Objective: To examine recommended target levels of low-density lipoprotein cholesterol (LDL-C) for hyperlipidaemia patients at high risk (i.e., with two or more risk factors or coronary heart disease or its risk equivalents) for cardiovascular disease (CVD); to determine the proportions of patients who do not achieve targeted LDL-C levels in real-world setting studies.
Methods: A targeted literature review identified guidelines and real-world studies that analysed hyperlipidaemia patients who were not at goal (as defined by study). MEDLINE, Embase, the Cochrane Library, and BIOSIS databases were searched. Guideline publications were searched from 2008; observational studies were searched from January 2005 to December 2013. There were no language or geographical restrictions.
Results: 17 guidelines and 70 observational studies were included in the review. While country-specific guideline recommendations vary slightly, the commonly used European Atherosclerosis Society and European Society of Cardiology (EAS/ESC) guidelines recommend a LDL-C target of less than 2.5 mmol/L for patients with high CVD risk. Most studies reported that between 61.8% and 95.4% of high-risk patients did not reach this target. 3 studies from North America reported lower proportions, between 18.9% and 42.3%. The EAS/ESC guidelines recommend a LDL-C target of less than 1.8 mmol/L for patients with very high CVD risk. Studies reported that 68.1% to 96.0% of patients do not achieve this goal.
Conclusion: Patients in higher cardiovascular-risk categories tend to have more stringent LDL-C target levels, which may contribute to failure to achieve target levels. This suggests several unmet needs: large numbers of patients who fail to achieve LDL-C targets, reducing the patients’ risk for CVD, and consequently reduce the occurrence of cardiovascular events. Based on recently published American College of Cardiology and American Heart Association guidelines, which do not recommend a treatment target LDL-C level, further research is needed to re-evaluate the unmet need in hyperlipidaemia patients.
