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. 2007 Sep;53(9):1502-7.

Are patients with hyperlipidemia undertreated? Study of patients admitted to hospital with coronary events

Alan H Lipson  1 , Wendy M Fallis, Xiqui Wang, Yanqing Yi
Affiliations

Are patients with hyperlipidemia undertreated? Study of patients admitted to hospital with coronary events

Alan H Lipson et al. Can Fam Physician. 2007 Sep.

Abstract
in English, French

Objective: To identify patients admitted to hospital with coronary events and to estimate their pre-admission coronary risk, including their lipid levels. Despite the available data and numerous guidelines, evidence indicates that many patients with hyperlipidemia are undertreated and are not achieving target lipid levels.

Design: Retrospective chart review.

Setting: Acute care community hospital in Winnipeg, Man.

Participants: A total of 153 patients who were diagnosed with acute myocardial infarction, unstable angina, or acute coronary syndrome upon admission.

Method: Each patient's 10-year risk of developing coronary artery disease was calculated, and his or her risk status was established. Each patient's low-density lipoprotein cholesterol (LDL-C) levels were recorded and categorized based on current Canadian guidelines.

Results: Mean age of patients was 67.6 years; 60.8% were male. Patients in the low-risk category had a mean LDL-C level of 2.98 mmol/L (95% confidence interval [CI] 2.66 to 3.29), and patients in the moderate-risk category had a mean LDL-C level of 3.01 mmol/L (95% CI 2.74 to 3.28), both significantly lower (P < .05) than the LDL-C target levels for patients in those risk categories according to Canadian guidelines. The mean LDL-C level for patients in the very high-risk category, however, was 2.53 mmol/L (95% CI 2.35 to 2.71), above the recommended goal. Almost half the patients (48.3%) in the very high-risk category had LDL-C levels that exceeded the goal. Slightly more than 1 in 3 patients in the very high-risk category was reported to be taking lipid-lowering agents.

Conclusion: Patients in the community who are at very high risk of having cardiovascular events are undertreated with respect to attaining LDL-C target levels. These findings point to an opportunity to prevent patient morbidity and reduce the number of hospitalizations for cardiovascular events.

OBJECTIF: Identifier les patients admis à l’hôpital pour un problème coronarien et estimer leur risque coronarien pré-admission, incluant le profil lipidique. En dépit des données et des nombreuses directives existantes, plusieurs patients hyperlipémiques sont soustraités et n’atteignent pas les niveaux lipidiques cibles.

TYPE D’ÉTUDE: Revue rétrospective de dossiers.

CONTEXTE: Hôpital communautaire de soins actifs à Winnipeg, Manitoba.

PARTICIPANTS: Un total de 153 patients admis à l’hôpital avec un diagnosticd’infarctus aigu du myocarde, d’angine instable ou de syndrome coronarien aigu.

MÉTHODE: Pour chaque patient, on a calculé le risque de développer une maladie coronarienne dans un laps de 10 ans et déterminé son niveau de risque. Pour chacun, les niveaux du cholestérol des lipoprotéines de faible densité (LDL-C) a été mesuré et classé selon les normes canadiennes actuelles.

RÉSULTATS: Les patients avaient en moyenne 67,6 ans; 60,8% étaient des hommes. Ceux de la classe à faible risque avaient un niveau moyen de LDL-C de 2,98 mmol/L (intervalle de confiance [IC] à 95%: 2,66–3,29) et ceux de la classe à risque modéré, un niveau moyen de LDL-C de 3,01 mmol/L (IC à 95%: 2,74–3,28), ces deux valeurs étant significativement inférieures aux niveaux cibles dans ces catégories de risque selon les normes canadiennes. Toutefois, ceux de la classe à risque très élevé avaient un niveau moyen de LDL-C de 2,53 mmol/L (IC à 95%; 2,35–2,71), ce qui dépasse la cible recommandée. Près de la moitié des patients (48,3%) de la classe à risque très élevé avaient des niveaux de LDL-C excédant les cibles. Un peu plus du tiers des patients de cette même catégorie prenait des hypolipidémiants.

CONCLUSION: Les patients à très haut risque d’avoir un incident coronarienet qui vivent dans la communauté ne sont pas suffisamment traités pour atteindre les niveaux cibles de LDL-C. Ces résultats laissent croire qu’on peut prévenir la morbidité des patients et réduire le nombre d’hospitalisations pour des problèmes cardiovasculaires.

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