Things we knew, things we did… Things we have learnt, things we should do LIPID MANAGEMENT IN...

Things we knew, things we did… Things we have learnt, things we should do

LIPID MANAGEMENT IN PRIMARY CARE: HOW WELL DO WE DO?

Dr. Carlos BrotonsResearch Unit

Sardenya Primary Health Care CenterBarcelona- Spain

International Congress of Medicine for Everyday Practice


50%

SBPSBP >115 mm >115 mm

HgHg

31%

Cholesterol>4.5 mmol/L

World Health Report 2002; available at: http://www.who.int/whr/2002/en/

Joint effects of risk factors on CVD risk burden worldwide

CVD = cardiovascular disease

Tobacco 14%


• 45% OF MI IN WESTERN EUROPE AND 35% OF MI IN CENTRAL AND EASTERN EUROPE ARE DUE TO ABNORMAL LIPIDS

• PATIENTS WITH ABNORMAL LIPIDS ARE AT OVER THREE TIMES THE RISK OF MI COMPARED TO THOSE WITH NORMAL LIPIDS


Efficacy and safety of cholesterol-lowering treatment:prospective meta-analysis of data from 90056 participantsin 14 randomised trials of statins

Cholesterol Treatment Trialists’ (CTT) Collaborators*Lancet 2005; 366;1267-78

Things we knew, things we did… Things we have learnt, things we should do Shalev V, et al. Arch Intern Med 2009;169:260–8

229,918 patients enrolled in a HMO in Israel Initiated statins for primary and secondary prevention of CVD

in 1998 through 2006PDC with statin was recordedFollow-up means 4–5 yrsPrimary outcome: total mortality

PDC = proportion of days covered


Primary prevention: mortality reduction versus PDC With statin1.6

1.2

1.0

0.8

0

Haz

ard

Rat

io

Any follow-upFollow-up >1 yearFollow-up >5 year

<10[Ref]

1.4

0.6

0.4

0.210–19

19–29

30–39

40–49

50–59

60–69

70–79

80–89

≥90

Shalev V, et al. Arch Intern Med. 2009;169:260–8

PDC with statins (%)


Mortality reduction with statins in the ‘real world’

When comparing statin PDC >90% versus PDC <10%, there was a 40–50% reduction in mortality in primary and secondary prevention groups

Benefits in ‘real world’ clinical practice exceed those seen in clinical trials

Emphasises the importance of promoting statin therapy to a wider group of at risk people and the need to continued therapy

Shalev V, et al. Arch Intern Med. 2009;169:260–8


Cardioprotective drug treatment across the EUROASPIRE surveys

Patients with CHD EUROASPIRE I (%) EUROASPIRE II (%)

EUROASPIRE III (%)

Antiplatelet therapies 80.8 83.6 93.2

Beta blockers 56.0 69.0 85.5 BPlowering drugs 84.5 90.6 96.8 All lipid-lowering drugs 32.2 62.7 88.8 Kotseva K, Lancet 2009; 373: 929-940.


Proportion of patients attaining LDL-C target levels in each country.

Waters DD, et al Circulation 2009;120:28-34


Proportion of patients attaining LDL-C target levels in each country according to risk group.

Waters DD, et al Circulation 2009;120:28-34


Prevalence of ATP III Risk Categories and Lipid lowering treatment in the United Sates

(NHANES, 1999-2006)

0

10

20

30

40

50

60

70

1999-2000 2001-2002 2003-2004 2005-2006

High Risk

IntermediateRisk

Low Risk

Using lipid-lowering drug

Kuklina, E. V. et al. JAMA 2009;302:2104-2110


Trends in High Levels of LDL-C in the United States(NHANES, 1999-2006)

0

5

10

15

20

25

30

35

1999-2000 2001-2002 2003-2004 2005-2006

Total

Eligible forTLC

Eligible fordrug(receiving)

Eligible fordrug (Notreceiving)



Trends in Mean Levels of LDL-C levels in the United Sates

(NHANES, 1999-2006)

108

110

112

114

116

118

120

122

124

126

128

1999-2000 2001-2002 2003-2004 2005-2006

Mean levels



CONCLUSIONS

65% of CV risk can be attributed to the joint effects of high blood pressure, dislipidemia and tobacco.

About 40% of MI in Europe are due to abnormal blood lipids

Statins use is associated with large reductions in the risk of major CV events

Lipid lowering therapy is being applied now much successfully although there is room for improvement

Mean LDL-c levels is decreasing at population level

S


Questions? ~ Answers!



¿Cuestiones? ~ ¡Respuestas!


Things we knew, things we did… Things we have learnt, things we should do LIPID MANAGEMENT IN...

Documents

Transcript of Things we knew, things we did… Things we have learnt, things we should do LIPID MANAGEMENT IN...