Attainment of low-density lipoprotein cholesterol target in the French general population according to levels of cardiovascular risk: Insights from the MONA LISA study

Abstract

Background: Controlling low-density lipoprotein (LDL)-cholesterol concentration is of tremendous importance to reduce cardiovascular risk.

Aims: To investigate the attainment of LDL-cholesterol targets recommended in French and European guidelines on cardiovascular prevention, according to levels of cardiovascular risk.

Methods: Participants aged 35 to 74 years (n=4609) were randomly selected from the general population of three French regions. A standardized data collection was performed to assess cardiovascular risk as described in the French and European guidelines.

Results: Overall, 17.5% of participants were considered to be at high risk and 25.4% at high or very high risk, according to the French and European guidelines, respectively. Only 1.2% of participants with no cardiovascular risk factors according to the French guidelines had an LDL-cholesterol concentration above the recommended target, whereas 82.5% of high-risk subjects did not attain their goal (70.8% among high-risk subjects receiving lipid-lowering therapy). Among untreated people, the median reduction in LDL-cholesterol needed to reach target ranged from 6.6% (lowest-risk groups) to 36.0% (highest-risk subjects). When risk was classified according to the European guidelines, the majority of participants did not reach the recommended LDL-cholesterol targets, irrespective of their level of risk or lipid-lowering therapy.

Conclusion: In a majority of primary prevention candidates with multiple risk factors and in most high-risk subjects, LDL-cholesterol targets recommended by French guidelines are not being achieved, either because of insufficient treatment or because subjects are not recognized as being at risk. More stringent targets proposed by the European guidelines are not being achieved in most cases.