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|Main results||The prevalence rates of elevated LDL-C, low HDL-C, and elevated TG were 28.0% 10.3%, and 27.2%, respectively. The distribution of lipid disorders is shown in Figure 1.
Among patients meeting target LDL-C, those with high triglycerides and/or low HDL-C exhibited a significantly higher number of cardiovascular risk factors (1.83 vs 1.68, p<0.001).
This study suggests that pharmacological lipid-lowering treatment has finite effects on reaching dyslipidemia therapeutic targets in current practice within primary care. However, the strength of the demonstration is limited by the study design, which did not allow a centralized measurement of lipid parameters. This may have introduced an important bias due to interlaboratory variability in serum lipid measurements. In addition, no information was given about statin dosage and patient’s compliance, two elements that may have impacted the results.
Notwithstanding these reservations, the study shows that only half of treated patients (on statin and fibrate monotherapy in 70% and 24% of cases, respectively) attained recommended lipid targets. This proportion would obviously have been lower if, for example, the NCEP-ATP III guidelines,2 which define a 1.60 mg/dL target for LDL-C concentration in subjects with 0 to 1 additional risk factor had been used instead of French guidelines. The prevalence of elevated LDL-C remained relatively high and more than one third of patients presented with one component of atherogenic dyslipidemia (low HDL-C and elevated TG) or both.
Another finding was that among patients meeting target LDL-C, those with high TG and/or low HDL-C exhibited a significantly higher mean number of cardiovascular risk factors (1.83 vs 1.68, p<0.001). Diabetes and hypertension were independently associated with low HDL-C and/or high TG (p<0.0001 and p=0.03, respectively). This was not unexpected, as low HDL-C and high TG levels are commonly found in patients with the common (type 2) form of diabetes. In addition, glucose homeostasis disturbances, elevated blood pressure, low HDL-C, and elevated TG tend to cluster in people with the metabolic syndrome. As the prevalence of type 2 diabetes and metabolic syndrome has reached epidemic proportions worldwide, clinicians will be increasingly challenged by the complex lipid disorders linked to these two conditions.Results of this cross-sectional study indicate that much remains to be done to control lipid disorders even in already treated dyslipidemic patients in primary care. To reduce vascular morbidity and mortality in the years to come, more attention should be paid in current practice to attain all recommended targets for the three main atherogenic lipid fractions.