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Adherence of hospital-based cardiologists to lipid guidelines in patients at high risk for cardiovascular events (2L registry)

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Abstract

Objectives

According to various national and international guidelines, the target LDL-C level is <100 mg/dl for patients with established coronary heart disease (CHD) or CHD risk equivalent (CE). We aimed to investigate aspects of the lipid-lowering management of patients at high cardiovascular risk in-hospital care and the achievement of target values.

Methods

In the internet-based 2L registry in Germany (2005–2006), cardiologists in 42 hospitals documented at a single visit 3,131 consecutive patients with known CHD, and/or diabetes mellitus, peripheral arterial disease, or a 10-year CHD risk >20% (summarized as CE), who were on chronic statin treatment. They received instructions on the guidelines and instant feedback on the effect of their treatment decisions (educational study component).

Results

The three groups comprised 1,458 patients with CHD + CE (46.6%; median LDL-C 107 mg/dl), 1,104 patients with CHD only (35.3%; median LDL-C 104 mg/dl), and 569 with CE only (18.2%; median LDL-C 111 mg/dl). At admission, LDL-C levels <100 mg/dl were observed in 43.1, 44.8 and 37.9% of patients in the three groups, respectively. Statin doses at admission were usually in the low to intermediate range (e.g., simvastatin 10–20 mg/day). Cardiologists switched to another statin in 14.6%, increased the dose of statins (if same drug) in 22.9% (mean increase from 26.8 mg/day at baseline to 31.6 mg/day) and/or added a cholesterol absorption inhibitor (CAI) in 11.6%. The cardiologists’ intervention improved estimated LDL-C levels (using a lipid calculator); however, the 100 mg/dl LDL-C target was only reached in 49.0, 48.5, and 42.9%.

Conclusions

When compared with earlier studies in the outpatient setting, the treatment to target for LDL-C of high-risk CHD patients has improved, but is not satisfactory.

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Acknowledgments

The registry was funded by MSD SHARP and DOHME GmbH, Haar and Essex Pharma GmbH, Munich, Germany.

Conflict of interest

C. Jannowitz and K. Bestehorn are employees of MSD Germany; B. Karmann is an employee of Essex Pharma, Germany. A. Gitt and J. Senges have received research grants from MSD and Essex Pharma Germany. The authors acknowledge the contribution of Prof. Dr. Pittrow, Institute for Clinical Pharmacology, to the interpretation of results.

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Authors and Affiliations

  1. Institut für Herzinfarktforschung Ludwigshafen an der Universität Heidelberg, Ludwigshafen, Germany

    Anselm K. Gitt, Claus Jünger & Jochen Senges

  2. Medical Department, MSD Sharp and Dohme GmbH, 85540, Haar, Germany

    Christina Jannowitz & Kurt Bestehorn

  3. Medical Department, Essex Pharma GmbH, Munich, Germany

    Barbara Karmann

  4. Institute for Clinical Pharmacology, Technical University, Dresden, Germany

    Kurt Bestehorn

Authors
  1. Anselm K. Gitt
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  2. Claus Jünger
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  3. Christina Jannowitz
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  4. Barbara Karmann
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  5. Jochen Senges
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  6. Kurt Bestehorn
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Correspondence to Kurt Bestehorn.

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Gitt, A.K., Jünger, C., Jannowitz, C. et al. Adherence of hospital-based cardiologists to lipid guidelines in patients at high risk for cardiovascular events (2L registry). Clin Res Cardiol 100, 277–287 (2011). https://doi.org/10.1007/s00392-010-0240-9

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  • DOI: https://doi.org/10.1007/s00392-010-0240-9

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