How effective are the ESC/EAS and 2013 ACC/AHA guidelines in treating dyslipidemia? Lessons from a lipid clinic

Abstract

Objective:

There is a paucity of data regarding the attainment of lipid-lowering treatment goals according to the recent American College of Cardiology/American Heart Association (ACC/AHA) guidelines. The aim of the present study was to assess how applicable these 2013 recommendations are in the setting of an Outpatient University Hospital Lipid Clinic.

Methods:

This was a retrospective (from 1999 to 2013) observational study including 1000 consecutive adults treated for hyperlipidemia and followed up for ≥3 years. Comparisons for the applicability of current European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) and recent ACC/AHA guidelines were performed.

Results:

Achievement rates of low density lipoprotein cholesterol (LDL-C) targets set by ESC/EAS were 21%, 44% and 62% among patients at very high, high and moderate cardiovascular risk, respectively, receiving statin monotherapy. Among individuals on high-intensity statins only 47% achieved the anticipated ≥50% LDL-C reduction, i.e. the ACC/AHA target. The corresponding rate was significantly greater among those on statin + ezetimibe (76%, p < 0.05). Likewise, higher rates of LDL-C target attainment according to ESC/EAS guidelines were observed in patients on statin + ezetimibe compared with statin monotherapy (37, 50 and 71% for the three risk groups, p < 0.05 for the very high risk group).

Conclusion:

The application of the ACC/AHA guidelines may be associated with undertreatment of high risk patients due to suboptimal LDL-C response to high-intensity statins in clinical practice. Adding ezetimibe substantially increases the rate of the ESC/EAS LDL-C target achievement together with the rate of LDL-C lowering response suggested by the ACC/AHA.

Keywords: :

• ACC/AHA
• ESC/EAS
• Ezetimibe
• Lipid lowering treatment
• Guidelines
• Statins
• Treatment goals

Transparency

Declaration of funding

This study was not funded. The authors have received no payment in preparation of this manuscript.

Declaration of financial/other relationships

HM, ME and EL have given talks, attended conferences and participated in trials and advisory boards sponsored by various pharmaceutical companies, including MSD. D.P.M. has given talks and attended conferences sponsored by MSD; he is also the Editor-in-Chief of CMRO. M.E. has disclosed that he is a CMRO Editorial Board member. FB and MK have no conflict of interest to report.

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