Total lipid management and cardiovascular disease in the dyslipidemia international study.

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.

Residual dyslipidaemia after statin treatment in France: Prevalence and risk distribution.

BACKGROUND: Residual dyslipidaemia in patients treated with statins needs to be addressed to reduce the prevalence of cardiovascular disease in primary and secondary care. AIMS: To estimate the prevalence of residual lipid abnormalities in statin-treated patients in France. METHODS: Plasma concentrations of low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides were recorded in patients classified by cardiovascular risk according to guidelines from Agence française de sécurité sanitaire des produits de santé. Recruitment took place between September 2008 and February 2009, and involved patients aged >45 years who had been on statin therapy for > or =3 months. RESULTS: Overall, 39.6% of the 4335 statin-treated patients had lipid values within desirable levels. Low-density lipoprotein cholesterol was not at goal more often (51.8%) in higher risk patients than in all patients averaged (37.2%). Also, high-risk patients with low-density lipoprotein cholesterol not at goal had additional lipid abnormalities (low high-density lipoprotein cholesterol and/or high triglycerides) more frequently (25.6%) than all patients averaged (18.4%). CONCLUSION: We conclude that a significant proportion of dyslipidaemic patients at high cardiovascular risk in France are not achieving treatment goals after statin treatment. A significant proportion of these patients might benefit from alternative therapies targeted at improving low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglyceride levels. More attention to the management of these patients is needed to use public health resources more effectively.