Abstract
This is a multicenter cross-sectional survey of 2,500 Bulgarian adult patients taking lipid-lowering drugs (LLDs) for at least 3 months with no dose change for a minimum of 6 weeks. The primary objective was to establish the proportion of patients who are on LDL-C target, according to the Fourth Joint European Task Force (FJETF) guidelines. The secondary objectives were to define the proportion of patients at target: according to the 2001 National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III and the 2004 NCEP ATP III guidelines. The patients’ demographics, current LLD treatment, cardiovascular medical history were recorded. Next the lipid profile, glucose level and HbA1c were obtained from these patients. The investigators and patients completed questionnaires related to the LLD therapy. Gender, BMI, history of CHD, therapy compliance, risk category, lack of patient’s awareness of LDL-C targets were all studied as determinants of the undertreatment. Despite the satisfactory awareness of guidelines for management of hypercholesterolaemia, their implementation in clinical practice is still poor. Only 43.10% of patients reached the FJETF-recommended LDL-C goal, 45.24% achieved the 2001 NCEP ATP III recommended LDL-C goal, and only 21.51% — reached the 2004 NCEP ATP III recommended target. Males, CHD patients and those who were aware of LDL-C targets had more chance of reaching their desired LDL-C target.
[1] Sans S, Kesteloot H, Kromhout D on behalf of the Task Force. The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Euro Heart J. 1997; 18:1231–1248 http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a01543410.1093/oxfordjournals.eurheartj.a015434Search in Google Scholar
[2] British Heart Foundation. European Cardiovascular Disease Statistics. British Heart Foundation, London 2005. (http://www.bhf.org.uk/cvc/pdf/CVC_10Years_2008_v2.pdf) Search in Google Scholar
[3] Scheen AJ, Kulbertus H. Interheart: nine risk factors predict nine out of ten myocardial infarctions. Rev Med Liege. 2004; 59:676–679 Search in Google Scholar
[4] Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ. 1994; 308:367–372 http://dx.doi.org/10.1136/bmj.308.6925.36710.1136/bmj.308.6925.367Search in Google Scholar
[5] Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003; 326:1423 http://dx.doi.org/10.1136/bmj.326.7404.142310.1136/bmj.326.7404.1423Search in Google Scholar
[6] Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360:7–22 http://dx.doi.org/10.1016/S0140-6736(02)09327-310.1016/S0140-6736(02)09327-3Search in Google Scholar
[7] EUROASPIRE: A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. Euro Heart J. 1997; 18:1569–1582 10.1093/oxfordjournals.eurheartj.a015136Search in Google Scholar PubMed
[8] EUROASPIRE II Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries. Euro Heart J. 2001; 22:554–572 http://dx.doi.org/10.1053/euhj.2001.261010.1053/euhj.2001.2610Search in Google Scholar PubMed
[9] Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009; 16:121–137 http://dx.doi.org/10.1097/HJR.0b013e3283294b1d10.1097/HJR.0b013e3283294b1dSearch in Google Scholar PubMed
[10] Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Reiner Z, Keil U. EUROASPIRE Study Group. EUROASPIRE III. Management of cardiovascular risk factors in asymptomatic high-risk patients in general practice: cross-sectional survey in 12 European countries. Eur J Cardiovasc Prev Rehabil. 2010; 17:530–540 http://dx.doi.org/10.1097/HJR.0b013e3283383f3010.1097/HJR.0b013e3283383f30Search in Google Scholar PubMed
[11] Ford ES, Mokdad AH, Giles WH, Mensah GA. Serum Total Cholesterol Concentrations and Awareness, Treatment, and Control of Hypercholesterolemia among US Adults. Findings from the National Health and Nutrition Examination Survey, 1999 to 2000. Circulation 2003; 107:2185–2189 http://dx.doi.org/10.1161/01.CIR.0000066320.27195.B410.1161/01.CIR.0000066320.27195.B4Search in Google Scholar PubMed
[12] Pearson TA, Laurora I, Chu H, Kafonek S. The Lipid Treatment Assessment Project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med. 2000; 160:459–467 http://dx.doi.org/10.1001/archinte.160.4.45910.1001/archinte.160.4.459Search in Google Scholar PubMed
[13] Frolkis JP, Pearce GL, Nambi V, Minor S, Sprecher DL. Statins do not meet expectations for lowering low-density lipoprotein cholesterol levels when used in clinical practice. Am J Med. 2002; 113:625–629 http://dx.doi.org/10.1016/S0002-9343(02)01303-710.1016/S0002-9343(02)01303-7Search in Google Scholar
[14] Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Scholte op Reimer W, Weissberg P, Wood D, Yarnell J, Zamorano JL, Walma E, Fitzgerald T, Cooney MT, Dudina A. European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG). European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (Constituted by representatives of nine societies and by invited experts). Euro Heart J. 2007; 28:2375–2414 http://dx.doi.org/10.1093/eurheartj/ehm31610.1093/eurheartj/ehm316Search in Google Scholar PubMed
[15] National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation and, treatment of high blood cholesterol in adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation and, treatment of high blood cholesterol in adults (Adult Treatment Panel III): final report. Circulation 2002; 106:3143–3421 10.1161/circ.106.25.3143Search in Google Scholar
[16] Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110:227–239 http://dx.doi.org/10.1161/01.CIR.0000133317.49796.0E10.1161/01.CIR.0000133317.49796.0ESearch in Google Scholar PubMed
[17] Hermans MP, Van Mieghem W, Vandenhoven G, Vissers E. Centralized Pan-european survey on tHE Undertreatment of hypercholesterolemia (CEPHEUS). Acta Cardiol. 2009; 64:2 (177–185) http://dx.doi.org/10.2143/AC.64.2.203534110.2143/AC.64.2.2035341Search in Google Scholar PubMed
[18] Hermans MP, Castro Cabezas M, Strandberd T, Ferrires J, Feely J, Elisaf M, Michel G, Sansoy V. Centralized Pan-European survey on the undertreatment of hypercholesterolaemia (CEPHEUS): Overall findings from eight countries. Curr Med Res Opin. 2010; 26:2 (445–454) http://dx.doi.org/10.1185/0300799090350056510.1185/03007990903500565Search in Google Scholar PubMed
[19] Elisaf MS, Nikas N. Centralized pan-European survey on the under-treatment of hypercholesterolemia in patients using lipid lowering drugs-the CEPHEUS — Greece survey. Angiology. 2010; 61:5 (465–474) http://dx.doi.org/10.1177/000331971036643210.1177/0003319710366432Search in Google Scholar PubMed
© 2013 Versita Warsaw
This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.
