Application in general practice of treatment guidelines for patients with dyslipidaemia: the RESPECT study.
BACKGROUND
Screening for and management of dyslipidaemia are crucial in primary and secondary prevention of cardiovascular disease. The impact on general practitioners (GP) of the 2005 French guidelines for hypercholesterolaemia has not been evaluated.


OBJECTIVE
To compare GP's estimation of cardiovascular risk with that from a theoretical calculation; to analyse the consequences of cardiovascular-risk estimation on the threshold of therapeutic intervention and the target low-density lipoprotein cholesterol (LDL-C) concentration; and to analyse patients' awareness of their hypercholesterolaemia.


METHODS
The RESPECT study was a transverse, multicentre, observational survey conducted between March 2006 and February 2007 by 1797 GP in France. Inclusion criteria were adults with primary hypercholesterolaemia who had not taken lipid-lowering drugs within the previous 6 months.


RESULTS
Of the 5627 patients included (60.9% men; mean age+/-standard deviation 58.2+/-11.0 years; body mass index 27.2+/-4.1 kg/m(2); mean total cholesterol 2.68+/-0.37 g/L; LDL-C 1.79+/-0.35 g/L), 1963 (36.2%) had at least three cardiovascular risk factors. GP identified a high cardiovascular risk level in 40.8%, moderate risk in 45.8% and low risk in 13.4% of patients. These compared with calculated rates of 48, 23 and 29%, respectively (kappa concordance 59.4%). For most patients (98.2%), GP defined the therapeutic target based on LDL-C concentration. The target LDL-C was significantly different when cardiovascular risk was estimated by GP versus that calculated theoretically. The higher the estimated risk level, the greater the rate of introduction of lipid-lowering drugs and the shorter the time to the next GP visit. Most patients considered themselves to be well or rather well informed about their cholesterol concentration (91.3%), the causes (64.3%) and consequences of cholesterol-induced diseases (83.7%), and the difference between 'good' and 'bad' cholesterol (57%). Most (81.5%) patients were aware of the benefits of lipid-lowering drugs on cardiovascular disease prevention; 95.8% considered adequate diet and compliance with pharmacological treatment to be very important.


CONCLUSIONS
Recent French guidelines for hypercholesterolaemia are used widely by GP in practice. They enable correct assessment of overall cardiovascular risk level, have an impact on the therapeutic threshold of intervention by physicians and improve patients' awareness of the relevance of cholesterol concentration.
Cacoub
Patrice
P
Service médecine interne, groupe hospitalier La-Pitié-Salpêtrière, université Pierre-et-Marie-Curie Paris-VI, AP-HP, 47, boulevard de l'Hôpital, 75013 Paris, France. patrice.cacoub@psl.aphp.fr
Tocque-Le Gousse
Elisabeth
E
Fabry
Caroline
C
Hermant
Sophie
S
Petzold
Loïc
L
D000368:Aged; D001364:Awareness; D002318:Cardiovascular Diseases / Q000097:blood / Q000209:etiology / Q000517:prevention & control*; D008078:Cholesterol, LDL; D005194:Family Practice; D005260:Female; D005602:France; D019983:Guideline Adherence; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D006937:Hypercholesterolemia / Q000097:blood / Q000150:complications / Q000188:drug therapy*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D010353:Patient Education as Topic; D010361:Patients / Q000523:psychology; D010465:Perception; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012042:Registries; D018570:Risk Assessment; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D008078:Cholesterol, LDL; D000960:Hypolipidemic Agents