Treatment and low-density lipoprotein cholesterol levels in patients with hypercholesterolaemia or mixed dyslipidaemia at high or very high cardiovascular risk: a population-based cross-sectional study in the Netherlands

Objective: To describe treatment patterns, low-density lipoprotein cholesterol (LDL-C) levels and healthcare resource utilization (HCRU) in the Netherlands in 2018 of patients with hypercholesterolaemia or mixed dyslipidaemia at high or very high cardiovascular (CV) risk. Methods: From the PHARMO Database Network adult patients with a diagnosis for hypercholesterolaemia or mixed dyslipidaemia or treated with lipid lowering therapy (LLT) between 2009 and 2018 were selected and the proportion at high or very high CV risk according to 2016 ESC/EAS guidelines was determined. The study population comprised patients at high or very high CV risk for whom LDL-C levels were recorded and who were treated with LLT or were characterized as statin intolerant in 2018. LLT treatment patterns, LDL-C levels and HCRU (GP consultations and hospitalizations) were assessed. Results: The study population included 54,346 patients with hypercholesterolaemia/mixed dyslipidaemia, of which 70% (37,978) were at very high CV risk and 30% (16,368) at high CV risk. The majority of patients (93%) were treated with statin monotherapy, consisting mostly (73%) of moderate intensity and 15% of high intensity statin. Only 3% were treated with a combination of statin and ezetimibe. Statin intolerance, based on a treatment algorithm, was estimated at 3%. Average LDL-C decreased with intensification of LLT with more intensive statins or combination therapy. Overall, 74% reached LDL-C Conclusion: The treatment of hypercholesterolaemia and mixed dyslipidaemia in patients at high or very high CV risk in the Netherlands was suboptimal in 2018. To further lower CV risk alternative treatment strategies using add-on therapies are needed.