Survey Among European Cardiologists Points To A Gap In Cardiovascular Disease Management

Main Category: Cardiovascular / Cardiology
Also Included In: Cholesterol
Article Date: 03 Sep 2008 - 1:00 PDT

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Cardiologists in Europe agree that reducing LDLcholesterol (LDL-C or "bad" cholesterol) is the most important consideration when treating dyslipidaemia (abnormal blood lipids). A majority of cardiologists also agree that in addition to lowering LDL-C, raising HDL-cholesterol (HDL-C or "good" cholesterol) and reducing triglycerides are important factors in choosing dyslipidaemia treatment. Yet, despite these views, physicians say they are treating less than one-third of their cardiovascular disease patients based on all three lipid parameters. These findings, from a new TNS Healthcare survey sponsored by Merck Sharp & Dohme (MSD), were presented at the 2008 European Society of Cardiology (ESC) Annual Congress.

"Established clinical evidence on the value of reducing LDL-C has driven the management of dyslipidaemia over the past two decades, resulting in a significant reduction in cardiovascular disease mortality," said Anselm Kai Gitt, M.D., Vice Director of the Myocardial Infarction Research Institute in Ludwigshafen, Germany. "Despite these great strides, significant cardiovascular risk remains for some patients who have lowered their LDL-C levels through lifestyle modification and medication. When treating a patient, we must consider all risk factors including low HDL-C and triglycerides, among others, and recommend appropriate intervention."

Research shows that lowering LDL-C with statin therapy may decrease the risk of cardiovascular disease by about 30 percent (versus placebo)1-6. Other factors that contribute to cardiovascular risk include low levels of HDL-C, high levels of triglycerides, elevated blood pressure, smoking, inactivity, excessive alcohol, excessive stress, diabetes, and obesity7,8. According to the survey results, more than two-thirds of cardiologists agree that despite lowering LDL levels, a residual risk for cardiovascular events remains.

Gap between perception and practice in factors for treating dyslipidaemia

According to the survey results, 97 percent of respondents said reducing LDL-C is a "fairly" or "extremely" important consideration when choosing a treatment for dyslipidaemia. 84 percent said they consider increasing HDL-C as either "fairly" or "extremely" important and 85 percent agree that HDL-C has a unique protective role against cardiovascular disease. However, less than half (47 percent) of their patients are treated with both of these lipids in mind. Moreover, although 66 percent said reducing triglycerides is either "fairly" or "extremely" important, only 29 percent of their patients are treated based on all three lipid parameters. This is despite 90% of the cardiologists surveyed acknowledging residual risk remains following LDL-C reduction. "These findings reveal a strong belief in the importance of treating beyond LDL-C alone to reduce the residual risk of cardiovascular events in patients with dyslipidaemia, yet this is not adequately translating into clinical practice," said Dr. Gitt. "Cardiologists are in a unique position to change this paradigm. Armed with scientific knowledge, clinical experience and new treatment advances, we can establish a comprehensive approach to cardiovascular disease management."

About the survey

TNS Healthcare conducted an online questionnaire of a total of 507 cardiologists in France (n=101), Germany (n=100), Italy (n=100), Spain (n=106), and the UK (n=100) between June 18 and July 30, 2008. Cardiologists' practices ranged from hospital-based to office-based to both hospital- and office-based in primarily urban areas.

Cardiovascular Disease and Coronary Heart Disease

Cardiovascular disease (CVD) is a general term referring to diseases that affect the heart or blood vessels. CVD is the main cause of death in Europe, accounting for over 4.3 million deaths (48% of all mortality).9 It is also the UK's number one killer with more than one in three people dying from a heart attack or stroke.10

Coronary heart disease (CHD), also known as coronary artery disease (CAD), is one of the most common forms of CVD. It is the leading cause of death globally11 and the U.K accounting for 101,000 deaths in the country per year.10

Major risk factors for CVD include abnormal blood lipids, meaning not only high LDL-C but also high levels of triglycerides and low levels of HDL-C.7,8 The Pan-European Survey (2005) found that about one third of men and 40 percent of women have low HDL-C levels, regardless of the use of lipid-modifying treatment (primarily statins). Low HDL-C in combination with high triglycerides is also common across Europe, where 21 percent of men and 25 percent of women having abnormal levels of both lipids despite receiving lipid-modifying treatment.12

About Merck Sharp & Dohme

Merck Sharp & Dohme Limited (MSD) is the UK subsidiary of Merck & Co., Inc., of Whitehouse Station, New Jersey, USA, a leading research-based pharmaceutical company that discovers, develops, manufactures and markets a wide range of innovative pharmaceutical products to improve human health. http://www.msd-uk.co.uk.

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11. World Health Organization. The Top 10 causes of death factsheet. February 2007

12. Bruckert E ; Baccara-Dinet M; McCoy F et al. High prevalence of low HDL-cholesterol in a paneuropean survey of 8545 dyslipidaemic patients. CMRO 2005; 21 (12):1927-1934

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