dr.

Muhadi SpPD KKV, FINASIM

Jakarta, August 22nd 1976

Internist Clinical Cardiologist FKUI-RSCM
ICCU RS Cipto Mangunkusumo, Jakarta
American Heart Association Licenced BLS ACLS Instructors
PB PAPDI (Perhimpunan Dokter Spesialis Penyakit Dalam
Indonesia)
PB IKKI (Ikatan Keseminatan Kardioserebrovaskular Indonesia)
Anggota Komite Ahli Nasional Penanggulangan Penyakit Tidak
Menular, Kemkes RI 2015-2020

Challenges in dyslipidemia
management and case study

Step 1. Anamnesis
Pasien wanita, 58 tahun dengan keluhan sering
pusing dan berat di belakang kepala sejak 3 bulan
terakhir.
Untuk keluhan tersebut, pasien 1 bulan ini
hampir setiap hari membeli obat jamu ( eg.kupukupu/laba-laba) di warung.

Pasien dengan hipertensi, diabetes melitus sejak

5 tahun terakhir ini dan rutin mendapat terapi
Captopril dan Metformin.

Step 2. Pemeriksaan Fisik dan Penunjang

Pada pemeriksaan fisik pasien didapatkan BMI
23 kg/m2, TD 150/80 mmHg.
Pasien kemudian diperiksakan lab dengan
hasil GDS 280 mg/dL, kolesterol total 260
mg/dL, Trigliserida 400 mg/dL, LDL 140
mg/dL, HDL 35 mg/dL

Step 3. Menentukan Masalah

Dislipidemia
HT
DM
Overweight

Dislipidemia
Dislipidemia adalah kelainan metabolisme
lipid yang ditandai dengan peningkatan
maupun penurunan satu atau lebih fraksi lipid
dalam darah.
Beberapa kelainan fraksi lipid yang utama
adalah kenaikan kadar kolesterol total,
kolesterol LDL, dan atau trigliserida, serta
penurunan kolesterol HDL.

Dislipidemia
No. ICPC (International Classification of Primary Care) II :
T93 Lipid disorder
No. ICD (International Classification of Diseases) X :
E78.5 Hiperlipidemia
Tingkat Kemampuan: 4A Lulusan dokter mampu
membuat diagnosis klinik dan melakukan
penatalaksanaan penyakit tersebut secara mandiri dan
tuntas.

ATP III Classification of Lipoprotein Levels

Total Cholesterol
Level (mg/dl)
Classification

HDL-Cholesterol
Level (mg/dl)

Classification

<200

Desirable

>40

Minimum goal*

200-239

Borderline High

40-50

Desired goal*

>240

High

>50

High

Triglyceride
Level (mg/dl)

Classification

<150

Normal

150-199

Borderline High

200-499

High

>500

Very High
*These goals apply to men. For women, the minimum goal is >50 mg/dL

HDL=High density lipoprotein

Source: Expert Panel on Detection, Evaluation, and Treatment of High Blood
Cholesterol in Adults. JAMA 2001;285:2486-2497

HT
Hipertensi adalah kondisi terjadinya
peningkatan TDS lebih dari 140 mmHg dan
atau TDD 90 mmHg.
No ICPC II : K86 Hypertension uncomplicated
No ICD X : I10 Essential (primary) hypertension
Tingkat Kemampuan: 4A

DM
DM adalah gangguan metabolik yang ditandai oleh
hiperglikemia akibat defek pada kerja insulin (resistensi
insulin) dan sekresi insulin atau kedua-duanya.
ICPC II :

T89 Diabetes insulin dependent

T90 Diabetes non-insulin dependent
ICD X : E10 Insulin-dependent diabetes mellitus
E11 Non-insulin-dependent diabetes mellitus
Tingkat Kemampuan:
a. Diabetes Melitus tipe 1 = 4A
b. Diabetes Melitus tipe 2 = 4A
c. Diabetes Melitus tipe lain = 3A

Overweight
No. ICPC II : T82 obesity, T83 overweight
No. ICD X : E66.9 obesity unspecified
Tingkat Kemampuan: 4A
Klasifikasi IMT untuk populasi Asia dewasa

Step 3a. Stratifikasi Faktor Risiko

SCORE Chart:
Assessment of Cardiovascular Risk Score http://www.heartscore.org/
10-year risk of fatal CVD is
based on risk factors: Age,
smoking, sex, systolic blood
pressure and total
cholesterol.

