Improving lipid goal attainment: is it enough?

Lowering elevated levels of low-density lipoprotein cholesterol (LDL-C) is a surefire way to reduce cardiovascular risk. On the basis of a wealth of clinical trial evidence, guidelines from the National Cholesterol Education Program Adult Treatment Panel (ATP) have established progressively lower LDL-C targets, with the most recent iteration recommending an optional treatment goal of <70 mg/dL for very-high-risk patients.1 Increased attention has focused on addressing global cardiovascular risk, although LDL-C remains the primary target of lipid-lowering therapy. Article see p 28 In this issue of Circulation , Waters et al2 present results from the Lipid Treatment Assessment Project (L-TAP) 2, a survey to determine the percentage of dyslipidemic patients receiving lipid-lowering therapy (which includes diet and exercise) and also achieving their LDL-C goals. The first L-TAP survey was conducted in 1996 to 1997 in the United States with approximately 5000 patients.3 L-TAP 2 assessed nearly twice as many patients in 9 countries, including the United States, Canada, Mexico, Brazil, Spain, the Netherlands, France, Taiwan, and Korea, in 2006 to 2007. The overall LDL-C goal achievement rate in L-TAP 2 was 73%, as compared with 38% in the original L-TAP. As in the last survey, low-risk patients were the most likely to attain their LDL-C goals (86%), whereas high-risk patients experienced more difficulty in reaching their correspondingly lower targets (67%). In the United States, only 35% of patients with coronary heart disease (CHD) and at least 2 risk factors attained the optional LDL-C goal of <70 mg/dL. Success rates ranged from 47% to 84% across countries, with the highest rates seen in Korea and the United States. L-TAP 2 also assessed high-density lipoprotein cholesterol (HDL-C) levels and found that the prevalence of low HDL-C varied widely among countries. The expansion of L-TAP 2 to encompass 9 countries provides …