A new survey by the International Atherosclerosis Society (IAS) provided a 'snapshot' of the gaps in knowledge among clinicians that limit best practice. This web-based survey was carried out in countries representing different regions of the world: Japan, Germany, Colombia and the Philippines. In Japan, the survey was a follow-up to an initial survey in 2017. Overall, 1,758 clinicians, 508 in Japan, 500 in Germany, 345 in Colombia, and 405 in the Philippines, took part in the survey. Participants were selected randomly from existing databases in each country and invitations to participate were sent to physicians from five medical fields:
All had experience of treating patients with high cholesterol.
This survey demonstrates that as difficulty elevates when treating patients, such as moderate and high-risk patients, a greater degree of uncertainty exists in the approach to care. Additionally, while most clinicians believe they treat elevated low-density lipoprotein (LDL) cholesterol according to the guidelines, only half know the targets in high-risk patients. This lack in understanding of the guidelines deters the best treatment of LDL cholesterol, a major risk factor for cardiovascular events.
This survey highlights gaps in beliefs and behavior among physicians in all four countries, resulting in the following take-away messages:
With the exception of FH, physicians are uncertain about how to manage higher- risk patients who may benefit from aggressive approaches to LDL-C lowering.
There is concern about potential adverse effects on cognitive, renal and hepatic function, and risk for new onset diabetes with statin use to lower LDL-C levels. Haemorrhagic stroke is the main concern as LDL-C levels go lower. In particular, more than one in three clinicians was uncertain about the risk of haemorrhagic stroke with such low LDL cholesterol levels.
Despite recent guidelines recommending target LDL cholesterol levels below 50 mg/dL or 1.29 mmol/L in very-high-risk patients more than one-third of clinicians had no opinion about the safety of low LDL cholesterol levels.
Failure to treat LDL cholesterol adequately is the number one cause of the high residual cardiovascular risk that persists in all regions of the world.
Clearly we need a CALL TO ACTION, as there is an urgent need for education programs to clarify the information in the guidelines and overcome barriers in practice, an action very much in line with the mission of the IAS to reduce the burden of cardiovascular disease,' commented IAS President Dr Raul Santos, Heart Institute -InCor, University of São Paulo Medical School Hospital, and Hospital Israelita Albert Einstein, São Paulo, Brazil.
This survey was supported by an unrestricted grant from Amgen. The Philippine Lipid and Atherosclerosis Society received an in-kind support from Merck Sharpe & Dome (Philippines) in setting up the platform.