Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries – Findings from the EUROASPIRE IV survey
Introduction
It is well known that dyslipidaemia is one of the most important causal risk factors for coronary heart disease (CHD) [1], [2]. Although the use of lipid-lowering drugs in primary prevention is less cost-effective, at least to some extent in subjects at low total cardiovascular (CV) risk, there are absolutely no doubts concerning the imperative use of lipid lowering drugs, more precisely statins, for secondary prevention, i.e. in patients with established CHD. Randomized controlled trials have clearly proven that LDL-cholesterol (LDL-C) lowering with statins, can reduce the risk of recurrent cardiovascular events in these patients [3]. It has also been shown that further lowering of LDL-C beyond the levels that can be achieved with less potent statins or at a lower dose of a given statin, is associated with more CHD prevention [3], [4].
Therefore the US guidelines recommend to use high-intensity statin therapy in coronary patients in order to achieve a lowering of LDL-C by at least 50% [5]. European guidelines recommend a LDL-C goal of <1.8 mmol/L (<70 mg/dL) or at least 50% reduction of LDL-C in patients with documented CHD [2], [6]. Unlike the US guidelines, the European guidelines and a number of European reviews recommended combined lipid-lowering treatment even before the results of IMPROVE-IT trial were published [7], [8]. The results of the IMPROVE-IT trial clearly showed that significantly more CHD patients treated with a combination of a statin and ezetimibe can meet LDL-C goals than patients treated with statin alone; this was also associated with improved outcomes after multivariable adjustment [9].
The objectives of this study in the hospital arm of the EUROASPIRE IV survey were to examine how lipid lowering drugs were prescribed in CHD patients at discharge from hospital throughout Europe and how the intake of these drugs was reported by the patients when they were seen for a standardized interview at least 6 months later. Possible correlates of the differences between what was prescribed at discharge versus what was reported at the interview were examined. A comparison is also made of the proportions of patients at goal for LDL-C (<1.8 mmol) versus those at goal for non-HDL-C (<2.6 mmol/L).
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Materials and methods
The design, methodology and main results of the EUROASPIRE IV survey have been described elsewhere [10]. EUROASPIRE IV was a cross-sectional survey conducted at 79 centres in 24 European countries during May 2012 to April 2013 using standardised methods and the same equipment in every centre. In a defined geographical area in each of these countries, consecutive male or female patients aged 18–80 years were identified from hospital admission and discharge lists or diagnostic registers by the
Results
A statistically significant shift in the prescription of statin therapy was observed between hospital discharge and interview (P < 0.0001). From a total of 6648 CHD patients 9.6% were not on a statin therapy at the time of discharge from the hospital; this increased to 14% at interview; 37.6% of the patients were prescribed a high-intensity LDL-C lowering therapy at discharge which decreased to 32.7% at the time of the interview. Table 1 presents the results regarding lipid lowering drug
Discussion
The results of the EUROASPIRE IV survey concerning lipid lowering therapy in CHD patients show that despite the clear evidence of the benefits of lipid-lowering treatment with statins in secondary prevention, many coronary patients with dyslipidaemia are still inadequately treated and a significant number of patients on lipid-lowering therapy is still not reaching the LDL-C treatment goals. According to these results every tenth patient in European centres has been discharged from the hospital
Funding
The EUROASPIRE IV survey was supported by unrestricted educational grants to the European Society of Cardiology from Amgen, AstraZeneca, Bristol-Myers Squibb, GlaxoSmithKline, F. Hoffman–La Roche and Merck, Sharp & Dohme. The sponsors of the EUROASPIRE surveys had no role in the design, data collection, data analysis, data interpretation, decision to publish, or writing the manuscript. .
Acknowledgements
The EUROASPIRE IV survey was carried out under the auspices of the European Society of Cardiology, EURObservational Research Programme. EUROASPIRE Study Group is grateful to all the hospitals in which the study was carried out. Their administrative staff, physicians, nurses and other personnel helped us in many ways and we very much appreciate this. We are also grateful to the patients who participated in the study.
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