Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Jul;15(4):821-831.
doi: 10.5114/aoms.2018.73961. Epub 2018 Mar 12.

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

Evangelos Liberopoulos  1 , Loukianos Rallidis  2 , Filio Spanoudi  3 , Elena Xixi  3 , Anselm Gitt  4 , Martin Horack  4 , Veronica Ashton  5 , Philippe Brudi  5 , Dominik Lautsch  5 , Baishali Ambegaonkar  5 , Moses Elisaf  1
Affiliations

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

Evangelos Liberopoulos et al. Arch Med Sci. 2019 Jul.

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.

PubMed Disclaimer

Conflict of interest statement

M. H. reports that his institution received funding for recruitment and biostatistics for the DYSIS registry. At the time of the study, A.V. was a full-time employee of Rutgers University, which received grant funding for this project from Merck & Co., Inc., Kenilworth, NJ USA. B.A., P.B., and D.L. are employees of Merck Sharp & Dohme Corp., a subsidiary of Merck & Co., Inc., Kenilworth, NJ USA. E.L. has participated in educational, research and advisory activities sponsored by: AstraZeneca, MSD, amgen, Sanofi-Aventis, Bayer, Novo-Nordisc, Lilly, Boehringer-Ingelheim, Servier and Novartis. F.S. and E.X. are employees of Merck Sharp & Dohme Pharmaceutical, Industrial and Commercial S.A, Athens, Greece. M.E. reports honoraria from MSD, Novartis, Chiesi, Bayer, Astra Zeneca, Pfizer, Abbott, Mylan, Sanofi, Amgen, Boehringer Ingelheim, Eli Lilly, GSK, Angelini, Winmedica, grants and personal fees from MSD and ASTRA ZENECA and has given talks and attended conferences sponsored by various pharmaceutical companies, including Bristol-Myers Squibb, Novartis, Chiesi, Bayer, Astra Zeneca, Pfizer, Abbott, Mylan, Sanofi, Amgen, Boehringer Ingelheim, Eli Lilly, GSK, Angelini, Winmedica and MSD.

Figures

Figure 1
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
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
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
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.
See this image and copyright information in PMC

References

    1. Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe 2014: epidemiological update. Eur Heart J. 2014;35:2950–9. - PubMed
    1. Catapano AL, Reiner Z, De Backer G, et al. ESC/EAS Guidelines for the management of dyslipidaemias The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) Atherosclerosis. 2011;217:3–46. - PubMed
    1. Panagiotakos DB, Georgousopoulou EN, Pitsavos C, et al. Ten-year (2002-2012) cardiovascular disease incidence and all-cause mortality, in urban Greek population: the ATTICA Study. Int J Cardiol. 2015;180:178–84. - PubMed
    1. Gikas A, Sotiropoulos A, Panagiotakos D, Pastromas V, Papazafiropoulou A, Pappas S. Prevalence trends for myocardial infarction and conventional risk factors among Greek adults (2002-06) QJM. 2008;101:705–12. - PubMed
    1. Papandreou C, Tuomilehto H. Coronary heart disease mortality in relation to dietary, lifestyle and biochemical risk factors in the countries of the Seven Countries Study: a secondary dataset analysis. J Hum Nutr Diet. 2014;27:168–75. - PubMed