Objectives: Despite statin use, many patients with cardiovascular disease (CVD) are not achieving treatment goals. An international observational study was performed to estimate the prevalence of residual lipid abnormalities in statin-treated patients with CVD to assess whether lipid management requires improvement. Methods: Fasting plasma concentrations of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides were recorded in 11,104 patients with atherosclerotic CVD and ≥3 months of statin therapy. Results: LDL-C and total cholesterol were not at goal levels in 41 and 46% of all patients, respectively; for patients with peripheral artery disease (PAD) only, 59 and 65%, respectively, were not at goal, and in those with coronary heart disease only, 38 and 42%, respectively, were not at goal. Patients with cerebrovascular disease only were least frequently observed to have low HDL-C (24%) and elevated triglycerides (36%). Overall, elevated LDL-C was the most frequent lipid anomaly observed, and preexisting heart failure was strongly and positively associated with dyslipidemia. Conclusions: Approximately two fifths of statin-treated patients with CVD are not reaching lipid goals or have abnormal lipid levels, while patients with PAD could particularly benefit from improved lipid management. In addition to targeting LDL-C, new evidence-based approaches are needed to target low HDL-C and elevated triglycerides.

Keywords:
Cardiovascular disease, Cholesterol, Dyslipidemia International Study, Dyslipidemia, Epidemiological study , Statin
1.
Nichols M, Townsend N, Luengo-Fernandez R, Leal J, Gray A, Scarborough P, Rayner M: European Cardiovascular Disease Statistics 2012. European Heart Network, Brussels, European Society of Cardiology, Sophia Antipolis.
2.
Roger VL, Go AS, Lloyd-Jones DM, Adams RJ, Berry JD, Brown TM, Carnethon MR, Dai S, de Simone G, Ford ES, Fox CS, Fullerton HJ, Gillespie C, Greenlund KJ, Hailpern SM, Heit JA, Ho PM, Howard VJ, Kissela BM, Kittner SJ, Lackland DT, Lichtman JH, Lisabeth LD, Makuc DM, Marcus GM, Marelli A, Matchar DB, McDermott MM, Meigs JB, Moy CS, Mozaffarian D, Mussolino ME, Nichol G, Paynter NP, Rosamond WD, Sorlie PD, Stafford RS, Turan TN, Turner MB, Wong ND, Wylie-Rosett J; on behalf of the American Heart Association Statistics Committee and Stroke Statistics Subcommittee: Heart disease and stroke statistics - 2011 update: a report from the American Heart Association. Circulation 2011;123:e18-e209.
3.
Wild S, Roglic G, Green A, Sicree R, King H: Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-1053.
4.
Poirier P, Giles TD, Bray GA, et al; American Heart Association; Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism: Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss: an update of the 1997 American Heart Association Scientific Statement on Obesity and Heart Disease from the Obesity Committee of the Council on Nutrition, Physical Activity, and Metabolism. Circulation 2006;113:898-918.
5.
Perk J, De Backer G, Gohlke H, et al: European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Developed with the special contribution of the European Association for Cardiovascular Prevention & Rehabilitation (EACPR). Eur Heart J 2012;33:1635-1701.
6.
Graham I, Atar D, Borch-Johnsen K, et al: European guidelines on cardiovascular disease prevention in clinical practice: full text. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (constituted by representatives of nine societies and by invited experts). Eur J Cardiovasc Prev Rehabil 2007;14(suppl 2):S1-S113.
7.
Smith SC Jr, Allen J, Blair SN, et al: AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update. J Am Coll Cardiol 2006;47:2130-2139.
8.
Baigent C, Keech A, Kearney PM, et al; Cholesterol Treatment Trialists' (CTT) Collaborators: Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267-1278.
9.
Cholesterol Treatment Trialists' (CTT) Collaborators, Kearney PM, Blackwell L, Collins R, et al: Efficacy of cholesterol-lowering therapy in 18,686 people with diabetes in 14 randomised trials of statins: a meta-analysis. Lancet 2008;371:117-125.
10.
Grundy SM, Cleeman JI, Merz CN, et al; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association: Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-239, erratum in Circulation 2004;110:763.
11.
Fourth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice: European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Eur Heart J 2007;28:2375-2414.
12.
