OBJECTIVES

To describe the proportion, clinical characteristics, and treatment practices of adult patients with dyslipidemia and high or very high cardiovascular (CV) risk according to the 2019 ESC/EAS guidelines in Germany.

METHODS

This retrospective cross-sectional analysis was done using healthcare claims data from BARMER, one of Germany's largest statutory health insurances, covering approximately 13% of statutory health insured population. Adult patients with a diagnosis of dyslipidemia (based on ICD 10 codes: E.78.- 0,2,4,5,8,9) were stratified by their individual CV risk, based on available data from 2008-2019, according to the 2019 ESC/EAS guidelines (based on ICD 10 and operation and procedure codes (OPS)). To have a sufficient prior observation period of CV risk for the cross-sectional analyses, study outcomes were reported per year for the period of 2010-2019.

RESULTS

Between 2010 and 2019, prevalence of dyslipidemia ranges between 213 (2012) and 233 (2018) adult patients per 1,000 based on ICD 10 codes. In 2019, 241 of 1,000 dyslipidemia patients were documented to be at high (12 cases per 1,000) or very high CV risk (229 cases per 1,000). In the observed frequency of dyslipidemia patients with high CV risk, limitations of the database to map risk factors (no documentation of laboratory values, underreporting of obesity and smoking) should be considered. The mean age of the cross-sectional 2019 study cohort was 76.7 (standard deviation (SD) 9.2) years for patients with high CV risk and 74.3 (SD 10.3) years for patients with very high CV risk. The proportion of female patients was 64.0% and 45.5%, respectively.

61.7% and 78.5% of patients with high/very high CV risk were treated with lipid lowering therapies (LLTs) in 2019, leaving 38.3% and 21.5% of high/very high CV risk patients untreated. The proportion of individuals with LLT prescriptions varied little over time. Cross-sectional analysis including pooled prevalent high/very high CV-risk patients showed that in 2019 statin monotherapy was the most common LLT (87.2%) administered mainly at moderate intensity (59.9%). 2.7% and 8.4% of the patients received ezetimibe as monotherapy or with statins, respectively. A share of 8.7% of prevalent patients with dyslipidemia, high/very high CV risk, treated with LLT were treated with a combination therapy of any LLT. Ongoing analysis will also cover the treatment pathways of patients and type of practitioners or specialists involved in treatment decisions.

CONCLUSIONS

Analysis of healthcare claims suggest that a substantial proportion of patients with dyslipidemia at high/very high risk of CV disease do not receive combination therapy, remain suboptimally treated or even untreated. This highlights a medical need for improved innovative treatment strategies.