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Dyslipidemia in primary care--prevalence, recognition, treatment and control: data from the German Metabolic and Cardiovascular Risk Project (GEMCAS).

Steinhagen-Thiessen E, Bramlage P, Lösch C, Hauner H, Schunkert H, Vogt A, Wasem J, Jöckel KH, Moebus S - Cardiovasc Diabetol (2008)

Bottom Line: Thresholds of the ESC seem to be difficult to meet.A simple call for more aggressive treatment or higher patient compliance is apparently not enough to enhance the proportion of controlled patients.A shift towards a multifactorial treatment considering lifestyle interventions and pharmacotherapy to reduce weight and lipids may be the only way in a population where just to be normal is certainly not ideal.

View Article: PubMed Central - HTML - PubMed

Affiliation: Charité - Universitätsmedizin Berlin, Germany. elisabeth.steinhagen-thiessen@charite.de

ABSTRACT

Background: Current guidelines from the European Society of Cardiology (ESC) define low thresholds for the diagnosis of dyslipidemia using total cholesterol (TC) and LDL-cholesterol (LDL-C) to guide treatment. Although being mainly a prevention tool, its thresholds are difficult to meet in clinical practice, especially primary care.

Methods: In a nationwide study with 1,511 primary care physicians and 35,869 patients we determined the prevalence of dyslipidemia, its recognition, treatment, and control rates. Diagnosis of dyslipidemia was based on TC and LDL-C. Basic descriptive statistics and prevalence rate ratios, as well as 95% confidence intervals were calculated.

Results: Dyslipidemia was highly frequent in primary care (76% overall). 48.6% of male and 39.9% of female patients with dyslipidemia was diagnosed by the physicians. Life style intervention did however control dyslipidemia in about 10% of patients only. A higher proportion (34.1% of male and 26.7% female) was controlled when receiving pharmacotherapy. The chance to be diagnosed and subsequently controlled using pharmacotherapy was higher in male (PRR 1.15; 95%CI 1.12-1.17), in patients with concomitant cardiovascular risk factors, in patients with hypertension (PRR 1.20; 95%CI 1.05-1.37) and cardiovascular disease (PRR 1.46; 95%CI 1.29-1.64), previous myocardial infarction (PRR 1.32; 95%CI 1.19-1.47), and if patients knew to be hypertensive (PRR 1.18; 95%CI 1.04-1.34) or knew about their prior myocardial infarction (PRR 1.17; 95%CI 1.23-1.53).

Conclusion: Thresholds of the ESC seem to be difficult to meet. A simple call for more aggressive treatment or higher patient compliance is apparently not enough to enhance the proportion of controlled patients. A shift towards a multifactorial treatment considering lifestyle interventions and pharmacotherapy to reduce weight and lipids may be the only way in a population where just to be normal is certainly not ideal.

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Known, treated and controlled dyslipidemia in primary care. Known dyslipidemia is defined as either "lipid disorders yes" or "lipid lowering agent yes". Treated dyslipidemia is defined as "lipid lowering agent yes". Controlled dyslipidemia is defined as "lipid lowering agent yes" and lab values within the limits previously defined. Reference for each percent number given is the number of patients in the previous category, e.g. 11.9% of the 20.9% dyslipidemic patients in the age group 18–20 are known to be dyslipidemic by their treating physician.
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Figure 2: Known, treated and controlled dyslipidemia in primary care. Known dyslipidemia is defined as either "lipid disorders yes" or "lipid lowering agent yes". Treated dyslipidemia is defined as "lipid lowering agent yes". Controlled dyslipidemia is defined as "lipid lowering agent yes" and lab values within the limits previously defined. Reference for each percent number given is the number of patients in the previous category, e.g. 11.9% of the 20.9% dyslipidemic patients in the age group 18–20 are known to be dyslipidemic by their treating physician.

Mentions: The proportion of patients whose dyslipidemia was known to the treating physician was between 9.5 and 64.3% in men, and 5.7 and 63.6% in women. Highest rates were seen in men between 61 and 70 years, the lowest in female patients between 18 and 20 years (Figure 2). Table 3 displays that the proportion of diagnosed patients was generally higher in women than in men (PRR 1.15 [95%CI 1.12–1.17]), likewise this was true for higher age (PRR 1.68 [95%CI 1.64–1.72]), risk factors like type-2-diabetes (PRR 1.51 [95%CI 1.41–1.58]), hypertension (PRR 1.70 [95%CI 1.65–1.76]), and a high BMI (PRR 1.48 [95%CI 1.42–1.53]) and WC (PRR 1.50 [95%CI 1.44–1.56]). Patients with cardiovascular end organ damage (cardiovascular disease, PAD, stroke, myocardial infarction, and heart failure) had more often a diagnosis of dyslipidemia. The same was true for patients with liver disease (PRR 1.57 [95%CI 1.47–1.68]).


