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Canadian Journal of Cardiology

Treatment and Low-Density Lipoprotein Cholesterol Management in Patients Diagnosed With Clinical Atherosclerotic Cardiovascular Disease in Alberta

      Abstract

      Background

      Low-density lipoprotein cholesterol (LDL-C) is an important indicator in the development and management of atherosclerotic cardiovascular disease (ASCVD). Herein, we describe the management of LDL-C with lipid-lowering therapy, among patients diagnosed with clinical ASCVD in Alberta, Canada.

      Methods

      A retrospective study was conducted by linking multiple health system databases to examine clinical characteristics, treatments, and LDL-C assessments. Patients with ASCVD were identified using a specific case definition on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification/International Statistical Classification of Diseases and Related Health Problems, 10th Revision, Canada codes between 2011 and 2015. LDL-C was assessed at the first measurement (index test) and second measurement (follow-up test) during the study period. LDL-C levels were evaluated on the basis of the 2016 Canadian Cardiovascular Society guideline recommendations for achieving < 2.0 mmol/L or a 50% reduction. Statin therapies were categorized as low-, moderate-, and high-intensity.

      Results

      Among the 281,665 individuals identified with ASCVD during the study period, 219,488 (77.9%) had an index LDL-C test, whereas 120,906 (55.1%) and 144,607 (65.9%) were prescribed lipid-lowering therapy before and after their index test, respectively. Most patients who received any lipid-lowering therapy were receiving moderate-/high-intensity statins (n = 133,029; 60.6%). Among the study cohort who had 2 LDL-C tests (n = 91,841; 32.6%), 48.5% of patients who received any lipid-lowering therapy did not achieve LDL-C levels < 2.0 at index date, whereas 36.6% did not achieve LDL-C levels < 2.0 or a 50% reduction at the follow-up test.

      Conclusions

      The current study revealed that only two-thirds of patients with ASCVD were receiving pharmacotherapy and of those, a significant proportion did not reach recommended LDL-C levels. A remarkable treatment gap was identified for at-risk ASCVD patients. Further implementation strategies are required to address this undermanagement.

      Résumé

      Introduction

      Le cholestérol à lipoprotéines de faible densité (cholestérol LDL) est un indicateur important du développement et de la prise en charge de la maladie cardiovasculaire athérosclérotique (MCVAS). Par la présente, nous décrivons la prise en charge du cholestérol LDL à l’aide d’un traitement hypolipémiant chez les patients de l’Alberta, au Canada, qui ont reçu un diagnostic clinique de MCVAS.

      Méthodes

      Nous avons réalisé une étude rétrospective en procédant au couplage des multiples bases de données du système de santé pour examiner les caractéristiques cliniques, les traitements et les évaluations du cholestérol LDL. Nous avons repéré les patients ayant une MCVAS grâce à une définition particulière de cas selon la Classification internationale des maladies, 9e révision, modification clinique, et la Classification statistique internationale des maladies et des problèmes de santé connexes, 10e révision, adaptation canadienne, entre 2011 et 2015. Nous avons évalué les taux de cholestérol LDL à la première mesure (analyse de référence) et à la deuxième mesure (analyse de suivi) durant la période étudiée. Nous avons évalué les taux de cholestérol LDL en nous basant sur les recommandations des lignes directrices de la Société canadienne de cardiologie de 2016 en vue d’obtenir des concentrations < 2,0 mmol/l ou une réduction de 50 %. Nous avons regroupé les traitements par statines en catégories d’intensité, c’est-à-dire faible, modérée et élevée.

      Résultats

      Parmi les 281 665 individus considérés atteints de la MCVAS durant la période étudiée, 219 488 (77,9 %) avaient une analyse de référence de cholestérol LDL, alors que 120 906 (55,1 %) et 144 607 (65,9 %) se faisaient prescrire respectivement avant et après leur analyse de référence un traitement hypolipémiant. La plupart des patients qui ne recevaient aucun traitement hypolipémiant recevaient des statines d’intensité modérée ou élevée (n = 133 029; 60,6 %). Parmi la cohorte étudiée qui subissait 2 analyses de cholestérol LDL (n = 91 841; 32,6 %), 48,5 % des patients qui ne recevaient aucun traitement hypolipémiant ne parvenaient pas à obtenir des concentrations de cholestérol LDL < 2,0 à la date de référence, alors que 36,6 % ne parvenaient pas à obtenir des concentrations de cholestérol LDL < 2,0 ou une réduction de 50 % à l’analyse de suivi.

      Conclusions

      La présente étude a révélé que seuls les deux tiers des patients atteints de MCVAS recevaient une pharmacothérapie et, parmi ces derniers, une proportion importante ne parvenait pas à obtenir les concentrations de cholestérol LDL recommandées. Nous avons noté des écarts de traitement considérables entre les patients exposés au risque de MCVAS. D’autres stratégies de mise en œuvre sont requises pour remédier à cette prise en charge inadéquate.
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