Gyula Pados

Lipid-modifying therapy and attainment of cholesterol goals in Hungary: the return on expenditure achieved for lipid therapy (REALITY) study.

AbstractBackground and objective: Cardiovascular disease is a leading cause of death in Eastern Europe. Few studies on cholesterol goal achievement have been conducted in Hungarian clinical settings. This study set out to evaluate lipid-modifying therapy practices and their effects on total cholesterol (TC) and low-density lipoprotein cholesterol (LDL-C) goal attainment in Hungarian patients with coronary heart disease (CHD), CHD risk equivalents, or ≥2 coronary risk factors. Methods: This multicentre observational study involved patients receiving lipid-modifying therapy who were under the care of general practitioners (n = 300) or specialists (n = 140). Physician questionnaires were used to collect data on baseline patient characteristics, including laboratory parameters. Using validated cardiovascular risk assessment measures, patients were stratified into high-risk (10-year absolute coronary risk >20%; n = 367) and lower risk groups (n = 73). Cholesterol goals were TC <4.5 mmol/L (<175 mg/dL) and LDL-C <2.5 mmol/L (<100 mg/dL) for the high-risk group and TC <5.0 mmol/L (<193 mg/dL) and LDL-C <3.0 mmol/L (<117 mg/dL) for those at lower risk. Results: Among 440 patients (n = 312 with CHD or CHD risk equivalents), 374 (85%) were initiated on HMG-CoA reductase inhibitors (statin monotherapy), 44 (10%) received fibric acid derivatives and 22 (5%) received combination regimens. Although >50% of patients needed >35% TC lowering to reach goal, <10% of patients received high or very high potency lipid-modifying regimens or combination regimens initially. A total of 116 (26.4%) patients achieved their TC goals after ≥1 year of treatment, including 27.9% of patients with CHD/risk equivalents and 22.7% of those with risk factors only. Sixty-six (15%) patients achieved goal on initial lipid-modifying regimens, while a further 50 (11.4%) achieved goal following treatment changes, including upward dosage adjustments. Conclusion: Approximately 74% of Hungarian patients receiving lipid-modifying therapy in our study did not achieve cholesterol goals. The proportion of patients realising their TC goals was higher in those treated by specialists but still did not exceed one-third.

Changes in attainment of lipid goals by general practitioners and specialists in patients at high cardiovascular risk in Hungary during 2004-2008

Introduction Lipid-lowering therapy should achieve target levels. We assessed the change of the achievement of targets and the mean low-density lipoprotein cholesterol (LDL-C) levels in high-risk Hungarian patients. Material and methods Six studies performed with patients of general practitioners (GPs) and specialists between 2004 and 2008 were evaluated: 9,508 patients from GPs and 2809 from specialist practices (total 12,317). Results During this 4-year period the LDL-C level decreased by 0.73 mmol/l and the LDL-C goal achievement rate increased from 14 to 32% in patients treated by GPs. LDL-C showed a decrease of 0.48 mmol/l and the goal achievement rate changed from 20 to 43% in patients treated by specialists. In the majority of the patients not achieving the LDL-C goal (57% for specialists and 89% for GPs) there was no modification in the current therapy. In addition to emphasizing the priority of LDL-C lowering, we should also strive for residual risk reduction, which means raising high-density lipoprotein cholesterol (HDL-C) and lowering triglyceride levels. There was no significant improvement in HDL-C or triglyceride levels during the examined period. Conclusion More attention needs to be paid to changing treatment of patients to achieve target levels.

How can we further improve the LDL-cholesterol target level achievement rate based on the Hungarian MULTI GAP 2011 study results and considering the new European dyslipidemia guidelines?

Introduction Despite the continuous improvement of the quality of lipid lowering therapy the achievement of target values is still not satisfactory, mainly in the very high cardiovascular risk category patients, where the goal of low density lipoprotein cholesterol (LDL-C) is 1.80 mmol/l. Material and methods The trends in lipid lowering treatment of 17420 patients from different studies conducted between 2004 and 2010 were compared to that of 1626 patients of MULTI GAP (MULTI Goal Attainment Problem) 2011 treated by general practitioners (GPs) and specialists. Results In MULTI GAP 2011 the mean LDL-C level ± SD) of patients treated by GPs was found to be 2.87 ±1.01 mmol/l, the target value of 2.50 was achieved by 40% of them, in the specialists’ patients the mean LDL-C level proved to be 2.77 ±1.10 mmol/l and the achievement rate was 45%. In the 2.50 mmol/l achievement rate of GPs’ patients a satisfactory improvement was observed in the studied years, but the 1.80 mmol/l LDL-C goal in 2011 was attained only in 11% of very high risk cases. There was a linear correlation between the patient compliance estimated by the physicians and the LDL-C achievement rate. Conclusions As the number of very high risk category patients has been increased according to the new European dyslipidemia guidelines, growing attention needs to be placed on attainment of the 1.80 mmol/l LDL-C level. Based on the results of the MULTI GAP studies, improving patients’ adherence and the continuous training of physicians are necessary.

