title: Lipid-modifying therapy and attainment of cholesterol goals in Europe: the Return on Expenditure Achieved for Lipid Therapy (REALITY) study.
abstract: 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.
authors.affiliation: Pharmacoepidemiology EA 3091 Centre Hospitalier Lyon-Sud, Pierre Bénite, France. eric.van-ganse@chu-lyon.fr
authors.forename: Eric
authors.initials: E
authors.lastname: Van Ganse
authors.forename: Laurent
authors.initials: L
authors.lastname: Laforest
authors.forename: Evo
authors.initials: E
authors.lastname: Alemao
authors.forename: Glenn
authors.initials: G
authors.lastname: Davies
authors.forename: Stephen
authors.initials: S
authors.lastname: Gutkin
authors.forename: Don
authors.initials: D
authors.lastname: Yin
mesh_terms: 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
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL