Unmet need in the hyperlipidaemia population with high risk of cardiovascular disease: a targeted literature review of observational studies.
BACKGROUND
The aim of this study was to examine recommended target levels of low-density lipoprotein cholesterol (LDL-C) for hyperlipidaemia patients at high risk (i.e., with two or more risk factors or coronary heart disease or its risk equivalents) for cardiovascular disease (CVD); to determine LDL-C targets recommended by guidelines, and to examine the proportions of patients who do not achieve targeted LDL-C levels in real-world studies.


METHODS
Electronic databases were searched: Medline, Medline In-Process, Embase, BIOSIS, and the Cochrane Library (1 January 2005 to 31 December 2013). Guideline searches were limited to publications in the last 5 years. There were no geographical or language restrictions.


RESULTS
Seventeen guidelines and 42 observational studies that reported on high-risk hyperlipidaemia patients were identified. The National Cholesterol Education Program-Adult Treatment Panel III's LDL-C target levels were the most common guidelines used for patients with very high hyperlipidaemia. However, between 68 and 96 % of patients in the studies did not achieve an LDL-C goal <70 mg/dL, except in one study conducted in China (16.9 %). In high-risk patients, 61.8 to 93.8 % did not achieve a target of <100 mg/dL. Regarding common comorbidities, patients with concomitant CVD or diabetes were least likely to reach their target LDL-C goals.


CONCLUSIONS
In patients with high risk for CVD, the majority of patients do not attain recommended LDL-C goals, highlighting worldwide suboptimal hyperlipidaemia management and missed opportunities for reduction of the patients CVD risk. Lipid-modifying management strategies need to be intensified.
RTI Health Solutions, The Pavilion, Towers Business Park, Wilmslow Road, Didsbury, Manchester, M20 2LS, UK. semitchell@rti.org.
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Mitchell
Pfizer Ltd., Walton Oaks, Dorking Road, Walton-on-the-Hill, Tadworth, Surrey, KT20 7NS, UK.
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Roso
NUS Yong Loo Lin School of Medicine, NUHS Tower Block, Level 11, 1E Kent Ridge Road, Singapore, 119228, Singapore.
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Samuel
RTI Health Solutions, Trav. Gracia 56 Atico 1 08006, Barcelona, Spain.|The Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, MI, USA.
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Pladevall-Vila
D000924:Anticholesteremic Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000209:etiology / Q000517:prevention & control*; D008078:Cholesterol, LDL / Q000097:blood*; D015897:Comorbidity; D015536:Down-Regulation; D006801:Humans; D006949:Hyperlipidemias / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D064887:Observational Studies as Topic; D017410:Practice Guidelines as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D000924:Anticholesteremic Agents; D015415:Biomarkers; D008078:Cholesterol, LDL
Cardiovascular; Hyperlipidaemia; LDL-C; Mortality; Observational studies; Review