Mixed dyslipidemias in primary care patients in France

Figures & data

Table 1 Comparison of French (AFSSAPS) and European guidelines lipid thresholds for dyslipidemia

Lipid parameter	French (AFSSAPS)^Citation33	European guideline (JES IV)^Citation2
LDL-C
High risk^*,†	<100 mg/dL	<100 mg/dL (option of <80 mg/dL)
Not high risk‡
≥3 risk factors	<130 mg/dL	<115mg/dL
2 risk factors	<160 mg/dL	<115mg/dL
1 risk factor	<190 mg/dL	<115mg/dL
0 risk factors	<220 mg/dL	<115mg/dL
HDL-C
Men	<40 mg/dL	<40 mg/dL
Women	<40 mg/dL	<45 mg/dL
Triglycerides	>150 mg/dL	>150 mg/dL

Notes:

* High cardiovascular risk was defined in the French guideline by a diagnosis of cardiovascular disease, a diagnosis of high-risk type 2 diabetes, and/or a 10-year CHD risk >20%.³³ High-risk diabetes was defined as diabetes mellitus with concomitant renal disease and/or at least two of the following cardiovascular risk factors: age, family history of coronary disease, HDL-C <40 mg/dL, and microalbuminuria (>30 mg/24 hours).³³

† In the JES IV guideline, the following high-risk patient groups have priority in lipid treatment: (1) those with established CVD; (2) asymptomatic individuals with (a) multiple risk factors resulting in ≥5% risk of CV-related death in the next 10 years, (b) diabetes, or (c) markedly increased single risk factors; and (3) those with a family history of early CVD or high CV risk. Factors used to calculate risk are age, sex, smoking status, total cholesterol, and blood pressure.

‡ Risk factors in the French guideline were age (≥50 for men and ≥60 for women); tobacco use (currently smoking or stopped <3 years earlier); a family history of early-onset coronary disease (MI or sudden death before age 55 in the father or first-degree male relative, and MI or sudden death before age 65 in the mother or first-degree female relative); permanent hypertension (diagnosis of hypertension (≥140/90 mmHg) or treatment with antihypertensive agents); type 2 diabetes (treatment with anti-diabetic agent or diagnosis of diabetes); and HDL-C <40 mg/dL regardless of gender.³³

Abbreviations: HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; CHD, coronary heart disease; CVD, cardiovascular disease; MI, myocardial infarction.

Figure 1 Sample selection.

Table 2 Patient characteristics

Characteristics	All patients (N = 2544)	High risk (N = 1201)
Age, years (SD)	65.75 (10.79)	68.36 (9.79)
Male gender, n (%)	1503 (59.08)	885 (73.69)
Cardiovascular risk factors
Current smoker, n (%)	273 (10.73)	138 (11.49)
Hypertension, n (%)	1825 (71.74)	961 (80.02)
Hypertension medication use, n (%)	1584 (62.26)	840 (69.94)
Systolic BP ≥140 mmHg, n (%)	928 (36.48)	506 (42.13)
Diastolic BP ≥90 mmHg, n (%)	184 (7.23)	93 (7.74)
Family history of CHD, n (%)	392 (15.41)	193 (16.07)
Diabetes mellitus
HBA1c,a mean (SD)	6.92 (1.16)	6.90 (1.18)
FBG,b mean (SD)	1.36 (0.59)	1.36 (0.61)
Diabetes medication use, n (%)	631 (24.80)	561 (46.71)
Body mass index (kg/m^2), n (%)c
25% or less	762 (30.23)	308 (25.90)
>25% and <30%	1103 (43.75)	516 (43.40)
30% or more (obesity)	656 (26.02)	365 (30.70)
Abdominal obesity,d n (%)	763 (44.16)	398 (48.54)
Menopause, n (% of women)	190 (18.25)e	49 (15.51)
Alcohol, n (%)	60 (2.36)	34 (2.83)
High cardiovascular riskf
1. History of cardiovascular diseaseg n (%)	809 (31.80)	809 (67.36)
Stroke, n (%)	440 (17.30)	440 (36.64)
CHD, n (%)	573 (22.52)	573 (47.71)
2. High-risk diabetes mellitus,h n (%)	514 (20.20)	514 (42.80)
3. >20% 10-year risk, n (%)	83 (3.26)	83 (6.12)
Any of criteria (1)–(3), n (%)	1201 (47.21)	1201(100)

Notes: All percentages referred to the overall sample in column 1 (2.544 patients) and to the overall number of high-risk patients in column 2, except for the following specific populations:

a N = 590 (all patients), N = 524 (high risk);

b N = 495 (all patients), N = 440 (high risk);

c N = 2521 (all patients), N = 1189 (high risk);

d N = 1728 (all patients), N = 820 (high risk);

e 190 women out of 1041; 49 women out of 316;

f by French (AFSAPPS) criteria;³³

g CHD or ischemic stroke;

h high-risk diabetes: patients with diabetes mellitus and at least two other cardiovascular risk factors or diabetes with a concomitant renal disease.

