Contemporary management and attainment of cholesterol targets for patients with dyslipidemia in China.

Gao F, Zhou YJ, Hu da Y et al.
PLoS One. 2013 Apr 9;8(4):e47681. doi: 10.1371/journal.pone.0047681.

Background

Despite the strong link between high LDL-C levels and cardiovascular (CV) risk  and the well- established potential of LDL-lowering drugs to reduce that risk, little is known on treatment  guideline attainment in ambulatory patients with dyslipidemia in China.
The authors therefore set out to investigate the current attainment of the recommended LDL-C targets among patients with dyslipidemia in Chinese outpatient clinics, and considering possible gender differences. Furthermore, they aimed to determine whether attainment of the recommended LDL-C targets is similar in ambulatory patients in different risk categories.
The Reality China survey is a multi-centre cross-sectional study involving 84 centres in 19 provinces in China. Assessment of risk factors was performed based on the NCEP ATP-III guidelines [1]. Data of 10958 patients with dyslipidemia were included.

Main results

• Baseline characteristics demonstrated a high-risk cohort, with over 50% of patients with hypertension, 37.5% with coronary artery disease (CAD), 17.5% with diabetes and more than 30% had peripheral artery disease.
• Based on ATP-III guidelines, 28.1% of included patients were in the optimal LDL-C category (<100 mg/dl), 23.8% in the above optimal (130 > LDL-C >100 mg/dl), 25.0% in the borderline high (160 > LDL-C > 130 mg/dl) and 23.1% were in the high LDL-C levels category (> 160 mg/dl). Females showed a higher prevalence of hypercholesterolemia, but a higher proportion of men had hypertriglyceridemia, low HDL-C or mixed lipid disorder.
• 39.3% of participants in this cohort received lipid-lowering drugs before study enrolment. Strikingly, prescription rate was only 42.1% or 46.5% in the high or very high risk group.
• After individual LDL-C targets were set, overall attainment was low (25.8%), specifically in females and in patients with increased BMI. Attainment was significantly lower in the high (19.9%) and very high (21.1%) risk categories.
• BMI, gender, CAD, systolic and diastolic blood pressure, hypertension, family history of premature CAD and current smoking were independent predictors for failure to reach recommended LDL-C targets.

Conclusion

This study shows that less than 40% of Chinese ambulatory high-risk patients receives lipid-lowering treatment and that only about a quarter of these patients achieves the target LDL-C levels. These data highlight an important treatment gap, specifically in high-risk patients. This work calls for national programs to raise public awareness and for more aggressive treatment strategies.

References

1. Grundy SM, Cleeman JI, Merz CN, et al (2004) Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. J Am Coll Cardiol 44: 720–32.

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