Hypercholesterolemia in France, from recommendations to management in real life: The French gap

Introduction HyperLDLemia is a major cardiovascular risk factor, often undiagnosed. Very few french data are available on the prevalence and the management of hyperLDLemia at the population level. Purpose The aim of the study was to estimate the prevalence of hyperLDLemia in adults and to describe its management in France in 2015, in the context of a large media crisis with publications in the lay press of false informations on statins. Methods Esteban is a cross-sectional study based on a representative sample of the French metropolitan population, implemented in 2015. Data were collected using questionnaires and a biological and clinical exam in adults aged 18–74. Results In the population, after application of the 2011 ESC/EAS guidelines, the prevalence of hypercholesterolemia LDL was 23.3% (LDL-c value over the goal regarding individual cardiovascular risk level or at least one delivery of lipid lowering treatment during the 6 months preceding the clinical exam). This prevalence of hyperLDLemia concerned 5% of the low-cardiovascular-risk population and more than 90% of the population with high and very high cardiovascular risk. The percentage of adults treated with lipid lowering drug was 7.2% (2.7% with a I/A grade treatment, 3.9 with a IIa/A grade and 0.6% out of the 2011 guidelines). More than 16% of adults in the population were untreated but should have been treated following 2011 guidelines (10.9% according to I/A guidelines and 5,2% according to IIa/A). Adherence to lipid-lowering drugs (proportion of days covered by treatment) was 66%. Conclusion This study showed that hyper LDLemia is a common metabolic disease in France, affecting 23.3% of the population. The cholesterol-lowering prescriptions in France are very far from the recommendations for practice. Less than a third of the patients who would justify treatment are actually treated. This gap between the recommendations and real life corresponds to a real loss of opportunity for patients.