Limits...
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.

Show MeSH

Related in: MedlinePlus

Dyslipidemia treatment and control in patients with a SCORE Score > 5%, PROCAM Score > 20% or Diabetes mellitus. Dyslipidemia treatment and control in patients with a SCORE Score > 5%, PROCAM Score > 20% or Diabetes mellitus (equals 100%). Displayed are the proportions of patients with known (left), treated (middle), and controlled dyslipidemia (right column in every age group). Reference for the first category is the total number of patients which are eligible according to the criteria defined; reference for subsequent percent numbers is the number of patients in the previous category.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC2572156&req=5

Figure 3: Dyslipidemia treatment and control in patients with a SCORE Score > 5%, PROCAM Score > 20% or Diabetes mellitus. Dyslipidemia treatment and control in patients with a SCORE Score > 5%, PROCAM Score > 20% or Diabetes mellitus (equals 100%). Displayed are the proportions of patients with known (left), treated (middle), and controlled dyslipidemia (right column in every age group). Reference for the first category is the total number of patients which are eligible according to the criteria defined; reference for subsequent percent numbers is the number of patients in the previous category.

Mentions: It is recommended by international guidelines that patients without existing cardiovascular disease (primary prevention) should receive lipid lowering therapy if their SCORE score exceeds 5% or their PROCAM score 20% or when Diabetes mellitus is present [14]. These patients are the basis of Figure 3. Amongst these about 2/3 were known to have dyslipidemia, 1/3 was treated with pharmacotherapy (with an age-dependent increase from 22.2 to 47.7%) and little more than 10% were finally controlled (low 8.1% in the age group 41 – 50, high 18.0 to 29.7% in the elderly).


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)

Dyslipidemia treatment and control in patients with a SCORE Score > 5%, PROCAM Score > 20% or Diabetes mellitus. Dyslipidemia treatment and control in patients with a SCORE Score > 5%, PROCAM Score > 20% or Diabetes mellitus (equals 100%). Displayed are the proportions of patients with known (left), treated (middle), and controlled dyslipidemia (right column in every age group). Reference for the first category is the total number of patients which are eligible according to the criteria defined; reference for subsequent percent numbers is the number of patients in the previous category.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Dyslipidemia treatment and control in patients with a SCORE Score > 5%, PROCAM Score > 20% or Diabetes mellitus. Dyslipidemia treatment and control in patients with a SCORE Score > 5%, PROCAM Score > 20% or Diabetes mellitus (equals 100%). Displayed are the proportions of patients with known (left), treated (middle), and controlled dyslipidemia (right column in every age group). Reference for the first category is the total number of patients which are eligible according to the criteria defined; reference for subsequent percent numbers is the number of patients in the previous category.
Mentions: It is recommended by international guidelines that patients without existing cardiovascular disease (primary prevention) should receive lipid lowering therapy if their SCORE score exceeds 5% or their PROCAM score 20% or when Diabetes mellitus is present [14]. These patients are the basis of Figure 3. Amongst these about 2/3 were known to have dyslipidemia, 1/3 was treated with pharmacotherapy (with an age-dependent increase from 22.2 to 47.7%) and little more than 10% were finally controlled (low 8.1% in the age group 41 – 50, high 18.0 to 29.7% in the elderly).

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