Lipid-lowering treatment in hypercholesterolaemic patients: the CEPHEUS Pan-Asian survey.
ABSTRACT Treatment of hypercholesterolaemia in Asia is rarely evaluated on a large scale, and data on treatment outcome are scarce. The Pan-Asian CEPHEUS study aimed to assess low-density lipoprotein cholesterol (LDL-C) goal attainment among patients on lipid-lowering therapy.
This survey was conducted in eight Asian countries. Hypercholesterolaemic patients aged ≥18 years who had been on lipid-lowering treatment for ≥3 months (stable medication for ≥6 weeks) were recruited, and lipid concentrations were measured. Demographic and other clinically relevant information were collected, and the cardiovascular risk of each patient was determined. Definitions and criteria set by the updated 2004 National Cholesterol Education Program guidelines were applied.
In this survey, 501 physicians enrolled 8064 patients, of whom 7281 were included in the final analysis. The mean age was 61.0 years, 44.4% were female, and 85.1% were on statin monotherapy. LDL-C goal attainment was reported in 49.1% of patients overall, including 51.2% of primary and 48.7% of secondary prevention patients, and 36.6% of patients with familial hypercholesterolaemia. The LDL-C goal was attained in 75.4% of moderate risk, 55.4% of high risk, and only 34.9% of very high-risk patients. Goal attainment was directly related to age and inversely related to cardiovascular risk and baseline LDL-C.
A large proportion of Asian hypercholesterolaemic patients on lipid-lowering drugs are not at recommended LDL-C levels and remain at risk for cardiovascular disease. Given the proven efficacy of lipid-lowering drugs in the reduction of LDL-C, there is room for further optimization of treatments to maximize benefits and improve outcomes.
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ABSTRACT: Abstract Background. Several studies that evaluated achieving lipid goals have demonstrated an undertreatment of dyslipidemia. We evaluated the use and efficacy of lipid-lowering agentsin reducing low-density lipoprotein cholesterol (LDL-C) to recommended levels in the Levant region. Design and Methods. A multi-center, cross-sectional survey enrolled 1002 dyslipidemic patients (August 2010- January 2011) on LLA for >3 months. Collection of data and blood samples was done over one visit. Physicians and patients filled out questionnaires pertaining to dyslipidemia diagnosis and treatment. LDL-C target levels were defined according to international guidelines. Results. The full analysis set included 992 patients. Mean age was 58.0+11.6 years (41% women, 65.7% diabetics and 51.5% had history of coronary heart disease). LLA were prescribed for primary prevention or secondary prevention or familial hypercholesterolemia in 45.8% and 52.8% and 1.4% of patients; respectively. Overall, 64.0% and 56.8% of the patients attained their LDL-C goal recommended by the NCEP ATP III and TJETF guidelines; respectively. According to the 2004 NCEP ATP III updated guidelines; about 24.8% of the very high risk group attained their LDL goal of <70 mg/dL. Smoking, diabetes, metabolic syndrome, history of cardiovascular disease, increased waist circumference, and elevated pre-treatment LDL-C level were all associated with not reaching LDL-C goals. Conclusions. Although the study cohort was a relatively high risk group and might not be representative of the general population, we found that about 60% of enrolled individuals achieved the LDL-C treatment goals and 24.8% of the very high risk group achieved the recommended LDL-C targets of <70 mg/dl.; national strategies and aggressive awareness campaigns to effectively control lipid levels to recommended target levels especially in the high risk groups are urgently needed.Current Medical Research and Opinion 06/2014; · 2.37 Impact Factor
