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L-TAP 2: Number of patients lowering LDL nearly doubled in the last decade

The percentage of patients lowering their LDL went from 38% to 73% in the last decade.

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In the L-TAP 2 survey of 10,174 patients (average age 62 years), researchers found that in nine countries conducting cholesterol-lowering and management efforts, 67% of high-risk patients achieved target levels of LDL in the last 10 years, 86% of low-risk patients achieved target levels of LDL and 74% of moderate-risk patients achieved target LDL (P<.001). Only 30% of very high-risk patients – those with existing CAD and two or more other risk factors such as obesity, diabetes and smoking – successfully reached their LDL target of 70 mg/dL or less.

David D. Waters, MD, emeritus professor at University of California, San Francisco, and colleagues examined patients’ compliance with LDL goals outlined in the National Cholesterol Education Program Adult Treatment Panel III, the 2003 Joint European Societies, or the 2003 Canadian Working Group. In the United States, goals are:

• For patients with CHD, diabetes or CV risk factors, <160 mg/dL.
• For patients without CHD or diabetes, but two or more CV risk factors, <130 mg/dL.
• For patients with CHD or diabetes, <100 mg/dL; when risk is very high, <70 mg/dL is a therapeutic option.

Seventy-five percent of patients surveyed were taking a statin with a median duration of therapy two years. Others took fibrates, ezetimibe (Zetia, Merck-Schering Plough) or incorporated lifestyle changes such as diet and exercise without a drug.

The proportion of patients achieving LDL goals according to relevant national guidelines ranged from 47% in Spain to 84% in South Korea, a variation that researchers couldn’t explain.

Despite the positive news, “…[A]pproximately one third of patients still do not attain their LDL goal, with wide variation among countries,” the researchers concluded.

In an accompanying editorial, Antonio M. Grotto, Jr., MD, DPhil, said that the results indicate there is still a considerable gap in the treatment of patients at highest risk for CV events.

“Rates of obesity and diabetes have worsened over the past decades, and cardioprotective drugs can only do so much to remedy the metabolic complications that often result from poor lifestyle choices,” Grotto, professor of medicine at Weill Cornell Medical College, N.Y., said in a press release.

Waters DD. Circulation. 2009:doi:0.1161/CIRCULATIONAHA.108.838466