Impact of new Joint British Societies’ (JBS 2) guidelines on prevention of cardiovascular disease: evaluation of serum total cholesterol goal achievement in UK clinical practice

ABSTRACT

Background: Consensus health panels, including the Joint British Societies (JBS), have established increasingly stringent cholesterol goals. However, in clinical settings, most patients do not achieve even the less stringent goals.

Objective: To provide descriptive data on the proportion of patients in the United Kingdom who would have achieved the new JBS 2 total cholesterol (TC) goal of < 4.0 mmol/L (< 155 mg/dL) without changes in therapy.

Methods: Cross-sectional analysis of patients initiated on lipid-modifying therapies in 2005 (before publication of the JBS 2 guidelines), as ascertained via a physician (general practitioner (GP)) database.

Results: Among 70 194 patients (mean age 64 years) receiving prescriptions for lipid-modifying therapies, 35 823 (51.0%) were considered to be at high risk because of CHD or diabetes mellitus and 34 371 (49.0%) were at low risk. A total of 66 642 (94.9%) patients received monotherapy with HMG-CoA reductase inhibitors (statins), including 33 853 (94.5%) of high-risk patients and 32 789 (95.4%) low-risk individuals. Statins were prescribed at medium (maximum daily dose = simvastatin 40 mg; atorvastatin 20 mg; rosuvastatin 10 mg) or lower equipotency doses in the majority of patients receiving these medications – 58 033 (87.1%) patients receiving statins, including 28 988 (85.6%) high-risk patients and 29 045 (88.6%) low-risk patients. Of the 28 874 patients with TC measurements, 7827 (27.1%) would have achieved the new JBS 2 goal without changes in medications or doses. In more than 51% of patients, TC values were ≥ 10% above the JBS 2 target despite prescribed therapy, suggesting that these individuals would also not have achieved the JBS 2 goal by doubling their statin doses.

Conclusions: Even though patient data were accessed before the JBS 2 guidelines were issued and data on other cardiovascular risk factors not captured, it can be concluded that most British patients (approximately 73%) would not have achieved the recent JBS 2 TC target of < 4.0 mmol/L without changes in lipid-modifying medications or medication doses. More effective and well-tolerated treatments, including combination statin regimens, are needed to increase the proportion of British patients reaching the more stringent JBS 2 goal.

Key words: :

• Coronary disease
• Hydroxymethylglutaryl CoA reductase inhibitors
• Hypercholesterolemia
• Prevention and control
• Treatment outcome