Via practica 5/2015

Reach target LDL cholesterol more effective dose of atorvastatin 30 mg in the practice of general practitioners

Introduction: Dyslipidemia is one of the most important risk factors for cardiovascular events. Its diagnostics and treatment is done by general practitioners and specialists. Despite existence of effective and safe treatment with statins, many patients in Slovakia do not reach target values for LDL cholesterol (LDL-C). Aim of this study was to identify patients with dyslipidemia treated by general practitioners, who did not reach target values on treatment with atorvastatin (ATST) 20mg and try to achieve decrease of LDL-C by increase of dose ATST to 30mg. Methods:Project was conducted as prospective non-randomized open-label study lasting 3 months. Included were 237 patients (117 men and 120 women aged 20-83 years), who did not reach target LDL-C values on treatment by ATST 20mg. Patients‘ dose of ATST was increased to 30mg and patients were educated on importance of adherence to non-pharmacological and pharmacological hypolipidemic treatment. After 3 months on follow-up visit lipid levels were measured. Project was supported by research grant from KRKA company. Results:Before change of treatment mean value of total cholesterol (TOT-C) was 6.94 ± 1.20 mmol/l, LDL-C was 4.34 ± 1.14 mmol/l, nonHDL cholesterol (nonHDL-C) was 5.59 ± 1.28 mmol/l, HDL cholesterol (HDL-C) was 1.34 ± 0.40 mmol/l. Target values before change of treatment for TOT-C reached 2.5% of patients, for LDL-C 9.3% of patients, for nonHDL-C 5.6% of patients and for HDL-C 46.3% of patients. Three months after change of treatment we observed significant improvement of lipid values: decreased TOT-C by 1.58 ± 1.01 mmol/l, LDL-C by 1.16 ± 0.88 mmol/l, nonHDL-C by 1.68 ± 1.07 mmol/l and increased HDL-C by 0.10 ± 0.34 mmol/l (all p<0.001). This related to significant increase of proportion of patients, who reached target lipid values: TOT-C by 33.1% of patients, LDL-C by 32.8% of patients, nonHDL-C by 38.7% of patients and HDLC by 38.7% of patients (all p<0.001). Conclusion:In our group of patients despite widely used treatment by ATST 20mg more than 90% patients did not reach target values for TOT-C, LDL-C and nonHDL-C. After increasing of dose of ATST from 20mg to 30mg and education of patients 42.1% of patients reached target LDL-C values. On the other hand, 57.9% of patients in the group did not reach target values for LDL-C; in these patients further change of treatment is needed in cooperation of general practitioner and specialist (internist, cardiologist, diabetologist).

Keywords: dyslipidemia, atorvastatin, general practitioner.