Prevalence and treatment of atherogenic dyslipidemia in the primary prevention of cardiovascular disease in Europe: EURIKA, a cross-sectional observational study

Abstract

Background: Atherogenic dyslipidemia is associated with poor cardiovascular outcomes, yet markers of this condition are often ignored in clinical practice. Here, we address a clear evidence gap by assessing the prevalence and treatment of two markers of atherogenic dyslipidemia: elevated triglyceride levels and low levels of high-density lipoprotein cholesterol.

Methods: This cross-sectional observational study assessed the prevalence of two atherogenic dyslipidemia markers, high triglyceride levels and low high-density lipoprotein cholesterol levels, in the study population from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA; N = 7641; of whom 51.6% were female and 95.6% were White/Caucasian). The EURIKA population included European patients, aged at least 50 years with at least one cardiovascular risk factor but no history of cardiovascular disease.

Results: Over 20% of patients from the EURIKA population have either triglyceride or high-density lipoprotein cholesterol levels characteristic of atherogenic dyslipidemia. Furthermore, the proportions of patients with one of these markers were higher in subpopulations with type 2 diabetes mellitus or those already calculated to be at high risk of cardiovascular disease. Approximately 55% of the EURIKA population who have markers of atherogenic dyslipidemia are not receiving lipid-lowering therapy.

Conclusions: A considerable proportion of patients with at least one major cardiovascular risk factor in the primary cardiovascular disease prevention setting have markers of atherogenic dyslipidemia. The majority of these patients are not receiving optimal treatment, as specified in international guidelines, and thus their risk of developing cardiovascular disease is possibly underestimated.

Trial registration: The present study is registered with ClinicalTrials.gov (ID: NCT00882336).

Keywords: Atherogenic dyslipidemia; Cardiovascular disease; Epidemiology; Risk factors/global assessment.

Fig. 1

Prevalence of high TG and/or low HDL-C levels in the EURIKA population. Percentages indicated are of the total EURIKA population (N = 7641). High TG: ≥ 2.3 mmol/l. Low HDL-C: < 1.0 mmol/l in men and < 1.3 mmol/l in women Abbreviations: EURIKA European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice, HDL-C high-density lipoprotein cholesterol, TG triglyceride

Fig. 2

Proportion of patients treated with or without statins according to markers of atherogenic dyslipidemia. Data were missing for 26 patients in the overall population, 8 patients in the high TG group, 5 patients in the low HDL-C group, and 2 patients in the high TG and low HDL-C group. Data within bars are n (%). High TG: ≥ 2.3 mmol/l. Low HDL-C: < 1.0 mmol/l in men and < 1.3 mmol/l in women. Abbreviations: HDL-C high-density lipoprotein cholesterol, TG triglyceride

Fig. 3

Proportion of patients with markers of atherogenic dyslipidemia, according to T2DM status and CVD risk. (a) Non-statin - treated patients; (b) statin-treated patients. Data within bars are n (%). High TG: ≥ 2.3 mmol/l. Low HDL-C: < 1.0 mmol/l in men and < 1.3 mmol/l in women. ^aACC/AHA risk calculator [14]. ^bSCORE-HDL risk calculator [6, 18]. Abbreviations: ACC American College of Cardiology, AHA American Heart Association, CVD cardiovascular disease, HDL-C high-density lipoprotein cholesterol, SCORE-HDL Systematic Coronary Risk Evaluation-high-density lipoprotein, T2DM type 2 diabetes mellitus, TG triglyceride

Fig. 4

Multivariate analysis of factors associated with markers of atherogenic dyslipidemia. (a) Low HDL-C levels; (b) high TG levels; (c) low HDL-C and high TG levels. p < 0.0001 for all factors. Countries of origin with an OR that was not significant have been omitted. ^aPer year. ^bRelative to male participants. ^cRelative to not having T2DM. ^dBMI ≥ 30 kg/m², relative to not being obese. ^ePer mmol/l. ^fPer mg/l. ^gRelative to never smoking. ^hRelative to non-use. ⁱRelative to the UK. Abbreviations: BMI body mass index, CI confidence interval, CRP C-reactive protein, HDL-C high-density lipoprotein cholesterol, OR odds ratio, T2DM type 2 diabetes mellitus, TG triglyceride

Fig. 5

Association between markers of atherogenic dyslipidemia and CRP. (a) CRP levels of < 1 mg/L, 1–< 3 mg/L or ≥ 3 mg/L; (b) CRP levels < 2 mg/L or ≥ 2 mg/L. Data were missing for 76 patients in the overall population, and for 1 patient in each of the dyslipidemia groups. Data within bars are n (%). High TG: ≥ 2.3 mmol/l. Low HDL-C: < 1.0 mmol/l in men and < 1.3 mmol/l in women. Abbreviations: CRP C-reactive protein, HDL-C high-density lipoprotein cholesterol, TG triglyceride