Application in general practice of treatment guidelines for patients with dyslipidaemia: The RESPECT study

SummaryBackgroundScreening for and management of dyslipidaemia are crucial in primary and secondary prevention of cardiovascular disease. The impact on general practitioners (GP) of the 2005 French guidelines for hypercholesterolaemia has not been evaluated.AimsTo compare GP's estimation of cardiovascular risk with that from a theoretical calculation; to analyse the consequences of cardiovascular-risk estimation on the threshold of therapeutic intervention and the target low-density lipoprotein cholesterol (LDL-C) concentration; and to analyse patients’ awareness of their hypercholesterolaemia.MethodsThe RESPECT study was a transverse, multicentre, observational survey conducted between March 2006 and February 2007 by 1797 GP in France. Inclusion criteria were adults with primary hypercholesterolaemia who had not taken lipid-lowering drugs within the previous 6 months.ResultsOf the 5627 patients included (60.9% men; mean age±standard deviation 58.2±11.0 years; body mass index 27.2±4.1kg/m2; mean total cholesterol 2.68±0.37g/L; LDL-C 1.79±0.35g/L), 1963 (36.2%) had at least three cardiovascular risk factors. GP identified a high cardiovascular risk level in 40.8%, moderate risk in 45.8% and low risk in 13.4% of patients. These compared with calculated rates of 48, 23 and 29%, respectively (κ concordance 59.4%). For most patients (98.2%), GP defined the therapeutic target based on LDL-C concentration. The target LDL-C was significantly different when cardiovascular risk was estimated by GP versus that calculated theoretically. The higher the estimated risk level, the greater the rate of introduction of lipid-lowering drugs and the shorter the time to the next GP visit. Most patients considered themselves to be well or rather well informed about their cholesterol concentration (91.3%), the causes (64.3%) and consequences of cholesterol-induced diseases (83.7%), and the difference between ‘good’ and ‘bad’ cholesterol (57%). Most (81.5%) patients were aware of the benefits of lipid-lowering drugs on cardiovascular disease prevention; 95.8% considered adequate diet and compliance with pharmacological treatment to be very important.ConclusionRecent French guidelines for hypercholesterolaemia are used widely by GP in practice. They enable correct assessment of overall cardiovascular risk level, have an impact on the therapeutic threshold of intervention by physicians and improve patients’ awareness of the relevance of cholesterol concentration

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Assessment of lipid-lowering treatment in France - The CEPHEUS study

Objective. - Most evidence-based practice guidelines identify tow-density lipoprotein cholesterol (LDL-C) as the primary target of cholesterol-towering therapy; the optimal LDL-C concentration is based on the patient's individual risk level. The aim of this study was to determine the proportion of patients on lipid-towering drugs who reach the LDL-C goals recommended in guidelines. Methods. - The CEPHEUS study was conducted in eight European countries in patients, who had been treated with lipid-towering drugs for at least three months, with no dose adjustment for a minimum of six weeks. In France, throughout 2006, 560 general practitioners enrolled 2222 patients into the study, 1966 of whom gave a fasting blood sample. Lipid and glucose parameters were measured centrally. Results. - Patients had been on treatment for a mean of 5.5 +/- 5.7 years. Most patients (90.4%) received a single lipid-lowering drug; 84.9% were treated with statins, and the second most frequently used lipid-lowering drugs were fibrates (13.7%). Among the treated subjects, 50% had LDL-C values >3.0 mmol/L, 30% had triglyceride values >11.7 mmol/L and 10% had HDL cholesterol values < 1.1 mmol/L. In high-risk patients, as defined by French guidelines, over 55% were above the recommended goal of 2.6 mmol/L. In the subgroup of high-risk patients who did not reach the goals, the LDL-C values were 0.7-1.4 mmol/L over the recommended concentration. Conclusion. - The results of this survey highlight the suboptimal management of hypercholesterolaemia in France, particularly in the high-risk population, in whom the percentage who achieved the LDL-C goals was the lowest. (c) 2008 Elsevier Masson SAS. All rights reserved