Management of dyslipidemia in primary care

BACKGROUND: Cardiovascular disease remains the leading cause of mortality in Canada. The link between hyperlipidemia and coronary heart disease has been clearly established. There is overwhelming evidence for reductions in coronary events and cardiovascular mortality with towering of low-density lipoprotein cholesterol (LDL-C). Despite the evidence, hyperlipidemia treatment remains suboptimal. OBJECTIVE: To evaluate compliance with published dyslipidemia guidelines in a primary care setting. The primary outcome measure was target LDL-C level. METHODS: Retrospective chart review of a random selection of 300 patients diagnosed with hyperlipidemia in a large academic family medicine clinic. The primary outcome measure was a target LDL-C level of less than 2.5 mmol/L for patients with diabetes or coronary heart disease. For patients without diabetes or coronary heart disease, Framingham risk assessment tables were used to determine ideal target LDL-C levels. RESULTS: Overall, 53% of patients achieved target LDL-C. Target LDL-C levels were achieved in 48% of patients with diabetes or coronary heart disease. Mates were twice as likely to be prescribed lipid lowering therapy than females. Males on lipid lowering therapy were twice as likely as females on lipid lowering therapy to achieve target LDL-C levels. Males with diabetes or coronary heart disease were twice as likely as females with diabetes or coronary heart disease to achieve target LDL-C levels. Only 44% of patients with diabetes or coronary heart disease were prescribed lipid lowering therapy. CONCLUSION: Results from an academic family medicine clinic indicate suboptimal compliance with current dyslipidemia management guidelines. Primary care physicians need to continue to take an aggressive stance on lipid lowering strategies, especially in high-risk patients and females.