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Impact of new Joint British Societies' (JBS 2) guidelines on prevention of cardiovascular disease: evaluation of serum total cholesterol goal achievement in UK clinical practice.

Abstract：

BACKGROUND:Consensus health panels, including the Joint British Societies (JBS), have established increasingly stringent cholesterol goals. However, in clinical settings, most patients do not achieve even the less stringent goals. OBJECTIVE:To provide descriptive data on the proportion of patients in the United Kingdom who would have achieved the new JBS 2 total cholesterol (TC) goal of < 4.0 mmol/L (< 155 mg/dL) without changes in therapy. METHODS:Cross-sectional analysis of patients initiated on lipid-modifying therapies in 2005 (before publication of the JBS 2 guidelines), as ascertained via a physician (general practitioner (GP)) database. RESULTS:Among 70,194 patients (mean age 64 years) receiving prescriptions for lipid-modifying therapies, 35,823 (51.0%) were considered to be at high risk because of CHD or diabetes mellitus and 34,371 (49.0%) were at low risk. A total of 66,642 (94.9%) patients received monotherapy with HMG-CoA reductase inhibitors (statins), including 33,853 (94.5%) of high-risk patients and 32,789 (95.4%) low-risk individuals. Statins were prescribed at medium (maximum daily dose = simvastatin 40 mg; atorvastatin 20 mg; rosuvastatin 10 mg) or lower equipotency doses in the majority of patients receiving these medications -58,033 (87.1%) patients receiving statins, including 28,988 (85.6%) high-risk patients and 29,045 (88.6%) low-risk patients. Of the 28,874 patients with TC measurements, 7827 (27.1%) would have achieved the new JBS 2 goal without changes in medications or doses. In more than 51% of patients, TC values were > or = 10% above the JBS 2 target despite prescribed therapy, suggesting that these individuals would also not have achieved the JBS 2 goal by doubling their statin doses. CONCLUSIONS:Even though patient data were accessed before the JBS 2 guidelines were issued and data on other cardiovascular risk factors not captured, it can be concluded that most British patients (approximately 73%) would not have achieved the recent JBS 2 TC target of < 4.0 mmol/L without changes in lipid-modifying medications or medication doses. More effective and well-tolerated treatments, including combination statin regimens, are needed to increase the proportion of British patients reaching the more stringent JBS 2 goal.

journal_name

Curr Med Res Opin

journal_title

Current medical research and opinion

authors

Rajagopalan S,Alemao E,Finch L,Yin D

doi

10.1185/030079907X219472

subject

Has Abstract

pub_date

2007-08-01 00:00:00

pages

2027-34

issue

eissn

0300-7995

issn

1473-4877

journal_volume

pub_type

杂志文章,实务指引

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Impact of new Joint British Societies' (JBS 2) guidelines on prevention of cardiovascular disease: evaluation of serum total cholesterol goal achievement in UK clinical practice.