Suboptimal control of lipid levels: results from the non-interventional Centralized Pan-Russian Survey of the Undertreatment of Hypercholesterolemia II (CEPHEUS II)
Authors: Boytsov Sergey , Logunova Natalia , Khomitskaya Yunona ,   on behalf of the CEPHEUS II investigators, Nuraliev Eradzh , Lebedeva Anastasiya , Shchelkunova Inessa , Vershuta Elena , Zhidkova Svetlana , Rostorotskaya Veronika , Shadaniya Yana , Ivanov Andrey , Zobenko Irina , Kvasova Olga , Zikun Svetlana , Glushchenya Alina , Rumyantsev Alexander , Prokof’eva Svetlana , Baturova Mariya , Oseshnyk Rodion , Zhukova Elena , Shumikhina Irina , Eltisheva Vera , Bugaets Larisa , Chernysh Vladimir , Ivochkina Marina , Svistunova Lyudmila , Klimenko Natalia , Kulchitskaya Olga , Alexandrova Valentina , Stepanova Marina , Chernysh Tatiana , Ivanchura Galina , Chachshina Olga , Afonina Elena , Chernyshev Andrey , Korostyleva Evgeniya , Staroverova Tatyana , Badin Yuriy , Il’icheva Galina , Monetkina Lyudmila , Novikova Oxana , Abashina Olga , Plaksina Galina , Kostomarova Svetlana , Alieva Ekaterina , Budanova Olga , Kartashova Inessa , Chepurnenko Svetlana , Oreshina Elena , Skachkova Natalia , Khanbekova Rkiya , Pashchenko Olga , Zolotova Yuliya , Volodina Elena , Fisher Konstantin , Shurkevich Anastasiya , Vikhman Elena , Poshinova Irina , Abramov Vladislav , Cherepnin Daniil , Leonova Olga , Kargina Olga , Gerent Galina , Nabokikh Natalia , Sokolovskikh Galina , Tkhorikova Valeria , Titova Lyudmila , Rachkova Svetlana , Baglikov Andrey , Giorgadze Marinsa , Malygin Alexander , Strelkova Svetlana , Ryzhova Tatyana , Kochladze Nina , Vyasova Natalia , Vasiliev Sergey , Bondarenko Inna , Mokhnacheva Elena , Shumilina Lyudmila , Pakhomova Svetlana 
Published: December 2017

Abstract
Background
Elevated levels of low-density lipoprotein cholesterol (LDL-C) and glycosylated hemoglobin (HbA1c) are risk factors for cardiovascular complications. This study evaluated LDL-C goal attainment in Russian clinical practice among patients with moderate to very high cardiovascular risk. The study also assessed LDL-C goal attainment in patients prescribed lipid-lowering therapy for primary compared with secondary cardiovascular disease (CVD) prevention, predictors of LDL-C goal attainment, and the proportion of individuals with diabetes mellitus who achieved HbA1c < 7%.

Methods
The Centralized Pan-Russian Survey on the Undertreatment of Hypercholesterolemia in Russia II (CEPHEUS II) was a multicenter, non-interventional, cross-sectional study conducted in the Russian Federation from September 2014 to November 2015. Participants were aged ≥ 18 years, were receiving a stable dose of lipid-lowering medication and had a moderate to very high cardiovascular risk. The primary variable was the proportion of patients reaching LDL-C goals established by the Fifth Joint European Task Force guidelines. Secondary analyses used McNemar and χ2 tests.

Results
Data from 2703 patients were analyzed; 91.2% had a very high cardiovascular risk and 24.0% had been diagnosed with diabetes mellitus. Overall, 17.4% of patients (95% confidence interval [CI] 15.9–18.8%) achieved LDL-C goals. Investigators estimated this proportion at 21.8% (95% CI 20.3–23.4%). LDL-C goals were achieved by more patients in the primary CVD prevention subgroup than in the secondary CVD prevention subgroup (19.7% vs 16.1%, p = 0.017). Patient-related factors associated with a decreased likelihood of achieving LDL-C goals included having ischemic heart disease or a family history of premature coronary heart disease, forgetting to take hypercholesterolemia treatment or considering it acceptable to miss prescribed doses more than once per week, and dissatisfaction with or concern about lipid-lowering therapy. Overall, 367/593 (61.9%) patients with diabetes mellitus and interpretable HbA1c results achieved HbA1c < 7%.

Conclusions
Hypercholesterolemia management is suboptimal in patients with moderate to very high cardiovascular risk in Russian clinical practice. Substantial opportunity remains to improve treatment target attainment and reduce the risk of cardiovascular complications. Lipid-modifying strategies may need to be intensified to reduce CVD risk in this setting.
Trial registration ClinicalTrials.gov: NCT02230241 (registered 26 August 2014)