SCORE, Systematic Coronary Risk Evaluation Project; CVD, cardiovascular disease

European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J. 2012;33:16351701

10-year Atherosclerotic Cardiovascular Disease Using

Pooled Cohort Equations

Stone NJ, Robinson J, Lichtenstein AH et al. 2013 ACC/AHA guideline on the treatment of blood cholesterol to reduce atherosclerotic cardiovascular risk in adults: A report of
the American College of Cardiology/American Heart Association Task Force on practice guidelines. 2013. Accessed January 28, 2014.

Risk Stratification:
Framingham Risk Score On Line Calculator

Source: Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol
in Adults Risk Assessment Tool. http://hp2010.nhlbihin.net/atpiii/calculator.asp

Step 3a. Stratifikasi Faktor Risiko

Qx Calculate
Wanita
58 thn
Ras Asia
Kol Total = 260 mg/dL
Kol HDL = 35 mg/dL

TDS = 150 mmHg

Pengobatan HT
DM *
Tidak merokok
Tidak ada riw peny
vaskular (PJK, PAD,
Stroke) *

16.3 %
10-year risk of Atherosclerotic
Cardiovascular Disease (ASCVD)
> 30 % (High Risk)
Estimated 10 year Global CVD Risk
11 % (Moderate Risk)
Estimated 10 year Global CVD Risk

Risk Assessment for LDL-C Lowering

A risk assessment tool* is needed for individuals with >2 RFs
10-year CHD Risk
0

10

20

0-1 RFs

2 RFs

CAD or Risk Equivalent**

*Such as the Framingham Risk Score (FRS)

**Includes DM, non-coronary atherosclerotic vascular disease, and
>20% 10-year CHD risk by the FRS
CAD=Coronary artery disease, CHD=Coronary heart
disease, DM=Diabetes mellitus, RF=Risk factor
Source: Expert Panel on Detection, Evaluation, and Treatment of
High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497

Diabetes More Than Doubles Mortality Rate

Compared With Nondiabetic Controls

Mortality Rate,
Deaths per 1000 Patient-years

All-cause Mortality Ratio

Diabetes:No diabetes
2.48:1

35

2.16:1

No diabetes
Diabetes (NIDDM)
2.06:1

30

25
20
15
10

5
0

N*= (1998/10,025) (27/61)

Whitehall Study
NIDDM = noninsulin-dependent diabetes mellitus

*Number of deaths/total patients

Adapted from Balkau B, et al. Lancet. 1997;350:1680.
Slide 18

(1446/6629) (119/279)

(175/631)

Paris Prospective
Study

Helsinki
Policemen Study

(12/24)

Deaths per 10,000 Person-years

Cardiovascular Mortality Increases Sharply

With Serum Cholesterol Concentration in
Patients With Diabetes
150

No diabetes
Diabetes

100

50

(n=62,448) (n=1105)

(n=75,122) (n=1038)

<180 mg/dL

200219 mg/dL

(n=40,090)

240259 mg/dL

Cholesterol Level
Slide 19 Adapted from Stamler J, et al. Diabetes Care. 1993;16:434444.

(n=529)

(n=17,604)

(n=353)

280 mg/dL

Diabetes Established as
CHD Risk Equivalent

Incidence*, %

Fatal and nonfatal MI in subjects with and without type 2 diabetes mellitus
50
45
40
35
30
25
20
15
10
5
0

No Diabetes
Diabetes

45

20.2

18.8

(n=890)

(n=69)

3.5
(n=1304)

No Prior MI
CHD = coronary heart disease; MI = myocardial infarction
*7-year incidence of fatal and nonfatal MI in 1373 nondiabetic and 1059 diabetic subjects

Adapted from Haffner SM, et al. N Engl J Med. 1998;339:229234.