Shah PK, Kaul S, Nilsson J, Cercek B: Exploiting the vascular protective effects of high-density lipoprotein and its apolipoproteins: an idea whose time for testing is coming. Part I. Circulation 2001;104:2376-2383.
13.
Gotto AM Jr: High-density lipoprotein cholesterol and triglycerides as therapeutic targets for preventing and treating coronary artery disease. Am Heart J 2002;144(suppl 6):S33-S42.
14.
Barter PJ, Puranik R, Rye KA: New insights into the role of HDL as an anti-inflammatory agent in the prevention of cardiovascular disease. Curr Cardiol Rep 2007;9:493-498.
15.
McBride P: Triglycerides and risk for coronary artery disease. Curr Atheroscler Rep 2008;10:386-390.
16.
Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U; EUROASPIRE Study Group: Cardiovascular prevention guidelines in daily practice: a comparison of EUROASPIRE I, II, and III surveys in eight European countries. Lancet 2009;373:929-940.
17.
Van Ganse E, Laforest L, Burke T, Phatak H, Souchet T: Mixed dyslipidemia among patients using lipid-lowering therapy in French general practice: an observational study. Clin Ther 2007;29:1671-1681.
18.
Phatak H, Wentworth C, Sazonov V, Burke T: Prevalence and predictors of lipid abnormalities in patients treated with statins in the UK general practice. Atherosclerosis 2009;202:225-233.
19.
Suárez C, Maiques A, Ambegaonkar BM, et al: Attainment of multiple recommended lipid levels following lipid modifying treatment in high-risk patients. PRIMULA Study, Spain (abstract). ISPOR 11th Annual European Congress, Athens, November 2008.
20.
Gitt A, Drexel H, Feely J, et al: Persistent lipid abnormalities in statin-treated patients and predictors of LDL-cholesterol goal achievement in clinical practice in Europe and Canada. Eur J Prev Cardiol 2012;19:221-230.
21.
Maron DJ, Fazio S, Linton MF: Current perspectives on statins. Circulation 2000;101:207-213.
22.
Roberts WC: The rule of 5 and the rule of 7 in lipid-lowering by statin drugs. Am J Cardiol 1997;80:106-107.
23.
Hobbs R, Erhardt L: Acceptance of guideline recommendations and perceived implementation of coronary heart disease prevention among primary care physicians in five European countries: the Reassuring European Attitudes about Cardiovascular Treatment (REACT) survey. Fam Pract 2002;19:596-604.
24.
Wolf-Maier K, Cooper RS, Kramer H, et al: Hypertension treatment and control in five European countries, Canada, and the United States. Hypertension 2004;43:10-17.
25.
Thambidorai SK, Deshmukh AR, Walters RW, Turner PD, Monaghan MS, Mooss AN, Hunter CB, Esterbrooks DJ, Mohiuddin SM: Impact of statin use on heart failure mortality. Int J Cardiol 2011;147:438-443.
26.
Khush KK, Waters DD, Bittner V, Deedwania PC, Kastelein JJP, Lewis SJ, Wegner NK: Effect of high-dose atorvastatin on hospitalizations for heart failure - subgroup analysis of the Treating to New Targets (TNT) study. Circulation 2007;115:576-583.
27.
Kjekshus J, Apetrei E, Barrios V, et al: Rosuvastatin in older patients with systolic heart failure. N Engl J Med 2007;357:2248-2261.
28.
Yamada T, Node K, Mine T, Morita T, Kioka H, Tsukamoto Y, Tamaki S, Masuda M, Fukunami M: Long-term effect of atorvastatin on neurohormonal activation and cardiac function in patients with chronic heart failure: a prospective randomized controlled study. Am Heart J 2007;153:1055-1058.
29.
Gissi-HF Investigators, Tavazzi L, Maggioni AP, Marchioli R, et al: Effect of rosuvastatin in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial. Lancet 2008;372:1231-1239.
30.
Kotseva K, Wood D, de Backer G, et al: EUROASPIRE III. Management of cardiovascular risk factors in asymptomatic high-risk patients in general practice: cross-sectional survey in 12 European countries. Eur J Cardiovasc Prev Rehabil 2010;17:530-540.
31.
Sharma M, Ansari MT, Abou-Setta AM, et al: Systematic review: comparative effectiveness and harms of combination therapy and monotherapy for dyslipidemia. Ann Intern Med 2009;151:622-630.
© 2013 S. Karger AG, Basel
2013
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.