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Current lipid management and low cholesterol goal attainment in common daily practice in Spain

The REALITY Study

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Abstract

Objective: To evaluate prescribing patterns of lipid-lowering drugs used in management of patients at risk of coronary heart disease (CHD) in usual clinical practice in Spain and to assess low-density lipoprotein cholesterol (LDL-C) goal attainment among CHD and CHD equivalent patients (<100 mg/dL) and non-CHD patients with two or more risk factors (<130 mg/dL) who were prescribed lipid-lowering drugs.

Methods: Cohort study with retrospective chart review at 23 primary care centres and 16 lipid treatment centres across Spain (59% primary care; 41% outpatient lipid centres). Physicians consecutively identified eligible patients. Adults (aged.18 years) with CHD/CHD equivalent or two or more major risk factors prior to first prescription of lipid-lowering drugs were eligible. Medical records were reviewed by physicians to collect patient characteristics, baseline and follow-up laboratory values and lipid-lowering drug treatment data.

Results: 619 patients (45.5% CHD and CHD equivalent patients and 54.5% non-CHD with two or more major risk factors) were included in the study with an average study follow-up of 3.6 years. Mean age was 60.1 years (SD 10.2), and 47.8% were female. Mean baseline LDL-C was 178 mg/dL (SD 45.0) for the CHD/CHD equivalent patients and 191 mg/dL (SD 56.95) for patients with two or more risk factors. Statins were the initial lipid-lowering drugs in 90.2% of patients; 52.5% of patients were initiated on low-dose (simvastatin 10mg or lower potency) statins. Overall 20.2% of CHD/CHD equivalent and 31.4% of patients with two or more risk factors attained LDL-C goal during the study period; of patients not attaining goal, 28.7% required an additional LDL-C reduction of >30% to attain goal. In a logistic regression model for goal attainment, CHD/CHD equivalent patients (odds ratio [OR] 0.47; 95% confidence interval [CI] 0.31, 0.72) and patients with baseline LDL-C >190 mg/dL (OR 0.53; 95% CI 0.35, 0.80) were least likely to reach cholesterol goal when compared with patients having baseline LDL-C >100 mg/dL and <130 mg/dL.

Conclusion: Only 12.9% of patients attained LDL-C goal on their initial lipid-lowering drugs, and an additional 13.4% achieved goal after a change in their lipid-lowering therapy, resulting in 73.7% of patients not attaining goal after at least 3 years of follow-up, after initiation of lipid-lowering therapy. Patients who would gain the most from aggressive lipid lowering (CHD patients and patients with high baseline LDL-C) were least likely to achieve goal. More effective lipid management is needed to help these patients lower their cholesterol to goal levels or even lower.

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References

  1. World Health Organization. World health report 2003 [online]. Available from URL: http://www.who.int/whr/2003/en/ [Accessed 2004 Feb 10]

  2. Instituto Nacional de Estadística. Defunciones según la causa de muerte 2001 [online]. Available from URL: http://www.ine.es [Accessed 2004 Feb 10].

  3. Kannel WB, Castelli WP, Gordon T, McNamara PM. Serum cholesterol, lipoproteins, and the risk of coronary heart disease: the Framingham study. Ann Intern Med 1971; 74: 1–12

    PubMed  CAS  Google Scholar 

  4. Multiple Risk Factor Intervention Trial Research Group. Multiple Risk Factor Intervention Trial: risk factor changes and mortality results. JAMA 1982; 248: 1465–77

    Article  Google Scholar 

  5. The Scandinavian Simvastatin Survival Study Group. Randomised trial of cholesterol lowering in 4444 patients with coronary heart disease: the Scandinavian Simvastatin Survival Study (4S). Lancet 1994; 334: 1383–9

    Google Scholar 

  6. Cholesterol and Recurrent Events (CARE) Trial Investigators. The effect of pravastatin on coronary events after myocardial infarction in patients with average cholesterol levels. N Engl J Med 1996; 335: 1001–9

    Article  Google Scholar 

  7. The LIPID Study Group. Prevention of cardiovascular events with pravastatin in patients with coronary heart disease and a broad range of initial cholesterol levels. N Engl J Med 1998; 339: 1349–57

