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A critical gap between recommended and achieved LDL-cholesterol levels. Results of statin therapy in Slovakia.

BACKGROUND
The achievement of low density lipoprotein cholesterol (LDL-C) target levels, as recommended by the evidence-based international guidelines, represents the crucial prerequisite for maximal cardiovascular risk reduction in patients with dyslipidemia.


OBJECTIVES
The efficacy of 3-hydroxy-3-methylglutaryl-coenzyme A reductase inhibitors (statins) monotherapy administered in ambulatory practice was evaluated in cooperation with 387 ambulatory specialists in Slovakia.


PATIENTS AND METHODS
Data of 5640 adult patients (21-88 years, 42.8% males) with low (7.4%), high (16.8%), and very high cardiovascular risks (75.7%), treated at least for 12 weeks with a stable statin dose were evaluated regarding the achievement of target LDL-C levels (< 4.2 mmol/L in low risk patients, < 3.4 mmol/L in high risk patients and < 2.6 mmol/L in very high risk patients).


RESULTS
The target levels were achieved in 74% of low risk patients (mean level of LDL-C 3.55 mmol/L), in 37.9% of high risk patients (3.7 mmol/L), and in 12.4% of very high risk patients (3.64 mmol/L). The proportion of received statins and their average daily doses were as follows: 64.3% simvastatin (22.5 mg); 21.3% atorvastatin (15.6 mg); 12.2% fluvastatin (69.7 mg); 1.5% pravastatin (19.4 mg), and 0.7% lovastatin (25.4 mg).


CONCLUSION
Statin therapy does not correspond with the current guidelines in common clinical practice. In patients with treated hypercholesterolemia the use of low doses of statins without titration seems to be the main reason of poor achieving of LDL-C target levels representing the critical values for reducing the atherosclerosis and its life-threatening complications (Tab. 3, Fig. 1, Ref 19). Full Text (Free, PDF) www.bmj.sk.