An attempt to make lipid-lowering therapy more effective in Hungary. The results of MULTI GAP 2010 and the PLUS Program.

Introduction The primary goal of lipid-lowering therapy is the attainment of low-density lipoprotein cholesterol (LDL-C) target levels. Material and methods The MULTI GAP (MULTI Goal Attainment Problem) 2010 is a part of surveys started a few years ago, in which the lipid results of 1540 patients treated by general practitioners (GPs) and specialists were measured. The data were compared to the results of similar studies involving 15,580 patients between 2004 and 2009. Results In 2010 the mean LDL-C level (± SD) of patients treated by GPs was found to be 3.01 ±1.0 mmol/l. The target of 2.50 mmol/l was achieved by 32%, with a mean LDL-C level of 2.84 ±1.0 mmol/l and an achievement rate of 39% in patients treated by specialists. The results of comparisons starting from 2004 showed a marked improvement every year in the beginning, but in the last 3 years stagnation was observed. In 2010 in addition to the MULTI GAP main study, a group of physicians took part in special training called the Plus Program. As a result of this, the LDL-C level was 0.18 mmol/l lower in 114 of the GPs’ patients (p = 0.088) and 0.27 mmol/l (p < 0.0001) lower in 313 of the specialists’ patients, with a significantly better, 42% (p = 0.045) and 50% (p = 0.001), goal attainment rate, respectively. Conclusions The 2010 MULTI GAP study shows that the quality of lipid-lowering therapy in Hungary seems to be in stagnation. The results of the PLUS Program suggest that continuous training of doctors is the key to further improvement.

[The pharmacological treatment of obesity: past, present and future].

Currently, obesity presents one of the biggest health problems. Management strategies for weight reduction in obese individuals include changes in life style such as exercise and diet, behavioral therapy, and pharmacological treatment, and in certain cases surgical intervention. Diet and exercise are best for both prevention and treatment, but both require much discipline and are difficult to maintain. Drug treatment of obesity offer a possible adjunct, but it may only have modest results, limited by side effects; furthermore, the weight lowering effects last only as long as the drug is being taken and, unfortunately, as soon as the administration is stopped, the weight is regained. These strategies should be used in a combination for higher efficacy. Drugs used to induce weight loss have various effects: they increase satiety, reduce the absorption of nutrients or make metabolism faster; but their effect is usually moderate. In the past, several drugs were used in the pharmacological therapy of weight reduction including thyroid hormone, dinitrophenol, amphetamines and their analogues, e.g. fenfluramine, At present, only orlistat is available in the long term treatment (≥ 24 weeks) of obesity as sibutramine and rimonabant were withdrawn form the market. Several new anti-obesity drugs are being tested at present, and liraglutide, a GLP-1 analogue (incretin mimetic), is the most promising one.

To What Extent are National Cardiovascular Disease Preventive Guidelines Accomplished in Hungary? The Goal Attainment Program (GAP)

Purpose: Improving the management of cardiovascular disease in Hungary represents an important clinical challenge. This article assesses the achievement of national consensus total cholesterol goals among Hungarian patients of physicians educated about the consensus guidelines and assisted in cardiovascular risk assessment. Methods and results: A total of 320 general practitioners provided data on 15,404 eligible patients. Among these individuals, 14,018 (91%) had documented atherosclerosis and the remaining 9% had ≥ 2 risk factors. Despite this, less than half of all patients received lipid-lowering therapy. Only 12% of high-risk patients attained the consensus total cholesterol target of < 4.5 mmol/L (< 175 mg/dL) and 31% of individuals at low-moderate risk achieved the consensus goal of < 5.0 mmol/L (< 194 mg/dL) at the first visit. Among patients in the high-risk group whose total cholesterol levels were above the consensus goal at the first visit, 54% received no lipid-lowering therapy and 46% receiv...

