Impact of new Joint British Societies' (JBS 2) guidelines on prevention of cardiovascular disease: evaluation of serum total cholesterol goal achievement in UK clinical practice.
BACKGROUND
Consensus health panels, including the Joint British Societies (JBS), have established increasingly stringent cholesterol goals. However, in clinical settings, most patients do not achieve even the less stringent goals.


OBJECTIVE
To provide descriptive data on the proportion of patients in the United Kingdom who would have achieved the new JBS 2 total cholesterol (TC) goal of < 4.0 mmol/L (< 155 mg/dL) without changes in therapy.


METHODS
Cross-sectional analysis of patients initiated on lipid-modifying therapies in 2005 (before publication of the JBS 2 guidelines), as ascertained via a physician (general practitioner (GP)) database.


RESULTS
Among 70,194 patients (mean age 64 years) receiving prescriptions for lipid-modifying therapies, 35,823 (51.0%) were considered to be at high risk because of CHD or diabetes mellitus and 34,371 (49.0%) were at low risk. A total of 66,642 (94.9%) patients received monotherapy with HMG-CoA reductase inhibitors (statins), including 33,853 (94.5%) of high-risk patients and 32,789 (95.4%) low-risk individuals. Statins were prescribed at medium (maximum daily dose = simvastatin 40 mg; atorvastatin 20 mg; rosuvastatin 10 mg) or lower equipotency doses in the majority of patients receiving these medications -58,033 (87.1%) patients receiving statins, including 28,988 (85.6%) high-risk patients and 29,045 (88.6%) low-risk patients. Of the 28,874 patients with TC measurements, 7827 (27.1%) would have achieved the new JBS 2 goal without changes in medications or doses. In more than 51% of patients, TC values were > or = 10% above the JBS 2 target despite prescribed therapy, suggesting that these individuals would also not have achieved the JBS 2 goal by doubling their statin doses.


CONCLUSIONS
Even though patient data were accessed before the JBS 2 guidelines were issued and data on other cardiovascular risk factors not captured, it can be concluded that most British patients (approximately 73%) would not have achieved the recent JBS 2 TC target of < 4.0 mmol/L without changes in lipid-modifying medications or medication doses. More effective and well-tolerated treatments, including combination statin regimens, are needed to increase the proportion of British patients reaching the more stringent JBS 2 goal.
Rajagopalan
Srinivasan
S
Med Data Analytics Inc., Williamsville, NY 14221, USA. sr62@columbia.edu <sr62@columbia.edu>
Alemao
Evo
E
Finch
Liz
L
Yin
Don
D
D000368:Aged; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D002784:Cholesterol / Q000097:blood*; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D006113:United Kingdom
D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D002784:Cholesterol