Attainment of cholesterol target values in Greece: results from the Dyslipidemia International Study II

Abstract

Introduction: Current European guidelines recommend treatment with lipid-lowering therapy (LLT) to a low-density lipoprotein cholesterol (LDL-C) target of < 70 mg/dl for patients at very high risk. LDL-C target attainment and use of LLTs in these patients in Greece is not known.

Material and methods: The Dyslipidemia International Study (DYSIS) II was a multicenter observational study. The coronary heart disease (CHD) cohort was divided into two groups based on treatment status (on LLT for ≥ 3 months or not on LLT). The acute coronary syndrome (ACS) cohort was evaluated at the time of admission and again 120 ±15 days after admission.

Results: In the CHD cohort (n = 499), 457 (91.6%) patients were on LLT. The LDL-C target value was attained by 26.5% of LLT users. Statin monotherapy was used by 77.5% of treated patients, with a mean ± SD atorvastatin dose equivalent of 24 ±16 mg/day. In the ACS cohort (n = 200), 159 (79.5%) patients were on LLT at admission. Mean ± SD LDL-C levels were 108 ±40 mg/dl at admission and 86 ±25 mg/dl at follow-up. LDL-C target value attainment rates were 16.2% at admission and 25.0% at follow-up. At admission, statin monotherapy was used by 86.8% of treated patients. The mean ± SD atorvastatin dose equivalent increased from 20 ±14 mg/day at admission to 29 ±15 mg/day at follow-up. The statin dose was associated with higher odds of LDL-C target value attainment (OR = 1.05, 95% CI: 1.02-1.08).

Conclusions: The LDL-C target attainment by very high risk patients in Greece is suboptimal. Increasing the statin dose or combining it with non-statins may improve target value attainment.

Keywords: acute coronary syndrome; cardiovascular disease; cholesterol; coronary heart disease; low-density lipoproteins; statins.

Figure 1

Lipid target value attainment in the CHD cohort CHD – coronary heart disease, LDL-C – low-density lipoprotein cholesterol, HDL-C– high-density lipoprotein cholesterol.

Figure 2

Use of (A) selected classes of lipid-lowering therapies and (B) statins in the CHD cohort. Percentages reflect the inclusion of all treated patients (n = 457) in panel (A), and all statin-treated patients (monotherapy or combination therapy, n = 454) in panel (B). The ‘other non-statin’ treatments in panel (A) included fibrates, omega- 3 fatty acids, and any other non-statin therapy (except ezetimibe). The ‘other’ treatment in panel (B) included pitavastatin and fluvastatin. CHD – coronary heart disease.

Figure 3

LDL-C target value attainment in ACS patients receiving lipid-lowering therapy (A) by pre-ACS risk level and (B) over time. A – The targets for very high, high, moderate, and low risk patients were, respectively, < 70 mg/dl, < 100 mg/dl, < 115 mg/dl, and < 130 mg/dl. Risk levels were determined from patient characteristics prior to admission. B – Goal attainment was calculated using available LDL-C data from 68 treated patients with data at both admission and follow-up ACS – acute coronary syndrome, LDL-C – low-density lipoprotein cholesterol.

Figure 4

(A) Lipid-lowering therapy and (B) statin use at admission and follow-up in the ACS cohort. A – Percentages reflect mutually exclusive treatment types among all treated patients at admission (n = 159) and, among them, the patients with available treatment data at follow-up (n = 153). B – Percentages are based on 156 patients receiving statins at admission and 151 patients receiving statins at follow-up. ‘Other’ includes fluvastatin and pravastatin. No patients received fluvastatin at follow-up ACS – acute coronary syndrome.