1Universitätsklinikum Jena Klinik für Innere Medizin I - Kardiologie Jena, Deutschland; 2BNK Service GmbH Forschung und Versorgung München, Deutschland; 3Universitätsklinikum Halle (Saale) Klinik und Poliklinik für Innere Medizin III Halle (Saale), Deutschland; 4Novartis Pharma GmbH Nürnberg, Deutschland; 5Real World Solutions, IQVIA Frankfurt, Deutschland; 6Herzklinik Ulm, Dr. Haerer und Partner Überörtliche BAG Ulm, Deutschland
Background: Accounting for one third of deaths in 2021, cardiovascular diseases (CVD) are the leading cause of death in Germany. Elevated levels of low-density lipoprotein cholesterol (LDL-C) are a major risk factor for CVD. Aim of this project is to evaluate differences in hypercholesterolemia treatment and LDL-C values in patients with atherosclerotic cardiovascular disease (ASCVD) documented by office-based cardiologists (OBCs) and general practitioners (GPs) in Germany. LipidSnapshot is a joint research project of the Center of Health Services Research of the German Cardiac Society (DGK-ZfKVF), Bundesverband niedergelassener Kardiologen (BNK), Deutsche Gesellschaft zur Bekämpfung von Fettstoffwechselstörungen und ihren Folgeerkrankungen DGFF (Lipid-Liga) e.V. and Novartis.
Methods: Data from ASCVD patients obtained from a prospective, non-interventional multicenter research project at OBCs in August 2023 were compared with patient data from a retrospective, aggregated analysis of anonymous electronic medical records documented by GPs between July 2022-June 2023 within the IQVIA Disease Analyzer. The proportion of patients reaching pre-defined LDL-C categories (<55 mg/dL, 55-<70 mg/dL, 70- <100 mg/dL, 100-<130, 130- <190 and ≥190), differences in lipid lowering therapies (LLT), gender- and age-related differences in LDL-C levels and LLTs in patients documented by OBCs compared to GPs were assessed.
Results: Data from 1500 patients (24.2% female) enrolled at 49 OBCs and 82,375 patients (39.5% female) at 996 GPs were included, mean age (Standard deviation (SD)) was 72.4 (10.0) and 73.0 (13.2), respectively. Mean LDL-C was 74.8 mg/dL (SD 31.8) and 96.1 mg/dL (SD 41.4), respectively (Table 1). Of the patients documented by GPs, more patients did not receive any LLT compared to patients documented by OBCs (26.6% vs. 1.5%). Patients documented by OBCs were more likely to receive statins plus other LLT (including ezetimibe, bempedoic acid and/or bile acid sequestrants) compared to patients documented by GPs (38.3% vs. 13.1%). In both specialties, men had lower LDL-C values compared to women (OBC documented patients: mean LDL-C (SD) male 72.6 mg/dL (29.3), female 81.9 mg/dL (37.7); GP documented patients: male 90.2 (39.5), female 105.3 (42.4) with a higher proportion of women on no LLT (OBC documented patients: male 1.2%, female 2.5%; GP documented patients: male 22.5%, female 32.9%) (Table 2). Older patients were more likely to receive a statin monotherapy (Table 3).
Conclusion: The majority of ASCVD patients were not treated sufficiently. We found differences in LLT and LDL-C levels in patients documented by OBCs and GPs indicating a structural gap in the treatment landscape of ASCVD patients in Germany. In addition, age and gender affected LLT prescription in ASCVD patients.