Outcomes guarantee for lipid-lowering drugs: results from a novel approach to risk sharing in primary care

Current guidelines emphasise the importance of lipid management in secondary prevention of coronary heart disease (CHD). This audit of lipid levels and lipid-modifying therapy was undertaken in 1,736 patients, 919 men and 817 women, who were either attending a lipid clinic in inner-city Britain (n=1,035, 60%) or a general practice surgery covering 9,500 patients (n=701, 40%). Patient data were obtained from review of case notes and latest results for serum total, low-density lipoprotein (LDL-C) and high-density lipoprotein cholesterol (HDL-C) were categorised in accordance with UK guideline targets (total cholesterol < 5 mmol/L, LDL-C < 3 mmol/L and HDL-C > 1 mmol/L). Overall, 48% of men and 61% of women had raised total cholesterol levels above target and 23% of men and 8% of women had low levels of HDL-C; these proportions were generally consistent for individual centre data. Amongst patients with established CHD who were receiving statin therapy, 31% of men and 47% of women had raised total cholesterol levels above target and 24% of men and 8% of women had low HDL-C levels. This suggests that a substantial proportion of patients at risk of developing or with established CHD, either attending general practice or a specialist lipid clinic, fail to meet recommended lipid targets. Redress of this failure requires more aggressive management, possibly with multidrug lipid-modifying therapy.