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. 2022 Apr 26;21(1):57.
doi: 10.1186/s12933-022-01495-8.

Physicians' misperceived cardiovascular risk and therapeutic inertia as determinants of low LDL-cholesterol targets achievement in diabetes

Mario Luca Morieri  1 , Olga Lamacchia  2 , Enzo Manzato  3 , Andrea Giaccari  4 , Angelo Avogaro  3 ; Lipid-Lowering-Relevance Study Group
Collaborators, Affiliations

Physicians' misperceived cardiovascular risk and therapeutic inertia as determinants of low LDL-cholesterol targets achievement in diabetes

Mario Luca Morieri et al. Cardiovasc Diabetol. .

Erratum in

Abstract

Background: Greater efforts are needed to overcome the worldwide reported low achievement of LDL-c targets. This survey aimed to dissect whether and how the physician-based evaluation of patients with diabetes is associated with the achievement of LDL-c targets.

Methods: This cross-sectional self-reported survey interviewed physicians working in 67 outpatient services in Italy, collecting records on 2844 patients with diabetes. Each physician reported a median of 47 records (IQR 42-49) and, for each of them, the physician specified its perceived cardiovascular risk, LDL-c targets, and the suggested refinement in lipid-lowering-treatment (LLT). These physician-based evaluations were then compared to recommendations from EAS/EASD guidelines.

Results: Collected records were mostly from patients with type 2 diabetes (94%), at very-high (72%) or high-cardiovascular risk (27%). Physician-based assessments of cardiovascular risk and of LDL-c targets, as compared to guidelines recommendation, were misclassified in 34.7% of the records. The misperceived assessment was significantly higher among females and those on primary prevention and was associated with 67% lower odds of achieving guidelines-recommended LDL-c targets (OR 0.33, p < 0.0001). Peripheral artery disease, target organ damage and LLT-initiated by primary-care-physicians were all factors associated with therapeutic-inertia (i.e., lower than expected probability of receiving high-intensity LLT). Physician-suggested LLT refinement was inadequate in 24% of overall records and increased to 38% among subjects on primary prevention and with misclassified cardiovascular risk.

Conclusions: This survey highlights the need to improve the physicians' misperceived cardiovascular risk and therapeutic inertia in patients with diabetes to successfully implement guidelines recommendations into everyday clinical practice.

Keywords: Adherence; Cardiovascular risk; Ezetimibe; Inertia; Misperceived risk; PCSK9i; Primary care physicians; Real-world; Real-world study; Self-reported survey; Statins.

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Conflict of interest statement

MLM received lecture or advisory fees or grant support from Mylan, SlaPharma, Servier, Lilly, MSD, Novo Nordisk, and was unconditionally supported by LatoC Srl for conducting the analyses of the data of the current work and writing the manuscript. OL received speaker or advisory board fees from Eli-Lilly and NovoNordisk, research grants from Astra Zeneca. EM none. AG has received honoraria or consulting fees from Amgen, AstraZeneca, Boehringer Ingelheim, Eli Lilly, MSD, and Sanofi, and research funding from AstraZeneca. AA received research grants, lecture or advisory board fees from Merck Sharp & Dome, AstraZeneca, Novartis, Boeringher-Ingelheim, Sanofi, Mediolanum, Janssen, Novo Nordisk, Lilly, Servier, and Takeda.

Figures

Fig. 1
Fig. 1
LDL-cholesterol distribution (top panels) and Lipid-lowering-Treatments (bottom panels) in the overall population and stratified by cardiovascular disease risk categories
Fig. 2
Fig. 2
Distribution of subjects according to physician-based cardiovascular (CVD) risk assessment and LDL-c suggested targets vs. those recommended by guidelines ( A), and relationship of physician-based misclassified CVD risk and achievement of LDL-c targets (B) or current lipid-lowering treatments (LLT) (C). A: green boxes show the number of subjects with physician-suggested LDL-c targets being equal or lower to those recommended by guidelines; Red boxes show the number of subjects with physician-suggested targets being higher than guidelines-recommended target. Patients with missing information on Physician-suggested targets (n = 105) were not included in the analysis. Notes on B and C: association between misclassified risk and achievement of LDL-c targets (B) or high-/very-high intensity lipid-lowering treatment (LLT) expressed as odds ratios, with OR < 1 suggestive of lower probability of subjects with physician-based misperceived CVD risk of achieving LDL-c targets or of being treated high/very-high- intensity LLT
Fig. 3
Fig. 3
A physician-suggested refinement of LLT as compared to guideline-recommended refinement of LLT needed to achieve LDL-c targets. B, C Proportion of records with inadequate physicians-suggested changes in treatment, in the overall population and among those on primary prevention. A green boxes show the number of subjects with Physician-suggested LLT with intensity being at least equal to that recommended by guidelines. Yellow boxes show the number of subjects with physician-suggested LLT going in the same direction as that recommended by guidelines (i.e. at least one-level increase in the intensity of treatments and allowing no less than 50% LDL-c reduction). Red boxes show the number of subjects where physicians-suggested an insufficient refinement of LLT as compared to guidelines recommendation
See this image and copyright information in PMC

References

    1. Ray KK, Molemans B, Schoonen WM, Giovas P, Bray S, Kiru G, et al. EU wide cross sectional observational study of lipid modifying therapy use in secondary and primary care: the DA VINCI study. Eur J Prev Cardiol. 2020;28(11):1279–89. doi: 10.1093/eurjpc/zwaa047. - DOI - PubMed
    1. Bruckert E, Parhofer KG, Gonzalez-Juanatey JR, Nordestgaard B, Arca M, Giovas P, et al. Proportion of high-risk/very high-risk patients in Europe with low-density lipoprotein cholesterol at target according to European guidelines: a systematic review. Adv Ther. 2020;37(5):1724–1736. doi: 10.1007/s12325-020-01285-2. - DOI - PMC - PubMed
    1. Arca M, Ansell D, Averna M, Fanelli F, Gorcyca K, Iorga SR, et al. Statin utilization and lipid goal attainment in high or very-high cardiovascular risk patients: insights from Italian general practice. Atherosclerosis. 2018;271:120–127. doi: 10.1016/j.atherosclerosis.2018.02.024. - DOI - PubMed
    1. Morieri ML, Perrone V, Veronesi C, Degli Esposti L, Andretta M, Plebani M, et al. Improving statin treatment strategies to reduce LDL-cholesterol: factors associated with targets' attainment in subjects with and without type 2 diabetes. Cardiovasc Diabetol. 2021;20(1):144. doi: 10.1186/s12933-021-01338-y. - DOI - PMC - PubMed
    1. Yao X, Shah ND, Gersh BJ, Lopez-Jimenez F, Noseworthy PA. Assessment of trends in statin therapy for secondary prevention of atherosclerotic cardiovascular disease in US adults from 2007 to 2016. JAMA Netw Open. 2020;3(11):e2025505. doi: 10.1001/jamanetworkopen.2020.25505. - DOI - PMC - PubMed

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