Lipid management in India: a nationwide, cross-sectional physician survey

Lipids in Health and Disease

Research

Amruta Chemburkar¹  Jaideep Gogtay¹  Meena Lopez¹  Gurpreet S. Wander²  Uday M. Jadhav³ 

[1] Cipla Ltd, Lower Parel, 400013, Mumbai, India;Department of Cardiology, Hero DMC Heart Institute, Dayanand Medical College and Hospital, Ludhiana, Punjab, India;Department of Cardiology, MGM New Bombay Hospital, 400703, New Mumbai, India;

关键词: Lipids;    Survey;    Physician survey;    Dyslipidemia;    India;   

DOI  :  10.1186/s12944-017-0519-1

 received in 2017-03-24, accepted in 2017-06-15,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundCurrent international guidelines on dyslipidemia are not concordant on various aspects of management. Also, there are no uniformly accepted Indian guidelines. We, therefore, performed a physician survey to understand lipid management practices in India.MethodsAn anonymous survey questionnaire was administered to gauge physicians’ self-reported behavior regarding lipid management aspects. Results were expressed in terms of percentages based on the number of responses obtained.ResultsA total of 404 physicians participated in the survey. Eighty-eight percent respondents ordered a lipid profile before starting statin therapy, and 80% preferred to set lipid targets, though the tools used for calculating cardiovascular risk varied. Atorvastatin was preferred over rosuvastatin in primary prevention (72.9 vs. 32.4%), secondary prevention (54.6 vs. 46.7%), diabetic patients (56.3 vs. 40.3%) and post-ACS (78.3 vs. 34%). High-intensity statins were preferred by 73.7% of respondents in post-ACS cases. Fifty percent doctors chose not to use a statin in diabetic patients, irrespective of their LDL-C levels. The most preferred drug option for managing atherogenic dyslipidemia and moderate hypertriglyceridemia was statin-fibrate combination (55.1%) and fibrates (35.4%), respectively. Sixty-three percent doctors preferred to prescribe statins in patients with moderately high LDL-C and normal triglycerides, without CHD or CHD risk equivalents. Around 28% of doctors preferred not to use pharmacotherapy for managing isolated low HDL. Of the participants, 73% used fibrates in ≤20% of their dyslipidemic patients, with fenofibrate being the most preferred (90.5%). Ezetimibe was mainly used in patients with uncontrolled LDL-C despite statin therapy (52.4% respondents). Most preferred approaches to manage statin intolerance included reducing statin dose (39%) and stopping and restarting statins at a lower dose (34.5%). Fifty-two percent of doctors chose not to alter pre-existing therapy in patients who had LDL-C levels at goal but elevated non-HDL-C levels.ConclusionThis is the first survey in India that provides useful insights into Indian physicians’ self-reported perspectives on managing dyslipidemia in routine clinical practice. Despite concordance with the currently available guidelines in certain aspects, there is incongruence in managing specific dyslipidemia problems. Further continuing medical education and the development of evidence-based, India-specific lipid guidelines can help reduce some of these differences.

【 授权许可】

CC BY   
© The Author(s). 2017