Achieving optimal lipid goals in patients with coronary artery disease

Am J Cardiol. 2011 Mar 15;107(6):886-90. doi: 10.1016/j.amjcard.2010.11.006. Epub 2011 Jan 19.

Abstract

Guidelines for lipid-lowering therapy recommend intensive low-density lipoprotein (LDL) cholesterol lowering for patients with coronary artery disease. Previous studies have found that many high-risk patients are not achieving their LDL cholesterol goals, and many patients, despite being treated with lipid-lowering therapy, also have elevated triglycerides or low levels of high-density lipoprotein (HDL) cholesterol. To evaluate lipid goals in a "real world" clinical setting, the electronic medical records of 10,040 patients with coronary artery disease from a large cardiology subspecialty practice from September 2008 to September 2009 were reviewed. Overall, 79% of patients achieved an LDL cholesterol goal of <100 mg/dl, while only 35% achieved the more aggressive goal of <70 mg/dl. Non-HDL cholesterol goals of <130 and <100 mg/dl were achieved in 79% and 44% of patients, respectively. Only 69% achieved normal triglyceride levels, and only 63% of men and 56% of women achieved normal levels of HDL cholesterol. Women and younger men were less likely to achieve their lipid goals. In conclusion, most patients with coronary artery disease achieve the minimal LDL cholesterol goal of 100 mg/dl, but few achieve the more aggressive goals of <70 mg/dl. Many high-risk patients have elevated levels of triglycerides or low levels of HDL cholesterol despite treatment. Combination lipid-lowering therapy is used infrequently in practice. There exists a significant opportunity for physicians to more aggressively treat lipids to achieve the levels recommended by clinical guidelines.

MeSH terms

  • Aged
  • Anticholesteremic Agents / therapeutic use*
  • Azetidines / therapeutic use*
  • Cholesterol / blood*
  • Cholesterol, HDL / blood
  • Cholesterol, LDL / blood
  • Coronary Disease / blood*
  • Ezetimibe
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
  • Hypercholesterolemia / drug therapy*
  • Hypolipidemic Agents / therapeutic use*
  • Logistic Models
  • Male
  • Practice Patterns, Physicians'
  • Sex Factors
  • Triglycerides / blood

Substances

  • Anticholesteremic Agents
  • Azetidines
  • Cholesterol, HDL
  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Hypolipidemic Agents
  • Triglycerides
  • Cholesterol
  • Ezetimibe