Assessment of lipid-lowering treatment in Bulgaria - The CEPHEUS study

• Authors: Nina Gotcheva , Dimitar Raev , Elina Trendafilova , Arman Postadzhiyan , Nikolay Runev , Guy Vandenhoven , Anne-Marie Temmerman , Marina Staneva
• Languages of publication: EN

Abstracts

EN

This is a multicenter cross-sectional survey of 2,500 Bulgarian adult patients taking lipid-lowering drugs (LLDs) for at least 3 months with no dose change for a minimum of 6 weeks. The primary objective was to establish the proportion of patients who are on LDL-C target, according to the Fourth Joint European Task Force (FJETF) guidelines. The secondary objectives were to define the proportion of patients at target: according to the 2001 National Cholesterol Education Program Adult Treatment Panel (NCEP ATP) III and the 2004 NCEP ATP III guidelines. The patients’ demographics, current LLD treatment, cardiovascular medical history were recorded. Next the lipid profile, glucose level and HbA1c were obtained from these patients. The investigators and patients completed questionnaires related to the LLD therapy. Gender, BMI, history of CHD, therapy compliance, risk category, lack of patient’s awareness of LDL-C targets were all studied as determinants of the undertreatment. Despite the satisfactory awareness of guidelines for management of hypercholesterolaemia, their implementation in clinical practice is still poor. Only 43.10% of patients reached the FJETF-recommended LDL-C goal, 45.24% achieved the 2001 NCEP ATP III recommended LDL-C goal, and only 21.51% - reached the 2004 NCEP ATP III recommended target. Males, CHD patients and those who were aware of LDL-C targets had more chance of reaching their desired LDL-C target.

Keywords

EN

Hypercholesterolaemia; LDL-goal; Pharmacoepidemiology; Lipid-lowering drugs; Guidelines; Dyslipidaemia management; Bulgaria

• Publisher: De Gruyter Open
• Journal: Open Medicine
• Year: 2013
• Volume: 8
• Issue: 5
• Pages: 627-637

Dates

published

1 - 10 - 2013

online

18 - 9 - 2013

Contributors

author

Nina Gotcheva

• Cardiology Department, National Heart Hospital, 65 Koniovitza St., 1309, Sofia, Bulgaria

author

Dimitar Raev

• Cardiology Department, Ministry of Internal Affairs Hospital, 79 Skobelev Blvd., 1606, Sofia, Bulgaria

author

Elina Trendafilova

• Cardiology Department, National Heart Hospital, 65 Koniovitza St., 1309, Sofia, Bulgaria

author

Arman Postadzhiyan

• MHAT “St. Anna”, 1 Dimitar Mollov St., 1709, Sofia, Bulgaria

author

Nikolay Runev

• Department of Propedeutics of Internal Medicine, MHAT “Aleksandrovska”, 1 St. Georgi Sofiiski St., 1431, Sofia, Bulgaria

author

Guy Vandenhoven

• Medical R&D CEEMEA, AstraZeneca, Zaventem, box 1 B-1935, AstraZeneca Corporate Village Armaris/Figueras Leonardo da Vincilaan 1, Brussels, Belgium

author

Anne-Marie Temmerman

• Medical R&D CEEMEA, AstraZeneca, Zaventem, box 1 B-1935, AstraZeneca Corporate Village Armaris/Figueras Leonardo da Vincilaan 1, Brussels, Belgium

author

Marina Staneva

• Medical Department, AstraZeneca, 36 Dragan Tzankov Blvd., 1057, Sofia, Bulgaria