Slide 20

(n=169)

Prior MI

Pertanyaan

Soal no.1
Pemeriksaan lanjutan yang paling tepat
dilakukan pada pasien untuk evaluasi
progresifitas penyakit ini adalah:
a. Darah perifer lengkap, asam urat
b. HbA1C, creatinin, EKG
c. Urinalisa lengkap, asam urat, HbA1c
d. USG Whole Abdomen, EKG

Soal no.2
Pasien dengan masalah di atas memiliki resiko
tinggi untuk terjadi penyakit ?
a. Gagal ginjal kronik
b. Sirosis hepatis
c. Penyakit Jantung koroner
d. Kolesistisis

Coronary Heart Disease Risk According to LDL-C Level

3.7

Relative Risk for Coronary

Heart Disease (Log Scale)

2.9
2.2
1.7
1.3
1.0

40

70

100

130

160

190

LDL-Cholesterol (mg/dL)

CHD=Coronary heart disease, LDL-C=Low-density lipoprotein cholesterol

Source: Grundy S et al. Circulation 2004;110:227-239

CHD Risk According to HDL-C Level

Framingham Study
4.0

4.0

CHD risk ratio

3.0
2.0

2.0
1.0

1.0
0
65
25
45
HDL-C (mg/dL)

CHD=Coronary heart disease, HDLC=High-density lipoprotein cholesterol

Source: Kannel WB. Am J Cardiol 1983;52:9B12B

CHD Risk According to Triglyceride Levels

Meta-analysis of 29 prospective studies evaluating the risk of CHD relative
to triglyceride level (top third vs. bottom third)

An elevated triglyceride level is associated with increased CHD risk

CHD=Coronary heart disease

Source: Sarwar N et al. Circulation 2007;115:450-458

Soal no.3
Terapi farmakologi yang paling tepat diberikan
pada pasien adalah ?
a. Simvastatin 10 mg
b. Atorvastatin 20 mg
c. Gemfibrozil 300 mg
d. Ezetimibe

Management of dyslipidaemia in women

ESC/EAS Guidelines for the management of Dyslipidemias 2011

LDL Cholesterol
is
The Primary Target
in Dyslipidemia Treatment

NCEP ATP III 2003/ NCEP ATP III Update 2004

ADA/ACC Guideline Update for Secondary Prevention 2006
ESC/EAS Guidelines for the management of Dyslipidemias 2011
2013 ACC/AHA Guideline on the Treatment of Blood Cholesterol to Reduce
Atherosclerotic Cardiovascular Risk in Adults

Therapies to Lower Levels of LDL-C

Class

Drug(s)

3-Hydroxy-3-Methylglutaryl Coenzyme A (HMGCoA) reductase inhibitors [Statins]

Atorvastatin (Lipitor)
Fluvastatin (Lescol XL)
Lovastatin (Mevacor)
Pitavastatin (Livalo)
Pravastatin (Pravachol)
Rosuvastatin (Crestor)
Simvastatin (Zocor)

Bile acid sequestrants

Cholestyramine (Questran)
Colesevelam (Welchol)
Colestipol (Colestid)

Cholesterol absorption inhibitor

Ezetimibe (Zetia)

Nicotinic acid

Niacin

Dietary Adjuncts

Soluble fiber
Soy protein
Stanol esters

Effect of Pharmacotherapy on Lipid Parameters

Therapy

TC

LDL-C

HDL-C

TG

Patient
tolerability

Statins*

- 19-37%

- 25-50%

+ 4-12%

- 14-29%

Good

- 13%

- 18%

+ 1%

- 9%

Good

Bile acid
sequestrants

- 7-10%

- 10-18%

+ 3%

Neutral or

Poor

Nicotinic acid

- 10-20%

- 10-20%

+ 14-35%

- 30-70%

Reasonable
to Poor

- 19%

- 4-21%

+ 11-13%

- 30%

Good

Ezetimibe

Fibrates

*Daily dose of 40mg of each drug, excluding rosuvastatin

HDL-C=High-density lipoprotein cholesterol, LDL-C=Low-density lipoprotein
cholesterol, TC=Total cholesterol, TG=Triglyceride

ADA Cholesterol Recommendations for Patients with DM

Primary and Secondary Prevention
In individuals without overt CV disease, the primary goal is an LDL-C
<100 mg/dL (2.6 mmol/L).
In individuals with overt CV disease, a lower LDL-C goal of <70 mg/dL
(1.8 mmol/L), using a high dose of statin is an option.
If drug-treated patients do not reach the above targets on maximal
tolerated statin therapy, a reduction in LDL-C of approximately 30-40%
from baseline is an alternative therapeutic goal.
Triglyceride levels <150 mg/dL (1.7 mmol/L) and HDL-C >40 mg/dL (1.0
mmol/L) in men and >50 mg/dL (1.3 mmol/L) in women, are desirable.
However, LDL-C targeted statin therapy remains the preferred strategy.

ADA=American Diabetes Association, CV=Cardiovascular, HDL-C=High density

lipoprotein cholesterol, LDL-C=Low density lipoprotein cholesterol
Source: American Diabetes Association. Diabetes Care 2010;33:S11-61

2013 ACC/AHA Guideline Recommendations for

Statin Therapy
ASCVD Statin Benefit Groups
Heart healthy lifestyle habits are the foundation of ASCVD prevention

Clinical ASCVD
High-Intensity statin
(age 75 years)
Moderate-intensity
statin if >75 years or
not a candidate for
high-intensity statin

LDL-C 190 mg/dL

High-intensity statin
Moderate-intensity
statin if not a
candidate for highintensity statin

Diabetes;
age
40-75 years*
Moderate-intensity
statin

Estimated 10-yr
ASCVD risk 7.5%;
age 40-75 years*
Moderate- to highintensity statin

High-intensity statin if
estimated 10 year
ASCVD risk 7.5%

ASCVD prevention benefit of statin therapy may be less clear in other groups . Consider additional factors
influencing ASCVD risk , potential ASCVD risk benefits and adverse effects, drug-drug interactions, and patient
preferences for statin treatment.
* With LDL-C of 70-189 mg/dL
Estimated using the Pooled Cohort Risk Assessment Equations
Stone NJ, et al. J Am Coll Cardiol. 2013: doi:10.1016/j.jacc.2013.11.002. Available at:
http://content.onlinejacc.org/article.aspx?articleid=1770217. Accessed November 13, 2013.

Target Terapi
Stratifikasi Risiko

Risiko

ACC/AHA CV Risk (2013)

16.3 %
10-year risk of Atherosclerotic
Cardiovascular Disease (ASCVD)

Target Kol LDL

Framingham Risk Score

(2008)

> 30 % (High Risk)

ATP III (2004)
Estimated 10 year Global CVD Risk LDL < 100 mg/dL
Optional goal < 70 mg/dL

Framingham Risk Score

(ATP III, 2004)

11 % (Moderate Risk)
ATP III (2004)
Estimated 10 year Global CVD Risk LDL < 130 mg/dL
Optional goal < 100
mg/dL

ATP III LDL-C Goals and Cut-points for Drug Therapy

Risk Category

Consider
Drug Therapy

LDL-C Goal

Initiate TLC

High risk:
CHD or CHD risk equivalents
(10-year risk >20%)

<100 mg/dL
(optional goal:
<70)

100 mg/dL

>100 mg/dL
(<100 mg/dL: consider
drug options)

Moderately high risk:

2+ risk factors*
(10-year risk 10% to 20%)

<130 mg/dL
(optional goal:
<100)

130 mg/dL

>130 mg/dL
(100-129 mg/dL: consider
drug options)

Moderate risk:
2+ risk factors*
(10 year risk <10%)

<130 mg/dL

130 mg/dL

>160 mg/dL

Lower risk:
0-1 risk factor*

<160 mg/dL

160 mg/dL

>190 mg/dL
(160-189 mg/dL: LDL-C
lowering drug optional)

*Risk factors for CHD include: cigarette smoking, hypertension (blood pressure >140/90 mmHg or on
antihypertensive medication, HDL-C <40 mg/dl (>60 mg/dl is a negative risk factor), family history of
premature CHD, age >45 years in men or >55 years in women

ATP=Adult Treatment Panel, CHD=Coronary heart disease, LDL-C=Low

density lipoprotein cholesterol, TLC=Therapeutic lifestyle changes
Source: Grundy S et al. Circulation 2004;110:227-239

Target of LDL-C: NCEP-ATP III

Risk Category

LDL-C

0-1

< 160 mg/dl

2 (10-year risk <10%)

< 130 mg/dl

2 (10-year risk 10-20%)

< 130 mg/dl

(Optional goal: < 100 mg/dl)

CHD and CHD risk equivalent

< 100 mg/dl

(optional goal: 70 mg/dl)

Grundy SM, et al. NCEP Report. Circulation 2004;110:227-239

Intensity of Statin Therapy

High-Intensity Statin
Therapy
LDLC 50%

Atorvastatin (40)80 mg
Rosuvastatin 20 (40) mg

Moderate-Intensity Stain
Therapy
LDLC 30% to <50%

Atorvastatin 10 (20) mg
Rosuvastatin (5) 10 mg
Simvastatin 2040 mg
Pravastatin 40 (80) mg
Lovastatin 40 mg
Fluvastatin XL 80 mg
Fluvastatin 40 mg bid
Pitavastatin 24 mg

