Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5

Low-density lipoprotein cholesterol awareness among physicians in Germany: results of the PROCYON survey indicate a discrepancy between theory and clinical practice
U. Makhmudova1, K. Stein2, L. Beier3, O. Weingärtner1
1Klinik für Innere Medizin I - Kardiologie, Universitätsklinikum Jena, Jena; 2Medical Franchise- Cardiovascular, Renal, Metabolism & Respiratory, Novartis Pharma GmbH, Nürnberg; 3Novartis Pharma GmbH, Nürnberg;
 

Keywords: low-density lipoprotein, cardiovascular disease, prevention

Background: Elevated low-density lipoprotein cholesterol (LDL-C) levels are a major risk factor for cardiovascular disease (CVD) and therefore, LDL-C reduction is an essential part of 2019 ESC/EAS guidelines for the management of dyslipidemias.

Purpose: The present survey evaluated the perception of LDL-C as a risk factor for atherosclerotic CVD (ASCVD) as well as the compliance with the 2019 ESC/EAS guideline among physicians in Germany.

Methods: PROCYON included an online survey among physicians involved in CVD prevention. A conjoint analysis on the relative importance of CV risk factors was incorporated.

Results: In total, 109 physicians participated in the survey (40.4% internists, 38.5% general practitioners, 21.1% cardiologists). Analysis of the theoretical LDL-C risk perception among participants revealed that almost all acknowledge its role as an important or very important risk factor (98.2%) and its causal relationship with CV risk (96.3%). The importance of cumulative LDL-C levels was fully agreed to by 45.9% and rather agreed to by 43.1%. Conjoint analysis determined LDL-C (32.0%) as risk factor with the highest relative importance followed by diabetes (24.5%), systolic blood pressure (15.8%), and smoking status (12.2%).

Furthermore, translation of LDL-C perception into implementation of the current ESC/EAS recommendation for CVD risk mitigation was assessed. Lipid-lowering therapy in primary prevention is initiated at an LDL-C level of <125 mg/dL by 20.2%, at 130 – 150 mg/dL by 22.0%, and at >150 mg/dL by 57.8% of physicians. In total, 55.0% have at least one third of their primary prevention patients untreated. An LDL-C target level of 55 mg/dL in combination with a 50% reduction in very high CV risk patients is only pursued by 19.3% of the physicians.

Several questions then addressed therapeutic decision making. In general, 78.9% of physicians are satisfied or very satisfied with the current treatment options. Regarding treatment escalation (based on statin therapy), the most common reasons are a CV event (61.5%), followed by target failure within 6 months (61.5%), patient request (27.5%) or when LDL-C target level is not reached after 8 weeks (20.2%; multiple answers allowed). In case of insufficient treatment regarding LDL-C target achievement, the most common options are addition of ezetimibe and a switch to another statin (Fig. 1).

Regarding the success of patient management, the majority of physicians (80.7%) reported an LDL-C target failure rate of at least one third in very high CV risk patients. Target failure is considered to be mostly due to a lack of adherence and side-effects followed by lifestyle adaption, a lack of efficacy, and reimbursement hurdles (Fig. 2).

Conclusion(s): The current data suggest that physicians, especially general practitioners and internists are still reluctant in initiating and escalating LDL-C treatment early and aggressive according to 2019 ESC/EAS recommendations. Furthermore, there is a discrepancy between the acknowledgement of LDL-C importance for ASCVD and the implementation of therapeutic risk management in the clinical setting in Germany. In summary, PROCYON identified potentials for improvement with respect to LDL-C awareness and guideline implementation to prevent future CV events as a result of elevated LDL-C Levels.




Fig. 1: Preferred treatment optimization options

 

Fig. 2: Main reasons for target failure

 

 

 

 

 


https://dgk.org/kongress_programme/jt2022/aP1150.html