowering therapy use, LDL-cholesterol therapeutic objective attainment was inadequate in high-risk patients, and TO differences were observed between drugs at prescribed doses.

404: Assessment of Statin Non-Adherence to Improve LDL Cholesterol Goal Attainment: A Medical Office Practice Evaluation

404: Assessment of Statin Non-Adherence to Improve LDL Cholesterol Goal Attainment: A Medical Office Practice Evaluation

Long-term achievement of the therapeutic objectives of lipid-lowering agents in primary prevention patients and cardiovascular outcomes: An observational study

Aims Lowering elevated cholesterol levels reduces cardiovascular (CV) morbidity and mortality. Nonetheless, most patients treated with lipid-lowering agents (LLA) do not reach recommended therapeutic objectives. In a setting of primary care in France, we investigated the association between LDL-cholesterol goal attainment and the occurrence of CV events in primary prevention patients with multiple CV risk factors (≥3). According to national guidelines, the therapeutic objective (TO) for such patients is an LDL-cholesterol value below 130 mg/dL. Methods 579 patients treated with LLA and with LDL-cholesterol values documented at least once a year over a period of at least 3 years (2000–2002) were allocated to three groups based on the number of years the TO was attained during the follow-up period: in all 3 years (TO+++: n = 145), only part of the time (TO intermediate: n = 256), and never (TO−−−: n = 178). CV events (angina pectoris, myocardial infarction, heart failure, stroke, peripheral artery disease) occurring during the last year of observation (2002) were retrospectively collected. The occurrence risk (OR) of CV events was assessed based on TO status, with a logistic regression model to adjust for baseline differences in CV risk factors. Results Only a quarter of patients attained TO during all 3 study years. CV events during the third year of observation occurred in 5.5%, 10.5% and 12.9% of patients in the TO+++, TO intermediate and TO−−− groups, respectively. Compared with TO+++ patients, the risk of CV events increased significantly in TO intermediate (OR = 2.34, 95% CI = [1.01–5.39]) and TO −−− patients (OR = 2.99, 95% CI = [1.26–7.08]). Conclusion In real practice, a prolonged attainment of TO is rarely observed in high CV risk patients treated with LLA as primary prevention. Therapeutic failure is related to an increased incidence of cardiovascular morbidity. Our data strongly support the need to improve adherence to treatment guidelines to achieve effective cardiovascular prevention.

Adherence to Statin Therapy and LDL Cholesterol Goal Attainment by Patients With Diabetes and Dyslipidemia

The purpose of this study was to assess the relationship between adherence to statin therapy and LDL cholesterol goal achievement in patients with diabetes and dyslipidemia. The records of patients being medically treated for dyslipidemia in a managed care diabetes program from January 2001 to December 2002 were used to assess LDL cholesterol goal attainment (<100 mg/dl) and to compute a 9-month medication possession ratio (percentage of days when medication was available [MPR], beginning with the first prescription in the database). A total of 653 patient records was analyzed. The average MPR was significantly higher for men than for women (0.75 vs. 0.66, P < 0.05). Overall, 44% (n = 290) of the patients achieved an LDL cholesterol level <100 mg/dl (52% of men and 37% of women, P < 0.05). A significant correlation emerged between MPR and plasma LDL cholesterol (P < 0.001), and MPR was significantly higher in patients who achieved the LDL cholesterol target than in those who did not (0.82 vs. 0.61, P < 0.05). Although statins are highly effective for decreasing LDL cholesterol levels in patients with dyslipidemia, including those with diabetes, failure to reach LDL cholesterol targets remains common. Adherence to statin therapy, as reflected by MPR, is closely related to LDL cholesterol goal attainment in patients with diabetes and dyslipidemia. The probability of goal achievement appears to increase substantially when the MPR is >0.80. Pharmacy records can be used to identify patients who are poorly compliant with statin therapy and at high risk for failure to attain LDL cholesterol goals. Because outcomes are directly related to patients' medication-taking behavior, when clinical goals (such as serum cholesterol levels) are not being reached, adherence should be the first item assessed by the clinician.

M.517 LDL-cholesterol goal attainment among patients treated with lipid lowering drugs in Spain

M.517 LDL-cholesterol goal attainment among patients treated with lipid lowering drugs in Spain

M.517 LDL-cholesterol goal attainment among patients treated with lipid lowering drugs in Spain

M.517 LDL-cholesterol goal attainment among patients treated with lipid lowering drugs in Spain

Attainment of LDL-Cholesterol Goals in a National Sample: Results From the Lipid Treatment Assessment Project (L-TAP)

Attainment of LDL-Cholesterol Goals in a National Sample: Results From the Lipid Treatment Assessment Project (L-TAP)

Attainment of LDL-cholesterol goals in a national sample: results from the lipid treatment assessment project (L-TAP)

Attainment of LDL-cholesterol goals in a national sample: results from the lipid treatment assessment project (L-TAP)