Abstract 4997: Longitudinal Assessment of Dyslipidemia & Treatment Patterns Among Patients Treated with Lipid Modfying Therapy in US Clinical Practice
Low density lipoprotein cholesterol (LDL-C) reduction remains the primary dyslipidemia treatment objective. High density lipoprotein cholesterol (HDL-C) and triglycerides (TG) are coronary heart disease (CHD) risk factors and treatment targets for certain sub-populations. The extent to which these targets are addressed in clinical settings has not been reported. We documented treatment patterns and the extent to which attainment of target/recommended lipid levels is achieved among users of lipid modifying therapy (LMT) in a cohort of managed care patients. Using electronic medical record from Kaiser Permanente Northwest, we identified 5,158 members age 35+ who initiated a LMT between July 2004 and June 2006, continued treatment for ≥ 1 year, and had a complete lipid panel (LDL-C, HDL-C and TG) prior to and between 9–15 months post therapy. High risk populations (history of CHD, 10 year CHD risk>20%) and equivalents (diabetes) were established based on diagnoses. Outcomes of interest were LMT dispensing records during the 1-year period post therapy and lipid levels. LDL-C treatment targets (by risk group) and recommended levels for TG (< 200 mg/dL) and HDL-C (>40mg/dL for men and >50mg/dL for women) were defined according to National guidelines (updated NCEP ATP III & ADA/AHA). Pre therapy, 77%, 34% and 49% of patients had elevated LDL-C, TG and low HDL-C respectively, while 14% had HDL-C and/or TG abnormality despite having LDL-C at goal. Nearly all patients (96%) initiated statin monotherapy; only 4% received other therapy in the overall and high risk groups. Treatment patterns suggested primarily LDL-C oriented management (e.g. statin titration). Post therapy, 78% of patients achieved LDL-C goal. However, 20% (22% among high risk) had elevated TG levels, 50% (59% among high risk) remained below recommended HDL-C levels while, 43% (46% among high risk) exhibited HDL-C and/or TG abnormality despite having LDL-C at goal. In this longitudinal study, patients initiating LMT largely remain treated with statins (96%). As a consequence up to 78% of patients typically achieve LDL-C goals, but about 50% patients experience persistent HDL-C and/or TG abnormality even when their LDL-C levels are at goal.