Lipid Abnormalities In Statin-treated Patients Research Articles

Improvement in achievement of lipid targets in France: Comparison of data from coronary patients in the DYSIS and DYSIS II studies

Hyperlipidaemia is a major contributor to the development of coronary heart disease (CHD), with a direct correlation between low-density lipoprotein cholesterol (LDL-C) and all-cause death [ 1 Wilson P.W. D'Agostino R.B. Levy D. Belanger A.M. Silbershatz H. Kannel W.B. Prediction of coronary heart disease using risk factor categories. Circulation. 1998; 97: 1837-1847 Crossref PubMed Scopus (7417) Google Scholar , 2 Stamler J. Daviglus M.L. Garside D.B. Dyer A.R. Greenland P. Neaton J.D. Relationship of baseline serum cholesterol levels in 3 large cohorts of younger men to long-term coronary, cardiovascular, and all-cause mortality and to longevity. JAMA. 2000; 284: 311-318 Crossref PubMed Scopus (460) Google Scholar ]. The cross-sectional, observational Dyslipidemia International Study (DYSIS) study [ 3 Gitt A.K. Drexel H. Feely J. Ferrieres J. Gonzalez-Juanatey J.R. Thomsen K.K. et al. Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada. Eur. J. Prev. Cardiol. 2012; 19: 221-230 Crossref PubMed Scopus (123) Google Scholar , 4 Gitt A.K. Lautsch D. Ambegaonkar B. Horack M. Ferrières J. Persistent high distance to recommended LDL-cholesterol-targets despite chronic statin treatment: results of DYSIS. J. Am. Coll. Cardiol. 2016; 67: 1934 Crossref Google Scholar ] was conducted between 2008 and 2012 in 26 countries. The study involved 57,885 patients aged ≥45 years treated in primary or secondary care and who had been on statin treatment for at least 3 months. In a previous examination of the first 12 countries included in DYSIS [ [3] Gitt A.K. Drexel H. Feely J. Ferrieres J. Gonzalez-Juanatey J.R. Thomsen K.K. et al. Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada. Eur. J. Prev. Cardiol. 2012; 19: 221-230 Crossref PubMed Scopus (123) Google Scholar ], half of the patients did not achieve their target LDL-C goals, as defined by the 2007 European Society of Cardiology (ESC) guidelines [ [5] Graham I. Atar D. Borch-Johnsen K. Boysen G. Burell G. Cifkova R. et al. European guidelines on cardiovascular disease prevention in clinical practice: executive summary: Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur. Heart J. 2007; 28: 2375-2414 Crossref PubMed Scopus (1293) Google Scholar ]. Among the French cohort in DYSIS, 37.2% of the patients [ [6] Agence Française de Sécurité Sanitaire des Produits de Santé Prise en charge therapeutique du patient dyslipidémique. in: Recommandations. 2005 Google Scholar ] met the French recommendations on LDL-C control [ [7] Ferrieres J. Berard E. Crisan O. Bongard V. Residual dyslipidaemia after statin treatment in France: prevalence and risk distribution. Arch. Cardiovasc. Dis. 2010; 103: 302-309 Crossref PubMed Scopus (13) Google Scholar ]. These data from DYSIS demonstrate a substantial gap between guideline recommendations and achievement of LDL-C targets in practice.

Abstract 155: Evaluation of Dyslipidemia Control and Its Risk Factors of Cardiac Outpatients

Objective: is to assess the dyslipidemia control and demographic differences in lipid patterns among dyslipidemic cardiac patients. Method: data based a retrospective analysis of 504 persons (age mean 58.16 ± 11.119 years) was conducted in Malaysia which estimated the lipid abnormalities in statin-treated patients. Demographic data including age, race, alcoholic and smoking status were collected. Lipid profiles including triglyceride (TG), total cholesterol (TC), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C) were measured. Results: a desirable level of (TC) and (TG) were 62.2% and 54.4% respectively, optimal level of (LDL-C) was 66.5% and the normal level of (HDL-C) was 54.2%. Risk factor analysis of dyslipidemia was done with a primary focus on the possible impact of statin type, gender, race and dyslipidemia type. Atorvastatin was significantly more effective for primary dyslipidemia than simvastatin and lovastatin in HDL cholesterol ( p < 0.002), while in LDL cholesterol (p = 0.001) and total cholesterol (p < 0.03) simvastatin was significantly found more effective for primary dyslipidemia. A significant correlation emerged between gender and statin type in HDL cholesterol (p < 0.02) and total cholesterol TC (p < 0.001), atorvastatin is found more effective to be used by males than females. A correlation was also significant between gender and dyslipidemia type in HDL cholesterol (p < 0.01). Results for triglyceride reported a significant relationship between age, race and statin type (p < 0.001), atorvastatin was found to be more effective among Chinese while lovastatin was more effective among Indians. Finally 18.2% abnormality of HDL was explained by interactions of risk factors: first statin type and dyslipidemia type, second for gender and dyslipidemia type and the third was gender and statin type. Conclusions: more than 50% of cardiac outpatients were in an acceptable range of lipid profile evaluation. This could support the need for increasing attention to basic monitoring of cardiovascular risk factors in these dyslipidemic patients particularly in Asian population.

