Purpose: Current European guidelines recommend that patients free from cardiovascular disease (CVD) but estimated to be at high (≥ 5%) 10-year risk of CVD mortality should be more vigorously pharmacologically treated than those at lower risk. The recommended target level of low-density lipoprotein cholesterol (LDL-C) is < 2.5 mmol/l, or < 1.8 mmol/l for those at very high risk (VHR; those with diabetes mellitus [DM] or a ≥ 10% 10-year mortality risk). We examined the use of lipid lowering therapy (LLT) and achievement of LDL-C level targets in routine clinical practice in Europe. Methods: The European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted simultaneously in 12 European countries from May 2009 to January 2010, recruiting 7641 patients aged ≥ 50 years who were free of clinical CVD but had at least one cardiovascular risk factor (dyslipidaemia, hypertension, DM, smoking or obesity). Ten-year CVD mortality risk was estimated using the Systematic Coronary Risk Evaluation (SCORE) algorithm. LDL-C levels were measured and use of LLT was noted, including the agents and doses used. Statin therapy was classified as low-intensity (LIS; pravastatin, simvastatin, lovastatin, fluvastatin, atorvastatin < 40 mg or rosuvastatin < 20 mg) or high-intensity (HIS; atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg). Results: We identified 3278 individuals who were receiving any form of LLT, of whom 3040 (92.7%) were receiving a statin. Of the 4363 patients not receiving LLT, 1741 (39.9%) had DM or a SCORE risk ≥ 5%. LDL-C levels were available for 3151 participants receiving LLT, for whom LDL-C levels were not at target (< 2.5 mmol/l) in 1931 (61.3%). Only 8.9% of patients on LLT were receiving HIS. Of the patients receiving LIS, only 39.8% had LDL-C levels < 2.5 mmol/l. A subset of 2970 patients were at VHR, of whom only 1469 (49.5%) were receiving any form of LLT. LDL-C levels were at target (< 1.8 mmol/l) in 17.1% of these patients. Only 9.1% of the VHR patients on LLT were receiving HIS. Of the VHR patients receiving LIS, only 17.1% had Conclusion: Approximately 40% of patients aged ≥ 50 years with at least 1 cardiovascular risk factor who are not currently receiving LLT are at high risk of CVD (DM or SCORE ≥ 5%). Furthermore, well over half of all those receiving LLT and more than 80% of VHR patients receiving LLT did not achieve recommended LDL-C levels. These results demonstrate that there is potential for major improvements in lipid level management in patients at risk of CVD in Europe.
Halcox J.P.J., Tubach F., Banegas J.R., Borghi C., Dallongeville J., De Backer G, et al. (2012). Use of lipid lowering therapy in primary care across Europe: results from the European study on cardiovascular risk prevention in daily practice (eurika). EUROPEAN HEART JOURNAL, 33(suppl 1), 810-810.
Use of lipid lowering therapy in primary care across Europe: results from the European study on cardiovascular risk prevention in daily practice (eurika)
BORGHI, CLAUDIO;
2012
Abstract
Purpose: Current European guidelines recommend that patients free from cardiovascular disease (CVD) but estimated to be at high (≥ 5%) 10-year risk of CVD mortality should be more vigorously pharmacologically treated than those at lower risk. The recommended target level of low-density lipoprotein cholesterol (LDL-C) is < 2.5 mmol/l, or < 1.8 mmol/l for those at very high risk (VHR; those with diabetes mellitus [DM] or a ≥ 10% 10-year mortality risk). We examined the use of lipid lowering therapy (LLT) and achievement of LDL-C level targets in routine clinical practice in Europe. Methods: The European Study on Cardiovascular Risk Prevention and Management in Daily Practice (EURIKA) (NCT00882336) was a cross-sectional study conducted simultaneously in 12 European countries from May 2009 to January 2010, recruiting 7641 patients aged ≥ 50 years who were free of clinical CVD but had at least one cardiovascular risk factor (dyslipidaemia, hypertension, DM, smoking or obesity). Ten-year CVD mortality risk was estimated using the Systematic Coronary Risk Evaluation (SCORE) algorithm. LDL-C levels were measured and use of LLT was noted, including the agents and doses used. Statin therapy was classified as low-intensity (LIS; pravastatin, simvastatin, lovastatin, fluvastatin, atorvastatin < 40 mg or rosuvastatin < 20 mg) or high-intensity (HIS; atorvastatin ≥ 40 mg or rosuvastatin ≥ 20 mg). Results: We identified 3278 individuals who were receiving any form of LLT, of whom 3040 (92.7%) were receiving a statin. Of the 4363 patients not receiving LLT, 1741 (39.9%) had DM or a SCORE risk ≥ 5%. LDL-C levels were available for 3151 participants receiving LLT, for whom LDL-C levels were not at target (< 2.5 mmol/l) in 1931 (61.3%). Only 8.9% of patients on LLT were receiving HIS. Of the patients receiving LIS, only 39.8% had LDL-C levels < 2.5 mmol/l. A subset of 2970 patients were at VHR, of whom only 1469 (49.5%) were receiving any form of LLT. LDL-C levels were at target (< 1.8 mmol/l) in 17.1% of these patients. Only 9.1% of the VHR patients on LLT were receiving HIS. Of the VHR patients receiving LIS, only 17.1% had Conclusion: Approximately 40% of patients aged ≥ 50 years with at least 1 cardiovascular risk factor who are not currently receiving LLT are at high risk of CVD (DM or SCORE ≥ 5%). Furthermore, well over half of all those receiving LLT and more than 80% of VHR patients receiving LLT did not achieve recommended LDL-C levels. These results demonstrate that there is potential for major improvements in lipid level management in patients at risk of CVD in Europe.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
