Secondary prevention of ischemic heart disease in the Ciudad Real province, Spain.: Effectiveness of lipid-lowering therapy in primary health care

BACKGROUND: The efficacy of lipid-lowering therapy (LLT) in ischemic heart disease (IHD) is well established. But there are some doubts about its effectiveness on Primary Health Care (PHC) where we develop the long-term control of this sickness and it is difficult to reproduce the terms of the clinical trials. METHODS: Multicenter cross-sectional study designed to evaluate the control of dyslipidemia achieved in patients with IHD diagnosed more than a year ago in our geografic primary health care system. The total cholesterol (tC), LDL, triglyceride, HDL levels and tC/HDL were determined to analyze the impact of LLT. 205 patients were collected by 14 general practitioners in several PHC centers. RESULTS: The average lipid profiles recorded (tC: 218 mg/dl; LDL: 151 mg/dl; triglyceride: 136 mg/dl; HDL: 49 mg/dl, and tC/HDL: 4,8) were far to the recommended by the international guidelines. The ideal (LDL < 100 mg/dl) and the acceptable targets (LDL < 130) were achieved by 9 and 30%. The HDL was not assess in 26.4% of the patients. It had had slight improvement of the women profile risk by more elevated values of HDLc than men (54.4 mg/dl vs. 46.9 mg/dl; p = 0.0002). Only 98 patients (45.85%) receive LLT, while 70% presented LDL > 130 mg/dl. The average dosis of hypolipidemiants was small and the combination therapy had been scanty used (2.7%). CONCLUSIONS:The hypolipidemic secondary prevention was incorrect, with a big gap between the efficacy of the LLT and the actual effectiveness. In the mayority of cases (75-80%) the values exceeded the secondary prevention targets. in a quarter of patients had never existed a clearly defined therapeutic target because the levels of HDL and LDL were not assessed. It was not prescribed neither fitting drug doses nor combinations to reach lipidemic preventive levels.