title: Attainment of normal lipid levels among high cardiovascular risk patients: pooled analysis of observational studies from the United Kingdom, Sweden, Spain and Canada.
abstract: BACKGROUND
  Although low-density lipoprotein cholesterol (LDL-C) is the primary lipid target for cardiovascular disease (CVD) risk reduction, high-density lipoprotein cholesterol (HDL-C) and triglycerides (TG) have also emerged as risk factors. This study evaluated attainment of goal/normal lipid levels in current clinical practice among high-risk patients following lipid-modifying therapy (LMT).
  
  
  METHODS
  Data for patients aged ≥35years and on LMT for ≥12months were identified from electronic medical records (United Kingdom and Sweden) and extracted from medical charts (Canada and Spain). High CVD risk was defined according to the Adult Treatment Panel III guidelines. An index period was defined, from January 1995-July 2008, during which patients received an initial LMT prescription. Prevalence of lipid abnormalities was assessed 12months before and after the index date. Multivariate logistic regressions evaluated predictors of attaining goal/normal lipid levels.
  
  
  RESULTS
  Among 12,768 high-risk patients, 75% had elevated LDL-C, 37% low HDL-C, and 30% elevated TG before LMT. Despite therapy (97% statins only), 23% had elevated LDL-C, 36% low HDL-C, 16% elevated TG, and 17% had ≥2 abnormal lipid levels. Framingham risk score >20% (Odds Ratio, 95% confidence interval: 0.37,0.31-0.43), diabetes (0.75,0.64-0.88), hypertension (1.26,1.09-1.46), current smoker (0.82,0.70-0.95) and increased body mass index (0.95,0.94-0.96) were associated with the likelihood of attaining ≥2 normal lipid levels (vs. LDL-C goal only).
  
  
  CONCLUSIONS
  Current approaches to lipid management improve LDL-C goal attainment; however, control of multiple lipid risk factors remains poor. Patients may benefit from more comprehensive approaches to lipid management, which treat multiple lipid abnormalities, as suggested in clinical guidelines.
authors: Merck and Co. Inc., Whitehouse Station, NJ, USA. Electronic address: baishali_ambegaonkar@merck.com.
authors: Baishali M
authors: BM
authors: Ambegaonkar
authors: Lori D
authors: LD
authors: Bash
authors: Diana R
authors: DR
authors: Chirovsky
authors: Kevin
authors: K
authors: Jameson
authors: Susan
authors: S
authors: Grant
authors: Gonzalo
authors: G
authors: Nocea
authors: Billie
authors: B
authors: Pettersson
authors: Vasilisa
authors: V
authors: Sazonov
mesh_terms: D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D008076:Cholesterol, HDL / Q000097:blood*; D008078:Cholesterol, LDL / Q000097:blood*; D050171:Dyslipidemias / Q000097:blood / Q000188:drug therapy / Q000453:epidemiology*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D064887:Observational Studies as Topic; D015995:Prevalence; D012307:Risk Factors; D013030:Spain / Q000453:epidemiology; D013548:Sweden / Q000453:epidemiology; D014280:Triglycerides / Q000097:blood*; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D008076:Cholesterol, HDL; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D014280:Triglycerides
keywords: Cardiovascular disease; Diabetes; High-density lipoprotein cholesterol; Lipid modifying therapy; Low-density lipoprotein cholesterol; Statins; Triglycerides