Endocrinol Metab.  2020 Jun;35(2):367-376. 10.3803/EnM.2020.35.2.367.

Achievement of LDL-C Targets Defined by ESC/EAS (2011) Guidelines in Risk-Stratified Korean Patients with Dyslipidemia Receiving Lipid-Modifying Treatments

Affiliations
  • 1Department of Internal Medicine, Seoul National University College of Medicine, Korea
  • 2Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Korea
  • 3Division of Endocrinology and Metabolism, Department of Internal Medicine, Korea University Guro Hospital, Seoul, Korea
  • 4Division of Nephrology, Department of Internal Medicine, Chungnam National University Hospital, Chungnam National University College of Medicine, Daejeon, Korea
  • 5Division of Cardiology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Korea
  • 6Cardiovascular Division, Department of Internal Medicine, Hallym University Kangnam Sacred Heart Hospital, Seoul, Korea
  • 7Division of Cardiology, Department of Internal Medicine, National Health Insurance Service Ilsan Hospital, Goyang, Korea
  • 8Medical Affairs, Sanofi-Aventis Korea, Seoul, Korea
  • 9Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Korea

Abstract

Background
This study assessed the proportion of risk-stratified Korean patients with dyslipidemia achieving their low-density lipoprotein cholesterol (LDL-C) targets as defined by the European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) (2011) guidelines while receiving lipid-modifying treatments (LMTs).
Methods
In this multicenter, cross-sectional, observational study, we evaluated data from Korean patients aged ≥19 years who were receiving LMTs for ≥3 months and had an LDL-C value within the previous 12 months on the same LMT. Data were collected for demographics, cardiovascular (CV) risk factors, medical history, and healthcare consumption. Patients were risk-stratified according to the ESC Systematic COronary Risk Evaluation (SCORE) chart and LDL-C target achievement rate was assessed.
Results
Guideline-based risk-stratification of the 1,034 patients showed the majority (72.2%) to be in the very high-risk category. Investigators’ assessment of risk was underestimated in 71.6% compared to ESC/EAS guidelines. Overall LDL-C target achievement rate was 44.3%; target achievement was the highest (66.0%) in moderate-risk patients and the lowest (39.0%) in very high-risk patients. Overall 97.1% patients were receiving statin therapy, mostly as a single-agent (89.2%). High-intensity statins and the highest permissible dose of high-intensity statins had been prescribed to only 9.1% and 7.3% patients in the very high-risk group, respectively. Physician satisfaction with patients’ LDL-C levels was the primary reason for non-intensification of statin therapy.
Conclusion
Achievement of target LDL-C level is suboptimal in Korean patients with dyslipidemia, especially in those at very high-risk of CV events. Current practices in LMTs need to be improved based on precise CV risk evaluation posed by dyslipidemia.

Keyword

Dyslipidemias; Cholesterol, LDL; Hydroxymethylglutaryl-CoA reductase inhibitors; Practice guideline; Risk assessment; Korea

Figure

  • Fig. 1 (A) Comparison of risk stratification according to European Society of Cardiology (ESC) Systematic COronary Risk Evaluation (SCORE) chart [27] and physician judgement. (B) The matching pattern of physician judgement for risk stratification compared to ESC/European Atherosclerosis Society (EAS) 2011 guidelines. Physician assessment overestimated and underestimated were defined as the physician’s risk assessment was higher and lower than the risk of the patients according to ESC/EAS guideline, respectively.

  • Fig. 2 Target low-density lipoprotein cholesterol achievement according to cardiovascular risk strata. Error bars represent 95% confidence intervals.


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Soo Jin Yun, In-Kyung Jeong, Jin-Hye Cha, Juneyoung Lee, Ho Chan Cho, Sung Hee Choi, SungWan Chun, Hyun Jeong Jeon, Ho-Cheol Kang, Sang Soo Kim, Seung-Hyun Ko, Gwanpyo Koh, Su Kyoung Kwon, Jae Hyuk Lee, Min Kyong Moon, Junghyun Noh, Cheol-Young Park, Sungrae Kim
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