Mixed dyslipidemia among patients using lipid-lowering therapy in French general practice: an observational study

Eric van Ganse , L. Laforest (1) , Thomas Burke , Hemant Phatak , Thierry Souchet

1 HESPER - Health Service and Performance Research

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C), and triglycerides (TGs) are associated with an increased incidence of coronary heart disease (CHD). However, limited data are available about the prevalence of dyslipidemias related to LDL-C, HDL-C, and TGs among French patients treated with lipid-lowering agents. OBJECTIVE: This paper describes the prevalence of various types of dyslipidemias among patients treated with lipid-lowering agents in French general practice. METHODS: This was a cross-sectional, observational study conducted using retrospective data collection at the time of enrollment. Eligible patients were those treated pharmacologically for dyslipidemia in the Cegedim Strategic Data general practice network. Fasting lipid values and cardiovascular (CV) risk factors were gathered by investigators using an ad hoc questionnaire. European guidelines were used to define various types of dyslipidemias. Polytomous logistic regression was used to assess the associations between different dyslipidemias and diabetes mellitus, a history of CHD, and the number of CV risk factors. RESULTS: A total of 946 patients had a complete lipid profile and valid data for determining CV risk status. The mean (SD) age of these patients was 64.0 (9.9) years, and 55.7% of the patients were men. At least 1 abnormality in LDL-C, HDL-C, or TGs was present in 791 (83.6 %) of the 946 patients. The rates of elevated LDL-C, low HDL-C, and elevated TGs were 73.2%, 16.9%, and 30.3%, respectively (these groups are not mutually exclusive). Among those who did not reach the LDL-C goal, 38.7% had dyslipidemias with low HDL-C, elevated TGs, or both. Compared with having a normal lipid profile, each additional CV risk factor increased the likelihood of the following types of dyslipidemias: low HDL-C and/or elevated TGs, but normal LDL-C (odds ratio [OR], 1.36; 95% CI, 1.03-1.79); elevated LDL-C and TGs, but normal HDL-C (OR, 1.58; 95% CI, 1.24-2.02); and all 3 lipid abnormalities (OR, 1.54; 95% CI, 1.10-2.14). Patients with diabetes had a similarly increased risk of mixed dyslipidemias, whereas patients with a history of CHD did not. CONCLUSIONS: Among these patients treated with lipid-lowering agents, 38.7% had mixed dyslipidemias, including low HDL-C, elevated TGs, both low HDL-C and elevated TGs, or all 3 lipid abnormalities. Patients with a greater number of nonlipid CV risk factors or with diabetes had a significantly increased risk of mixed dyslipidemias involving elevated TGs and/or low HDL-C in addition to elevated LDL-C.

Mots clés: Female; Humans; France; Male; Aged; Middle Aged; Risk Factors; Odds Ratio; Retrospective Studies; Triglycerides; Prevalence; Risk Assessment; Cardiovascular Diseases; Diabetes Mellitus; Dyslipidemia; LDL; Hypolipidemic Agents; Databases as Topic; Practice Guidelines as Topic; Cross-Sectional Studies; primary care; cholesterol; Dyslipidemias; Family Practice; HDL; HDL-C; high-density lipoprotein cholesterol; LDL-C; low-density lipoprotein; TGs

Domaines: Santé publique et épidémiologie

Eric van Ganse, L. Laforest, Thomas Burke, Hemant Phatak, Thierry Souchet. Mixed dyslipidemia among patients using lipid-lowering therapy in French general practice: an observational study. Clinical Therapeutics, 2007, 29 (8), pp.1671--1681. ⟨10.1016/j.clinthera.2007.08.003⟩. ⟨hal-01838998⟩