Low rates of both lipid-lowering therapy use and achievement of low-density lipoprotein cholesterol targets in individuals at high-risk for cardiovascular disease across Europe

Abstract

Aims: To analyse the treatment and control of dyslipidaemia in patients at high and very high cardiovascular risk being treated for the primary prevention of cardiovascular disease (CVD) in Europe.

Methods and results: Data were assessed from the European Study on Cardiovascular Risk Prevention and Management in Usual Daily Practice (EURIKA, ClinicalTrials.gov identifier: NCT00882336), which included a randomly sampled population of primary CVD prevention patients from 12 European countries (n = 7641). Patients' 10-year risk of CVD-related mortality was calculated using the Systematic Coronary Risk Evaluation (SCORE) algorithm, identifying 5019 patients at high cardiovascular risk (SCORE ≥5% and/or receiving lipid-lowering therapy), and 2970 patients at very high cardiovascular risk (SCORE ≥10% or with diabetes mellitus). Among high-risk individuals, 65.3% were receiving lipid-lowering therapy, and 61.3% of treated patients had uncontrolled low-density lipoprotein cholesterol (LDL-C) levels (≥2.5 mmol/L). For very-high-risk patients (uncontrolled LDL-C levels defined as ≥1.8 mmol/L) these figures were 49.5% and 82.9%, respectively. Excess 10-year risk of CVD-related mortality (according to SCORE) attributable to lack of control of dyslipidaemia was estimated to be 0.72% and 1.61% among high-risk and very-high-risk patients, respectively. Among high-risk individuals with uncontrolled LDL-C levels, only 8.7% were receiving a high-intensity statin (atorvastatin ≥40 mg/day or rosuvastatin ≥20 mg/day). Among very-high-risk patients, this figure was 8.4%.

Conclusions: There is a considerable opportunity for improvement in rates of lipid-lowering therapy use and achievement of lipid-level targets in high-risk and very-high-risk patients being treated for primary CVD prevention in Europe.

Conflict of interest statement

Competing Interests: The authors have the following interests. Julian P. Halcox and Jean Dallongeville have received speaker and consulting fees from AstraZeneca. Florence Tubach and Eliseo Guallar have received research funding from AstraZeneca. Stephen Sweet is an employee of Oxford PharmaGenesis Ltd, which has received funding from AstraZeneca. Jesús Medina and Ogün Sazova are employees of AstraZeneca. The EURIKA study was funded by a commercial source (AstraZeneca). Writing support was provided by Oxford PharmaGenesis Ltd, Oxford, UK, and was funded by AstraZeneca. The rest of the authors declare that they have no competing interests. There are no patents, products in development or marketed products to declare. This does not alter the authors′ adherence to all the PLOS ONE policies on sharing data and materials, as detailed online in the guide for authors.

Figures

Figure 1. Percentage of patients in the high-risk and very-high-risk groups receiving any form of lipid-lowering therapy (LLT) who have controlled and uncontrolled levels of low-density lipoprotein cholesterol (LDL-C).

Patients for whom data regarding LDL-C levels were not available were excluded. Controlled LDL-C levels were defined as

Figure 2. Percentage of high-risk (A) and very-high-risk (B) patients with controlled or uncontrolled low-density lipoprotein cholesterol (LDL-C) levels who are treated with low-intensity statins (LIS) or high-intensity statins (HIS).

Controlled LDL-C levels were defined as