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ABSTRACT: Abstract Objective: British clinical guidelines recommend statins as first-line lipid-modifying treatment (LMT) for patients at high risk of cardiovascular disease (CVD). We undertook an observational study to assess total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) levels in high-risk patients who were treated with atorvastatin monotherapy by UK general practitioners. Methods: This retrospective database study included patients with a prescription for atorvastatin monotherapy between November 30, 2008, and November 30, 2011, with the index date defined as the first atorvastatin prescription during this period. Eligible high-risk patients with evidence of coronary heart disease (CHD), atherosclerotic vascular disease (AVD), diabetes mellitus (DM), or familial hypercholesterolemia (FH) were required to have ≥1 TC and LDL-C measurement between 3 and 12 months after the index date, and continuous enrollment 1 year before and 1 year after the index date. Cholesterol levels were assessed using the National Institute for Health and Care Excellence (NICE) guidelines: TC <4.0 mmol/L or LDL-C <2.0 mmol/L. Results: Of 2,999 high-risk patients (60.2% men; mean [SD] age = 67.9 [10.6] years) meeting selection criteria, 23.9% 28.2%, 36.2%, and 11.6% received prescriptions for atorvastatin 10, 20, 40, and 80 mg, respectively (percents do not sum to 100 because of rounding). Across all doses, the mean (SD) follow-up TC was 4.08 (0.80) mmol/L and LDL-C, 2.08 (0.65) mmol/L. A large proportion of patients (88.8%) had TC <5.0 mmol/L. However, only 45.8% had TC < 4.0 mmol/L, and 46.5% had LDL-C <2.0 mmol/L. Although a larger proportion of patients with CHD/AVD + DM reached guideline-recommended lipid levels, only 63.7% of such patients had TC <4.0 or LDL-C <2.0 mmol/L, which are the current targets for this subgroup as recommended by NICE. Conclusions: Less than half of UK high-CVD-risk patients receiving atorvastatin monotherapy achieved guideline-recommended treatment targets for TC, and less than two-thirds of patients with CHD/AVD + DM had values below TC (4.0 mmol/L) or LDL-C (2.0 mmol/L). More effective lipid-lowering strategies may be warranted to optimize cholesterol lowering and target attainment in high-risk patients. Limitations of this study include its retrospective, observational nature.Current Medical Research and Opinion 02/2014; · 2.37 Impact Factor
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ABSTRACT: Guidelines emphasise the importance of low-density lipoprotein cholesterol (LDL-C) goals for cardiovascular risk reduction. Given the importance of association between high-density lipoprotein (HDL-C) and triglycerides (TG) normal levels and cardiovascular risk, there is an additional need to further evaluate diverse dyslipidaemic populations. A retrospective longitudinal observational study of patients aged ≥ 35 years on lipid-modifying therapy (LMT) for ≥ 12 months was conducted from patient records pooled from five Asian countries (Malaysia, Korea, Hong Kong, Thailand and Philippines). The prevalence of lipid abnormalities and goal attainment was assessed 12 months before and after LMT initiation. Among 3256 patients (mean age - 58.6 years, 50.4% men), 65.4% were high-risk patients and 88% were on statin therapy. At baseline 94.7% of all patients had at least one abnormal lipid value elevated, LDL-C (86.2%) being the most prevalent. Non-smokers [OR (95% CI): 1.42 (1.08-1.87)], non-diabetics [2.35 (1.96-2.82)], non-cardiovascular disease patients [1.77 (1.42-2.21)] and those from Korea [2.56 (1.83-3.59)] were more likely to attain LDL-C goals. On the contrary, women [0.82 (0.68-0.98)], subjects with FRS > 20% [0.56 (0.41-0.77)] those from Malaysia [0.55 (0.39-0.77)] and the Philippines [0.18 (0.12-0.28)] were less likely to reach LDL-C goals. Fewer characteristics were independently associated with reaching normal levels of HDL-C and TG and attaining at least two normal lipid levels. While current LMT reduced the prevalence of dyslipidaemia, a third of patients still failed to achieve target/normal levels. We highlight country differences and the importance of improving therapy to attain multiple lipid goals/normal levels.International Journal of Clinical Practice 03/2014; · 2.54 Impact Factor