Low-density lipoprotein cholesterol in a global cohort of 57,885 statin-treated patients.
There is an inconsistency between international guidelines on lipid-lowering treatment regarding whether to pursue LDL-C treatment targets or to focus on the intensity of treatment. While either approach is attractive, there is no recent global data on actual LDL-C values, treatment targets attained, and the intensity of treatment in statin-treated patients. We aimed to determine and compare the extent of treatment target attainment globally using standardized data collection.



Analyses were based on the Dyslipidemia International Study (DYSIS), a cross-sectional study documenting statin-treated outpatients throughout 30 countries worldwide (across Europe, the Middle East, Canada, Africa, and Asia). Patients were classified as being at very high, high, or non-high cardiovascular risk based on the 2011 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines.



Data were available for a total of 57,885 patients with a median LDL-C value of 98.2 mg/dl (IQR: 76.6, 125.7 mg/dl). Overall, only 26.8% of patients were documented to have attained their risk-based target LDL-C level. Of the 76% of patients who were classified as being at very high risk, only 21.7% attained their LDL-C goal. Globally, the median distance to target was 33.0 mg/dl, ranging from 18.8 to 42.1 mg/dl across countries. We calculated that a further LDL-C reduction of just 10 mg/dl would result in an 11% increase in the proportion of very-high-risk and high-risk patients attaining their target level (9% for non-high risk patients).



In spite of statin therapy, LDL-C values were high, with a substantial distance to target that was even more pronounced in (very) high risk patients. These results call for the optimization of existing treatment strategies and a collaborative effort to improve the impact of treatment guidance on clinical practice.
Klinikum der Stadt Ludwigshafen, Medizinische Klinik B, Ludwigshafen, Germany; Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany. Electronic address: gitta@klilu.de.
Anselm K
AK
Gitt
Merck & Co., Inc., Kenilworth, NJ, USA.
Dominik
D
Lautsch
Toulouse University School of Medicine, Toulouse, France.
Jean
J
Ferrieres
Dept of Vascular Medicine, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
John
J
Kastelein
Dept. of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Vorarlberg Institute for Vascular Investigation and Treatment (VIVIT), Feldkirch, Austria; Private University of the Principality of Liechtenstein, Triesen, Liechtenstein; Drexel University College of Medicine, Philadelphia, PA, USA.
Heinz
H
Drexel
Stiftung Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Martin
M
Horack
Merck & Co., Inc., Kenilworth, NJ, USA.
Philippe
P
Brudi
Merck & Co., Inc., Kenilworth, NJ, USA.
Brecht
B
Vanneste
Institute for Pharmacology and Preventive Medicine, Mahlow, Germany.
Peter
P
Bramlage
Merck & Co., Inc., Kenilworth, NJ, USA.
Francois
F
Chazelle
Merck & Co., Inc., Kenilworth, NJ, USA.
Vasilisa
V
Sazonov
Merck & Co., Inc., Kenilworth, NJ, USA.
Baishali
B
Ambegaonkar
D000368:Aged; D015415:Biomarkers / Q000097:blood; D008078:Cholesterol, LDL / Q000097:blood*; D015897:Comorbidity; D003430:Cross-Sectional Studies; D015536:Down-Regulation; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D054625:Healthcare Disparities; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
Cardiovascular disease (CVD); Dyslipidemia; Low-density lipoprotein cholesterol (LDL-C); Statins; Treatment targets