LIPI-WATCH, a Belgian/Luxembourg survey on achievement of European atherosclerosis society lipid goals

Objective: To determine the proportion of dyslipidaemic patients reaching on-treatment low density lipoprotein cholesterol (LDL-C) goals as defined by European Atherosclerosis Society (EAS) guidelines. Design: Prospective, cross-sectional survey. Demographic characteristics and cardiovascular risk factors were assessed in 1664 on-treatment dyslipidaemic patients during a 5-month period (from September 1997 to January 1998). A fasting lipid profile was drawn within 1 week of the study visit. Setting: 147 investigators (cardiologists, endocrinologists and general practitioners) from Belgium and Luxembourg. Patients: 1664 patients; mean age 63 years (18 to 90 years); 46% female, 54% male; 86.4% at high risk for coronary heart disease (CHD). Outcome Measures: The frequency of achieving EAS goals and factors associated with achieving these goals. Results: Overall, 36% of patients achieved the 1992 EAS goals [high risk: LDL-C < 135 mg/dl (3.5 mmol/L); medium risk: LDL-C < 155 mg/dl (4.0 mmol/L); low risk: LDL-C < 175 mg/dl (4.5 mmol/L)]. The success rate (33.7%) was lowest among high risk patients. Factors independently associated with a failure to achieve EAS goals were: younger age, male gender, body mass index ≥ 28 kg/m², while the presence of diabetes mellitus, the use of statins and the speciality of the investigator were positively associated with success rate. Only 14% of high risk patients reached the LDL-C target < 115 mg/dl (3.0 mmol/L) proposed by the 1998 Joint European Guidelines. Conclusions: A large proportion of patients treated with lipid-lowering agents did not achieve LDL-C goals according to EAS guidelines. Undertreatment is a major problem in the management of hyperlipidaemia. More aggressive implementation of treatment guidelines, especially for patients at high risk for CHD, would be highly desirable.