Contemporary management of dyslipidemia in high-risk patients: targets still not met.
OBJECTIVE
Our objective was to evaluate treatment patterns and the attainment of current National Cholesterol Education Program (NCEP)-recommended lipid targets in unselected high-risk ambulatory patients.


METHODS
Between December 2001 and December 2004, the prospective Vascular Protection and Guidelines Oriented Approach to Lipid Lowering Registries recruited 8056 outpatients with diabetes, established cardiovascular disease (CVD), or both, who had a complete lipid profile measured within 6 months before enrollment. The primary outcome measure was treatment success, defined as the achievement of LDL-cholesterol<2.6 mmol/L (100 mg/dL) according to NCEP guidelines. We examined patient characteristics and use of lipid-modifying therapy in relation to treatment outcome, which included the recently proposed optional LDL-cholesterol target (<1.8 mmol/L [70 mg/dL]) for very high-risk patients.


RESULTS
Overall, 78.2% of patients were treated with a statin and 51.2% had achieved the recommended LDL-cholesterol target. Treatment success rate was highest in diabetic patients with CVD (59.6%), followed by nondiabetic patients with CVD (51.8%), and lowest (44.8%) in diabetic patients without CVD (P<.0001). Compared with untreated patients, those on statins were more likely to achieve target (34.4% vs 55.9%, P<.0001). Of the patients who failed to meet target, only 9.9% were taking high-dose statin, while 29.3% were not prescribed any statin therapy. Among very high-risk patients, 20.8% attained the optional LDL-cholesterol goal. In multivariable analysis, advanced age, male sex, diabetes, coronary artery disease, coronary revascularization, and use of statin were associated with treatment success (all P<.0001).


CONCLUSIONS
Despite the well-established benefits of available lipid-modifying drugs, current management of dyslipidemia continues to be suboptimal, with a substantial proportion of patients failing to achieve guideline-recommended lipid targets. There remains an important opportunity to improve the quality of care for these high-risk patients.
Yan
Andrew T
AT
Canadian Heart Research Centre and Terrence Donnelly Heart Centre, Division of Cardiology, Toronto, Ontario, Canada.
Yan
Raymond T
RT
Tan
Mary
M
Hackam
Daniel G
DG
Leblanc
Kori L
KL
Kertland
Heather
H
Tsang
Jennifer L
JL
Jaffer
Shahin
S
Kates
Martin L
ML
Leiter
Lawrence A
LA
Fitchett
David H
DH
Langer
Anatoly
A
Goodman
Shaun G
SG
D000368:Aged; D002170:Canada / Q000453:epidemiology; D008076:Cholesterol, HDL / Q000097:blood; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006801:Humans; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D009313:National Health Programs; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D008076:Cholesterol, HDL; D000960:Hypolipidemic Agents; D008077:Lipoproteins, LDL