Prevalence and management of dyslipidemia in primary care practices in Canada

Olivia Spohn; Rachael Morkem; Alexander G. Singer; David Barber

doi:10.46747/cfp.7003187

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Figure 1.
Flow chart for study population determination
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Figure 2.
Chart abstraction vs algorithm results

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Table 1.

Proportion of patients who met dyslipidemia case definition: N=773,081.

CASE DEFINITION^*	PATIENTS, n (%)
Criterion A • ICD-9 code 272	118,054 (15.27)
Criterion B • Laboratory test results: LDL-C ≥3.5 mmol/L OR total cholesterol to HDL-C ratio ≥4.3	302,566 (39.14)
Criterion C • Medication: lipid-modifying agent	190,062 (24.59)
Dyslipidemia case definition • Criterion A, B, or C	386,795 (50.03)

HDL-C—high-density lipoprotein cholesterol, LDL-C—low-density lipoprotein cholesterol.
↵* The dyslipidemia case definition (criterion A, B, or C) was validated by a full chart review. See supplementary material, available from CFPlus,* for detailed algorithm.

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Table 2.

Characteristics of patients with and without dyslipidemia and practice characteristics: Includes all patients who had at least 1 encounter at a participating practice in the 2-year study period.

CHARACTERISTIC	PATIENTS, n (%)			P VALUE^*
CHARACTERISTIC	ALL (N=773,081)	WITH DYSLIPIDEMIA	WITHOUT DYSLIPIDEMIA
Age, y
• 40-64	474,757 (61.41)	203,428 (42.85)	271,329 (57.15)		<.0001
• ≥65	298,324 (38.59)	183,367 (61.47)	114,957 (38.53)
Sex
• Female	429,622 (55.57)	192,225 (44.74)	237,397 (55.26)	<.0001
• Male	343,459 (44.43)	194,570 (56.65)	148,889 (43.35)
Practice location^{^†}
• Rural	121,028 (16.77)	54,732 (45.22)	66,296 (54.78)	<.0001
• Urban	600,572 (83.23)	300,513 (50.04)	300,059 (49.96)
BMI,^{^†} kg/m²
• <18 (underweight)	3041 (0.90)	1178 (38.74)	1863 (61.26)	<.0001
• 18-24 (normal)	66,214 (19.70)	27,932 (42.18)	38,282 (57.82)
• 25-29 (overweight)	121,205 (36.07)	70,301 (58.00)	50,904 (42.00)
• ≥30 (obese)	145,583 (43.32)	94,524 (64.93)	51,059 (35.07)
Smoking status^{^†}
• Current smoker	101,733 (23.88)	55,462 (54.52)	46,271 (45.48)	<.0001
• Past smoker	82,305 (19.32)	50,354 (61.18)	31,951 (38.82)
• Never smoker	146,133 (34.30)	76,079 (52.06)	70,054 (47.94)
• Not currently^{^‡}	95,863 (22.50)	52,091 (54.34)	43,772 (45.66)
Patients with diabetes	123,030 (15.91)	70,723 (57.48)	52,307 (42.52)	<.0001
Patients with hypertension	263,139 (34.04)	174,346 (66.26)	88,793 (33.74)	<.0001
No. of comorbid conditions
• 0	293,253 (37.93)	106,333 (36.26)	186,920 (63.74)	<.0001
• 1	238,978 (30.91)	125,716 (52.61)	113,262 (47.39)
• 2	138,583 (17.93)	86,163 (62.17)	52,420 (37.83)
• 3	66,249 (8.57)	44,133 (66.62)	22,116 (33.38)
• ≥4	36,018 (4.66)	24,450 (67.88)	11,568 (32.12)
Practice size
• Small (<1000)	170,141 (22.01)	82,129 (48.27)	88,012 (51.73)	.1085
• Medium (1000-1800)	285,508 (36.93)	149,387 (52.32)	136,121 (47.68)
• Large (≥1800)	317,432 (41.06)	155,279 (48.92)	162,153 (51.08)

BMI—body mass index.
↵* A ² test was used for categorical variables and a t test for continuous variables.
↵† Due to missing data, subgroup totals differ from group total.
↵‡ Not currently smoking, could be past smoker or never smoker.

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Table 3.

