Factors Associated with Goal Achievement in Patients with Dyslipidemia in Primary Care
DOI:
https://doi.org/10.17533/udea.iatreia.285Keywords:
Atherosclerosis, Heart Disease Risk Factors, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Hyperlipidemias, Lipoproteins, LDLAbstract
Introduction: Dyslipidemia promotes atherosclerotic disease. A strategy to reduce this risk is to achieve low-density lipoprotein (LDL) goals; however, these are often not attained.
Objectives: To analyze variables associated with achieving proposed goals in primary care.
Methods: A cross-sectional study with an analytical approach was conducted. Sociodemographic variables, comorbidities, cardiovascular risk categories, and statin use were included. Binomial regression was performed to obtain crude prevalence ratios (PR), and a multivariate model was used to determine variables associated with achieving LDL goals, represented by adjusted prevalence ratios (aPR).
Results: 147 patients were included. The median age was 63 years. 62.6% were female. 88.4% of patients were hypertensive. 43.5% had very high cardiovascular risk, and only 34.7% of patients met LDL goals. Factors associated with goal achievement in the bivariate analysis were: sex, diabetes, hypertension, cardiovascular risk, and statin intensity and type. In the multivariate model, being male (aPR 1.69), age (aPR 1.03), and hypertension (aPR 6.59) were significant; as was the degree of risk classified by guidelines: high risk (aPR 0.44), very high (aPR 0.07), and extreme (aPR 0.01).
Conclusions: LDL goal achievement in primary care is low. The main factors associated with achieving LDL goals are age, sex, and hypertension; while high cardiovascular risk is a factor that hinders goal attainment.
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References
(1) Roth GA, Mensah GA, Johnson CO, Addolorato G, Ammirati E, Baddour LM, et al. Global Burden of Cardiovascular Diseases and Risk Factors, 1990–2019. J Am Coll Cardiol [Internet]. 2020;76(25):2982-3021. https://doi.org/10.1016/j.jacc.2020.11.010
(2) Camacho PA, Otero J, Pérez M, Arcos E, García H, Narvaez C, et al. The spectrum of the dyslipidemia in Colombia: The PURE study. Int J Cardiol [Internet]. 2019;284:111-7. https://doi.org/10.1016/j.ijcard.2018.10.090
(3) Tsujita K, Sugiyama S, Sumida H, Shimomura H, Yamashita T, Yamanaga K, et al. Impact of Dual Lipid-Lowering Strategy With Ezetimibe and Atorvastatin on Coronary Plaque Regression in Patients With Percutaneous Coronary Intervention. J Am Coll Cardiol [Internet]. 2015;66(5):495-507. https://doi.org/10.1016/j.jacc.2015.05.065
(4) Mach F, Baigent C, Catapano AL, Koskinas KC, Casula M, Badimon L, et al. 2019 ESC/EAS Guidelines for the management of dyslipidaemias: lipid modification to reduce cardiovascular risk: The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Eur Heart J [Internet]. 2020;41(1):111-88. http://doi.org/10.1093/eurheartj/ehz455
(5) Jellinger PS, Handelsman Y, Rosenblit PD, Bloomgarden ZT, Fonseca VA, Garber AJ, et al. American Association of Clinical Endocrinologists and American College of Endocrinology Guidelines for Management of Dyslipidemia and Prevention of Cardiovascular Disease. Endocr Pract [Internet]. 2017;23(2 Suppl):1-87. http://doi.org/10.4158/EP171764.APPGL
(6) Grundy SM, Stone NJ, Bailey AL, Beam C, Birtcher KK, Blumenthal RS, et al. 2018 AHA/ACC/AACVPR/AAPA/ABC/ACPM/ADA/AGS/APhA/ASPC/NLA/PCNA Guideline on the Management of Blood Cholesterol: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol [Internet]. 2019;139(25):e285-350. http://doi.org/10.1161/CIR.0000000000000625
(7) Mitchell S, Roso S, Samuel M, Pladevall-Vila M. Unmet need in the hyperlipidaemia population with high risk of cardiovascular disease: a targeted literature review of observational studies. BMC Cardiovasc Disord [Internet]. 2016;16(1):74. http://doi.org/10.1186/s12872-016-0241-3
