title: Low rates of both lipid-lowering therapy use and achievement of low-density lipoprotein cholesterol targets in individuals at high-risk for cardiovascular disease across Europe.
abstract: OBJECTIVE
  To analyse the treatment and control of dyslipidaemia in patients at high and very high cardiovascular risk being treated for the primary prevention of cardiovascular disease (CVD) in Europe.
  
  
  RESULTS
  Data were assessed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials.gov identifier: NCT00882336), which included a randomly sampled population of primary CVD prevention patients from 12 European countries (n = 7641). Patients' 10-year risk of CVD-related mortality was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm, identifying 5019 patients at high cardiovascular risk (SCORE ≥5% and/or receiving lipid-lowering therapy), and 2970 patients at very high cardiovascular risk (SCORE ≥10% or with diabetes mellitus). Among high-risk individuals, 65.3% were receiving lipid-lowering therapy, and 61.3% of treated patients had uncontrolled low-density lipoprotein cholesterol (LDL-C) levels (≥2.5 mmol/L). For very-high-risk patients (uncontrolled LDL-C levels defined as ≥1.8 mmol/L) these figures were 49.5% and 82.9%, respectively. Excess 10-year risk of CVD-related mortality (according to SCORE) attributable to lack of control of dyslipidaemia was estimated to be 0.72% and 1.61% among high-risk and very-high-risk patients, respectively. Among high-risk individuals with uncontrolled LDL-C levels, only 8.7% were receiving a high-intensity statin (atorvastatin ≥40 mg/day or rosuvastatin ≥20 mg/day). Among very-high-risk patients, this figure was 8.4%.
  
  
  CONCLUSIONS
  There is a considerable opportunity for improvement in rates of lipid-lowering therapy use and achievement of lipid-level targets in high-risk and very-high-risk patients being treated for primary CVD prevention in Europe.
authors.affiliation: Institute of Life Sciences 2, Swansea University College of Medicine, Swansea, United Kingdom.
authors.forename: Julian P
authors.initials: JP
authors.lastname: Halcox
authors.affiliation: INSERM CIC-EC 1425 and Epidemiology and Clinical Research Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France; Univ Paris Diderot, Sorbonne Paris Cité, UMR 1123, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.affiliation: Department of Preventative Medicine and Public Health, Universidad Autónoma de Madrid IdiPaz and CIBERESP, Madrid, Spain.
authors.forename: Esther
authors.initials: E
authors.lastname: Lopez-Garcia
authors.affiliation: Department of Public Health, University of Ghent, Ghent, Belgium.
authors.forename: Guy
authors.initials: G
authors.lastname: De Backer
authors.affiliation: Department of Internal Medicine, Ageing and Clinical Nephrology, University of Bologna, Bologna, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Borghi
authors.affiliation: INSERM U 744, Institut Pasteur de Lille, Université Lille-Nord de France, Lille, France.
authors.forename: Jean
authors.initials: J
authors.lastname: Dallongeville
authors.affiliation: Departments of Epidemiology and Medicine and Welch Center of Prevention, Epidemiology and Clinical Research, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America; Department of Cardiovascular Epidemiology and Population Genetics, National Center for Cardiovascular Research, Madrid, Spain.
authors.forename: Eliseo
authors.initials: E
authors.lastname: Guallar
authors.affiliation: Observational Research Centre, Global Medical Affairs, AstraZeneca Farmacéutica Spain, Madrid, Spain.
authors.forename: Jesús
authors.initials: J
authors.lastname: Medina
authors.affiliation: School of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
authors.forename: Joep
authors.initials: J
authors.lastname: Perk
authors.affiliation: AstraZeneca Global Medical Affairs, London, United Kingdom.
authors.forename: Ogün
authors.initials: O
authors.lastname: Sazova
authors.affiliation: Research Evaluation Unit, Oxford PharmaGenesis Ltd, Oxford, United Kingdom.
authors.forename: Stephen
authors.initials: S
authors.lastname: Sweet
authors.affiliation: INSERM CIC-EC 1425 and Epidemiology and Clinical Research Department, Assistance Publique-Hôpitaux de Paris, Hôpital Bichat, Paris, France.
authors.forename: Carine
authors.initials: C
authors.lastname: Roy
authors.affiliation: Department of Preventative Medicine and Public Health, Universidad Autónoma de Madrid IdiPaz and CIBERESP, Madrid, Spain.
authors.forename: José R
authors.initials: JR
authors.lastname: Banegas
authors.affiliation: Department of Preventative Medicine and Public Health, Universidad Autónoma de Madrid IdiPaz and CIBERESP, Madrid, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Rodriguez-Artalejo
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D008078:Cholesterol, LDL / Q000097:blood*; D050171:Dyslipidemias / Q000097:blood* / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D000960:Hypolipidemic Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D000960:Hypolipidemic Agents