Dyslipidemia in primary care--prevalence, recognition, treatment and control: data from the German Metabolic and Cardiovascular Risk Project (GEMCAS).

Steinhagen-Thiessen E, Bramlage P, Lösch C, Hauner H, Schunkert H, Vogt A, Wasem J, Jöckel KH, Moebus S - Cardiovasc Diabetol (2008)

Known, treated and controlled dyslipidemia in primary care. Known dyslipidemia is defined as either "lipid disorders yes" or "lipid lowering agent yes". Treated dyslipidemia is defined as "lipid lowering agent yes". Controlled dyslipidemia is defined as "lipid lowering agent yes" and lab values within the limits previously defined. Reference for each percent number given is the number of patients in the previous category, e.g. 11.9% of the 20.9% dyslipidemic patients in the age group 18–20 are known to be dyslipidemic by their treating physician.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2572156&req=5

Figure 2: Known, treated and controlled dyslipidemia in primary care. Known dyslipidemia is defined as either "lipid disorders yes" or "lipid lowering agent yes". Treated dyslipidemia is defined as "lipid lowering agent yes". Controlled dyslipidemia is defined as "lipid lowering agent yes" and lab values within the limits previously defined. Reference for each percent number given is the number of patients in the previous category, e.g. 11.9% of the 20.9% dyslipidemic patients in the age group 18–20 are known to be dyslipidemic by their treating physician.
Mentions: The proportion of patients whose dyslipidemia was known to the treating physician was between 9.5 and 64.3% in men, and 5.7 and 63.6% in women. Highest rates were seen in men between 61 and 70 years, the lowest in female patients between 18 and 20 years (Figure 2). Table 3 displays that the proportion of diagnosed patients was generally higher in women than in men (PRR 1.15 [95%CI 1.12–1.17]), likewise this was true for higher age (PRR 1.68 [95%CI 1.64–1.72]), risk factors like type-2-diabetes (PRR 1.51 [95%CI 1.41–1.58]), hypertension (PRR 1.70 [95%CI 1.65–1.76]), and a high BMI (PRR 1.48 [95%CI 1.42–1.53]) and WC (PRR 1.50 [95%CI 1.44–1.56]). Patients with cardiovascular end organ damage (cardiovascular disease, PAD, stroke, myocardial infarction, and heart failure) had more often a diagnosis of dyslipidemia. The same was true for patients with liver disease (PRR 1.57 [95%CI 1.47–1.68]).

Bottom Line: Thresholds of the ESC seem to be difficult to meet.A simple call for more aggressive treatment or higher patient compliance is apparently not enough to enhance the proportion of controlled patients.A shift towards a multifactorial treatment considering lifestyle interventions and pharmacotherapy to reduce weight and lipids may be the only way in a population where just to be normal is certainly not ideal.

View Article: PubMed Central - HTML - PubMed

Affiliation: Charité - Universitätsmedizin Berlin, Germany. elisabeth.steinhagen-thiessen@charite.de

ABSTRACT

Background: Current guidelines from the European Society of Cardiology (ESC) define low thresholds for the diagnosis of dyslipidemia using total cholesterol (TC) and LDL-cholesterol (LDL-C) to guide treatment. Although being mainly a prevention tool, its thresholds are difficult to meet in clinical practice, especially primary care.

Methods: In a nationwide study with 1,511 primary care physicians and 35,869 patients we determined the prevalence of dyslipidemia, its recognition, treatment, and control rates. Diagnosis of dyslipidemia was based on TC and LDL-C. Basic descriptive statistics and prevalence rate ratios, as well as 95% confidence intervals were calculated.

Results: Dyslipidemia was highly frequent in primary care (76% overall). 48.6% of male and 39.9% of female patients with dyslipidemia was diagnosed by the physicians. Life style intervention did however control dyslipidemia in about 10% of patients only. A higher proportion (34.1% of male and 26.7% female) was controlled when receiving pharmacotherapy. The chance to be diagnosed and subsequently controlled using pharmacotherapy was higher in male (PRR 1.15; 95%CI 1.12-1.17), in patients with concomitant cardiovascular risk factors, in patients with hypertension (PRR 1.20; 95%CI 1.05-1.37) and cardiovascular disease (PRR 1.46; 95%CI 1.29-1.64), previous myocardial infarction (PRR 1.32; 95%CI 1.19-1.47), and if patients knew to be hypertensive (PRR 1.18; 95%CI 1.04-1.34) or knew about their prior myocardial infarction (PRR 1.17; 95%CI 1.23-1.53).

Conclusion: Thresholds of the ESC seem to be difficult to meet. A simple call for more aggressive treatment or higher patient compliance is apparently not enough to enhance the proportion of controlled patients. A shift towards a multifactorial treatment considering lifestyle interventions and pharmacotherapy to reduce weight and lipids may be the only way in a population where just to be normal is certainly not ideal.

Show MeSH
Related in: MedlinePlus