    Article  Google Scholar 

  8. West of Scotland Coronary Prevention Study Group. Prevention of coronary heart disease with pravastatin in men with hypercholesterolemia. N Engl J Med 1995; 333: 1301–7

    Article  Google Scholar 

  9. Downs JR, Clearfield M, Weis S, et al. Primary prevention of acute coronary events with lovastatin in men and women with average cholesterol levels: results of AFCAPS/TexCAPS. JAMA 1998; 279: 1615–22

    Article  PubMed  CAS  Google Scholar 

  10. National Heart, Lung, and Blood Institute. Third report of the expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (Adult Treatment Panel III) full report (2002) [online]. Available from URL: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3_rpt.pdf [Accessed 2004 Feb 10]

  11. De Backer G, Ambrosioni E, Borch-Johnsen K, et al. European guidelines on cardiovascular disease prevention in clinical practice: Third Joint Task Force of European and other Societies on Cardiovascular Disease Prevention in Clinical Practice. Eur J Cardiovasc Prev Rehab 2003; 10 Suppl. 1: S1–S78

    Article  Google Scholar 

  12. Ministerio de Sanidad y Consumo. Secretaría General de Sanidad; Agencia de Calidad del Sistema Nacional de Salud 2003 [online]. Available from URL: http://www.msc.es/planesIntegrales/PICI/pdf/cardiopatia.pdf [Accessed 2004 Feb 10]

  13. PROVE-IT Study Group. Comparison of intensive and moderate lipid lowering with statins after acute coronary syndromes. N Engl J Med 2004; 350 (15): 1495–504

    Article  Google Scholar 

  14. de Velasco JA, Cosín J, López JL, et al. La prevención secundaria del infarto de miocardio en España: Estudio PREVESE. Rev Esp Cardiol 1997; 50: 406–15

    PubMed  Google Scholar 

  15. de Velasco JA, Cosín J, López JL, et al. New data on secondary prevention of myocardial infarction in Spain. Results of the PREVESE II Study. Rev Esp Cardiol 2002; 55: 801–9

    PubMed  Google Scholar 

  16. EUROASPIRE I and II Group. Clinical reality of coronary prevention guidelines: a comparison of EUROASPIRE I and II in nine countries. Lancet 2001; 357: 995–1001

    Article  Google Scholar 

  17. McBride P, Schrott H, Plane M, et al. Primary care practice adherence to National Cholesterol Education Program guidelines for patients with coronary heart disease. Arch Intern Med 1998; 158: 1238–44

    Article  PubMed  CAS  Google Scholar 

  18. Stafford R, Blumenthal D, Pasternak R. Variations in cholesterol management practices of US physicians. J Am Coll Cardiol 1997; 29: 139–46

    Article  PubMed  CAS  Google Scholar 

  19. Frolklis JP, Zyzanski SJ, Schwartz JM, Sushan PS. Physician noncompliance with the National Cholesterol Education Program (NCEP — ATPII) guidelines. Circulation 1998; 98 (9): 851–5

    Article  Google Scholar 

  20. Cohen M, Byrne M, Levine B, et al. Low rate of treatment of hypercholesterolemia by cardiologists in patients with suspected and proven coronary artery disease. Circulation 1991; 83: 1294–304

    Article  PubMed  CAS  Google Scholar 

  21. EUROASPIRE Study Group. A European Society of Cardiology survey on secondary prevention of coronary heart disease: principal results. Eur Heart J 1997; 18: 1569–82

    Article  Google Scholar 

  22. Shepherd J, Alcalde V, Befort P-A, for the HELP Study Group. International comparison of awareness and attitudes towards coronary risk factor reduction: the HELP study. J Cardiovasc Risk 1997; 4: 373–84

    Article  PubMed  CAS  Google Scholar 

  23. Merino Romero J, Gutiérrez Jodas J, López Luque C. Análisis de la prescripción de hipolipidemiantes en un centro de Atención Primaria. SEMERGEN 2002; 28: 127–30

