Achievement of lipoprotein goals among patients with metabolic syndrome at high cardiovascular risk across Europe. the EURIKA study

Objective: To examine for the first time the achievement of lipoprotein treatment goals in patients with metabolic syndrome and lipid abnormalities who are at elevated cardiovascular risk in Europe. Methods: Cross-sectional study conducted in 2009-2010 in 12 European countries among outpatients aged ≥ 50 years free of clinical cardiovascular disease. We assessed achievement of American Diabetes Association/American College of Cardiology lipid treatment goals in those with metabolic syndrome at highest risk (diabetes plus ≥ 1 additional major cardiovascular risk factor beyond lipid abnormalities) or high risk (no diabetes but ≥ 2 additional major cardiovascular risk factors). Results: Among 1431 highest-risk patients, 64.6% (between-country range [BCR] 40-84.5%) were on lipid-lowering medication. Of them, 13.4% (BCR: 2.5-28.6%) had LDL-cholesterol < 70 mg/dl, non-HDL-cholesterol < 100 mg/dl, and apolipoprotein B < 80 mg/dl. Among 832 high-risk patients, 38.7% BCR: 27.5-55.3%) were on lipid-lowering medication. Of them, 20.5% (BCR: 5.5-57.6%) had LDL-cholesterol < 100 mg/dl, non-HDL-cholesterol < 130 mg/dl, and apolipoprotein B < 90 mg/dl. About 96% of highest-risk patients and 94% of high-risk patients were given at least one lifestyle advice (weight reduction, healthy diet, physical activity, no-smoking), but only 1.3% of the former and 4.9% of the latter reached all three lipid goals. Conclusion: There is a substantial gap between clinical guidelines and medical practice since only one in 5-7 patients met all treatment targets. Although most patients received lifestyle advice, the effectiveness of counseling was very low. Large between-country differences in outcomes suggest considerable room for improvement.