Characteristics of Patients With Atherosclerotic Cardiovascular Disease in Belgium and Current Treatment Patterns for the Management of Elevated LDL-C Levels

Clin Cardiol. 2024 Sep;47(9):e24330. doi: 10.1002/clc.24330.

Abstract

Background: Dyslipidemia remains the major cause of atherosclerotic cardiovascular disease (ASCVD). Lipid management in patients with increased cardiovascular (CV) risk needs improvement across Europe, and data gaps are noticeable at the country level.

Hypothesis: We described the current treatment landscape in Belgium, hypothesizing that lipid management in patients with ASCVD remains inadequate and aiming to understand the reasons.

Methods: Using data from an anonymized primary care database in Belgium derived from 494 750 individuals, we identified those with any CV risk factor between November 2019 and October 2022 and described the clinical features of patients with ASCVD. The main outcomes were the proportion of patients (i) receiving lipid-lowering therapies (LLTs), (ii) per low-density lipoprotein cholesterol (LDL-C) threshold, stratified per LLT, (iii) reaching the 2021 ESC recommended LDL-C goals, and (iv) LDL-C reduction per type of LLT was also determined.

Results: Among 40 888 patients with very high CV risk, 24 859 had established ASCVD. Most patients with ASCVD were either receiving monotherapy (59.6%) or had no documented LLT (25.1%). Further, 64.2% of those with no documented LLT exhibited LDL-C levels ≥ 100 mg/dL. Among common treatment options, one of the greatest improvements in LDL-C levels was achieved with combination therapy of statin and ezetimibe, reducing LDL-C levels by 41.5% (p < 0.0001). Yet, in this group, 24.8% of patients had still LDL-C levels ≥ 100 mg/dL and only 20.7% were at goal.

Conclusion: Our study emphasizes the importance of developing strategies to help patients achieve their LDL-C goals, with a focus on supporting the implementation of combination LLT in routine clinical practice.

Keywords: atherosclerotic cardiovascular disease; general practitioners; high cardiovascular risk; lipid‐lowering therapy; real‐world evidence.

Publication types

  • Multicenter Study

MeSH terms

  • Aged
  • Atherosclerosis* / blood
  • Atherosclerosis* / drug therapy
  • Atherosclerosis* / epidemiology
  • Belgium / epidemiology
  • Biomarkers / blood
  • Cholesterol, LDL* / blood
  • Dyslipidemias / blood
  • Dyslipidemias / drug therapy
  • Dyslipidemias / epidemiology
  • Female
  • Humans
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use
  • Hypolipidemic Agents / therapeutic use
  • Male
  • Middle Aged
  • Practice Patterns, Physicians'
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome

Substances

  • Cholesterol, LDL
  • Hydroxymethylglutaryl-CoA Reductase Inhibitors
  • Biomarkers
  • Hypolipidemic Agents