Achieving low-density lipoprotein cholesterol treatment goals among dyslipidemic individuals in the Levant: the CEntralized Pan-Levant survey on tHE Undertreatment of hypercholeSterolemia (CEPHEUS) study

Abstract

Background:

Several studies that evaluated achieving lipid goals have demonstrated an undertreatment of dyslipidemia. We evaluated the use and efficacy of lipid-lowering agents (LLAs) in reducing low-density lipoprotein cholesterol (LDL-C) to recommended levels in the Levant region.

Design and methods:

A multi-center, cross-sectional survey enrolled 1002 dyslipidemic patients (August 2010 – January 2011) on LLAs for ≥3 months. Collection of data and blood samples was done over one visit. Physicians and patients filled out questionnaires pertaining to dyslipidemia diagnosis and treatment. LDL-C target levels were defined according to international guidelines.

Results:

The full analysis set included 992 patients. Mean age was 58.0 ± 11.6 years (41% women, 65.7% diabetics and 51.5% had history of coronary heart disease). LLAs were prescribed for primary prevention or secondary prevention or familial hypercholesterolemia in 45.8% and 52.8% and 1.4% of patients; respectively. Overall, 64.0% and 56.8% of the patients attained their LDL-C goal recommended by the NCEP ATP III and TJETF guidelines, respectively. According to the 2004 NCEP ATP III updated guidelines, about 24.8% of the very high risk group attained their LDL goal of ≤70 mg/dL. Smoking, diabetes, metabolic syndrome, history of cardiovascular disease, increased waist circumference, and elevated pre-treatment LDL-C level were all associated with not reaching LDL-C goals.

Conclusions:

Although the study cohort was a relatively high risk group and might not be representative of the general population, we found that about 60% of enrolled individuals achieved the LDL-C treatment goals and 24.8% of the very high risk group achieved the recommended LDL-C targets of ≤70 mg/dl; national strategies and aggressive awareness campaigns to effectively control lipid levels to recommended target levels, especially in the high risk groups, are urgently needed.

Keywords::

• Cardiovascular diseases
• Low-density lipoprotein cholesterol
• Statins
• Treatment goals

Transparency

Declaration of funding

This work is an AstraZeneca study (ClinicalTrials.gov identifier: NIS-LT-CRE-2010/01), and therefore funded by AstraZeneca. Patient enrolment, data analysis, and manuscript writing were independent.

Declaration of financial/other relationships

A.J.H. has disclosed that he is a research grant recipient from AstraZeneca. J.H. has disclosed that he is a member of the advisory panel of Novo Nordisk and is on the speakers’ bureaus of AstraZeneca, Merck Sharp and Dohme, Merck Serono, Novartis and Novo Nordisk. A.E. and G.Y.G. have disclosed that they have no significant relationships with or financial interests in any commercial companies related to this study or article.

CMRO peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Acknowledgments

The authors thank Dr. Laila Tutunji (Clinicalquest, Amman, Jordan) for performing the statistical analyses and editorial support in manuscript preparation. The authors also thank the physicians from Jordan and Lebanon who participated in the study (CEPHEUS-Levant survey investigators), especially Omar Hamoui, MD, and Hadi Abu Hantash for their contribution to the design, conduction and abstracts presentations.