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Hypercholesterolemia, eligibility for lipid lowering therapy and therapeutic success - population-based study in a Portuguese urban population

L Alves, Department of Hygiene and Epidemiology, University of Porto Medical School; Institute of Public Health - University of Porto (ISPUP), Porto, Portugal
A Azevedo, Department of Hygiene and Epidemiology, University of Porto Medical School; Institute of Public Health - University of Porto (ISPUP), Porto, Portugal

Correspondence: Luis Alves, Email: luisaaalves{at}gmail.com

Abstract

Background: We aimed to estimate (1) the prevalence of hypercholesterolemia, (2) the proportion of individuals eligible for treatment with lipid-lowering drugs, and (3) therapeutic success, according to the European guidelines on cardiovascular disease prevention in clinical practice.

Design: Population-based cross-sectional study.

Methods: We surveyed a representative sample of the population of Porto aged 40-65 years. Trained interviewers collected data from 1215 subjects (789 women) on demographic variables, medical history and medication using structured questionnaires. A fasting venous blood sample was withdrawn. Subjects were considered low-risk or high-risk as indicated in the European guidelines. Hypercholesterolemia was defined as total cholesterol (TC) 5mmol/L or LDL-cholesterol (LDL-C) 3mmol/L in low-risk subjects, TC 4.5mmol/L or LDL-C 2.5mmol/L in high-risk subjects or being medicated with lipid lowering drugs. Eligibility for treatment was defined as being high-risk and having TC 4.5mmol/L, LDL-C 2.5mmol/L or being on treatment. We defined therapeutic success as having TC <4.5mmol/L and LDL-C <2.5mmol/L among medicated subjects.

Results: Overall, 84.9% (95% confidence interval (95% CI): 82.7-86.8) of subjects had hypercholesterolemia and 9.1% (95% CI: 7.5-10.8) were medicated with lipid-lowering drugs. Men were more likely to be eligible for treatment (42.4%) than women (22.4%) (OR=2.69, 95%CI 2.07-3.52). Therapeutic success was less frequent in men (46.8%) than in women (66.7%), (OR=0.39, 95% CI 0.17-0.87).

Conclusion: Strict interpretation of the European guidelines would label 85% of the general population in this age group as hypercholesterolemic and a third eligible for drug treatment. Questions arise regarding medicalization, resource allocation and sustainability within the healthcare system.