Lipid lowering treatment patterns and goal attainment in Nordic patients with hyperlipidemia

Figures & data

Table I.  Studies included in the analysis of lipid lowering treatment patterns and goal attainment in Nordic countries

Study	Patients (origin)	Patients (n)	Patients (type)	Study objective(s)	Study location	Study date	Published reference	Support/conflict of interest declared
European Action on Secondary Prevention by Intervention to Reduce Events (EUROASPIRE) II	Finland, Sweden	990 (records) 740 (interviews)	With established coronary disease	Through record review & patient interview to determine whether European guidelines are being followed for coronary prevention	Cardiology practices	1999–2000	EURO-ASPIRE II study group 2001^6	ESC through grant from AstraZeneca, Bristol-Myers Squibb, MSD, Pfizer
The Northern Sweden MONICA Study	Sweden	8 827	General population	Survey to explore time trends in total cholesterol	N/A	1986–2004	Eliasson et al. 2006^7	Various Independent Swedish Independent Councils and Foundations
Treatment of dyslipidemia in T2DM	Denmark	14 644	T2DM	Register study to evaluate monitoring of cholesterol and use of lipid-lowering treatment in T2DM	Hospital & Primary Care	2000–2002	Kristensen et al. 2006^8	No declaration
Cardiovascular Risk Factors (FINRISK)	Finland	622	On lipid lowering treatment +/- CVD	Survey to evaluate cholesterol goal achievement and influential factors		2002	Alemao et al. 2006^9	Merck & Co/Schering-Plough
Lipid Management and Cholesterol Goal attainment	Norway	3 111	On lipid lowering treatment +/- CVD and/or T2DM	Register study to evaluate cholesterol goal attainment and influential factors	Primary Care	1987–2003	Ose et al. 2006^10	MSD/Schering Plough
Routine management study	Denmark	1 163	With dyslipidemia	Register study to evaluate routine dyslipidemia management practices	Primary Care	1998–2000	Kanstrup et al. 2005^11	No declaration
Association between treatment goals and cardiovascular events	Sweden	4 976	On lipid lowering treatment	Register study to investigate if lack of goal achievement translates into higher risk of cardiovascular events	Primary Care	1993–2001	Lindgren et al. 2005^12	Merck & Co
Gap between guidelines and reality in T2DM	Sweden	17 547 in 1996, 57 119 in 2003	With T2DM	Register study to analyse metabolic risk factor level and goal achievement	N/A	1996–2003	Eliasson et al. 2005^13	No declaration
Quality of lipid-lowering study	Denmark	3 477	With IHD	Register study to evaluate lipid treatment patterns	Hospital & Primary care	1990–1999	Kanstrup et al. 2004^14	No declaration
Oslo Heart Study	Norway	1 404	With CVD and/or diabetes	Assessment of prevalence and factors associated with cholesterol lowering statins	General population	2000-
2001	Tonstad et al. 2004^15	No
Tromsø study	Norway	7 973	With CHD or risk factors	Population-based study to characterize lipid-lowering drug users	General population	2001	Hartz et al. 2001^16	University of Tromsø and Norwegian Institution of Health
Losartan Intervention For Endpoint reduction in hypertension (LIFE)	DenmarkFinland, Iceland, Norway, Sweden	6 397	With hypertension & LVH	Comparison of CV morbidity & mortality with losartan- or atenolol-based therapy; use of lipid-lowering agents at investigator's discretion	Outpatient clinics & General Practice	1995–2001	Kristianson et al. 2003^17	Merck & Co
Evaluation of Secondary Prevention Programme	Sweden	760	With CHD	Survey to evaluate adherence to guidelines for secondary prevention	Hospital and Primary Care	1996	Kahan et al. 2001^18	No
Goal achievement study in statin users	Finland	676	On statin monotherapy	Through office lipid measurements to determine whether European guidelines are being achieved for coronary prevention	Primary care		Strandberg et al. 2001^19	Pfizer Finland
Goal achievement study in statin users	Finland	747	On statin monotherapy	Through office lipid measurements to determine whether European guidelines are being achieved for coronary prevention	Primary care		Strandberg et al. 2006^20	MSD Finland / Schering-Plough Finland
Study of statin use after acute MI	Norway	473	With MI	Retrospective study to assess statin prescribing practices	Hospital out-patients	1995–98	Notø et al. 2001^21	Pfizer
Monitoring and treatment after MI study	Denmark	409	With MI, < 70y	Register study to evaluate lipid lowering treatment according to guidelines	Hospital & Primary Care	1995–1997	Kanstrup et al. 2001^22	Danish Pharmacy Foundation, Danish Medical Research Council, Danish Ministry of Research
Goal achievement study	Norway	3 935	On statin monotherapy	To determine to which extent European lipid guidelines are achieved	Primary care	1999	Svilaas et al. 2000^23	MSD Norway
Secondary prevention study	Norway	707 (1994/951 353 (1996/97)	With atherosclerotic disease	Multipractice survey to examine changing trends in prevention of atherosclerotic disease	Primary care	1994/95 & 1996/97	Svilaas et al. 2000^24	MSD Norway

CVD = cardiovascular disease; LVH = left ventricular hypertrophy; IHD = ischemic heart disease; CHD = coronary heart disease; MI = myocardial infarction; T2DM = type 2 diabetes.

