Lipid-Lowering Treatment in Hypercholesterolemic Patients: the CEPHEUS Thailand Survey
Apichard Sukonthasarn MD*, Mayuree Homsanit MD, MPH, PhD Epidemiology**, Bundit Prommete MD***, Chunhakasem Chotinaiwattarakul MD**, Chumpol Piamsomboon MD****, Khanchit Likittanasombat MD*****
Affiliation : * Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ** Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand *** Her Majesty Cardiac Center, Faculty of Medicine, Mahidol University Bangkok, Thailand ****Phramongkutklao Hospital, Bangkok, Thailand ***** Department of Medicine, Ramathibodi Hospital, Bangkok, Thailand
Background : Atherosclerotic cardiovascular disease (ASCVD) has become the leading cause of death and disability in
Thailand. Low-density lipoprotein cholesterol is the major risk factor of this condition that can be intervened by means of
lifestyle modification and pharmacologic treatment. Adequacy of hypercholesterolemia treatment with lipid lowering drugs in
Thailand needed to be more clarified. The present study was conducted to determine low-density cholesterol goal attainment
in Thai population at risk for developing ASCVD
Material and Method: Twenty-seven physicians with their 909 hypercholesterolemic patients whose age of > 18 years,
actively under pharmacologic treatment for at least three months with no dose adjustment for a minimum of six weeks from
seven centers across Thailand were enrolled. Plasma glucose, total cholesterol, LDL cholesterol, HDL-cholesterol, and
triglyceride levels were measured after overnight fast. Demographic and other relevant data including information on lipid
lowering drug used were retrieved. Patients’ awareness, knowledge on their management, compliance, and satisfaction were
evaluated by questionnaire survey as well as physicians’ use of guidelines, choice of management and goal setting, and their
attitudes towards lipid management. Cardiovascular risk level and LDL goal were assessed by the updated 2004 NCEP-ATP
III guidelines.
Results : All patients had LDL goal of < 130 mg/dl with 86.1% needed LDL goal of < 100 mg/dL. Overall, 52.7% of the
patients reached their LDL goal. The most prescribed treatment was statin monotherapy (82.7%). LDL goal attainment was
inversely associated with LDL goal set by NCEP-ATP III according to the patients’ risk profile, with only 16.7% of those who
were in the very high risk group with LDL goal of < 70 mg/dL achieved their goal whereas 60.6% and 84.7% of those with
high (LDL goal < 100 mg/dl) and moderately high-risk (LDL goal < 130 mg/dl) achieved their goal, respectively (p < 0.001).
Other factors associated with less favorable LDL goal attainment were coronary heart disease, carotid artery disease,
diabetes, 10-year risk of > 20%, and metabolic syndrome (p < 0.05 for all). Type of lipid lowering drug was not significantly
associated with LDL goal attainment.
Conclusion : LDL goal attainment was not achieved in a high proportion of Thai patients especially in those who had high
to very high risk for developing cardiovascular disease. Despite availability of well-established treatment guideline and
efficacious lipid lowering drugs, many patients still miss the opportunity to effectively control their lipid profile.
Keywords : Lipid lowering treatment, LDL goal
