Missed opportunity in the treatment of hyperlipidemia in patients with coronary heart disease: The primary care setting

Background: Multiple clinical trials have established the benefits of controlling hyperlipidemia in patients with coronary heart disease (CHD). Nonetheless, many patients still remain untreated or not at goal low-density lipoprotein (LDL). There is limited data concerning the control of this risk factor in CHD patients in the primary care outpatient setting. Methods: We evaluated the treatment of hyperlipidemia in the main primary care clinics of an academic, urban hospital. We identified 147 patients in a one-month period with a diagnosis of CHD and assessed the frequency of lipid-lowering therapy as well as the number of patients with LDL values that were at goal according to the National Cholesterol Education Program (NCEP) guidelines. Results: A large proportion of patients were minorities and of low income, with 91.8% being African-American and 54.4% female. Although the frequency of statin therapy was relatively high (74.8%), only 55 patients (45.8%) were at goal LDL: < 100 mg/dl. The mean dose of statin prescribed (primarily simvastatin) was 33.3 +/- 17.1 mg. Only seven patients (6.5%) were on the maximum statin dose of 80 mg. Conclusions: These data show that while the frequency of lipid-lowering therapy in CHD patients in the primary care outpatient setting is relatively high, there remains a treatment gap. Specific areas for improvement are the initiation of higher doses of statins and more aggressive statin titration. The primary care outpatient setting may represent an ideal opportunity to improve control of hyperlipidemia in CHID patients.