Prevalence, incidence, and treatment of dyslipidemia in patients with high or very high cardiovascular risk in Germany.

BACKGROUND

2019 European Society of Cardiology (ESC)/European Atherosclerosis Society (EAS) guidelines on management of dyslipidemia outline treatment goals of low-density lipoprotein cholesterol reduction in patients with high and very high cardiovascular (CV) risk.

OBJECTIVE

To describe the proportion, clinical characteristics, and treatment practices of adult patients with dyslipidemia and high or very high CV risk in Germany.

METHODS

Based on German claims data from 2010 to 2019, a retrospective cross-sectional study on prevalence, incidence, and treatment pathways in patients with dyslipidemia and high and very high CV risk was performed.

RESULTS

Between 2010 and 2019, there were 213 to 233 adult patients per 1000 with prevalent dyslipidemia based on ICD 10 codes. Annual incidence ranged from 31.7 to 40.2 per 1000. In 2019, 1.2% and 22.8% of the prevalent patients were classified to high or very high CV risk. Out of these patients, 61.7% and 78.5% received lipid-lowering treatments (LLT). Among incidence patients, prescription rates were further apart between high-risk and very-high-risk patients, at 56.6% and 79.2%. Cross-sectional analysis showed that in 2019 statin monotherapy was the most common LLT (87.2%) administered mainly at moderate dose (59.9%). In that year, 2.7% and 8.4% of the patients received ezetimibe as monotherapy or in combination with statins. The proportion of treatment pause, or discontinuation was 56.6% over time, with subsequent reinitiation for 42.0% of patients.

CONCLUSION

Analysis indicates that despite recommendations, intensive treatment therapies are underutilized in clinical practice even in high and very high CV risk patients with primary hypercholesterolemia/mixed dyslipidemia, who may have benefited from LLT optimization.