Abnormal lipids in high-risk patients achieving cholesterol targets: a cross-sectional study of routinely collected UK general practice data

ABSTRACT

Background and objectives: Lipid management in UK general practice targets the achievement of total cholesterol (TC) targets in high-risk individuals. Statins alone have a modest effect on non-LDL-C components of the lipid profile, leaving these patients at significant residual cardiovascular (CV) risk. Improving risk further would require the addition of non-statin therapies. This analysis explores what proportion of the UK population with cardiovascular disease (CVD) and TC levels at or below target may still be at risk because of residual dyslipidaemia.

Methods: CV risk profiles were extracted from a research database of 602 222 patients from 98 UK general practices. Patients were categorised according to their prior CV history and use of statins. Mean values and proportions achieving treatment targets were assessed for TC, low density lipoprotein (LDL-C), high density lipoprotein (HDL-C) and triglycerides (TG).

Results: In all, 48 499 patients with pre-existing CVD or diabetes were identified. 73% of statin-treated patients and 63% of untreated patients had a TC ≤ 5 mmol/L. 28.6% of patients treated to a TC target had LDL-C > 3 mmol/L. Amongst those with both TC and LDL-C treated to target, 22.5% had low HDL-C and 37.2% had high triglyceride (TG). Within this group, more women than men had abnormal HDL-C (25.4 vs. 20.7% p < 0.0001). Patients with diabetes were more likely than non-diabetics to have abnormalities of both HDL-C (28.9 vs. 16.4% p < 0.0001) and triglyceride (44.9 vs. 29.5% p < 0.0001) despite normal TC and LDL-C.

Conclusions: Around 60% of high-risk patients have residual dyslipidaemias despite achieving the Quality and Outcomes Framework (QOF) TC target. New patterns of treatment are required in order to extend lipid management beyond simple total cholesterol lowering.

Key Words::

• Cardiovascular disease
• Cerebrovascular disease
• Cholesterol
• Coronary heart disease
• Peripheral vascular disease
• Primary care
• Secondary prevention

Acknowledgements

Declarations of interest: This work was supported by an unrestricted educational grant from Merck Sharp & Dohme Limited. The views expressed in this publication are those of the authors, and not necessarily those of the publisher or sponsor.

The PCDQ (Primary Care Data Quality) programme is based within Primary Care Informatics, Division of Community Health Sciences, St. George's – University of London and received funding from Merck Sharp & Dohme Ltd to collect the original data between October 2005 and January 2006.

JB is a director of JB Medical Ltd, a medical education consultancy, and an honorary research assistant at St. George's – University of London. JB Medical Ltd has been paid by Merck Sharp & Dohme Ltd to write educational programmes and clinical papers in the area of cardiology. JB has also received an unrestricted grant from Merck Sharp & Dohme Ltd for his participation in writing this paper. SdeL, TC, JvV and NH did not receive any financial support for writing this paper, and have not declared any conflict of interest.

SdeL, TC, JvV and NH conceived the PCDQ project, recruited practices and collected data. JB initiated this analysis, designed the research question, carried out the data analysis and wrote the first draft of the paper. SdeL, TC, JvV and NH commented on the first draft and JB managed the incorporation of comments to produce a final draft manuscript for submission.