Room for improvement: Initiation of lipid lowering treatment and achievement of lipid target levels - a Danish registry-based study

AIMS: Prevention of adverse outcomes in individuals with high cholesterol levels may be improved by intensified lipid lowering treatment (LLT). We studied whether treatment goals of low density lipoprotein cholesterol (LDL-C) were reached within one year from baseline (defined as first LDL-C measurement) in a Danish population.

METHODS AND RESULTS: Danish registries were used to identify all persons in the Northern Region of Denmark who had LDL-C measured between 1997-2012 and who were naïve to LLT. Patients were categorized in LDL-C <5 or ≥ 5 mmol/L and further subdivided into low, high, and very high predicted cardiovascular (CV)-risk as suggested by European guidelines for risk stratification. Initiation of LLT and lipid target levels were assessed after one year (3.0, 2.5 and 1.8 mmol/L, respectively).In this study we examined the intensity of LLT and whether treatment goals were reached. More patients with LDL-C ≥5 mmol/L, regardless of the CV-risk, initiated LLT compared with patients who had a very high CV-risk and LDL-C <5 mmol/l. In total 37.7% (n = 32,581) of all patients with a follow-up LDL-C, and 25.1% (n = 3,229) of patients with LDL-C ≥5 mmol/l, had achieved their target levels after one year. Only 45.2% (n = 4,545) of the LDL-C ≥5 mmol/l high risk patients with a follow up LDL-C had started LLT 12 months after baseline.

CONCLUSION: Less than half of patients presenting with an LDL-C ≥5 mmol/l start LLT within one year, representing a missed opportunity for both primary and secondary prevention of cardiovascular disease.