title: Lipid therapy utilization rates in a managed-care mixed dyslipidemia population.
abstract: BACKGROUND
  National clinical treatment guidelines recommend pharmacologic treatment in addition to therapeutic lifestyle modifications in patients with mixed dyslipidemia and multiple risk factors for coronary heart disease (CHD).
  
  
  OBJECTIVE
  To evaluate real-world pharmacologic treatment of mixed dyslipidemia patients with cardiovascular disease (CVD) risk factors.
  
  
  METHODS
  Commercial health plan members in a large, United States managed-care database with complete lipid panel results (ie, high-density lipoprotein cholesterol [HDL-C], low-density lipoprotein cholesterol [LDL-C], total cholesterol [TC], triglycerides [TG]) between January 1, 2006 and December 31, 2006 were included. Mixed dyslipidemia was defined as any two nonoptimal lipid parameters (LDL-C, HDL-C, TG) according to National Cholesterol Education Program/Adult Treatment Panel III guidelines. Subjects were observed for 182 days pre-index to determine CVD risk factors (ie, male aged 45+ years, female 55+ years, CHD history, hypertension, diabetes mellitus). Lipid treatment status 6 months pre- and post-index dates was determined using pharmacy claims for any lipid monotherapy (statin, fibrate, niacin, "other"), or combination therapy (statin + fenofibrate; statin + niacin; statin + other).
  
  
  RESULTS
  Lipid treatment increased post-index for all mixed dyslipidemia groups and by total number of risk factors. The increased LDL-C and low HDL-C group had the lowest treatment rates; the group with low HDL-C and elevated TG had the highest. In the latter group, when treated, primarily statin monotherapy (51%) was used post-index; only 26% received niacin or fibrate therapy targeting HDL-C or TG abnormalities. Across all mixed dyslipidemia patients, >30% with three to four CVD risk factors were not treated ≥6 months post-index.
  
  
  CONCLUSIONS
  In real-world clinical practice, pharmacologic treatment rates increased upon assessment of multiple lipid abnormalities and by total risk factors for CHD. However, mixed dyslipidemia remained undertreated with low rates of niacin and fibrate usage.
authors.affiliation: Sterling Rock Falls Clinic, 101 E Miller Road, Sterling IL 61081, USA, University of Illinois College of Medicine Peoria, IL, USA and Southern Illinois University School of Medicine Springfield, Illinois.
authors.forename: Peter P
authors.initials: PP
authors.lastname: Toth
authors.forename: Victoria
authors.initials: V
authors.lastname: Zarotsky
authors.forename: Jane M
authors.initials: JM
authors.lastname: Sullivan
authors.forename: Dave
authors.initials: D
authors.lastname: Laitinen