Status of lipid-lowering therapy prescribed based on recommendations in the 2002 report of the Japan Atherosclerosis Society Guideline for Diagnosis and Treatment of Hyperlipiclemia in Japanese Adults: A study of the Japan Lipid Assessment Program (J-LAP)

Background: In its 1997 Guideline for Diagnosis and Treatment of Hyperlipidemia in Japanese Adults and subsequent revisions, the Japan Atherosclerosis Society (JAS) recommends serum lipid management goals (SLMGs) based on a coronary heart disease (CHD) risk classification. A literature search revealed that the status of lipid-lowering therapy based on the current JAS recommendations in Japan has not been assessed. Objective: The aim of this study was to evaluate the efficacy of current lipid-lowering regimens, and to provide the best possible therapeutic strategies for patients with hyperlipidemia by identifying risk factors for the development of CHD, based on the current JAS recommendations. Methods: This multicenter, retrospective study was conducted using data from patients under the care of physicians at 12,500 randomly selected institutions across Japan. Physicians received a survey concerning lipid-lowering therapy, on which each physician provided data from 10 consecutive adult patients with hyperlipidemia. who had been prescribed lipid-lowering therapy for at least 3 months before the survey was administered, and who were undergoing routine follow-up on an outpatient basis. Physicians provided patients' demographic and clinical data, including JAS-defined CHD risk classification, coronary risk factors and pre- and posttreatment (after >= 3 months) serum lipid levels, and the types and dosages of drugs in patients' current and prior treatment regimens. These data were used to assess the efficacy of lipid-lowering regimens and rates of patients achieving the SLMGs recommended by the JAS. Results: A total of 2540 physicians participated in the survey, and data from 24,893 Japanese patients (mean [SD] age, 65.8 [10.5] years) with hyperlipidemia were included in the study. Patients with familial hyperlipidemia (845/24,893 [3.4%]) were excluded from most of the analyses, leaving 24,048 patients with primary hyperlipidemia. The most prevalent coronary risk factors included age (21,902 [91.1%]), hypertension (14,275 [59.4%]), diabetes mellitus type 2 and/or impaired glucose tolerance (6346 [26.4%]), and smoking (3841 [16.0%]). A total of 20,948 patients (87.1%) had a CHD risk classification of B (ie, >= 1 coronary risk factor but no history of CHD). At the time of the survey, the lipid-lowering regimens of 22,080 patients (91.8%) included a statin. The rates of achievement of SLMGs were as follows: total cholesterol (TC), 12,659/23,840 patients (53.1%); low-density lipoprotein cholesterol (LDL-C), 14,025/22,121 (63.4%); high-density lipoprotein cholesterol, 19,702/21,279 (92.6%); and triglycerides (TG), 14,892/23,569 (63.2%). TC and LDL-C goals were achieved by most patients (>= 61.1%) in risk categories A, B1, and B2 (ie, 0-2 coronary risk factors; low to moderate risk) but by a low percentage of patients (<= 45.4%) in risk categories B3, B4, and C (ie, >= 3 coronary risk factors or history of CHD; high risk). In the high-risk group (n = 10,515), the TC goal was achieved by 4059 patients (38.6%). The TC and LDL-C goals were achieved by significantly higher percentages of patients prescribed atorvastatin (5133/7928 [64.7%] and 5487/7426 [73.9%], respectively) compared with the rates of patients prescribed any other statin at the recommended starting doses (all, P < 0.05). Conclusions: The results of this study of Japanese patients undergoing lipid-lowering therapy for the prevention of CHD, prescribed based on the recommendations in the JAS guideline, suggest insufficient reduction of TC, LDL-C, and TG in patients at high risk for CHD and the need for more aggressive lipid-lowering therapy in such patients. Copyright (c) 2005 Excerpta Medica, Inc.