Published online before print June 22, 2009, doi: 10.1161/CIRCULATIONAHA.108.838466
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(Circulation. 2009;120:28-34.)
© 2009 American Heart Association, Inc.
Coronary Heart Disease |
Lipid Treatment Assessment Project 2
A Multinational Survey to Evaluate the Proportion of Patients Achieving Low-Density Lipoprotein Cholesterol Goals
From the Division of Cardiology, San Francisco General Hospital and the University of California, San Francisco (D.D.W.); Sardenya Primary Care Center, Barcelona, Spain (C.B.); Cathay General Hospital and Taipei Medical University, Taipei, Taiwan (C.-W.C.); Department of Cardiology, Toulouse University School of Medicine, Rangueil Hospital, Toulouse, France (J.F.); Division of Cardiovascular Medicine, Department of Internal Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Mass (J.F.); Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands (J.W.J.); the Lipid Clinic Heart Institute (InCor), University of São Paulo Hospital, São Paulo, Brazil (R.D.S.); National Institute of Cardiology "Ignacio Chávez," Tlalpan, Mexico (J.V.); Pfizer Inc., New York, NY (M.M., L.T.); Lipid Research Laboratory, University of Ottawa Heart Institute, Ottawa, Canada (R.M.); and Department of Internal Medicine, Kangnam St Mary’s Hospital, Catholic University of Korea, Seoul, Korea (K.-B.S.).
Correspondence to Dr David D. Waters, Division of Cardiology, Room 5G1, San Francisco General Hospital, 1001 Potrero Ave, San Francisco, CA 94114. E-mail dwaters{at}medsfgh.ucsf.edu
Received December 1, 2008; accepted April 10, 2009.
Background— Information about physicians’ adherence to cholesterol management guidelines remains scant. The present survey updates our knowledge of lipid management worldwide.
Methods and Results— Lipid levels were determined at enrollment in dyslipidemic adult patients on stable lipid-lowering therapy in 9 countries. The primary end point was the success rate, defined as the proportion of patients achieving appropriate low-density lipoprotein cholesterol (LDL-C) goals for their given risk. The mean age of the 9955 evaluable patients was 62±12 years; 54% were male. Coronary disease and diabetes mellitus had been diagnosed in 30% and 31%, respectively, and 14% were current smokers. Current treatment consisted of a statin in 75%. The proportion of patients achieving LDL-C goals according to relevant national guidelines ranged from 47% to 84% across countries. In low-, moderate-, and high-risk groups, mean LDL-C was 119, 109, and 91 mg/dL and mean high-density lipoprotein cholesterol was 62, 49, and 50 mg/dL, respectively. The success rate for LDL-C goal achievement was 86% in low-, 74% in moderate-, and 67% in high-risk patients (73% overall). However, among coronary heart disease patients with 
2 risk factors, only 30% attained the optional LDL-C goal of <70 mg/dL. In the entire cohort, high-density lipoprotein cholesterol was <40 mg/dL in 19%, 40 to 60 mg/dL in 55%, and >60 mg/dL in 26% of patients.
Conclusions— Although there is room for improvement, particularly in very-high-risk patients, these results indicate that lipid-lowering therapy is being applied much more successfully than it was a decade ago.
CLINICAL PERSPECTIVE
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