Status of LLA treatment among patients with documented dyslipidemia and those with other LLA-indicated conditions

CONDITION	TREATED, n (%)	UNTREATED, n (%)
Dyslipidemia	80,141 (32.48)	166,574 (67.52)
Diabetes mellitus
• Age ≥40	86,250 (70.10)	36,780 (29.90)
• Age ≥30 and 15-y duration	3923 (69.20)	1746 (30.80)
Chronic kidney disease	37,382 (63.21)	21,753 (36.79)
Cardiovascular disease	63,788 (71.76)	25,098 (28.24)
Abdominal aortic aneurysm	1300 (74.93)	435 (25.07)
Genetic dyslipidemia (LDL-C ≥5 mmol/L)	16,176 (61.00)	10,340 (39.00)

LDL-C—low-density lipoprotein cholesterol, LLA—lipid-lowering agent.

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Table 4.

Status of LLA treatment among patients with documented dyslipidemia, according to Framingham risk score

FRAMINGHAM RISK SCORE	TREATED, n (%)	UNTREATED, n (%)
Low	37,781 (22.81)	127,863 (77.19)
Intermediate	36,467 (48.73)	38,367 (51.27)
High	20,576 (65.04)	11,058 (34.96)
Missing data	51,448 (73.79)	18,276 (26.21)

LLA—lipid-lowering agent.

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Table 5.

Associations between patients’ demographic characteristics, patients’ clinical characteristics, and practice characteristics and the odds of receiving LLA treatment among those with documented dyslipidemia: Includes all patients who had at least 1 encounter at a participating practice in the 2-year study period and had documented dyslipidemia.

CHARACTERISTIC	UNADJUSTED ODDS RATIO			ADJUSTED ODDS RATIO
CHARACTERISTIC	ESTIMATE	95% CI	P VALUE	ESTIMATE	95% CI	P VALUE
Age	1.060	1.059-1.061	<.0001	1.045	1.044-1.046	<.0001
Sex
• Female	Reference	Reference	Reference	Reference	Reference	Reference
• Male	1.479	1.459-1.499	<.0001	1.947	1.913-1.981	<.0001
Practice location
• Urban	0.876	0.860-0.891	<.0001	1.038	1.015-1.061	.0008
• Rural	Reference	Reference	Reference	Reference	Reference	Reference
BMI, kg/m²
• <18 (underweight)	1.342	1.177-1.529	.1482	1.050	0.895-1.231	.5509
• 18-24 (normal)	Reference	Reference	Reference	Reference	Reference	Reference
• 25-29 (overweight)	1.281	1.243-1.320	.0460	1.256	1.210-1.304	<.0001
• ≥30 (obese)	1.582	1.537-1.629	<.0001	1.363	1.315-1.414	<.0001
• Missing data	1.094	1.064-1.124	<.0001	1.167	1.128-1.208	<.0001
Smoking status
• Never	Reference	Reference	Reference	Reference	Reference	Reference
• Current	1.508	1.473-1.543	<.0001	1.485	1.443-1.528	<.0001
• Past	1.585	1.548-1.624	<.0001	1.222	1.186-1.258	<.0001
• Not current	1.089	1.064-1.116	<.0001	1.087	1.055-1.119	<.0001
• Missing data	1.152	1.131-1.174	<.0001	1.090	1.064-1.116	<.0001
No. of comorbid conditions
• 0	Reference	Reference	Reference	Reference	Reference	Reference
• 1	2.549	2.498-2.600	<.0001	0.741	0.723-0.760	<.0001
• 2	5.423	5.307-5.540	<.0001	1.110	1.085-1.137	<.0001
• 3	9.268	9.023-9.520	<.0001	1.145	1.108-1.183	<.0001
• ≥4	15.791	15.226-16.376	<.0001	1.098	1.048-1.151	<.0001
No. of clinical encounters in past 2 y	1.049	1.0438-1.051	<.0001	1.010	1.009-1.011	<.0001
Practice size
• Small (<1000)	1.087	1.064-1.097	<.0001	1.099	1.074-1.124	<.0001
• Medium (1000-1800)	1.080	1.064-1.107	<.0001	1.072	1.052-1.092	<.0001
• Large (>1800)	Reference	Reference	Reference	Reference	Reference	Reference
LLA-indicated condition
• Diabetes mellitus	6.052	5.938-6.168	<.0001	4.551	4.441-4.664	<.0001
• Hypertension	3.787	3.734-3.842	<.0001	1.898	1.858-1.939	<.0001
• Chronic kidney disease	3.403	3.320-3.487	<.0001	1.101	1.066-1.138	<.0001
• Cardiovascular disease	6.394	6.253-6.539	<.0001	3.658	3.563-3.755	<.0001
• Abdominal aortic aneurysm	6.255	5.403-7.242	<.0001	1.425	1.207-1.682	<.0001
• Genetic dyslipidemia (LDL-C ≥5 mmol/L)	2.227	2.171-2.285	<.0001	3.530	3.425-3.637	<.0001