(8) Chan RHW, Chan PH, Chan KKW, Lam SCC, Hai JJ, Wong MKL, et al. The CEPHEUS Pan-Asian survey: high low-density lipoprotein cholesterol goal attainment rate among hypercholesterolaemic patients undergoing lipid-lowering treatment in a Hong Kong regional centre. Hong Kong Med J [Internet]. Octubre de 2012;18(5):395-406. Available from: https://www.hkmj.org/system/files/hkm1210p395.pdf
(9) Waters DD, Brotons C, Chiang C-W, Ferrières J, Foody J, Jukema JW, et al. Lipid Treatment Assessment Project 2: A Multinational Survey to Evaluate the Proportion of Patients Achieving Low-Density Lipoprotein Cholesterol Goals. Circulation [Internet]. 2009;120(1):28-34. http://doi.org/10.1161/CIRCULATIONAHA.108.838466
(10) Clark LT, Maki KC, Galant R, Maron DJ, Pearson TA, Davidson MH. Ethnic differences in achievement of cholesterol treatment goals: Results from the national cholesterol education program evaluation project utilizing novel E-technology II. J Gen Intern Med [Internet]. 2006;21(4):320-6. http://doi.org/10.1111/j.1525-1497.2006.00349.x
(11) Steinhagen-Thiessen E, Bramlage P, Lösch C, Hauner H, Schunkert H, Vogt A, et al. Dyslipidemia in primary care – prevalence, recognition, treatment and control: data from the German Metabolic and Cardiovascular Risk Project (GEMCAS). Cardiovasc Diabetol [Internet]. 2008;7(1):31. http://doi.org/10.1186/1475-2840-7-31
(12) Muñoz OM, García ÁA, Fernández-Ávila D, Higuera A, Ruiz ÁJ, Aschner P, et al. Guía de práctica clínica para la prevención, detección temprana, diagnóstico, tratamiento y seguimiento de las dislipidemias: evaluación del riesgo cardiovascular. Rev Colomb Cardiol [Internet]. 2015;22(6):263-9. http://doi.org/10.1016/j.rccar.2015.04.009
(13) Handelsman Y, Jellinger PS, Guerin CK, Bloomgarden ZT, Brinton EA, Budoff MJ, et al. Consensus Statement by the American Association of Clinical Endocrinologists and American College of Endocrinology on the Management of Dyslipidemia and Prevention of Cardiovascular Disease Algorithm – 2020 Executive Summary. Endocr Pract [Internet]. 2020;26(10):1196-224. http://doi.org/10.4158/CS-2020-0490
(14) Friedewald WT, Levy RI, Fredrickson DS. Estimation of the concentration of low-density lipoprotein cholesterol in plasma, without use of the preparative ultracentrifuge. Clin Chem [Internet]. 1972;18(6):499-502. http://doi.org/10.1093/clinchem/18.6.499
(15) Gitt AK, Lautsch D, Ferrières J, De Ferrari GM, Vyas A, Baxter CA, et al. Cholesterol target value attainment and lipid-lowering therapy in patients with stable or acute coronary heart disease: Results from the Dyslipidemia International Study II. Atherosclerosis [Internet]. 2017;266:158-66. http://doi.org/10.1016/j.atherosclerosis.2017.08.013
(16) Al Sifri SN, Almahmeed W, Azar S, Okkeh O, Bramlage P, Jünger C, et al. Results of the Dyslipidemia International Study (DYSIS)-Middle East: Clinical Perspective on the Prevalence and Characteristics of Lipid Abnormalities in the Setting of Chronic Statin Treatment. Plos ONE [Internet]. 2014;9(1):e84350. http://doi.org/10.1371/journal.pone.0084350
Danchin N, Almahmeed W, Al-Rasadi K, Azuri J, Berrah A, Cuneo CA, et al. Achievement of low-density lipoprotein cholesterol goals in 18 countries outside Western Europe: The International Cholesterol Management Practice Study (ICLPS). Eur J Prev Cardiol [Internet]. 2018;25(10):1087-94. http://doi.org/10.1177/2047487318777079
(18) Romanelli RJ, Ito MK, Karalis DG, Huang H-C, Iorga ŞR, Kam IW, et al. Statin utilization and low-density lipoprotein cholesterol in statin-treated patients with atherosclerotic cardiovascular disease: Trends from a community-based health care delivery system, 2002–2016. J Clin Lipidol [Internet]. 2020;14(3):305-14. http://doi.org/10.1016/j.jacl.2020.03.006
(19) Mann DM, Woodward M, Muntner P, Falzon L, Kronish I. Predictors of nonadherence to statins: a systematic review and meta-analysis. Ann Pharmacother [Internet]. 2010;44(9):1410-21. http://doi.org/10.1345/aph.1P150
