Abstract 15149: Achievement of NCEP-Recommended Lipid Goals in Patients with Dyslipidemia: Insights From the NCDR PINNACLE Registry
Background: Epidemiologic studies have found that nonHDL cholesterol (nonHDL-C) is a superior marker for coronary heart disease risk (CHD) compared to low-density lipoprotein cholesterol (LDL-C). The National Cholesterol Education Program (NCEP) recommends a secondary nonHDL goal 30 mg/dL above LDL-C goal. Little is known about whether or not nonHDL-C and LDL-C goals are being achieved in real world practice.
Objective: To determine rates of attainment of NCEP lipid goals within the NCDR's outpatient PINNACLE Registry.
Methods: Patients enrolled in PINNACLE from 7/1/2008 to 12/31/10 with at least 1 fasting lipid panel and a diagnosis of dyslipidemia were identified. LDL-C and nonHDL-C goals were calculated for each patient using standard NCEP definitions. A hierarchical modified Poisson regression model was used to identify factors associated with attainment of LDL-C, nonHDL-C, and both goals.
Results: Of 576,787 patients enrolled in PINNACLE, 146,064 (25.3%) had a history of dyslipidemia and at least 1fasting lipid panel. Mean age was 66.6 ± 12.4 yrs, 58.1% were male and 89.3% were white. The prevalence rates of co-morbidities were DM 24.8%, CAD 65.7%, MI 21.5%, and stroke/TIA, 5.1%. Mean LDL-C was 93.2±38.5 mg/dL and nonHDL-C 120.6±43.6 mg/dL. LDL-C, nonHDL-C and both goals were achieved by 73%, 73.4%, and 68.9%, respectively. Patients with CHD or NCEP CHD risk equivalents were less likely to achieve them while use of both statins and non-statins were the best predictors of goal achievement.
Conclusions: In a large, outpatient cardiac registry, the majority of patients with dyslipidemia were at or below their LDL-C and nonHDL-C goals, and more than 2 in 3 achieved goals for both. Predictors of nonHDL-C goal attainment did not differ from those associated with LDL-C goal attainment, with lipid modifying therapy having the greatest impact on goal attainment. These data suggest current treatment patterns are equally successful in LDL-C and nonHDL-C goal attainment.
- © 2011 by American Heart Association, Inc.