    Google Scholar 

  24. Grupo de Investigación del estudio ELIPSE. Prevención secundaria de la cardiopatía isquémica en la provincia de Ciudad Real: efectividad de la terapéutica hipolipemiante en atención primaria. Med Clin (Barc) 2000; 115: 321–5

    Google Scholar 

  25. Martínez AA, Aguilar MJ, Rabadán M, et al. Prevención secundaria de cardiopatia isquémica a nivel lipídico en Atención Primaria Aragón. Estudio PRECIAR 1. Rev Esp Salud Pública 2001; 75: 143–50

    Article  Google Scholar 

  26. Anderson KM, Odell PM, Wilson PWF, Kannel WB. Coronary disease risk profiles. Am Heart J 1991; 121: 293–8

    Article  PubMed  CAS  Google Scholar 

  27. Maron DJ, Fazio S, Linton MF. Current perspectives on statins. Circulation 2000; 101 (2): 207–13

    Article  PubMed  CAS  Google Scholar 

  28. Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20 536 high-risk individuals: a randomised placebo controlled trial. Lancet 2002; 360: 7–22

    Article  Google Scholar 

  29. de Velasco JA, Llargués E, Fitó R, et al. Prevalencia de los factores de riesgo y tratamiento farmacológico al alta hospitalaria en el paciente coronario: resultados de u registro multicéntrico nacional (Programa 3C). Rev Esp Cardiol 2001; 54: 159–68

    PubMed  Google Scholar 

  30. Nissen SE, Tuzcu EM, Schoenhagen P, et al. Effect of intensive compared with moderate lipid-lowering therapy on progression of coronary atherosclerosis: a randomized controlled trial. REVERSAL investigators. JAMA 2004; 291(9): 1071–80

    Article  PubMed  CAS  Google Scholar 

  31. Roberts WC. The rule of 5 and the rule of 7 in lipid-lowering by statin drugs. Am J Cardiol 1997; 80(1): 106–7

    Article  PubMed  CAS  Google Scholar 

  32. Gagné C, Bays HE, Weiss SR, et al. Efficiency and safety of eztimibe added to on-going statin therapy for treatment of patients with primary hypercholesterolemia Am J Cardiol 2002; 90: 1084–1091

