Management of Mixed Dyslipidemia: Knowledge and Practice

U. Shanette Granstaff, Farrokh Sohrabi, Hamid Doroodchi, Nancy Roepke, Maziar Abdolrasulina


Background: Despite the beneficial effects of lowering low-density lipoprotein cholesterol (LDL-C) to Adult Treatment Panel (ATP) III guideline recommended levels, major statin trials have revealed a two-thirds residual cardiovascular event risk in high-risk populations. This study was designed to explore how clinicians address residual cardiovascular risk.

Methods: Case-vignette surveys were distributed to a representative set of 4 US provider groups to investigate perceptions and practice patterns in the management of high-risk patients with mixed dyslipidemia.

Results: Ninety-three percent of cardiologists, 96% of endocrinologists, and 97% of primary care practitioners (PCPs) and nurse practitioners (NP) and physician assistants (PAs) underestimated residual risk in a patient achieving LDL-C goal. Sixty-nine percent of cardiologists, 61% of endocrinologists, 66% of PCPs and 70% of NP/PAs would not focus on LDL-C and non–high-density lipoprotein cholesterol (HDL-C) levels for lipid-lowering therapy in a high-risk patient, and 69% of cardiologists, 59% of endocrinologists, 57% of PCPs, and 68% of NP/PAs did not identify appropriate lipid profile management goals. Sixty-four percent of cardiologists would not initiate treatment targeting both LDL-C and non–HDL-C in a very high-risk patient with mixed dyslipidemia; 50% of endocrinologists would not add niacin in a patient with atherogenic dyslipidemia; and 64% of PCPs and 55% of NP/PAs would not treat with combination statin and fenofibrate in a patient with mixed dyslipidemia.

Conclusion: Although many clinicians report familiarity with National Cholesterol Education Program (NCEP) guideline recommendations, there is low concordance with recommendations when managing high-risk patients with mixed dyslipidemia. Educational initiatives and practice tools that enhance understanding of non–HDL-C and improve clinicians’ skills in using combination therapies to optimally manage mixed dyslipidemia in high-risk patients may reduce variability in practice and improve patient outcomes.

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