The prevalence, low-density lipoprotein cholesterol levels, and treatment of patients at very high risk of cardiovascular events in the United Kingdom: a cross-sectional study

Abstract

Objective: To assess the prevalence of patients at very high risk of cardiovascular (CV) events in the United Kingdom (UK) and evaluate low-density lipoprotein cholesterol (LDL-C) values and treatment patterns in these patients.

Methods: This cross-sectional study used primary care data from UK electronic medical records in the Clinical Practice Research Datalink (CPRD) in 2013. Very high-risk patients were defined per European Society of Cardiology guidelines as those with hyperlipidemia (assessed by co-medication) and documented cardiovascular disease (CVD) or hyperlipidemia and type 2 diabetes (DM2) without CVD (DM2w/oCVD). All analyses were descriptive.

Results: Data from 4,940,226 patients were captured in the CPRD in 2013. Of these, 5% of patients had received ≥2 lipid-modifying therapy prescriptions and were at very high risk of CVD (3% [n = 138,536] had documented CVD, 2% [n = 98,743] had DM2w/oCVD). In documented CVD patients, coronary artery disease (73%) was the most frequent type of event (25% had myocardial infarction [MI]), followed by cerebrovascular disease (18%), and peripheral arterial disease (9%); 21% had experienced multiple CV events, 25% had DM2, and 3% had MI within 1 year. In documented CVD and DM2w/oCVD patients, >95% received statin treatment; 24% received high-intensity statin, and 1.5% statin plus ezetimibe. Across both populations, 64–66% had LDL-C levels ≥1.8 mmol/L, 27–28% ≥2.5 mmol/L, 6–7% ≥3.5 mmol/L, and 3% had levels ≥4.0 mmol/L, respectively.

Conclusion: A well-defined proportion of patients remain at very high-risk of CVD. Statin therapy needs optimization, but, for some patients with high LDL-C levels, multiple CV events, MI within 1 year, or CVD and DM2, additional more intensive therapy may be needed.

Keywords:

• Cardiovascular disease
• Cholestero, LDL
• Diabetes mellitus, Type 2
• Epidemiology
• Hypercholesterolemia
• Hyperlipidemias
• Risk factors

Transparency

Declaration of funding

This study was sponsored by Amgen (Europe) GmbH. Eduard Sidelnikov and Lucie Kutikova are authors on this paper and are also employees of Amgen (Europe) GmbH.

Declaration of financial/other interests

MDD is an employee of Outcomes Insights, Inc. and receives consulting and research funding from Amgen. ES and LK are employees of Amgen (Europe) GmbH and own Amgen stock. Peer reviewers on this manuscript have received an honorarium from CMRO for their review work, but have no other relevant financial relationships to disclose.

Acknowledgments

Medical writing assistance was provided by Dawn Batty PhD (Bioscript Medical Ltd, Macclesfield, UK) and funded by Amgen (Europe) GmbH (Zug, Switzerland). The analyses reported here were also presented in a poster presentation at the ISPOR Annual European Congress, Glasgow, UK; November 4–8, 2017.