Lipid-modifying therapy and attainment of cholesterol goals in Europe: the Return on Expenditure Achieved for Lipid Therapy (REALITY) study.
BACKGROUND
Few studies have been conducted in actual clinical practice settings to evaluate the ways in which dyslipidemia is managed using lipid-modifying therapies.


OBJECTIVE
To determine lipid-modifying therapy practices and their effects on low-density lipoprotein cholesterol (LDL-C) and/or total cholesterol (TC) goal attainment in Europeans based on prevailing guidelines at the time of therapy in each country.


METHODS
Retrospective cohort analysis involving 58,223 patients initiated on lipid-modifying therapies in 10 European countries, with a median patient follow-up on lipid-modifying therapy of 15.3 months. Data on prescriptions of lipid-modifying therapies, laboratory data including LDL-C and TC, achievement of cholesterol goals for LDL-C and/or TC, and hospitalizations were obtained from healthcare administrative databases and/or patient chart reviews.


RESULTS
Across Europe, statin monotherapy was the initial lipid-modifying treatment in 51,786 (89.3%) of 58,009 patients with available data. In addition, 38,853 (89.5%) of 43,410 patients with available follow-up statin potency data were initiated on statin regimens of medium or lower equipotency. Low-equipotency regimens include atorvastatin 5 mg, simvastatin 10 mg, and pravastatin 20 mg, whereas medium-equipotency regimens include atorvastatin 10 mg, simvastatin 20 mg, and pravastatin 40 mg. Regimens were adjusted to higher equipotency via either up-titration or switches to combination regimens in 16.2% of patients. On average, 40.5% of patients across Europe who were not initially at guideline recommended cholesterol goals (either LDL-C or TC) and had follow-up data attained recommended cholesterol levels, including <30% of patients in Spain, Italy, or Hungary. In many countries, the likelihood of goal attainment was inversely associated with baseline cardiovascular risk and/or LDL-C levels.


CONCLUSIONS
Lipid management strategies in Europe during the study period were dominated by statin monotherapy. Even after prolonged follow-up on lipid-modifying therapy, approximately 60% of Europeans studied did not achieve guideline recommended cholesterol goals. Future emphasis must be placed on subsequent lipid panel monitoring, as well as the use of more efficacious, well-tolerated lipid-modifying therapies such as dual cholesterol inhibitors to enable more European patients to attain their recommended cholesterol goals.
Van Ganse
Eric
E
Pharmacoepidemiology EA 3091 Centre Hospitalier Lyon-Sud, Pierre Bénite, France. eric.van-ganse@chu-lyon.fr
Laforest
Laurent
L
Alemao
Evo
E
Davies
Glenn
G
Gutkin
Stephen
S
Yin
Don
D
D000368:Aged; D000924:Anticholesteremic Agents / Q000008:administration & dosage / Q000191:economics / Q000627:therapeutic use*; D008078:Cholesterol, LDL / Q000032:analysis / Q000097:blood / Q000187:drug effects*; D015331:Cohort Studies; D019992:Databases as Topic; D017723:Drug Utilization Review / Q000191:economics*; D005060:Europe; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D009937:Organizational Objectives; D017410:Practice Guidelines as Topic; D012189:Retrospective Studies; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL