Audit of cholesterol management among primary care patients in rural southern Italy

There has not yet been an audit of achievement rates of therapeutic targets for cholesterol management in the rural Italian primary care setting. The purpose of this study was to measure the percentage of patients with hypercholesterolaemia in a rural primary care setting in southern Italy, classify their risk category and measure the proportions of those patients who achieved optimal cholesterol levels according to the Adult Treatment Panel III guidelines. The audit was completed using records from 1 January 2005 to 31 December 2007. An electronic search key was entered into the electronic clinical records of 10 family doctors in a rural area of southern Italy for subjects with a diagnosis of or being treated for hypercholesterolaemia. A total of 194 hypercholesterolaemic patients were randomly selected from a cohort of patients registered with these family doctors. The low density lipoprotein cholesterol (LDL-C) target level was 100 mg/dL (2.6 mmol/L) in patients with existing cardiovascular disease, 130 mg/dL (3.3 mmol/L) for patients with ≥2 risk factors, and 160 mg/dL (4.1 mmol/L) for all other patients. The results regarding the efficacy of the therapy were categorised as follows: (1) on target, LDL-C lower or equal to levels of affiliated class; (2) poor control, 1-30 mg/dL (0.03-0.78 mmol/L) above the target level of LDL-C; (3) very poor control, ≥31 mg/dL (≥0.8 mmol/L) above the LDL-C target level. The average age of the hypercholesterolaemic patients included in the study was 62.0 ± 9.0 years; 55% were males, 30% were smokers, 71.3% suffered from hypertension, 46.3% had diabetes, 39.9% were obese and 31.9% had a family history of coronary disease. There were 114 subjects in Class I (personal history of coronary disease, cardiovascular risk ≥ 20, diabetes mellitus) LDL-C target level. Of these patients, 24.6% were at target, 30.7% had poor control and 44.7% had very poor control. A total of 42.3% of the subjects examined with the score system adopted by the Italian Heart Project showed levels of cardiovascular risk between 5% and 19% and were not eligible for a free prescription of lipid-lowering drugs. These data suggest that cholesterol management in this rural area is not always optimal in patients with high cardiovascular risk. Italian healthcare regulation seems to be a barrier to drug prescription and it may influence optimal LDL-C control.