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8/15/2000

Lipid Levels Remain High Despite Therapy

Katherine M. Bennett

Reduction of low-density-lipoprotein cholesterol (LDL-C) levels to nationally recommended goals occurs in only two of five patients receiving lipid-lowering drugs, according to a national study of high-prescribing physicians and their patients.

Begun in 1996, the Lipid Treatment Assessment Project set out to determine whether patients with dyslipidemia who received lipid-lowering therapy actually achieved the LDL-C levels recommended by the National Cholesterol Education Program (NCEP). NCEP develops guidelines for treating patients' LDL-C levels in an effort to prevent coronary heart disease (CHD) and its complications. 

Frequent prescribers of lipid-lowering drugs provided the researchers with information and blood samples from 4,888 patients, ages 20 to 75 years, who had been following the same diet and drug therapy for at least three months. 

Despite therapy, only 38 percent of patients had LDL-C levels in the target ranges recommended by NCEP. Target levels were achieved by 68 percent of the patients without CHD and with one or no risk factor for development of the condition, compared with only 18 percent of patients with CHD. Researchers noted that substantial proportions of the patients with LDL-C levels not in the target ranges still had levels above the threshold for starting lipid-lowering therapy. 

Drug therapy was significantly more effective than diet in helping patients reach their LDL-C target ranges. Actual drug choice also made a difference. Compared with drug regimens not containing a statin such as simvastatin, statin therapy was more likely to successfully lower LDL-C levels in patients without CHD. Among patients with CHD, the drug choice did not matter. 

Although the researchers expected that their focus on high prescribers would produce inflated success rates for lipid-lowering therapy, the results suggest that a major problem exists in community practice. Namely, large percentages of patients with dyslipidemia are taking lipid-lowering drugs and not achieving desirable results. The researchers suggested more aggressive treatment, including greater reliance on statins and higher dosages of all lipid-lowering drugs. 

The report appeared in the Feb. 28 issue of Archives of Internal Medicine. To read the article, go to archinte.ama-assn.org/issues/v160n4/pdf/ioi90070.pdf (PDF).