Management of Atherogenic Dyslipidemia in the Primary Care Settting in Spain

OBJECTIVES: To describe the management of atherogenic dyslipidemia (AD) in routine clinical practice in the Primary Care (PC) setting in Spain. METHODS: Observational, descriptive, cross-sectional study, based on a structured questionnaire designed for this study. The questionnaire content was based on a literature review and was validated by 3 experts in AD. It included 23 items divided in 4 dimensions and was addressed to PC physicians with experience in AD management in the Spanish healthcare system. RESULTS: A total of 1,029 PC physicians participated in the study [mean age:53.49(SD 7.78); clinical experience: 26.5(SD 8.29)). Most physicians (76.68% and 93.00%) reported that AD is characterized by low HDL-C, elevatedTGs and elevated small, dense LDL-C particles, and that metabolic syndrome, early coronary disease andT2DM are phenotypes associated with it. 96.99% indicated that AD is a determinant factor for cardiovascular risk, even if LDL-C levels are appropriate. Most physicians (88.43%) evaluated residual cardiovascular risk in their clinical practice, however, only 27.89% of them evaluated it in secondary prevention. Regarding diagnosis, 82,22% reported thatTC,TG, HDL-C and non-HDL-C are essential measures when evaluating AD. Physicians often/very often usedTC/HDL-C (53.06%) and LDL-C/HDL-C (49.56%) lipoprotein ratios, considering them useful/very useful (86.30% and 85.04%, respectively). Almost all physicians reported that they can request fractionated cholesterol to assess HDL-C and LDL-C, however 3.69% could not. Physicians(95.63%) considered that the first step in AD treatment should be diet, regular exercise, smoking cessation along with pharmaceutical treatment, if necessary. 69.97% stated that pharmaceutical treatment should start with the combination of a statin and a fibrate (being fenofibrate the most appropriate one). CONCLUSIONS: Physicians have access to guidelines and recommendations regarding AD management, however, it is necessary to continue rising awareness about the importance of early detection and optimal control of AD to reduce patients' cardiovascular risk.