Abbreviations: SD, standard deviation; BP, blood pressure; CHD, coronary heart disease; FBG, fasting blood glucose; HBA1c, glycosylated hemoglobin.

Figure 2 Prevalence of dyslipidemias in all patients.*

Note: *N = 2,544 patients.
Abbreviations: HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; TG, triglycerides.

Table 3 Prevalence of dyslipidemias among all subjects and high-risk subjects with at least one dyslipidemia

Dyslipidemia(s)	All subjects (N = 1292)		High-risk subjects (N = 854)
	N	(%)	N	(%)
Individual dyslipidemia
Elevated LDL-Ca	705	54.6%	613	71.2%
Elevated triglyceridesa	731	56.6%	390	45.7%
Low HDL-Ca	315	24.4%	219	25.6%
Isolated dyslipidemia
Elevated LDL-C alone	395	30.6%	351	41.1%
Elevated triglycerides alone	384	29.7%	120	14.1%
Low HDL-C alone	114	8.8%	69	8.1%
Mixed dyslipidemiasb	399	30.9%	314	36.8%
Two dyslipidemias	339	26.2%	260	30.5%
Low HDL-C and/or elevated triglycerides	897	69.4%	503	58.9%
Low HDL-C and/or elevated triglycerides and elevated LDL-C	310	24.0%	262	30.7%
All three dyslipidemias	60	4.6%	54	6.3%

Notes:

a Without regard to other lipid parameters;

b combinations of two or more dyslipidemias.

Abbreviations: HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol.

Figure 3 Prevalence of dyslipidemias in high-risk patients.*

Note: *N = 1201.
Abbreviations: HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; TG, triglycerides.

Table 4 Clinical factors associated with attainment of targets/normal levels for individual lipids and two or more lipids among the total population

Predictor variablea	Odds ratio (95% CI) associated with attainment of lipid target/normal level
	LDL-C (N = 2521)	HDL-C (N = 2521)	Triglycerides (N = 2521)	≥2 lipids* (N = 1822)
Age (per 1 year increase)	NS	1.04 (1.03–1.05)†	1.02 (1.01–1.03)†	1.05 (1.02–1.07)†
Gender (M/F)	1.56 (1.23–1.98)†	0.52 (0.38–0.70)†	NS	0.58 (0.34–0.99)§
Body mass index (kg/m^2)
25–30 versus ≤25	NS	0.59 (0.42–0.83)‡	0.59 (0.46–0.74)†	0.50 (0.26–0.95)§
>30 versus ≤25	NS	0.47 (0.32–0.68)†	0.32 (0.25–0.42)†	0.35 (0.17–0.69)‡
Diabetes (yes/no)	NS	0.74 (0.56–0.98)§	0.76 (0.61–0.94)‡	NS
Current smoker (yes/no)	0.44 (0.31–0.61)†	NS	NS	NS
Hypertension (yes/no)	0.72 (0.57–0.90)‡	NS	0.71 (0.58–0.86)†	NS
History of CVD/CHD and FRS
FRS > 20% versus FRS ≤ 20%	0.01 (0.01–0.02)†	0.21 (0.14–0.32)†	0.56 (0.39–0.81)‡	0.09 (0.03–0.31)†
History of CVD/CHD versus FRS ≤ 20%	0.12 (0.09–0.15)†	0.48 (0.36–0.64)†	NS	0.39 (0.23–0.63)†

Notes:

a All models included: age, gender, body mass index, diabetes status, smoking status, hypertension status, history of CVD/CHD, FRS (>/<20%), year of statin prescription;

* attainment of thresholds in ≥2 lipid parameters versus attainment of LDL-C target only;

† P ≤ 0.001;

‡ P ≤ 0.01;

§ P ≤ 0.05.

Abbreviations: HDL-C, high density lipoprotein cholesterol; LDL-C, low density lipoprotein cholesterol; CHD, coronary heart disease; CVD, cardiovascular disease; FRS, Framingham Risk Score.

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