Prevalence of persistent lipid abnormalities in statin-treated patients: Belgian results of the Dyslipidaemia International Study (DYSIS).

Devroey D, Radermecker RP, Van der Schueren BJ, et al.
Int J Clin Pract. 2013 Dec 6. doi: 10.1111/ijcp.12315. [Epub ahead of print]

Background

Despite the efficacy of statins in treating dyslipidaemia to reduce the risk of major cardiovascular (CV) events, not all clinical events are prevented by statin treatment [1-5]. It has been questioned whether lipid-lowering therapies are used in an optimal way [4,6].
The European Action on Secondary Prevention through Intervention to Reduce Events (EUROASPIRE) III survey of medical records from patients with coronary heart disease in 20 European centers, found that 79% of all patients in Belgium had total cholesterol > 175 mg/dl [7]. Thus, there appears to be an unmet medical need for optimal use of current lipid-lowering therapies or new therapies to provide adequate lipid management.
Information on the prevalence of persistent dyslipidaemia in statin-treated patients in a real-life setting is scarce. The Dyslipidaemia International Study (DYSIS) therefore aimed to assess the prevalence and types of persistent lipid abnormalities in patients receiving statin therapy in a real-life setting in Belgium, based on the most recent European Society of Cardiology and the European Atherosclerosis Society (ESC/EAS) guidelines for the management of dyslipidaemia [8]. 941 patients were recruited, 61% of those had very high CV risk, 37.6% had pre-existing CV disease, 54.0% had metabolic syndrome and 31.0% were diabetic.

Main results

• Simvastatin was most often used (44.8%), followed by atorvastatin (25.8%) and rosuvastatin (21.0%). Only 11.6% of patients received additional lipid therapies to statins, such as ezetimibe (10 mg) in 7.2% of all patients. Most patients used lower statin potencies (potency 1-4, equivalent to simvastatin 5-40 mg/day).
• More than half of all patients (56.2%) had not reached the target LDL-c levels as recommended in the ESC/EAS guideline. Low HDL-c levels were seen in 16.3% and high triglycerides were observed in 29.0% of patients. In patients at very high CV risk, 71.4% did not reach target LDL-c, while 60.0% of high-risk patients and 34.1% of moderate-risk patients were not at goal for LDL-c.
• Abnormally elevated LDL-c was the most common lipid anomaly, either alone (34.3%) or in combination with elevated triglycerides (17.8%), low HDL-c (9.6%) or both (5.5%).
• In patients at very high risk, only 16.4% showed no lipid abnormalities. In non-very high-risk patients, 48.7% had no dyslipidaemie.
• In multiple logistic regression analysis age >70, consumption of >2 units alcohol per week, diabetes, ischaemic heart disease and blood pressure > 140/90 mmHg were positively associated with LDL-c abnormalities, as was no use of ezetimibe (OR: 16.9, P<0.0001).
  Ischaemic heart disease and diabetes were positively associated with low HDL-c.
  Current smoking, sedentary lifestyle, large waist circumference and hypertension were positively associated with elevated triglycerides, while age >70 years was negatively associated with elevated triglycerides.

Conclusion

This observational study shows that only about 30% of statin-treated patients were free from residual lipid abnormalities. Statin use for both primary and secondary prevention was considered, and this study in a real-life setting shows that most patients do not reach the guideline-recommended lipid targets. This study illustrates that specifically very high-risk patients, e.g. with previous ischaemic heart disease and diabetes need more powerful treatment. Better lipid goal achievement may be obtained by higher intensity statin treatment and/of add-on therapy with ezetimibe.

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