Frequency of Obtaining National Cholesterol Education Program Adult Treatment Panel III Goals for All Major Serum Lipoproteins After Initiation of Lipid Altering Therapy^†

Statin treatment targeting low-density lipoprotein (LDL) cholesterol is widely used for cardiovascular risk reduction, but many statin users still face greatly elevated risks. Some experts advocate additional therapy that targets high-density lipoprotein (HDL) cholesterol. However, the size of the patient group that could benefit from HDL cholesterol or triglyceride therapy has not been reported. Using observational data from a large health maintenance organization, 5,158 patients were identified who initiated dyslipidemia pharmacotherapy from July 2004 to June 2006, continued therapy for 1 year, and had full lipid panels within 6 months before and 9 to 15 months after therapy initiation. Therapy (primarily statins) reduced the proportion of patients not at LDL cholesterol goals from 77% to 22% and the proportion with high triglyceride levels from 34% to 20%. HDL cholesterol levels were unchanged (49% and 50% were less than normal levels before and after therapy, respectively) in the aggregate and in high-risk subgroups (patients with coronary artery disease, diabetes, and 10-year heart disease risk >20%). After therapy, 29% of high-risk patients still had multiple lipid abnormalities. In conclusion, current dyslipidemia therapy substantially improved LDL cholesterol goal attainment in this cohort, but low HDL cholesterol levels were unaffected. About half the patients starting statins could be candidates for additional therapy targeting non–LDL cholesterol lipid fractions.

• † Conflicts of interest: Drs. Nichols and Brown are employees of Kaiser Permanente Northwest. Drs. Ambegaonkar and Sazonov are employees of Merck & Company, Inc. Drs. Nichols and Brown have received research support from Amgen, Inc., Thousand Oaks, California; Novo Nordisk A/S, Bagsværd, Denmark; Novartis Pharmaceuticals Corporation, East Hanover, New Jersey; Takeda Pharmaceuticals North America, Inc., Deerfield, Illinois; and GlaxoSmithKline, Inc., London, United Kingdom.