Egyre.,célratörobb" lipidterápiás szokásaink-A Magyar MULTI GAP 2010 eredményei

A korabbi vizsgalatok azt mutattak, hogy a nagy kockazatu betegek jelentős resze nem eri el az LDL-C-celertekeket, es az alkalmazott lipidcsokkentő kezeles ellenere az ajanlottnal magasabb trigliceridszinttel es alacsony HDL-C-szinttel is rendelkeznek. Celok: A szerzők a 2008. es 2009. evi felmeresekhez hasonloan, a jelen vizsgalatban is a cardiovascularis esemenyen atesett betegek dyslipidaemiajanak kezelesi strategiajat elemeztek. Modszerek: A MULTI GAP (MULTI Goal Attainment Problem) 2010 vizsgalatban standard strukturalt kerdőivek segitsegevel 2332 beteg adatai kerultek feldolgozasra. Az elemzesben az osszkoleszterin-, LDL-C- mellett a HDL-C- es atherogen koleszterin- (A-C), illetve a triglicerid-celerteket elerők aranya is kiertekelesre kerult. Eredmenyek: A vizsgalt betegek 15%-a (n = 355) nem reszesult lipidcsokkentő kezelesben. A szakorvosok altal kezelt betegek 44%-a elerte a 2,5 mmol/l LDL-C-celerteket. A HDL-C-celerteket a nagy rizikoju betegek 61%-a, mig a triglicerid-celerteket a betegek 43%-...

[Becoming more "goal-oriented" in therapy of dyslipidemias: results of the Hungarian MULTI GAP 2010].

A korabbi vizsgalatok azt mutattak, hogy a nagy kockazatu betegek jelentős resze nem eri el az LDL-C-celertekeket, es az alkalmazott lipidcsokkentő kezeles ellenere az ajanlottnal magasabb trigliceridszinttel es alacsony HDL-C-szinttel is rendelkeznek. Celok: A szerzők a 2008. es 2009. evi felmeresekhez hasonloan, a jelen vizsgalatban is a cardiovascularis esemenyen atesett betegek dyslipidaemiajanak kezelesi strategiajat elemeztek. Modszerek: A MULTI GAP (MULTI Goal Attainment Problem) 2010 vizsgalatban standard strukturalt kerdőivek segitsegevel 2332 beteg adatai kerultek feldolgozasra. Az elemzesben az osszkoleszterin-, LDL-C- mellett a HDL-C- es atherogen koleszterin- (A-C), illetve a triglicerid-celerteket elerők aranya is kiertekelesre kerult. Eredmenyek: A vizsgalt betegek 15%-a (n = 355) nem reszesult lipidcsokkentő kezelesben. A szakorvosok altal kezelt betegek 44%-a elerte a 2,5 mmol/l LDL-C-celerteket. A HDL-C-celerteket a nagy rizikoju betegek 61%-a, mig a triglicerid-celerteket a betegek 43%-...

Becoming more focused therapeutic lipid patterns: results from the Hungarian MULTI GAP 2010

A korabbi vizsgalatok azt mutattak, hogy a nagy kockazatu betegek jelentős resze nem eri el az LDL-C-celertekeket, es az alkalmazott lipidcsokkentő kezeles ellenere az ajanlottnal magasabb trigliceridszinttel es alacsony HDL-C-szinttel is rendelkeznek. Celok: A szerzők a 2008. es 2009. evi felmeresekhez hasonloan, a jelen vizsgalatban is a cardiovascularis esemenyen atesett betegek dyslipidaemiajanak kezelesi strategiajat elemeztek. Modszerek: A MULTI GAP (MULTI Goal Attainment Problem) 2010 vizsgalatban standard strukturalt kerdőivek segitsegevel 2332 beteg adatai kerultek feldolgozasra. Az elemzesben az osszkoleszterin-, LDL-C- mellett a HDL-C- es atherogen koleszterin- (A-C), illetve a triglicerid-celerteket elerők aranya is kiertekelesre kerult. Eredmenyek: A vizsgalt betegek 15%-a (n = 355) nem reszesult lipidcsokkentő kezelesben. A szakorvosok altal kezelt betegek 44%-a elerte a 2,5 mmol/l LDL-C-celerteket. A HDL-C-celerteket a nagy rizikoju betegek 61%-a, mig a triglicerid-celerteket a betegek 43%-...