Persistent lipid abnormalities in statin-treated patients: Portuguese diabetic subpopulation of the Dyslipidaemia International Study (DYSIS)

AimsTo assess the treatment patterns and prevalence of persistent lipid abnormalities in Portuguese statin-treated patients with diabetes. MethodsDYSIS was an epidemiological, cross-sectional and multicentre international study. Outpatients ≥45 years old seen at primary and secondary care centres and treated with statins for at least three months were enrolled. This study presents the results for the Portuguese subpopulation, focusing on lipid control of the diabetic patients. ResultsOf the 916 patients recruited, 348 (38%) had diabetes mellitus (DM). The majority of the diabetic patients (58%) failed to attain an LDL-C<2.5mmol/L, and 77% did not reach the optional goal of LDL-C<2.0mmol/L set by the 2007 recommendations of the European Society of Cardiology. The most frequently used statin was simvastatin, both in patients with and without diabetes (55.7% vs. 57.1%, p=0.68). The mean (SD) statin dose in simvastatin-equivalent units was 26.1 (9.2) mg in diabetics and 25.3 (8.8mg) in non-diabetics (p=0.19). ConclusionsThe majority of Portuguese diabetic patients treated with statins failed to attain the recommended LDL cholesterol goals. Relatively low doses of medium potency statins were the prevailing therapy. There seems to be considerable room for improvement through the use of more potent statins, dose up-titration and/or the addition of other lipid-modifying therapies.

GW25-e3273 Persistent lipid abnormalities in statin-treated patients with coronary artery disease in China: part of the Dyslipidemia International Study

To evaluate the prevalence of persistent lipid abnormalities and statin use in Chinese patients with coronary artery disease. This cross-sectional observational study consecutively enrolled 9420 outpatients with coronary artery disease in China. ESC/EAS Guidelines for the management of dyslipidemia

AB0795 Cardiovascular Preventive Medication and Treatment Targets in Patients with Osteoarthritis: Results from the Must-Heart Study

BackgroundGuidelines recommend cardiovascular (CV) preventive pharmacotherapy when the CV risk evaluated by SCORE is ≥5% (primary prevention), and after diagnosed CV disease (secondary prevention). Undertreatment and poor goal attainment of...

Prevalence of persistent lipid abnormalities in statin‐treated patients: Belgian results of the Dyslipidaemia International Study ( DYSIS )

AimA substantial number of cardiovascular events are not prevented by statin therapy, which is still regarded as the first-line therapy for hyperlipidaemia. Insights into the prevalence of lipid abnormalities of statin-treated patients in Belgium are lacking and may shed light on an unmet medical need for optimal use of current lipid-lowering therapies. This study aims to assess the prevalence and types of persistent lipid abnormalities in patients receiving statin therapy in a real-life primary care setting in Belgium.MethodsThis cross-sectional cohort study was designed to estimate the prevalence of specific lipid abnormalities in statin-treated patients in Belgium. Total cholesterol, low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides were recorded from the patients' medical record. Patient's total cardiovascular risk and corresponding lipid treatment goals were defined based on the recent European Society of Cardiology/European Atherosclerosis Society recommendations.ResultsOverall, 56.2% of the statin-treated patients were not at goal for LDL-C. Low HDL-C (< 40 mg dl−1 in men, < 45 mg dl−1 in women) and elevated triglycerides (> 150 mg dl−1) were seen in 16.3% and 29.0% of patients, respectively. Very high-risk patients were more likely to have LDL-C not at goal (71.4% of them), while 60.0% of high-risk patients and 34.1% of moderate-risk patients were not at goal for LDL-C. Use of ezetimibe (10 mg) was strongly associated with meeting LDL-C goals (OR 16.9, p < 0.0001).ConclusionIn Belgium, lipid abnormalities remained highly prevalent despite statin treatment, with more than half of all patients not reaching their LDL-C treatment goal. This finding clearly indicates that more aggressive lipid-lowering treatment is required in clinical daily practice to achieve the goals of the current guidelines.

