Achieving goals in managing dyslipidemia patients in primary care: challenges and solutions
DOI:
https://doi.org/10.34687/2219-8202.JAD.2024.03.0005Keywords:
very high cardiovascular risk, survey, primary care physicians, low-density lipoprotein cholesterol, rosuvastatin, atorvastatin.Abstract
Summary:
Purpose of the study. To analyze the awareness of primary care physicians in the city of Surgut regarding approaches to cardiovascular risk stratification adopted in the current clinical guidelines “Lipid Metabolism Disorders”, target levels of low-density lipoprotein (LDL) cholesterol, and modern aspects of lipid-lowering therapy.
Materials and methods. In February-March 2024, an anonymous survey of 93 general practitioners from city clinics in Surgut was conducted. The questionnaire based on the provisions of the clinical recommendations “Lipid metabolism disorders”, developed by employees of the Department of Cardiology of Surgut State University (SurSU), consisted of three blocks and contained 15 questions with several possible answers regarding the problem of dyslipidemia (the questionnaire is given in the appendix to the article). The protocol of the study and the questionnaire for interviewing doctors were approved by the Local Ethics Committee of Surgut State University. All doctors were informed about the purpose of the study and gave informed voluntary consent to participate in it.
Results. 85% of the surveyed doctors correctly identified a very high SVR. 92% of surveyed therapists observe patients with very high and high cardiovascular risk in their clinical practice. The most prescribed statins were atorvastatin and rosuvastatin. 40% of doctors prefer atorvastatin because of its availability and preferential terms, 34% of doctors more often prescribe rosuvastatin due to its high effectiveness. More than 48% of doctors most often prescribe rosuvastatin at a dose of 10-20 mg, while 69% of physicians prefer atorvastatin at a dose of 20 mg and 30% at a dose of 40 mg. Rosuvastatin at a dose of 40 mg is used by only 3% of primary care physicians, and atorvastatin at a dose of 80 mg is used by only 1 specialist. Reasons limiting the use of statins in maximum doses: 1) 60% of surveyed doctors due to the possibility of side effects and serious complications, as well as concerns about the risk of progression of liver disease. 2) 20% of surveyed doctors refuse due to the risk of developing rhabdomyolysis. Among the respondents, 51% and 21% of doctors are aware of the effectiveness and safety of alirocumab and evolocumab, respectively. After achieving the target values of LDL cholesterol in a patient with high and very high cardiovascular risk receiving the maximum dose of a statin, 46% of respondents responded to maintain treatment at the same dosage, 52% of respondents considered it possible to reduce the dose of statin. If severe hypercholesterolemia is detected, 53% of respondents are inclined to prescribe treatment; if the target LDL levels are not achieved, they refer the patient to a lipidologist. Only 17% of respondents suggested immediately referring the patient to a lipidologist. After unjustified withdrawal, 78% of surveyed doctors often resume statin therapy.
Conclusion: a survey of practicing physicians in outpatient medical organizations in Surgut showed that specialists in most cases have sufficient knowledge about the stratification of CV risk, however, in real practice there remains a low frequency of use of statins in high-intensity regimens, the use of combination lipid-lowering therapy, and insufficient knowledge of primary care specialists on the possibilities of effective routing of patients with severe dyslipidemia.
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