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Are patients with hyperlipidemia undertreated?

Study of patients admitted to hospital with coronary events

Wendy M. Fallis, RN PhD
Director of the Clinical Institute of Applied Research and Education at Victoria General Hospital and an Adjunct Professor in the Faculty of Nursing at the University of Manitoba

Xiqui Wang, PhD PStat (SSC)
Associate Professor of Statistics at the University of Manitoba

Yanqing Yi, MSc
Doctoral student in statistics

Correspondence to: Dr Alan H. Lipson, Victoria General Hospital, 2340 Pembina Highway, Winnipeg, MB R3T 2E8; telephone 204 477–3217; fax 204 275–5100; e-mail alipson{at}vgh.mb.ca

OBJECTIVE To identify patients admitted to hospital with coronary events and to estimate their pre-admission coronary risk, including their lipid levels. Despite the available data and numerous guidelines, evidence indicates that many patients with hyperlipidemia are undertreated and are not achieving target lipid levels.

DESIGN Retrospective chart review.

SETTING Acute care community hospital in Winnipeg, Man.

PARTICIPANTS A total of 153 patients who were diagnosed with acute myocardial infarction, unstable angina, or acute coronary syndrome upon admission.

METHOD Each patient’s 10-year risk of developing coronary artery disease was calculated, and his or her risk status was established. Each patient’s low-density lipoprotein cholesterol (LDL-C) levels were recorded and categorized based on current Canadian guidelines.

RESULTS Mean age of patients was 67.6 years; 60.8% were male. Patients in the low-risk category had a mean LDL-C level of 2.98 mmol/L (95% confidence interval [CI] 2.66 to 3.29), and patients in the moderate-risk category had a mean LDL-C level of 3.01 mmol/L (95% CI 2.74 to 3.28), both significantly lower (P < .05) than the LDL-C target levels for patients in those risk categories according to Canadian guidelines. The mean LDL-C level for patients in the very high-risk category, however, was 2.53 mmol/L (95% CI 2.35 to 2.71), above the recommended goal. Almost half the patients (48.3%) in thevery high-risk category had LDL-C levels that exceeded the goal. Slightly more than 1 in 3 patients in the very high-risk category was reported to be taking lipid-lowering agents.

CONCLUSION Patients in the community who are at very high risk of havingcardiovascular events are undertreated with respect to attaining LDL-C target levels. These findings point to an opportunity to prevent patient morbidity and reduce the number of hospitalizations for cardiovascular events.