title: Degree of Lipid Control in Patients With Coronary Heart Disease and Measures Adopted by Physicians. REPAR Study.
abstract: OBJECTIVE
  Lipid control is insufficient in patients with coronary heart disease but this situation may be improving with the implementation of the latest clinical practice guidelines. The aim of this study was to analyze whether target values of low-density lipoprotein cholesterol are achieved and to identify associated factors and physicians' attitudes to deficient control.
  
  
  METHODS
  We conducted a national, multicenter, prospective, observational study of 1103 patients with stable coronary heart disease, analyzing lipid values and a broad set of clinical variables. The statistical analysis involved a binary logistic regression model using backward stepwise elimination.
  
  
  RESULTS
  Low-density lipoprotein cholesterol was < 70 mg/dL in only 26% of patients, even though 95.3% were receiving cholesterol-lowering agents, 45% of which were high-intensity therapies. Independent predictors of low-density lipoprotein cholesterol < 70 mg/dL were diabetes mellitus, wholegrain bread, shorter history of dyslipidemia, and, especially, high-intensity cholesterol-lowering therapies. Physicians increased therapy in only 26% of poorly controlled patients. The main predictor of increased therapy was low-intensity baseline therapy (odds ratio=5.05; 95% confidence interval, 3.3-9.2). A more proactive approach was observed in older physicians (P=.019) and longer physician practice (P=.02).
  
  
  CONCLUSIONS
  Despite the new guidelines, only 26% of patients with coronary heart disease have adequate lipid control. In 70% of patients, physicians continue the same therapy, even though high-intensity cholesterol-lowering therapies are a key factor in good control.
authors.affiliation: Servicio de Cardiología, Hospital General Universitario Vall d'Hebron, Barcelona, Spain. Electronic address: egalve@vhebron.net.
authors.forename: Enrique
authors.initials: E
authors.lastname: Galve
authors.affiliation: Departamento de Cardiología, Hospital de San Juan, San Juan de Alicante, Alicante, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Cordero
authors.affiliation: Servicio de Cardiología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
authors.forename: Angel
authors.initials: A
authors.lastname: Cequier
authors.affiliation: Ferrer Internacional, Barcelona, Spain.
authors.forename: Emilio
authors.initials: E
authors.lastname: Ruiz
authors.affiliation: Departamento de Cardiología, Complejo Hospitalario Universitario, Santiago de Compostela, A Coruña, Spain.
authors.forename: José Ramón
authors.initials: JR
authors.lastname: González-Juanatey
mesh_terms: D000368:Aged; D000924:Anticholesteremic Agents / Q000627:therapeutic use; D001291:Attitude of Health Personnel; D000072096:Cardiologists / Q000592:standards; D008078:Cholesterol, LDL / Q000097:blood*; D002908:Chronic Disease; D003327:Coronary Disease / Q000097:blood / Q000517:prevention & control*; D005260:Female; D006801:Humans; D006937:Hypercholesterolemia / Q000517:prevention & control*; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011446:Prospective Studies
chemical_list: D000924:Anticholesteremic Agents; D008078:Cholesterol, LDL
keywords: Coronary heart disease; Dislipemia; Dyslipidemia; Enfermedad coronaria; Estudio observacional; Observational study; Target values; Valores objetivo