title: Use of Lipid-modifying Therapy and LDL-C Goal Attainment in a High-Cardiovascular-Risk Population in the Netherlands.
abstract: OBJECTIVE
  This study investigates lipid-modifying therapy (LMT) and LDL-C goal attainment in a real-world, high-cardiovascular-risk population in the Netherlands.
  
  
  METHODS
  From the PHARMO Database Network, patients aged ≥18 years with an LDL-C measurement in 2012 (index date) were selected and hierarchically classified into the following mutually exclusive high-cardiovascular-risk categories: familial hypercholesterolemia (FH), recent acute coronary syndrome (ACS), coronary heart disease, ischemic stroke, peripheral arterial disease, and diabetes mellitus. LMT use and LDL-C goal attainment at the index date was assessed.
  
  
  RESULTS
  Of 61 839 patients who met the inclusion criteria, 1132 (2%) had FH, 2431 (4%) had recent ACS, 6292 (10%) had coronary heart disease, 2868 (5%) had ischemic stroke, 3017 (5%) had peripheral arterial disease, and 46 099 (75%) had diabetes mellitus. Overall, 67% of patients were receiving LMT. Use of LMT ranged from 77% for recent ACS to 53% for FH, and standard-potency statins were the most prescribed. The percentage attaining an LDL-C goal of <100 mg/dL was 55%, ranging from 23% (FH) to 58% (recent ACS). Among LMT users, 69% taking high-potency statins, 70% taking standard-potency statins, and 20% receiving nonstatin LMTs attained an LDL-C goal of <100 mg/dL.
  
  
  CONCLUSIONS
  LMT use among high-cardiovascular-risk patients was modest, which contributed to 46% of the cohort failing to reach LDL-C goals <100 mg/dL. Underuse and suboptimal use of LMTs in this cohort represent opportunities for quality improvement programs aimed at reducing the risk of cardiovascular events.
authors.affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands. Electronic address: Josine.kuiper@pharmo.nl.
authors.forename: Josephina G
authors.initials: JG
authors.lastname: Kuiper
authors.affiliation: Regeneron, Tarrytown, New York.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sanchez
authors.affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.
authors.forename: Eline
authors.initials: E
authors.lastname: Houben
authors.affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.
authors.forename: Edith M
authors.initials: EM
authors.lastname: Heintjes
authors.affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.
authors.forename: Fernie J A
authors.initials: FJA
authors.lastname: Penning-van Beest
authors.affiliation: Sanofi, Bridgewater, New Jersey.
authors.forename: Irfan
authors.initials: I
authors.lastname: Khan
authors.affiliation: Sanofi, Gouda, the Netherlands.
authors.forename: Melanie
authors.initials: M
authors.lastname: van Riemsdijk
authors.affiliation: PHARMO Institute for Drug Outcomes Research, Utrecht, the Netherlands.
authors.forename: Ron M C
authors.initials: RMC
authors.lastname: Herings
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D008078:Cholesterol, LDL / Q000097:blood*; D003327:Coronary Disease / Q000097:blood / Q000188:drug therapy*; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006040:Goals; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use; D006938:Hyperlipoproteinemia Type II / Q000097:blood / Q000188:drug therapy*; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000097:blood / Q000188:drug therapy*; D009426:Netherlands; D058729:Peripheral Arterial Disease / Q000097:blood / Q000188:drug therapy*; D012306:Risk
chemical_list: D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: LDL-C; cardiovascular disease; prevention; statin