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

The REALITY Spain Study members are as follows: Carmen Ahumada, Schering Plough, Madrid; Evo Alemao, Merck & Co., Whitehouse Station, NJ; Belen Aragon, Chiltern International, Madrid; Dra Rosa Aragonés Fores, CAP Gotic, Barcelona; Dr Jesús María Arnaiz de las Revillas Arroyo, C.S. Cotolino, Castrourdiales (Cantabria); Dra Francisca Isabel Barrena Serrano, C.S. Toledo, Madrid; Dr Joan Pedro Botet Montoya, Hospital del Mar — Servicio de Medicina Interna, Barcelona; Ma Teresa Caloto, Merck, Sharp & Dohme, Madrid; Dr Josep Cañellas Isern, Consultorio médico Balsareny, Balsareny (Barcelona); Dr Carlos Capellán Gamo, C.S. Fátima, Madrid; Dr José Joaquín Casado Martínez, C.S. La Orden, Huelva; Dra Begoña Corbacho Bonilla, C.S. Cotolino, Castrourdiales (Cantabria); Dr Arturo Fernández Cruz, Hospital Universitario Clínico San Carlos — Servicio de Medicina Interna, Madrid; Leslie Fosbrook, Schering Plough, Madrid; Dr Miguel Franco Peral, Hospital Santa Creu i Sant Pau — Servicio de Medicina Interna, Barcelona; Dr José Gallart Ferrer, C.S. Manises, Valencia; Dr Francisco García Ruiz, C.S. Las Åguilas, Madrid; Dr Juan de Dios García Díaz, Hospital Universitario Príncipe de Asturias — Servicio de Medicina Interna, Alcalá de Henares (Madrid); Dr Juan Antonio Garrido San Juan, Complejo Hospitalario Arquitecto Marcide-Novoa Santos — Unidad de Lípidos, Ferrol (A Coruña); Dr Sergio Giménez Basallote, C.S. Ciudad Jardín, Málaga; Dr Leovigildo Ginel Mendoza, C.S. Ciudad Jardín, Málaga; Dr Francisco Miguel Gómez Trujillo & Dña. Maite Antón, C.S. Los Boliches, Fuengirola (Málaga); Dr Pedro González Santos, Complejo Hospitalario Virgen de la Victoria — Servicio de Medicina Interna, Málaga; Dr Carlos Lahoz Rallo, Hospital Carlos III — Unidad de Arteriosclerosis, Madrid; Dra Carmen Losada Ruiz, C.S. La Orden, Huelva; Dr Iñaki Mabe Angulo, C.S. Bidezábal, Vizcaya; Dr Antonio Maiques Galán, C.S. Manises, Valencia; Dr Alejandro Marín Ibáñez, C.S. San José Norte y Centro, Zaragoza; Dr Emilio Márquez Contreras, C.S. La Orden, Huelva; Dr Alberto Martín Hidalgo, Hospital General Universitario — Servicio de Medicina Interna, Elche (Alicante); Dra Ma Teresa Martínez Ibáñez, C.S. San Gregorio, Telde-Gran Canaria; Dr Lluis Masana Marín, Hospital Universitari Sant Joan de Reus — Servicio de Medicina Interna, Reus (Tarragona); Dr Pedro Mata López, Fundación Jiménez Díaz — Unidad de Lípidos, Madrid; Gonzalo Nocea, Merck, Sharp & Dohme, Madrid; Dra Josefina Olivan Martínez, Hospital Universitario Virgen Macarena — Unidad de Hipertensión y Factores de Riesgo, Sevilla; Dr Quintín Olivares Escribano, C.S. Zona V Pedro La Mata, Albacete; Dr Jacinto Ortiz Molina, CAP Les Corts, Barcelona; Dra Åfrica Pacheco Pérez, C.S. Cotolino, Castrourdiales (Cantabria); Dr Miguel Palencia Pérez, Hospital Universitario La Fe — Servicio de Cardiología, Valencia; Dra Montserrat Pérez Abad, C.S. Cotolino, Castrourdiales (Cantabria); Dr Francisco Pérez Jiménez, Complejo Hospitalario Reina Sofía — Medicina Interna — Unidad de Lípidos y Arteriosclerosis, Córdoba; Dr Xavier Pintó Sala, Ciutat Sanitaria de Bellvitge — Princeps d’Espanya — Servicio de Medicina Interna — Unidad de Lípidos y Arteriosclerosis, L’Hospitalet de Llobregat (Barcelona); Dr Francisco Sarmiento, C.S. Vélez, Vélez-Málaga (Málaga); Dr Cristóbal Soto Ballesteros, C.S. Fuengirola, Fuengirola (Málaga); Dr Antonio Vázquez Foncubierta, C.S. ISFAS, Sevilla; Dr José Antonio Vázquez García, Hospital de Cruces — Servicio de Endocrinología, Barakaldo (Bilbao); Dr José Villar Ortiz, Hospital Universitario Virgen del Rocío — Servicio de Medicina Interna, Sevilla; Don Yin, Merck & Co., Whitehouse Station, NJ.

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Authors and Affiliations

  1. CS Las Águilas, Madrid, Spain

    F. J. García Ruiz

  2. CS San José Norte y Centro, Zaragoza, Spain

    A. Marín Ibáñez

  3. CH Reina Sofia, Medicina Interna U. Lípidos, Córdoba, Spain

    F. Pérez-Jiménez

  4. CS Bellvitge-Prínceps d’Espanya, Medicina Interna U. Lípidos., Barcelona, Spain

    X. Pintó

  5. Outcomes Research, MSD, Madrid, Spain

    G. Nocea

  6. Health Economics, Schering-Plough, Madrid, Spain

    C. Ahumada

  7. Outcomes Research, Merck and Co., Whitehouse Station, New Jersey, 2E60, USA

    Evo Alemao & D. Yin

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García Ruiz, F.J., Ibáñez, A.M., Pérez-Jiménez, F. et al. Current lipid management and low cholesterol goal attainment in common daily practice in Spain. Pharmacoeconomic 22 (Suppl 3), 1–12 (2004). https://doi.org/10.2165/00019053-200422003-00002

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