Achievement of lipoprotein goals among patients with metabolic syndrome at high cardiovascular risk across Europe. The EURIKA study.

OBJECTIVE

To examine for the first time the achievement of lipoprotein treatment goals in patients with metabolic syndrome and lipid abnormalities who are at elevated cardiovascular risk in Europe.

METHODS

Cross-sectional study conducted in 2009-2010 in 12 European countries among outpatients aged ≥50 years free of clinical cardiovascular disease. We assessed achievement of American Diabetes Association/American College of Cardiology lipid treatment goals in those with metabolic syndrome at highest risk (diabetes plus ≥1 additional major cardiovascular risk factor beyond lipid abnormalities) or high risk (no diabetes but ≥2 additional major cardiovascular risk factors).

RESULTS

Among 1431 highest-risk patients, 64.6% (between-country range [BCR] 40-84.5%) were on lipid-lowering medication. Of them, 13.4% (BCR: 2.5-28.6%) had LDL-cholesterol<70 mg/dl, non-HDL-cholesterol<100mg/dl, and apolipoprotein B<80 mg/dl. Among 832 high-risk patients, 38.7% BCR: 27.5-55.3%) were on lipid-lowering medication. Of them, 20.5% (BCR: 5.5-57.6%) had LDL-cholesterol<100mg/dl, non-HDL-cholesterol<130 mg/dl, and apolipoprotein B<90 mg/dl. About 96% of highest-risk patients and 94% of high-risk patients were given at least one lifestyle advice (weight reduction, healthy diet, physical activity, no-smoking), but only 1.3% of the former and 4.9% of the latter reached all three lipid goals.

CONCLUSION

There is a substantial gap between clinical guidelines and medical practice since only one in 5-7 patients met all treatment targets. Although most patients received lifestyle advice, the effectiveness of counseling was very low. Large between-country differences in outcomes suggest considerable room for improvement.