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
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