Table II.  Reported rates of patients achieving total cholesterol treatment goal (<5 mmol/L), and statin dosing trends (only those studies reporting data are presented)

		Goal attainment (%)
Study	Country	Overall	With lipid-lowering treatment	No lipid-lowering treatment	Statin prescribing patterns
The Northern Sweden MONICA Study^7	Sweden	25.7 ♂ 38.3 ♀	N/A	N/A	N/A
Treatment of dyslipidemia in T2DM^8	Denmark	N/A	43	34	N/A
Cardiovascular Risk Factors (FINRISK)^9	Finland	N/A	46	N/A	Pravastatin 10 mg or equivalent 13%; simvastatin 10 mg or equivalent 38%; simvastatin 20 mg or equivalent 40%; simvastatin 40 mg or equivalent 8%; simvastatin 80 mg or equivalent 1%.
Lipid Management and Cholesterol Goal attainment^10	Norway	N/A	33	N/A	Average initial dose (1987-2003): simvastatin 18.4 mg; atorvastatin 12.7 mg; pravastatin 26.0 mg; lovastatin 29.5 mg; fluvastatin 36.5 mg. Mean prescribed statin dose 2003: simvastatin 26.7 mg; atorvastatin 18.4 mg; pravastatin 30.7 mg; lovastatin 30.5 mg; fluvastatin 70.1 mg.
Routine management study^11	Denmark	N/A	42.3	N/A	N/A
Association between treatment goals and cardiovascular events^12	Sweden	31	N/A	N/A	N/A
Gap between guidelines and reality in T2DM^13	Sweden	48	59	40	N/A
Quality of lipid-lowering study^14	Denmark	42	55	33	92% patients simvastatin 10 or 20 mg; 8% patients simvastatin 40 or 80 mg 80% patients pravastatin 20 mg; 20% patients pravastatin 40 mg 84% patients atorvastatin 10 or 20 mg; 16% patients atorvastatin 40 mg 75% patients lovastatin 20 mg; 25% patients lovastatin 40 mg 25% patients cerivastatin 200 µg; 75% patients cerivastatin 300 µg 72% patients fluvastatin 20 mg; 28% patients fluvastatin 40 mg
Oslo Heart Study^15	Norway	N/A	61% ♂ 40% ♀	N/A	N/A
Tromsø study^16	Norway	17%	25.7%	75%	N/A
Losartan Intervention For Endpoint reduction in hypertension (LIFE)^17	Iceland Norway Finland Sweden Denmark	N/A N/A N/A N/A N/A	31.6 40.8 32.3 34.7 30.9	N/A N/A N/A N/A N/A	N/A
Evaluation of Secondary Prevention Programme^18	Sweden	22	N/A	N/A	N/A
Goal achievement study in statin users^19	Finland	N/A	54.3 + CHD 35.8-CHD	N/A	60.2% of patients received simvastatin 10 mg; 81.2% atorvastatin 10 mg; 59.0% pravastatin 20 mg; 62.3% lovastatin 20 mg; 56.1% fluvastatin 20 mg
Goal achievement study in statin users^20	Finland	N/A	70.4 + CHD 54.3-CHD	N/A	48.0% of patients received simvastatin 10 mg; 68.0% atorvastatin 10 mg; 23.5% pravastatin 20 mg; 66.7% lovastatin 20 mg; 15.1% fluvastatin 20 mg
Study of statin use after acute MI^21	Norway	49%	54%	41%	N/A
Monitoring and treatment after MI study^22	Denmark	45.8	N/A	N/A	46% patients simvastatin 10 mg; 44% patients simvastatin 20 mg; 9% patients simvastatin 40 mg 64% patients pravastatin 20 mg; 36% patients pravastatin 40 mg
Goal achievement study^23	Norway	35.5	35.5	N/A	Average doses: simvastatin 22.7 mg; atorvastatin 16.8 mg; pravastatin 26.0 mg; lovastatin 32.0 mg; fluvastatin 31.6 mg; cerivastatin 0.2 mg
Secondary prevention study^24	Norway	7.8 (1994/95) 26 (1996/97)	N/A	N/A	N/A

CHD = coronay heart disease; N/A = not applicable.