Total Lipid Management and Cardiovascular Disease in the Dyslipidemia International Study

Objectives: Despite statin use, many patients with cardiovascular disease (CVD) are not achieving treatment goals. An international observational study was performed to estimate the prevalence of residual lipid abnormalities in statin-treated patients with CVD to assess whether lipid management requires improvement. Methods: Fasting plasma concentrations of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides were recorded in 11,104 patients with atherosclerotic CVD and ≥3 months of statin therapy. Results: LDL-C and total cholesterol were not at goal levels in 41 and 46% of all patients, respectively; for patients with peripheral artery disease (PAD) only, 59 and 65%, respectively, were not at goal, and in those with coronary heart disease only, 38 and 42%, respectively, were not at goal. Patients with cerebrovascular disease only were least frequently observed to have low HDL-C (24%) and elevated triglycerides (36%). Overall, elevated LDL-C was the most frequent lipid anomaly observed, and preexisting heart failure was strongly and positively associated with dyslipidemia. Conclusions: Approximately two fifths of statin-treated patients with CVD are not reaching lipid goals or have abnormal lipid levels, while patients with PAD could particularly benefit from improved lipid management. In addition to targeting LDL-C, new evidence-based approaches are needed to target low HDL-C and elevated triglycerides.

Persistent lipid abnormalities in statin‐treated patients with diabetes mellitus in Europe and Canada: results of the Dyslipidaemia International Study

To assess the prevalence of persistent lipid abnormalities in statin-treated patients with diabetes with and without the metabolic syndrome. This was a cross-sectional study of 22,063 statin-treated outpatients consecutively recruited by clinicians in Canada and 11 European countries. Patient cardiovascular risk factors, risk level, lipid measurements and lipid-modifying medication regimens were recorded. Of the 20,129 subjects who had documented diabetes and/or metabolic syndrome status, 41% had diabetes (of whom 86.8% also had the metabolic syndrome). Of those with diabetes, 48.1% were not at total cholesterol target compared with 58% of those without diabetes. Amongst those with diabetes, 41.6 and 41.3% of those with and without the metabolic syndrome, respectively, were not at their LDL cholesterol goal relative to 54.2% of those with metabolic syndrome and without diabetes, and 52% of those with neither condition. Twenty per cent of people with diabetes but without the metabolic syndrome were not at the optimal HDL cholesterol level compared with 9% of those with neither condition. Of people with diabetes and the metabolic syndrome, 49.9% were not at optimal triglyceride level relative to 13.5% of people with neither diabetes nor the metabolic syndrome. Simvastatin was the most commonly prescribed statin (>45%) and the most common statin potency was 20-40 mg/day (simvastatin equivalent). Approximately 14% of patients were taking ezetimibe alone or in combination with a statin. Despite evidence supporting the benefits of lipid modification and international guideline recommendations, statin-treated patients with diabetes had a high prevalence of persistent lipid abnormalities. There is frequently room to optimize therapy through statin dose up-titration and/or addition of other lipid-modifying therapies.

Prevalence and Risk Distribution of Residual Dyslipidemia in Statin-Treated Patients in Greece

Many statin-treated patients are not achieving treatment goals and are at risk of cardiovascular (CV) disease. We report the results of patients enrolled in an observational study in Greece, which estimated the residual lipid abnormalities in statin-treated patients. Low-density lipoprotein cholesterol (LDL-c), high-density lipoprotein cholesterol (HDL-c), and triglyceride concentrations were recorded in patients receiving statin therapy for ≥ 3 months, classified by CV risk according to European Society of Cardiology guidelines. Sixty-three percent of statin-treated patients had an LDL-c not at goal. Low-risk patients were more likely to have an LDL-c not at goal compared with high-risk patients (67.3% vs 61.0%, respectively). They were also less likely to have low HDL-c levels and elevated triglyceride levels compared with high-risk patients. Smoking and sedentary lifestyle were not associated with dyslipidemia in this population. Approximately two thirds of statin-treated patients in Greece are not reaching target/normal lipid levels and could benefit from improved lipid management.

Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada

The prevalence of persistent lipid abnormalities in patients receiving statins in primary and secondary care is needed to formulate recommendations for future treatment. Studies associating cardiovascular risk factors with lipid target goal achievement are lacking. A cross-sectional, observational study that assessed the prevalence of persistent dyslipidemia in patients treated with statins and analyzed predictors of lipid target achievement. Serum lipid values of 22,063 statin-treated patients were studied in the context of their cardiovascular risk factors, and the potency and composition of their lipid-lowering treatment. European Society of Cardiology recommendations were used to classify patient risk, and to define LDL-cholesterol goal and normal levels for HDL-cholesterol and triglycerides. Overall, 48.2% of patients did not achieve the therapeutic goal for LDL-cholesterol, either as a single lipid anomaly or associated with low HDL-cholesterol, elevated triglycerides, or both. Lack of goal achievement was more prevalent among low-risk patients (55.8%) than high-risk patients (46.8%). Serum LDL-cholesterol levels were lower in high-risk patients. Predictors associated with LDL-cholesterol goal achievement were higher statin dose (odds ratio (OR): 0.35), specialist treatment (OR: 0.74), or combined lipid-lowering therapy (OR: 0.80). Nearly half of statin-treated patients missed their therapeutic LDL-cholesterol goal, highlighting a gap between recommendations and clinical practice. Better achievement of LDL-cholesterol therapeutic goal was found among patients at high cardiovascular risk, those on high statin doses or using combination therapy, and patients managed by specialists. Results suggest that residual dyslipidemia in statin-treated patients at low cardiovascular risk may be reduced by increasing statin dose.

Prevalence and overlap of different lipid abnormalities in statin-treated patients at high cardiovascular risk in clinical practice in Germany

BackgroundIn line with current guideline recommendations, patients at high cardiovascular risk are usually treated with statins for secondary as well as for primary prevention. While many studies investigated treatment goal achievement with regards to low-density lipoprotein (LDL-C) and total cholesterol (TC) there is paucity of data regarding high density lipoprotein (HDL-C), and/or triglycerides (TG).SettingProspective, cross-sectional study (Dyslipidemia International Survey, DYSIS) with data provided by 748 office-based physicians throughout Germany.MethodsConsecutive patients were eligible for participation, if they were at least 45 years old, currently treated with a statin and had had a documented lipid profile (at least 1 parameter) within the last 6 months. Besides descriptive analyses, logistic regression was performed with backward selection to assess predictors for lipid abnormalities (non-attainment of goals for TC, LDL-C, low HDL-C or elevated TG) classified according to current European Society of Cardiology guidelines.ResultsThe 4,282 documented patients (98.6% Caucasian, 56.4% male; 86.6% at high cardiovascular risk) were predominantly treated with simvastatin (83.9%), pravastatin (7.7%) or atorvastatin (3.9%), usually with doses equivalent to simvastatin 20–40 mg daily. Non-statins were used in at most 12% of patients. No lipid abnormalities were found in 21.0% of patients, one abnormality in 38.5%, two in 31.9%, and all three in 8.5%. LDL-C goals were not attained in 58.1%, elevated TC was found in 66.6%, low HDL-C in 22.7%, and elevated TG in 47.3%. In the multivariate logistic regression model, non-attainment of LDL-C levels was predicted by hypertension (odds ratio, OR 1.4), current smoking (OR 1.3), sedentary lifestyle (OR 1.3), and female gender (OR 1.3). On the other hand, a reduced risk for missing LDL-C targets was noted in the presence of ischemic heart disease (OR 0.6), diabetes (0.5), higher statin doses, ezetimibe treatment, or specialist care, respectively.ConclusionA substantial proportion of statin-treated patients not only missed targets for LDL-C, but also did not attain the normal levels for HDL-C and/or TG. There is a large disconnect between high prevalence of HDL and/or TG disorders, with or without elevated LDL-C, and utilization of therapies targeting these lipids. Particularly in high-risk patients, additional efforts should be made to improve their lipid profile.

