General practitioners’ adherence to guidelines on management of dyslipidaemia: ADDITION-Denmark

Abstract

Objective. To describe the management of dyslipidaemia in patients with high risk of cardiovascular disease (CVD) and patients with a history of CVD identified by screening for diabetes in general practice in Denmark, concentrating on prescription of lipid-lowering drugs. Moreover, to analyse predicting factors for starting lipid-lowering drugs related to patient and general practice characteristics. Design. Population-based cross-sectional study with follow-up. Setting. A total of 139 general practices from three of five Danish regions, totalling 216 GPs. Subjects. The study population comprised 4986 patients with a high risk of CVD and dyslipidaemia and 764 patients with a history of CVD and dyslipidaemia out of a population of 16 572 patients who completed screening for diabetes but were cleared for diabetes in the ADDITION study. Results. Of patients with a high risk of CVD and dyslipidaemia not receiving lipid-lowering drugs at the time of screening (n = 4823), 20% started lipid-lowering therapy within the follow-up period (median 2.1 years). This percentage was 45% (n = 536) for patients with CVD and dyslipidaemia (median follow-up period 1.6 years). Age over 50, high cholesterol, impaired fasting glucose and/or impaired glucose tolerance, minor polypharmacy, use of heart/circulation drugs, and cholesterol measurements after screening predicted the prescription of lipid-lowering drugs for patients at high risk of CVD. For patients with CVD, male gender, high cholesterol and use of heart/circulation drugs predicted the prescription of lipid-lowering drugs. No general practice characteristics were associated with different prescription habits. Conclusion. There is a gap between the recommended lipid-lowering drug therapy and current practice, with a substantial under-treatment and a considerable delay in the first prescription of lipid-lowering drugs.

Key Words::

• Cardiovascular risk factors
• dyslipidaemia
• family practice
• prevention
• screening

Acknowledgement

The study was supported by the National Health Services in the counties of Copenhagen, Aarhus, Ringkøbing, Ribe and South Jutland, together with the Danish Council for Strategic Research, the Danish Research Foundation for General Practice, the Danish Centre for Evaluation and Health Technology Assessment, the diabetes fund of the National Board of Health, the Danish Medical Research Council, the Aarhus University Research Foundation, and the Novo Nordisk Foundation. The study received unrestricted grants from Novo Nordisk, Novo Nordisk Scandinavia, Astra Denmark, Pfizer Denmark, GlaxoSmithKline Pharma Denmark, Servier Denmark and HemoCue Denmark.