Yang-Feng Wu1. 1. Peking University School of Public Health, Beijing, China. wuyf@bjmu.edu.cn
Abstract
OBJECTIVE: To assess the current status in dyslipidemia management in China. METHODS: We recruited 2306 patients who received lipid-lowering drugs between January 1, 2004 and February 28, 2006, and maintained on the treatment for at least 2 months, from 21 provincial level hospitals and 6 prefecture and country level hospitals. The goal attainment rate was defined as the percentage of patients reaching cholesterol goals recommended by the updated Adult Treatment Panel III (ATPIII) of the National Cholesterol Education Program and the new Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. RESULTS: (1) Among 2094 patients who met guidelines' criteria for initiating drug therapy, there were 80% patients treated in provincial level hospitals, 60% aged 60 years and above, 57% hyperlipidemia, 15% with normal lipids values, 68% coronary heart disease and other atherosclerotic diseases, 75% hypertensive, 80% high or very high risk patients, 84% statin-users and 83% referred to diet change. (2) According to ATPIII 2004, overall 34% patients attained the LDL-C goal. The goal attainment rates was 85%, 78%, 61%, 31% and 22% for patients at low risk, moderate, moderate high, high and very high risk respectively (P for trends < 0.001). According to the new Chinese guidelines, the goal attainment rate was 50% for overall patients and was 91%, 77%, 49% and 38% for patients at low risk, moderate, high and very high risk respectively (P for trend < 0.001). (3) The goal attainment rate was 51% for patients using combination therapy, 35% for those using statins, 23% for those using fibrates, 24% for those using niacin, 28% for those using other lipid-lowering medications (P < 0.001). (4) Among 1808 patients treated with statins, a multi-variable Logistic regression analysis showed that the dosage of statins (high vs. low dose, OR = 1.72, 95% CI: 1.15 - 2.58), risk of patients (very high vs. low risk, OR = 0.02, 95% CI: 0.01 - 0.03), baseline LDL-C [every 0.259 mmol/L (10 mg/dl) increase, OR = 0.83, 95% CI: 0.80 - 0.86] and sex (women vs. men, OR = 0.77, 95% CI: 0.60 - 0.99) were major factors that affected goal attainment. CONCLUSIONS: The characteristics of target patients taking lipid-lowering drugs have changed significantly in China and were used not only for lipid lowering but also for other purposes, which is well in accordance with current guidelines. However, current clinical management of dyslipidemia in China is still far behind the desirable goals derived both Chinese guidelines and the updated ATPIII guidelines, especially for high and very high risk patients. To further improve the clinical management of dyslipidemia, it is necessary to strengthen the choice of drugs and dosage, new drug development to allow better and safer combination therapy, intensive therapeutic lifestyle changes, patient health education, etc.
OBJECTIVE: To assess the current status in dyslipidemia management in China. METHODS: We recruited 2306 patients who received lipid-lowering drugs between January 1, 2004 and February 28, 2006, and maintained on the treatment for at least 2 months, from 21 provincial level hospitals and 6 prefecture and country level hospitals. The goal attainment rate was defined as the percentage of patients reaching cholesterol goals recommended by the updated Adult Treatment Panel III (ATPIII) of the National Cholesterol Education Program and the new Chinese Guidelines on Prevention and Treatment of Dyslipidemia in Adults. RESULTS: (1) Among 2094 patients who met guidelines' criteria for initiating drug therapy, there were 80% patients treated in provincial level hospitals, 60% aged 60 years and above, 57% hyperlipidemia, 15% with normal lipids values, 68% coronary heart disease and other atherosclerotic diseases, 75% hypertensive, 80% high or very high risk patients, 84% statin-users and 83% referred to diet change. (2) According to ATPIII 2004, overall 34% patients attained the LDL-C goal. The goal attainment rates was 85%, 78%, 61%, 31% and 22% for patients at low risk, moderate, moderate high, high and very high risk respectively (P for trends < 0.001). According to the new Chinese guidelines, the goal attainment rate was 50% for overall patients and was 91%, 77%, 49% and 38% for patients at low risk, moderate, high and very high risk respectively (P for trend < 0.001). (3) The goal attainment rate was 51% for patients using combination therapy, 35% for those using statins, 23% for those using fibrates, 24% for those using niacin, 28% for those using other lipid-lowering medications (P < 0.001). (4) Among 1808 patients treated with statins, a multi-variable Logistic regression analysis showed that the dosage of statins (high vs. low dose, OR = 1.72, 95% CI: 1.15 - 2.58), risk of patients (very high vs. low risk, OR = 0.02, 95% CI: 0.01 - 0.03), baseline LDL-C [every 0.259 mmol/L (10 mg/dl) increase, OR = 0.83, 95% CI: 0.80 - 0.86] and sex (women vs. men, OR = 0.77, 95% CI: 0.60 - 0.99) were major factors that affected goal attainment. CONCLUSIONS: The characteristics of target patients taking lipid-lowering drugs have changed significantly in China and were used not only for lipid lowering but also for other purposes, which is well in accordance with current guidelines. However, current clinical management of dyslipidemia in China is still far behind the desirable goals derived both Chinese guidelines and the updated ATPIII guidelines, especially for high and very high risk patients. To further improve the clinical management of dyslipidemia, it is necessary to strengthen the choice of drugs and dosage, new drug development to allow better and safer combination therapy, intensive therapeutic lifestyle changes, patient health education, etc.