Have the Valencian government’s prescription algorithm and the 2013 American College of Cardiology/American heart association guidelines for managing dyslipidemia influenced the management of dyslipidemia? The MEJORALO-CV project

Abstract Objective To determine the management of dyslipidaemia in primary care after the publication of the American College of Cardiology/American Heart Association (ACC/AHA) 2013 guidelines and Valencian government’s algorithm. Method We conducted a cross-sectional descriptive study that employed a survey of primary care physicians of the Community of Valencia between January and October 2016. Results A total of 199 physicians (mean age, 48.9 ± 11.0 years; experience, 21.3 ± 11.1 years) participated in the survey. The most followed guidelines were those of the European Society of Cardiology (37.5 % of respondents) and Valencian government (23.4 % of respondents). Some 6.3 % of the respondents followed the 2013 ACC/AHA guidelines, and 88.0 % established objectives based on LDL cholesterol (LDL-C) and cardiovascular risk. The choice of lipid-lowering drug was based on its LDL-C lowering capacity (28.6 % of respondents), on the Valencian government’s algorithm (23.4 %) and on the drug’s safety (20.4 %). Statins, ezetimibe and fibrates were the preferred hypolipidemic agents, and their combination (51 % of respondents) and dosage increases (35 %) were the strategies employed for poor control. Lipid profile and transaminase and creatine kinase levels were measured every 6 (59.5 %, 52.3 % and 54.3 % of respondents, respectively) or 12 months (25.1 %, 29.2 % and 30.3 %, respectively). Forty-one percent of the respondents were aware of the controversy surrounding the 2013 ACC/AHA guidelines. Although 60 % of the respondents acknowledged its relevance, only 21 % changed their daily practices accordingly. Conclusions The Valencian government’s algorithm had a greater impact than the 2013 ACC/AHA guidelines in primary care in Valencia. Areas for improvement included the low use of validated guidelines and risk tables and the streamlining of laboratory test periodicity.