eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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SCImago Journal & Country Rank
4/2012
vol. 8
 
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abstract:

Editorial
Lipid-lowering therapies and achievement of LDL-cholesterol targets

Manfredi Rizzo
,
Maciej Banach
,
Giuseppe Montalto
,
Dimitri P. Mikhailidis

Arch Med Sci 2012; 8, 4: 598-600
Online publish date: 2012/09/08
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In the present issue of Archives of Medical Science, Mark et al. [1] report the results of a survey conducted last year in Hungary. This consisted of 1,626 adult patients with high cardiovascular (CV) risk, due to unstable angina (23%), peripheral artery disease (17%), previous myocardial infarction (34%), stroke (30%) or transient ischemic attack (17%). The main aim of the study was to assess the achievement of low density lipoprotein cholesterol (LDL-C) target levels, and to compare it with previous data from surveys performed by the same authors. The LDL-C target value in the present study was 2.6 mmol/l (100 mg/dl), in line with the recommendation of the Hungarian Cardiovascular Consensus Conference (2010) [2]; using this LDL-C target, the authors reported a 43.3% achievement rate. Furthermore, they noticed that the goal achievement rate was higher in patients followed by specialists (n = 1,152) vs. those followed by general practitioners (n = 474) (45% vs. 40%, respectively), but this difference did not reach significance [1].

The overall achievement rate was poor despite the high CV risk; this is a common problem in Europe and especially in Central and Eastern European countries [3]. As recently discussed [4], although the quality of lipid-lowering treatments has improved, in many European countries therapeutic inertia and a lack of sufficient knowledge regarding the best management of patients with lipid disorders remains an important problem [4, 5]. In addition, there is insufficient collaboration between specialists and primary care physicians [3-5]. We discuss potential problems of adherence to therapy in 3 different categories: patient-, prescriber- and drug-related factors.

Regarding patient-related factors, it is important to highlight the potential role of side effects and polypharmacy; indeed, patients at high CV risk usually need several drugs (e.g. anti-hypertensive, anti-diabetic and anti-platelet drugs). This was also true for the patients included in the Mark et al. study [1], where 46% had diabetes and 88% hypertension. Other patient-related factors include patient participation and understanding why the treatment is needed (awareness). This is linked to attendance and optimal frequency of follow-up visits [4-6].

Prescriber-related factors include the knowledge of LDL-C guideline targets, which have become more difficult to achieve over the years: this is a universal phenomenon that persisted...


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