Actitud clínica ante la dislipemia en pacientes con elevado riesgo cardiovascular en España. Estudio ALMA

OBJECTIVE: To assess the attitude of primary care (PCPs) and specialized care (SCPs) physicians towards the general set of patients with dyslipidemia, particularly those with cardiovascular risk factors. DESIGN: Observational, descriptive, multi-center study based on a survey. LOCATION: Different healthcare regions in Spain. PARTICIPANTS: 1,402 PCPs, and 596 SCPs. MAIN MEASUREMENTS: Physician's profile, routine practices in the management of patients with dyslipidemia. RESULTS: 84.3% took the global cardiovascular risk into account when prescribing the treatment. Target LDL-C concentration in patients without cardiovascular risk factors was < 130 mg/dL and < 160 mg/dL for 51.9% and 29.0% of physicians, respectively. In smokers and patients with hypertension or diabetes, the LDL target was < 100 mg/dL for 49-55% of physicians, whereas in patients with cardiovascular complication, ischemic cardiopathy or stroke, target LDL-C was < 70 mg/dL in 71-88% of them. First-line treatment for patients without cardiovascular risk factors was atorvastatin (66%), whereas in patients with diabetes, kidney disease or metabolic syndrome, most physicians (80-89%) used pitavastatin. SCPs showed a greater trend than PCPs to establish a LDL-C target of < 70 mg/dL in patients with previous stroke (77.5% vs 66.8%) or coronary disease (92.1% vs 80.6%) (P < .0001), as well as to prescribe a combined treatment in patients not achieving the target LDL-C concentrations (58.1% vs 50.2%, P = .0013). CONCLUSIONS: Although CVR assessment is generally accepted, there is broad disagreement in defining the objectives of LDL-C. Most often than PCPs, the SCPs consider more ambitious targets for LDL-C and the association of lipid-lowering drugs.