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Achieving Vascular Risk Factor Targets: A Survey of a London General Practice

Crouch Hall Road Surgery, Hornsey, United Kingdom, Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital, Royal Free, University College School of Medicine, University College London (University of London), London, United Kingdom

Dimitri P. Mikhailidis, MD, FASA, FRCP

Department of Clinical Biochemistry (Vascular Disease Prevention Clinics), Royal Free Hospital, Royal Free, University College School of Medicine, University College London (University of London), London, United Kingdom, MIKHAILIDIS{at}aol.com

Tessa Moross, MB, BCh, MRCGP

Crouch Hall Road Surgery, Hornsey, United Kingdom

Karen Benson, MB, BCh, MRCP, MRCGP

Crouch Hall Road Surgery, Hornsey, United Kingdom

Mayur Gor, MB, BCh, DRCOG

Crouch Hall Road Surgery, Hornsey, United Kingdom

We assessed lipid goal achievement in patients at high risk for vascular events from a general practice (London, United Kingdom). Patients were identified as those with a prescription for hypolipidaemic medication, a significant (>20%) Framingham risk, and from the myocardial infarction register. Two hundred forty-five patients were currently taking a statin (average dose, 23.1 mg/day). Cholesterol, high-density lipoprotein—cholesterol, low-density lipoprotein—cholesterol, and triglycerides changed significantly following statin treatment. Of 285 patients who had taken statins at some time point, 11 (3.9%) were intolerant, 5 of which subsequently tolerated another statin. Approximately 10.1% of patients discontinued statin treatment for unclear reasons. Only 64 patients (29.1% of 220) reached the Joint British Societies' Guidelines on Prevention of Cardiovascular Disease target of a total cholesterol of <4.0 mmol/L; 50 patients (38.8% of 129) reached the low-density lipoprotein—cholesterol target of <2.0 mmol/L. This value of low-density lipoprotein—cholesterol is similar to that recommended by the American Heart Association/American College of Cardiology. With regard to the General Medical Services guidelines target for total cholesterol, 162 (73.6% of 220) patients reached 5.0 mmol/L. The group that best achieved target cholesterol (Joint British Societies' Guidelines and General Medical Services) were those with comorbidities. In conclusion, while reaching General Medical Services targets was satisfactory, the percentage of patients reaching Joint British Societies' Guidelines targets was not. This discrepancy may reflect the presence of multiple guidelines. The current stricter lipid targets are difficult to achieve; possible methods that may be used to improve lipids further could involve using combination therapy, statin dose titration, and better education.

Key Words: cholesterol • ischemic heart disease • statin • intolerance • guidelines • primary care

Angiology, Vol. 59, No. 1, 36-46 (2008)
DOI: 10.1177/0003319707309538


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