Low-Intensity Statin
Therapy
LDLC <30%

Simvastatin 10 mg
Pravastatin 1020 mg
Lovastatin 20 mg
Fluvastatin 2040 mg
Pitavastatin 1 mg

Lifestyle modification remains a critical component of ASCVD risk reduction, both prior to and in concert with the use of cholesterol
lowering drug therapies.
Statins/doses that were not tested in randomized controlled trials (RCTs) reviewed are listed in italics
Evidence from 1 RCT only: down-titration if unable to tolerate atorvastatin 80 mg in IDEAL
Initiation of or titration to simvastatin 80 mg not recommended by the FDA due to the increased risk of myopathy, including rhabdomyolysis.
Stone NJ, et al. J Am Coll Cardiol. 2013: doi:10.1016/j.jacc.2013.11.002. Available at:
http://content.onlinejacc.org/article.aspx?articleid=1770217. Accessed November 13, 2013.

Atorvastatin

Fluvastatin

Pitavastatin

Lovastatin

Pravastatin

Rosuvastatin

Simvastatin

% decrease in
LDL-C

Relative LDL-lowering efficacy of different

doses of statins

40 mg

1 mg

20 mg

20 mg

10 mg

30%

10 mg

80 mg

2 mg

40 or 80
mg

40 mg

20 mg

38%

20 mg

4 mg

80 mg

80 mg

5 mg

40 mg

41%

40 mg

10 mg

80 mg

47%

80 mg

20 mg

55%

40 mg

63%

US FDA. Web site http://www.fda.gov/drugs/drugsafety/ucm256581.htm. Accessed on December 9, 2013.

Training Use Only

Benefit of HMG CoA Reductase

Inhibitor (Statin)
Lowering Total and LDL Cholesterol, Triglyceride
and raising HDL Cholesterol levels
Antiatherothrombotic effects
Improvement of endothelial function
Anti-inflammatory effects
Inhibition of arterial smooth muscle proliferation
Prevention of oxidation of LDL Cholesterol
Plaque stabilization effects on macrophages
Sattar N et al, Lancet 2010; Buse J et al. Clin Diabetes 2003

Soal no.4
Pada pasien dengan pemakaian terapi
simvastatin jangka panjang, efek samping yang
paling sering terjadi dan perlu diperhatikan
adalah ?
a. Gejala gastrointestinal
b. Miositis
c. Gastritis
d. Alergi obat

HMG-CoA Reductase Inhibitor:

Adverse Effects
74,102 subjects in 35 randomized clinical trials with statins

1.4% incidence of elevated

hepatic transaminases (1.1%
incidence in control arm)
Dose-dependent phenomenon that
is usually reversible

Hepatocyte

15.4% incidence of myalgias*

(18.7% incidence in control arm)
0.9% incidence of myositis (0.4%
incidence in control arm)
0.2% incidence of rhabdomyolysis
(0.1% incidence in control arm)

Skeletal myocyte

*The rate of myalgias leading to discontinuation of

atorvastatin in the TNT trial was 4.8% and 4.7% in
the 80 mg and 10 mg arms, respectively
Source: Kashani A et al. Circulation 2006;114:2788-2797

Dosis simvastatin maksimal

Pada tahun 2011, FDA Amerika Serikat
mengeluarkan rekomendasi baru tentang
keamanan simvastatin 80 mg.

Dosis statin maksimal

Dosis simvastatin maksimal

Simvastatin yang digunakan dengan dosis
maksimum (80 mg) berhubungan dengan miopati
atau jejas otot terutama jika digunakan selama 12
bulan berturutan.
Simvastatin dosis 80 mg tidak dianjurkan
diresepkan bagi pasien baru, melainkan bagi
mereka yang telah menggunakan dosis tersebut
selama 12 bulan berturutan tanpa keluhan atau
gejala miopati.