116 Prevalence of persistent lipid abnormalities in high-risk patients treated with statins: results of the dyslipidemia international study in the UK

Background The majority of patients with dyslipidemia in the UK are currently treated with a statin. However, many patients do not achieve recommended lipid targets. DYSIS UK was a part of a large multinational Dyslipidemia International Study (DYSIS) conducted in Canada and Europe. The aim was to assess the lipid profile abnormalities in patients on statin medication and the following results are for the UK. Methods DYSIS UK was conducted as a cross sectional study. Patients, men and women, 45 years or older, with a clinical diagnosis of coronary or other atherosclerotic disease, or at high risk of developing cardiovascular disease, were included if they had used statins for at least 3 months. All patients had a clinical examination and their latest lipid values on statin (≥3-month duration) were recorded. Results A total of 1277 patients (mean age 63.5 (SD 9.1) years old; 34.1% female) were enrolled to the study. Coronary heart disease was found in 44.3% of patients, cerebrovascular disease in 5.4% and peripheral arterial disease in 3.4%. Of these patients, 16.9% were current smokers, 39.4% were obese (BMI>30 kg/m 2 ), 60.1% had hypertension, and 27.1% diabetes. The prevalence of lipid abnormalities in statin-treated patients with total lipid profile was: elevated total cholesterol (TC) (≥4.0 mmol/l) 58.2%, low HDL-cholesterol (HDL-C) ( Conclusion The results show that the majority of patients on statin medication (64.4%) do not achieve the recommended lipid targets and/or have abnormal levels of HDL-C and triglycerides. Despite the statin medication, the persistent lipid abnormalities increase the cardiovascular risk in these patients. There is a need for a more comprehensive and intensive lipid management in this high-risk population.

No accord for the ACCORD-Lipid trial results

No accord for the ACCORD-Lipid trial results

Residual dyslipidaemia after statin treatment in France: Prevalence and risk distribution

Residual dyslipidaemia in patients treated with statins needs to be addressed to reduce the prevalence of cardiovascular disease in primary and secondary care. To estimate the prevalence of residual lipid abnormalities in statin-treated patients in France. Plasma concentrations of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides were recorded in patients classified by cardiovascular risk according to guidelines from Agence française de sécurité sanitaire des produits de santé. Recruitment took place between September 2008 and February 2009, and involved patients aged >45 years who had been on statin therapy for > or =3 months. Overall, 39.6% of the 4335 statin-treated patients had lipid values within desirable levels. Low-density lipoprotein cholesterol was not at goal more often (51.8%) in higher risk patients than in all patients averaged (37.2%). Also, high-risk patients with low-density lipoprotein cholesterol not at goal had additional lipid abnormalities (low high-density lipoprotein cholesterol and/or high triglycerides) more frequently (25.6%) than all patients averaged (18.4%). We conclude that a significant proportion of dyslipidaemic patients at high cardiovascular risk in France are not achieving treatment goals after statin treatment. A significant proportion of these patients might benefit from alternative therapies targeted at improving low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride levels. More attention to the management of these patients is needed to use public health resources more effectively.

Prevalence and predictors of lipid abnormalities in patients treated with statins in the UK general practice

Objective To identify the prevalence and predictors of lipid abnormalities in statin-treated patients in the UK. Methods A retrospective cohort study was performed using the UK General Practice Research Database. Patients ≥35 years of age were included if they received first-ever statin between January 2000 and December 2004, received statins for at least 6 weeks, had >2 years of pre- and 1 year of post-statin initiation database history, received no concomitant lipid lowering drugs and had at least one complete lipid profile conducted within 1 year before and after initiating statins. Predictors of each lipid abnormality were determined using random effects logistic regression. Results Within 1 year of statin initiation, 34.7%, 27.4%, 68.2% and 57.6% of patients did not reach optimal levels of TC, LDL-C, HDL-C and TG, respectively. Failure to attain TC goal was explained by smoking (odds ratio = 1.13, 95% confidence interval [1.02–1.23]) and baseline TC >6.2 mmol/L (5.01, [4.58–5.48]). Failure to attain LDL-C goal was associated with smoking (1.28, [1.14–1.43]), LDL-C ≥4.1 to <4.9 mmol/L (2.72, [2.45–3.03]) and LDL-C ≥4.9 mmol/L (8.54, [7.62–9.54]). High CHD risk was associated with low HDL-C in women at follow-up (1.94, [1.51–2.48]). Elevated TG was associated with baseline TG ≥2.2 to <5.6 mmol/L (4.19, [3.81–4.59]), TG ≥5.6 mmol/L (16.10, [3.67–70.57]), smoking (1.26, [1.11–1.42]) and hypertension (1.12, [1.01–1.23]). Conclusion While TC and LDL-C management appear appropriate in the UK, attainment of recommended levels of HDL-C and TG remains poor. The latter remains a concern, as poor attainment of recommended levels of HDL-C and TG is associated with high CHD risk in women, smoking and hypertension.