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October 23, 2017

Prof Schunkert said: "Our study focused on cholesterol treatment of patients in Germany, and, more specifically, the awareness of primary care physicians for how patients' characteristics affect LDL target values. Even though confined to one nation, the study may highlight similar scenarios in other European countries and those around the world. In fact, similar data were reported from Italy. The core question involves the perception of patient risk: for example, women are often perceived as having a lower cardiovascular risk compared to their real risk, and this may lead to insufficient treatment. This aspect has also been reported in other regions of the world.

"We hope that the data from our study will remind physicians of the need to observe relevant guidelines to calculate individually every patient's target value, so that they can deliver the best possible care to all their patients."

He said there might be a number of reasons why doctors failed to follow guidelines correctly. "I am afraid to say that women are simply overlooked by their physicians, when it comes to cardiovascular risk. Moreover, not all physicians believe in the concept of risk reduction by LDL modification, although the evidence is overwhelming. Their reasons may be multifactorial: some might be confused by different, changing and frequently updated guidelines and some may simply lack time to spend on their patients in primary care. Physicians may need more assistance in determining the risk of their patients, for instance with nurse practitioners or computer programs calculating the risk from the patients' electronic file notes.

"We believe efforts should be made to make guidelines simpler and easier to understand and follow; instruments to identify high-risk patients more easily should be developed; and special attention should be paid to women and patients without known cardiovascular disease, but with an accumulation of risk factors, since both groups appear frequently to escape the notice of doctors for aggressive cholesterol-lowering treatment."

Speaking on behalf of the European Society of Cardiology, Professor Ian Graham, consultant cardiologist at the Adelaide and Meath Hospital, Dublin, Ireland, who was unconnected with the study, said: "Cholesterol in the blood is a risk factor for heart attack. This interesting study suggests that about one half of German primary care physicians have difficulty in assigning appropriate therapeutic target values for LDL cholesterol in subjects with raised blood cholesterol levels. If the target is not clear, less adequate therapy is likely. The study used American target levels for LDL and the situation may be worse than this because European target values for LDL cholesterol are slightly more stringent than American ones.

"These finding will be of value to the ESC's Prevention Implementation Committee in its efforts to promote guideline knowledge and usage throughout Europe, as well as to all involved in medical education at undergraduate and postgraduate level. In some countries, physician re-imbursement is dependent upon achieving risk factor targets which may also be an incentive."

Source European Heart Journal