(20) Kim S, Han S, Rane PP, Qian Y, Zhao Z, Suh HS. Achievement of the low-density lipoprotein cholesterol goal among patients with dyslipidemia in South Korea. Plos one [Internet]. 2020;15(1):e0228472. http://doi.org/10.1371/journal.pone.0228472
(21) Wong ND, Young D, Zhao Y, Nguyen H, Caballes J, Khan I, et al. Prevalence of the American College of Cardiology/American Heart Association statin eligibility groups, statin use, and low-density lipoprotein cholesterol control in US adults using the National Health and Nutrition Examination Survey 2011–2012. J Clin Lipidol [Internet]. 2016;10(5):1109-18. http://doi.org/10.1016/j.jacl.2016.06.011
(22) Gómez-Barrado JJ, Ortiz C, Gómez-Turégano M, Gómez-Turégano P, Garcipérez-de-Vargas FJ, Sánchez-Calderón P. Control lipídico en pacientes con enfermedad coronaria del Área de Salud de Cáceres (España): estudio LIPICERES. Clínic Investig Arterioscler [Internet]. 2017;29(1):13-9. http://doi.org/10.1016/j.arteri.2016.09.003
(23) Ruiz ÁJ, Vargas-Uricoechea H, Urina-Triana M, Román-González A, Isaza D, Etayo E, et al. Las dislipidemias y su tratamiento en centros de alta complejidad en Colombia. Clínica E Investig En Arterioscler [Internet]. Abril de 2020;32(3):101-10. https://doi.org/10.1016/j.arteri.2019.11.005
(24) Presta V, Figliuzzi I, Miceli F, Coluccia R, Fogacci F, Cicero AFG, et al. Achievement of low density lipoprotein (LDL) cholesterol targets in primary and secondary prevention: Analysis of a large real practice database in Italy. Atherosclerosis [Internet]. 2019;285:40-8. https://doi.org/10.1016/j.atherosclerosis.2019.03.017
(25) Bissonnette S, Habib R, Sampalis F, Boukas S, Sampalis JS. Efficacy and tolerability of ezetimibe 10 mg/day coadministered with statins in patients with primary hypercholesterolemia who do not achieve target LDL-C while on statin monotherapy: A Canadian, multicentre, prospective study – the Ezetrol® Add-On Study. Can J Cardiol [Internet]. 2006;22(12):1035-44. https://doi.org/10.1016/s0828-282x(06)70319-1
(26) De Backer G, Jankowski P, Kotseva K, Mirrakhimov E, Reiner Ž, Rydén L, et al. Management of dyslipidaemia in patients with coronary heart disease: Results from the ESC-EORP EUROASPIRE V survey in 27 countries. Atherosclerosis [Internet]. 2019;285:135-46. https://doi.org/10.1016/j.atherosclerosis.2019.03.014
(27) Saely CH, Sternbauer S, Vonbank A, Heinzle C, Zanolin-Purin D, Larcher B, et al. Type 2 diabetes mellitus is a strong predictor of LDL cholesterol target achievement in patients with peripheral artery disease. J Diabetes Complications [Internet]. 2020;34(11):107692. https://doi.org/10.1016/j.jdiacomp.2020.107692
(28) Hajahmadi Pourrafsanjani M, Khayati Shal E, Khezrpour S. Risk Factors Associated with Failure to Achieve the Low Density Lipoprotein Cholesterol Therapeutic Target in Patients with Acute Coronary Syndrome: A Longitudinal, Single Centre Investigation. High Blood Press Cardiovasc Prev [Internet]. 2019;26(1):37-43. https://doi.org/10.1007/s40292-019-00298-5
(29) Ferrières J, Gorcyca K, Iorga ŞR, Ansell D, Steen DL. Lipid-lowering Therapy and Goal Achievement in High-risk Patients From French General Practice. Clin Ther [Internet]. 2018;40(9):1484-1495.e22. https://doi.org/10.1016/j.clinthera.2018.07.008
(30) Wang X, He Y, Wang T, Li C, Ma Z, Zhang H, et al. Lipid-Lowering Therapy and Low-Density Lipoprotein Cholesterol (LDL-C) Goal Achievement in High-Cardiovascular-Risk Patients in Fuzhou, China. J Cardiovasc Pharmacol Ther [Internet]. 2020;25(4):307-15. https://doi.org/10.1177/1074248419899298
(31) Arca M, Ansell D, Averna M, Fanelli F, Gorcyca K, Iorga ŞR, et al. Statin utilization and lipid goal attainment in high or very-high cardiovascular risk patients: Insights from Italian general practice. Atherosclerosis [Internet]. 2018;271:120-7. https://doi.org/10.1016/j.atherosclerosis.2018.02.024
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