Impact of optimal lipid value achievement between 2005 and 2009 in patients with mixed dyslipidaemia on cardiovascular event rates

Summary Background:  The burden of cardiovascular (CV) disease remains high despite substantial improvements in low-density lipoprotein cholesterol (LDL-C) goal achievement rates. Methods and Results:  Two cohorts of mixed dyslipidaemia patients were identified from the HealthCore Integrated Research Database. Patients with no baseline lipids [LDL-C, triglycerides (TG), high-density lipoprotein cholesterol (HDL-C)] at optimal values (n = 27,094) and patients at LDL-C goal but with at least one other lipid not at optimal value at baseline (n = 83,067) were followed for approximately 2 years. The primary outcome was the association between achievement of optimal lipid values (OLV) and occurrence of ischaemic heart disease, cerebrovascular disease or peripheral arterial disease. Achievement of OLV during follow up occurred in 6.8% of patients with no baseline lipids at optimal values and in 17.9% of patients at LDL-C goal with at least one other lipid not at optimal value at baseline. After adjustment, significant reductions in CV events were associated with achievement of OLV across the entire lipid panel in patients who had no optimal baseline lipid values (hazard ratio, 0.407; 95% confidence interval, 0.303–0.546) or when patients were at LDL-C goals at baseline (hazard ratio, 0.764; 95% confidence interval, 0.703–0.831). Conclusions:  In conclusion, challenges to effective treatment of mixed dyslipidaemia remain, as evidenced by a minority of patients achieving optimal lipid levels. There appears to be an association with incremental lowering of CV event rates beyond LDL-C goal attainment when compared with achieving OLV across the entire lipid panel for LDL-C, TG and HDL-C.