Primary prevention in high-risk dyslipidemic patients without an established cardiovascular disease: Undertreatment and rationale for lipid-lowering therapy.

Background: Recent updated guidelines expand the usage of lipid-lowering therapy for primary prevention in high-risk individuals without an established cardiovascular disease (CVD). In contrast to secondary prevention, the extent of the target population and the utilization of lipid-lowering drugs are insufficiently clear. We examine the implementation of statin therapy as primary prevention in high-risk patients without a known CVD and discuss the rationale for the management of dyslipidemia in this population.

Methods: Records of 371 consecutive patients without an established CVD who were hospitalized in an internal medicine department between January and June 2005 were evaluated for CVD-equivalent high-risk factors (diabetes mellitus, stroke of carotid origin, peripheral vascular disease, abdominal aortic aneurysm, or Framingham 10-year risk score >/=20%). Demographic and clinical data, in addition to lipid profile and usage of statin drugs prior to and during hospitalization, were analyzed.

Results: Of the 371 non-cardiovascular patients, 88 (24%) were defined as high-risk individuals eligible for statin therapy as primary prevention of CVD. Their mean age was 71+/-11 years and their mean LDL-C level was 132+/-30 mg/dL. Seventeen patients (19%) were treated with statin drugs prior to admission and only two more patients (19/88, 22%) received statins in addition during hospitalization. Patients treated with statins had non-significantly higher LDL-C levels.

Conclusions: There is considerable undertreatment of high-risk patients without an established CVD with lipid-lowering drugs. There is also sub-optimal implementation of guidelines in clinical practice, despite well-established evidence of the benefits of statins in the primary prevention of CVD for high-risk individuals with average cholesterol levels, diabetes mellitus, and in elderly patients, as represented by our study population.