Prevention of coronary heart disease in clinical practice: a commentary on current treatment patterns in six European countries in relation to published recommendations.

Market research surveys can be a source of up-to-date information about current clinical practices. Data from one such survey, Cholesterol Monitor (made available by Merck & Co., Inc., Whitehouse Station, N.J., USA) was examined to ascertain to what extent management of cholesterol in six European countries conforms with the advice of the joint Task Force of the European Society of Cardiology, European Atherosclerosis Society and European Society of Hypertension for prevention of coronary heart disease (CHD). Rates of cholesterol testing in patients with CHD varied from less than 50% in the UK to more than 80% in France and Italy. Across Europe, the average cholesterol levels in surveyed patients was 6 mmol/l, and the average intervention level was 7.5 mmol/l. In all countries, there was evidence of a substantial treatment gap, even among high-risk patients with established CHD. This gap took the form of non-treatment of a proportion of patients whose risk status merited intervention on the basis of expert recommendations and the results of the Scandinavian Simvastatin Survival Study (in which sustained lowering of total and low-density lipoprotein cholesterol reduced total and coronary mortality in patients with baseline total cholesterol as low as 5.5 mmol/l). The findings indicate that a concerted programme of physician education is required if the recommendations of the joint Task Force are to be put into effect, and if the present nontreatment/undertreatment of cholesterol in high-risk patients is to be corrected.