Uncontrolled Cholesterol in Individuals with Severe Hypercholesterolemia in a Health Evaluation Program in Brazil

Abstract

Background: Individuals with severe hypercholesterolemia (SH) are considered at high atherosclerosis risk and should be intensively treated with lipid-lowering drugs aiming for an LDL-C reduction of≥50% and a goal of <70 mg/dL.

Objectives: This study aimed to evaluate cholesterol control in individuals with SH (LDL-C ≥ 190 mg/dL or 160-189 mg/dL using lipid-lowering drugs) followed in a health evaluation program.

Methods: 55,000 individuals were evaluated, of which 2,214 (4%) had SH, and 1,016 (45.8%) had repeated assessments. Achievement of recommended LDL-C goals was the primary study endpoint. A p-value < 0.05 was considered significant.

Results: Mean age (± SD) was 44.9±8.8 years, 84.2% were men, and 0.5% reported previous myocardial infarction. Mean LDL-C was 203.0±22.0 mg/dL, and although 62.5% referred dyslipidemia, only 19% were using lipid-lowering drugs (5.9% in cases with LDL-C ≥ 190 mg/dL). During a 4.1±2.8-year follow-up, use of lipid-lowering drugs increased from 18.1% to 48.4% (p<0.00001), 5.9% to 45.4% in those with LDL-C ≥ 190 mg/dL (p< 0.00001) though 31% of cases with LDL-C 160-189 mg/dL stopped taking medications. Overall, there was a mean 26.7% reduction in LDL-C (p<0.0001), and LDL-C reductions ≥50% were attained in 19.2%, 19.1%, and 19.7 % of all individuals, and in those with LDL-C > 190 mg/dL and 160-189 mg/dL respectively. Only 3.1% reached LDL-C < 70 mg/dL (2.7% in those with LDL-C ≥ 190 and 5.3% in those with 160-189 mg/dL).

Conclusions: A serious gap was found between treatment recommendations and reality in individuals at high atherosclerosis risk due to SH.

Figura Central:. Colesterol Não Controlado em Indivíduos com Hipercolesterolemia Grave Acompanhados em um Programa de Avaliação da Saúde no Brasil

Figura 1. – Fluxograma da seleção e categorização dos pacientes.

Figura 2. Uso de agentes hipolipemiantes por grupo de pacientes categorizados por níveis de LDL-colesterol; teste do qui-quadrado, p<0,00001 vs. Basal.

Figura 3. – Porcentagens dos pacientes com hipercolesterolemia grave no basal que atingiram as metas de LDL-colesterol (<100 mg/dL, <70 mg/dL, and < 50 mg/dL).

Central Illustration. : Uncontrolled Cholesterol in Individuals with Severe Hypercholesterolemia in a Health Evaluation Program in Brazil

Figure 1. – Flowchart of patient selection and categorization; LLT: pharmacological lipid-lowering therapy.

Figure 2. – Use of lipid-lowering therapy by LDL-cholesterol (LDL-C) level groups; chi-squared 2 test, p<0.00001 vs. baseline.

Figure 3. – Percentages of individuals with severe hypercholesterolemia at baseline achieving LDL-cholesterol goals (<100 mg/dL, <70 mg/dL, and < 50 mg/dL).