Differences in hypercholesterolemia patient management in secondary and primary care: lessons learned from the German PROCYON survey
Authors: Weingaertner O , Beier L , Stein K 
Published: October 2021

Abstract

Background
In Germany, cardiovascular (CV) disease was the leading cause of mortality (39% of all deaths), responsible for 340,000 deaths in 2014 (1). Considering its role as a major risk factor for CV disease, awareness for hypercholesterolemia in clinical practice seems insufficient.

Purpose
The purpose of the present survey was to identify patients' journey differences between primary and secondary prevention in patients with hypercholesterolemia.

Methods
PROCYON was a two-part online survey on disease perception, awareness, burden, and management of hypercholesterolemia consisting of a patient survey (PROCYON A) and a healthcare practitioner (HCP) survey (PROCYON B). The survey included over 5,000 patients with and without prior CV events as well as 109 HCPs (general practitioners, internists, cardiologists) involved in primary and secondary prevention.

Results
71% of the HCPs consider low-density lipoprotein cholesterol (LDL-C) as “very important” to assess a patients CV risk and 96% acknowledge a “causal relationship” between CV risk and LDL-C levels. Despite the theoretical awareness of LDL-C as a risk factor, 58% of the secondary prevention patients were initially diagnosed with hypercholesterolemia only while hospitalized due to a CV event, indicating insufficient translation of LDL-C awareness into clinical screening routine.
General practitioners (GP) and internists are the main point of contact for patients with hypercholesterolemia after the diagnosis. In primary and even in secondary prevention, cardiologists play a minor role in hypercholesterolemia patient care (cardiologist vs. GP/internist ratio 1:5), the majority of patients are managed by their general practitioners and internists and (cardiologist vs. GP/internist ratio 2:3) (Table 1). The frequency of LDL-C control assessments is lower in primary prevention patients compared to secondary prevention (Table 2). In primary prevention, only 43% of the patients are on a lipid lowering therapy compared to 87% in secondary prevention. From the point of diagnosis, LDL-C levels improved at least to some extent in only 30% of the primary prevention patients and 51% of the secondary prevention patients. Of the patients without LDL-C improvement who are on drug therapy, 53% (primary prevention) and 39% (the secondary prevention) are still on their initial treatment since diagnosis.

Conclusion(s)
Major differences in relation to assessment intervals, treatment initiation, and specialist care were identified between primary and secondary prevention populations, reflecting a major focus in secondary prevention with respect to primary prevention. The high percentage of patients on secondary prevention diagnosed after the first CV event reflects the need to improve preventive screening. It is essential to identify measures to increase LDL-C risk awareness, improve screening efforts and efficient LDL-C reduction in order to prevent future CV events in both populations.

Funding Acknowledgement
Type of funding sources: Private company. Main funding source(s): Novartis Pharma GmbH