Preventive cardiology
Achieving Optimal Lipid Goals in Patients With Coronary Artery Disease

https://doi.org/10.1016/j.amjcard.2010.11.006Get rights and content

Guidelines for lipid-lowering therapy recommend intensive low-density lipoprotein (LDL) cholesterol lowering for patients with coronary artery disease. Previous studies have found that many high-risk patients are not achieving their LDL cholesterol goals, and many patients, despite being treated with lipid-lowering therapy, also have elevated triglycerides or low levels of high-density lipoprotein (HDL) cholesterol. To evaluate lipid goals in a “real world” clinical setting, the electronic medical records of 10,040 patients with coronary artery disease from a large cardiology subspecialty practice from September 2008 to September 2009 were reviewed. Overall, 79% of patients achieved an LDL cholesterol goal of <100 mg/dl, while only 35% achieved the more aggressive goal of <70 mg/dl. Non-HDL cholesterol goals of <130 and <100 mg/dl were achieved in 79% and 44% of patients, respectively. Only 69% achieved normal triglyceride levels, and only 63% of men and 56% of women achieved normal levels of HDL cholesterol. Women and younger men were less likely to achieve their lipid goals. In conclusion, most patients with coronary artery disease achieve the minimal LDL cholesterol goal of 100 mg/dl, but few achieve the more aggressive goals of <70 mg/dl. Many high-risk patients have elevated levels of triglycerides or low levels of HDL cholesterol despite treatment. Combination lipid-lowering therapy is used infrequently in practice. There exists a significant opportunity for physicians to more aggressively treat lipids to achieve the levels recommended by clinical guidelines.

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Methods

The study site was Cardiology Consultants of Philadelphia, a large cardiology subspecialty practice in the Philadelphia area. Using an electronic medical record, we identified 23,408 patients with histories of CAD who had been seen at 1 of our outpatient offices over a 12-month period from September 2008 to September 2009. Patients were excluded if they did not have a complete lipid profile in the electronic medical record flow sheet dated within the study period or within 6 months of their

Results

A total of 10,040 patients with CAD met the criteria for inclusion in the study. The clinical characteristics of the patients are listed in Table 1. Among patients prescribed ezetimibe, 88% were also taking statins, while the remaining 12% were treated with ezetimibe alone. Among patients prescribed fibrates, 61% were taking fenofibrate, 23% fenofibric acid, and 16% gemfibrozil.

Overall, 79% of patients achieved the LDL cholesterol goal of <100 mg/dl, while only 35% achieved the lower LDL

Discussion

Since the National Cholesterol Education Program update published in 2004,9 overall LDL goal achievement has improved. The results of our study demonstrate that most patients with CAD are achieving the minimal National Cholesterol Education Program LDL cholesterol goals,10 but few patients in clinical practice are achieving the more aggressive LDL cholesterol goal of <70 mg/dl. Similarly, few are achieving the non-HDL cholesterol goal of <100 mg/dl.

In the recently published Lipid Treatment

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