The benefit of secondary prevention with statin therapy in patients with established coronary heart disease (CHD) is well documented. Patients with MPD (triglyceride [TG] ≥2.3mmol/L with low HDL-C) have additional cardiovascular risk, which is not fully addressed by statin therapy. These patients may benefit from therapy with non-statin lipid lowering therapy such as fibrates and fish-oil.

We examined lipid profiles and vascular protection treatment strategies in 1949 consecutive outpatients treated by specialist cardiologists with a diagnosis of established CHD. Data for the sub-group of patients with comorbid diabetes (N=419) were similarly analysed.

A substantial proportion of patients had suboptimal lipid control: 727 (37.3%) had low HDL-C (<1.0mmol/L in men and 1.8mmol/L), and 190 (9.7%) had high TG (≥2.3mmol/L). Similar data were observed amongst patients with diabetes (Table 1). Treatment gaps were identified. Among patients with elevated LDL-C levels, most were treated with either high intensity (572 [63.2%]) or moderate/low intensity (250 [26.6%]) statin therapy; 34 patients (3.8%) were treated with fibrate or ezetimibe and 49 patients (5.4%) had no lipid-lowering therapy. MPD was observed in 121 (6.2%) of CHD patients. The prevalence of MPD was higher amongst patients with diabetes (N=54, 12.8%).  Only 13.2% of patients with MPD received fibrate therapy, with similar fibrate utilisation in diabetics (N=8, 14.8%) and non-diabetics (N=8, 11.9%).  

In our outpatient cohort, LDL > 1.8mmol/l was more common than MPD.  Nevertheless, MPD was observed in 6.2% of patients with CHD and 12.8% of those with CHD and diabetes. These patients may benefit from further medical or lifestyle interventions aimed at improving dyslipidaemia.