Article type
Abstract
Background: Hyperlipidemia was identified as a topic needing national clinical guidance in Singapore, owing to its rising prevalence, association with cardiovascular (CV) risk, and recent evidence for stricter low-density lipoprotein cholesterol (LDL-C) targets, particularly for patients with high and very high CV risk.
Objectives: Using population health data on LDL-C to assess achievement of newly proposed LDL-C targets to inform feasibility and acceptability of recommendations in clinical guidance
Methods: Clinical diagnoses and LDL-C measurements were extracted from national electronic health records between 2012 and 2019 for patients with hyperlipidemia and analyzed as panel data in relation to various LDL-C targets. Consumers were not involved.
Results: 557,244 patients were included in the analysis. At the point of hyperlipidaemia diagnosis, 16.0% had atherosclerotic cardiovascular disease (ASCVD), 2.7% had diabetes mellitus (DM) with chronic kidney disease (CKD); 3.9% had CKD stage ≥3; and 23.8% had DM without ASCVD or CKD. In 2019, between 41% and 62% of patients met existing LDL-C targets (Figure 1). When applying stricter targets to the 2019 cohort, only 9.4% with ASCVD would meet a proposed target of <1.4 mmol/L. Among patients who have DM with CKD, CKD stage ≥3, and DM without ASCVD or CKD, only 22.6%, 13.6%, and 17.8%, respectively, would meet a proposed target of <1.8 mmol/L.
A median reduction of 37.5% (interquartile range [IQR]: 27.3 to 51.7%) in LDL-C for patients with ASCVD would be needed to meet a proposed target of <1.4 mmol/L (Figure 2). Median reductions of 26.2% (IQR: 15.1% to 37.9%), 31.0% (IQR: 19·3% to 41.9%), and 29.3% (IQR: 17.8% to 40.7%) in LDL-C for patients with DM with CKD, CKD stage ≥3, and DM without ASCVD or CKD, respectively, would be required to meet a proposed target of <1.8 mmol/L. This information forecasted an increase in healthcare utilization associated with the proposed targets, which influenced both specialist and generalist experts in formulating clinical recommendations considering the potential clinical benefits, impact on the healthcare system, and overall evidence.
Conclusion: Routinely collected population health data on LDL-C control in different population subgroups and the percentage reduction required to meet stricter LDL-C targets were instrumental in anticipating the resource impact on the healthcare system and informing the development of practicable evidence-based recommendations.
Objectives: Using population health data on LDL-C to assess achievement of newly proposed LDL-C targets to inform feasibility and acceptability of recommendations in clinical guidance
Methods: Clinical diagnoses and LDL-C measurements were extracted from national electronic health records between 2012 and 2019 for patients with hyperlipidemia and analyzed as panel data in relation to various LDL-C targets. Consumers were not involved.
Results: 557,244 patients were included in the analysis. At the point of hyperlipidaemia diagnosis, 16.0% had atherosclerotic cardiovascular disease (ASCVD), 2.7% had diabetes mellitus (DM) with chronic kidney disease (CKD); 3.9% had CKD stage ≥3; and 23.8% had DM without ASCVD or CKD. In 2019, between 41% and 62% of patients met existing LDL-C targets (Figure 1). When applying stricter targets to the 2019 cohort, only 9.4% with ASCVD would meet a proposed target of <1.4 mmol/L. Among patients who have DM with CKD, CKD stage ≥3, and DM without ASCVD or CKD, only 22.6%, 13.6%, and 17.8%, respectively, would meet a proposed target of <1.8 mmol/L.
A median reduction of 37.5% (interquartile range [IQR]: 27.3 to 51.7%) in LDL-C for patients with ASCVD would be needed to meet a proposed target of <1.4 mmol/L (Figure 2). Median reductions of 26.2% (IQR: 15.1% to 37.9%), 31.0% (IQR: 19·3% to 41.9%), and 29.3% (IQR: 17.8% to 40.7%) in LDL-C for patients with DM with CKD, CKD stage ≥3, and DM without ASCVD or CKD, respectively, would be required to meet a proposed target of <1.8 mmol/L. This information forecasted an increase in healthcare utilization associated with the proposed targets, which influenced both specialist and generalist experts in formulating clinical recommendations considering the potential clinical benefits, impact on the healthcare system, and overall evidence.
Conclusion: Routinely collected population health data on LDL-C control in different population subgroups and the percentage reduction required to meet stricter LDL-C targets were instrumental in anticipating the resource impact on the healthcare system and informing the development of practicable evidence-based recommendations.