References

• [1] Sans S, Kesteloot H, Kromhout D on behalf of the Task Force. The burden of cardiovascular diseases mortality in Europe. Task Force of the European Society of Cardiology on Cardiovascular Mortality and Morbidity Statistics in Europe. Euro Heart J. 1997; 18:1231–1248 http://dx.doi.org/10.1093/oxfordjournals.eurheartj.a015434[Crossref]
• [2] British Heart Foundation. European Cardiovascular Disease Statistics. British Heart Foundation, London 2005. (http://www.bhf.org.uk/cvc/pdf/CVC_10Years_2008_v2.pdf)
• [3] Scheen AJ, Kulbertus H. Interheart: nine risk factors predict nine out of ten myocardial infarctions. Rev Med Liege. 2004; 59:676–679
• [4] Law MR, Wald NJ, Thompson SG. By how much and how quickly does reduction in serum cholesterol concentration lower risk of ischaemic heart disease? BMJ. 1994; 308:367–372 http://dx.doi.org/10.1136/bmj.308.6925.367[Crossref]
• [5] Law MR, Wald NJ, Rudnicka AR. Quantifying effect of statins on low density lipoprotein cholesterol, ischaemic heart disease, and stroke: systematic review and meta-analysis. BMJ. 2003; 326:1423 http://dx.doi.org/10.1136/bmj.326.7404.1423[Crossref]
• [6] Heart Protection Study Collaborative Group. MRC/BHF Heart Protection Study of cholesterol lowering with simvastatin in 20,536 high-risk individuals: a randomised placebo-controlled trial. Lancet. 2002; 360:7–22 http://dx.doi.org/10.1016/S0140-6736(02)09327-3[Crossref]
• [7] EUROASPIRE: A European Society of Cardiology survey of secondary prevention of coronary heart disease: principal results. Euro Heart J. 1997; 18:1569–1582 [Crossref]
• [8] EUROASPIRE II Study Group. Lifestyle and risk factor management and use of drug therapies in coronary patients from 15 countries. Euro Heart J. 2001; 22:554–572 http://dx.doi.org/10.1053/euhj.2001.2610[Crossref]
• [9] Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Keil U. EUROASPIRE Study Group. EUROASPIRE III: a survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. Eur J Cardiovasc Prev Rehabil. 2009; 16:121–137 http://dx.doi.org/10.1097/HJR.0b013e3283294b1d[Crossref][WoS]
• [10] Kotseva K, Wood D, De Backer G, De Bacquer D, Pyörälä K, Reiner Z, Keil U. EUROASPIRE Study Group. EUROASPIRE III. Management of cardiovascular risk factors in asymptomatic high-risk patients in general practice: cross-sectional survey in 12 European countries. Eur J Cardiovasc Prev Rehabil. 2010; 17:530–540 http://dx.doi.org/10.1097/HJR.0b013e3283383f30
• [11] Ford ES, Mokdad AH, Giles WH, Mensah GA. Serum Total Cholesterol Concentrations and Awareness, Treatment, and Control of Hypercholesterolemia among US Adults. Findings from the National Health and Nutrition Examination Survey, 1999 to 2000. Circulation 2003; 107:2185–2189 http://dx.doi.org/10.1161/01.CIR.0000066320.27195.B4[Crossref]
• [12] Pearson TA, Laurora I, Chu H, Kafonek S. The Lipid Treatment Assessment Project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med. 2000; 160:459–467 http://dx.doi.org/10.1001/archinte.160.4.459[Crossref]
• [13] Frolkis JP, Pearce GL, Nambi V, Minor S, Sprecher DL. Statins do not meet expectations for lowering low-density lipoprotein cholesterol levels when used in clinical practice. Am J Med. 2002; 113:625–629 http://dx.doi.org/10.1016/S0002-9343(02)01303-7[Crossref]
• [14] Graham I, Atar D, Borch-Johnsen K, Boysen G, Burell G, Cifkova R, Dallongeville J, De Backer G, Ebrahim S, Gjelsvik B, Herrmann-Lingen C, Hoes A, Humphries S, Knapton M, Perk J, Priori SG, Pyorala K, Reiner Z, Ruilope L, Sans-Menendez S, Scholte op Reimer W, Weissberg P, Wood D, Yarnell J, Zamorano JL, Walma E, Fitzgerald T, Cooney MT, Dudina A. European Society of Cardiology (ESC) Committee for Practice Guidelines (CPG). European guidelines on cardiovascular disease prevention in clinical practice: executive summary. Fourth Joint Task Force of the European Society of Cardiology and other societies on cardiovascular disease prevention in clinical practice (Constituted by representatives of nine societies and by invited experts). Euro Heart J. 2007; 28:2375–2414 http://dx.doi.org/10.1093/eurheartj/ehm316[WoS][Crossref]
• [15] National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation and, treatment of high blood cholesterol in adults (Adult Treatment Panel III). Third report of the National Cholesterol Education Program (NCEP) Expert panel on detection, evaluation and, treatment of high blood cholesterol in adults (Adult Treatment Panel III): final report. Circulation 2002; 106:3143–3421
• [16] Grundy SM, Cleeman JI, Merz CN, Brewer HB Jr, Clark LT, Hunninghake DB, Pasternak RC, Smith SC Jr, Stone NJ; National Heart, Lung, and Blood Institute; American College of Cardiology Foundation; American Heart Association. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004; 110:227–239 http://dx.doi.org/10.1161/01.CIR.0000133317.49796.0E[Crossref]
• [17] Hermans MP, Van Mieghem W, Vandenhoven G, Vissers E. Centralized Pan-european survey on tHE Undertreatment of hypercholesterolemia (CEPHEUS). Acta Cardiol. 2009; 64:2 (177–185) http://dx.doi.org/10.2143/AC.64.2.2035341[Crossref][WoS]
• [18] Hermans MP, Castro Cabezas M, Strandberd T, Ferrires J, Feely J, Elisaf M, Michel G, Sansoy V. Centralized Pan-European survey on the undertreatment of hypercholesterolaemia (CEPHEUS): Overall findings from eight countries. Curr Med Res Opin. 2010; 26:2 (445–454) http://dx.doi.org/10.1185/03007990903500565[Crossref][WoS]
• [19] Elisaf MS, Nikas N. Centralized pan-European survey on the under-treatment of hypercholesterolemia in patients using lipid lowering drugs-the CEPHEUS - Greece survey. Angiology. 2010; 61:5 (465–474) http://dx.doi.org/10.1177/0003319710366432[Crossref]

Identifiers

DOI

10.2478/s11536-013-0215-0