HMG-CoA Reductase Inhibitor:

Adverse Effects
Risk factors for the development of myopathy*
Concomitant Use of Meds

Other Conditions

Fibrate

Advanced age (especially >80 years)

Nicotinic acid (Rarely)

Women > Men especially at older age

Cyclosporine

Small body frame, frailty

Antifungal azoles**

Multisystem disease

Macrolide antibiotics

Multiple medications

HIV protease inhibitors

Perioperative period

Nefazadone

Alcohol abuse

Verapamil, Amiodarone

Grapefruit juice (>1 quart/day)

*General term to describe diseases of muscles

**Itraconazole, Ketoconazole
Erythromycin, Clarithromycin
Chronic renal insufficiency, especially from
diabetes mellitus
Source: Pasternak RC et al. Circulation 2002;106:1024-1028

Soal no.5
Terapi non farmakologis utama yang perlu
disarankan pada pasien adalah, kecuali ?
a. Turunkan berat badan
b. Olah raga rutin
c. Stop konsumsi jamu
d. Menjaga pola makan

Intervensi gaya hidup yang dapat dilakukan untuk

mengurangi kolesterol LDL, kolesterol HDL dan TG

Follow up
Rekomendasi profil lipid yang diperiksa secara rutin adalah
kolesterol total, kolesterol LDL, kolesterol HDL, dan TG.
Kolesterol non-HDL dapat dihitung dengan mengurangkan
kolesterol HDL terhadap kolesterol total:
Kolesterol non-HDL = Kolesterol Total Kolesterol HDL
Dengan formula Friedewald dapat diperhitungkan bahwa:
Kolesterol LDL (mg/dL) = kolesterol total kolesterol HDL
TG/5
(kecuali bila TG > 400 mg/dL atau dalam keadaan tidak puasa)

Recommendations for monitoring lipids in

patiens on lipid-lowering therapy

Follow Up
Jika memungkinkan, sampel darah diambil setelah puasa 12
jam (diperlukan untuk pemeriksaan TG yang juga dipakai
untuk penghitungan konsentrasi kolesterol LDL memakai
formula Friedewald).
Kolesterol total dan HDL dapat diperiksa dalam keadaan tidak
puasa.
Konversi dari mg/dL menjadi mmol/L :
Untuk kolesterol total, LDL dan HDL: dikalikan 0,0259
Untuk TG: dikalikan 0,0113

Recommendations for monitoring enzymes in

patiens on lipid-lowering therapy

NEXT ???

Treatment of low HDL

cholesterol (<40 mg/dL)
First reach LDL goal, then:
Intensify weight management and increase
physical activity.
If triglycerides 200-499 mg/dL, achieve nonHDL goal.
If triglycerides <200 mg/dL (isolated low HDL)
in CHD or CHD equivalent consider nicotinic
acid or fibrate.

Non-HDL Cholesterol
LDL-C is the primary goal of therapy for
persons with dyslipidemia
Non HDL Chol is a secondary goal of therapy in
persons with TG >= 200 mg/dl
Non HDL-C = Total Cholesterol HDL C
= VLDL Chol + LDL C

2004 PPS

Classification

ATP III: Management of

Elevated TG
TG Level (mg/dL)

Treatment Strategy

Borderline high*

150199

weight, physical activity

High*

200499

weight, physical activity,

consider drug treatment to reach
nonHDL-C goal

500

Very low-fat diet, weight,

physical activity, nicotinic acid or
fibrate

Very high

*Primary aim of therapy is to get to LDL-C goal.

Primary aim of therapy is to reduce risk for pancreatitis through TG lowering first,
then focus on LDL-C.
To achieve nonHDL-C goal (set at 30 mg/dL higher than LDL-C goal), intensify
therapy with LDL-Clowering drug, or add nicotinic acid or fibrate.
56

Expert Panel on Detection, Evaluation, and Treatment of

High Blood Cholesterol in Adults. JAMA. 2001;285:2486-2497.

Most physicians believe they adhere to guidelines, but

most patients remain undertreated
% of treated patients
reaching goal

Physicians who report being consistent with

or more aggressive than guidelines (%)

100
90
80
70
60
50
40
30
20
10
0
Basis for
% reaching goal :

US
L-TAP

UK
EUROASPIRE II

Australia
VIC II

France
EUROASPIRE II

Pearson T et al. Arch Intern Med. 2000;160:459-467. EUROASPIRE II Study group. Eur Heart J. 2001;22:554-72.
Vale M et al. Med J Aust. 2002;176:211-215. Physician self-reported behavior based on Pfizer Market Research.

Germany
EUROASPIRE II

TERIMA KASIH

Hypertension

Diabetes

Dyslipidemia

Obesity

58