Comprehensive control of multiple cardiovascular risk factors in high-risk patients was found to be suboptimal worldwide, according to a study published in the European Journal of Preventive Cardiology.
The International ChoLesterol management Practice Study sought to examine achievement in patients receiving lipid-modifying therapy of target levels of low-density lipoprotein cholesterol (LDL-C) specified in a guideline by the European Society of Cardiology and the European Atherosclerosis Society.
In this observational study, the data of 2377 patients (mean age, 61.4±10.4 years; 51.3% men) with dyslipidemia, diabetes, and hypertension from 452 centers in 18 countries outside Western Europe. Type 2 diabetes was the most prevalent (96.9%) form of diabetes in this cohort, and prevalences for other conditions were: 67.8% for metabolic syndrome, 40.4% for obesity, 39.6% for atherosclerotic disease, and 33.5% for coronary artery disease. Cardiovascular risk, according to the guideline was high in 38.2% of patients, and very high in 61.8%. Body mass index (BMI) was <25 kg/m2 in 20.3% of the participants, 62.8% had never smoked, and 25.2% were former smokers.
Overall, 12.2% of patients achieved simultaneous control of LDL-C, diabetes, and blood pressure, and risk factor control was comparable across all participating countries. The percentage of participants who achieved individual guideline-specified treatment targets was 43.9% for LDL-C, 55.5% for blood pressure, and 39.3% for diabetes. In addition, an association was established between control of LDL-C, control of blood pressure, control of diabetes, BMI, and smoking.
“High rates of obesity, metabolic syndrome, atherosclerotic disease, and coronary artery disease were noted in the subgroup of patients in whom no risk factors were controlled, which suggests that these patients constitute a group that is particularly difficult to treat.”
The observed limited use of intensive statin therapy, cholesterol absorption inhibitors, and combination antihypertensive therapy indicates undertreatment of these high-risk patients, which may result from physician and healthcare system factors, according to the study authors.
Study limitations include its observational nature, missing data, possible selection bias, and the facts that lipid-modifying therapy and treatment doses varied according to site and physician preference.
“A comprehensive approach should be taken to cardiovascular risk factor management rather than treating individual risk factors in isolation,” recommended the study authors. “Wider adoption of intensive therapy coupled with greater patient education is needed to address the worldwide problem of poor risk factor control.”
Disclosures: This study was supported by Sanofi.
Blom DJ, Santos RD , Daclin V, et al; on behalf of the ICLPS study group. The challenge of multiple cardiovascular risk factor control outside Western Europe: Findings from the International ChoLesterol management Practice Study. Eur J Prev Cardiol. 2020;27(13):1403-1411.