Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia

Objective: Few studies have directly assessed suboptimal management of dyslipidemia in Turkey. This study was conducted to assess patients’ understanding and perceptions of high cholesterol as well as physicians’ knowledge and awareness of lipid management strategies.Methods: This was a multicenter, observational study (ClinicalTrials.gov identifier: NCT02608645). Consecutive patients admitted to the participating cardiology clinics who were at least 18 years of age and who had been classified in a secondary prevention (SP) group or a high-risk primary prevention (PP) group were enrolled. The study population included 1868 patients from 40 sites in Turkey. Two-thirds (67.5%) of the patients in the SP group had been prescribed a statin, whereas only 30.1% of thePP group patients received statin therapy (p<0.001).Results: It was determined that 18% of the SP patients and 10.6% of the PP patients had a low-density lipoprotein cholesterol level at the recommended level (p<0.001). A patient survey revealed that almost half of the patients in the PP and in the SP groups were aware that their cholesterol levels were high. Negative information about statin treatment disseminated by media programs was the most common reason (9.4%) givenfor treatment discontinuation.Conclusion: Perceptions, knowledge and compliance with the guidelines for PP and SP patients in real-life practice have increased, but it remains far below the desired level. Patients and physicians should have more information about the treatmentof hyperlipidemia. More accurate media programming could help to prevent the dissemination of misinformation

Anahtar Kelime:

Dislipidemi kılavuzuna uyumun, bilgi ve hasta algı düzeylerinin gerçek yaşamda saptanması

Öz:

Amaç: Türkiye’de dislipideminin suboptimal yönetimini az sayıda çalışma doğrudan değerlendirmiştir. Bu çalışma, hastaların yüksek kolesterol algısını ve lipit yönetim stratejileri ile ilgili olarak hekimlerin kolesterol hakkındaki bilgi ve farkındalığını değerlendirmek amacıyla yapıldı.Yöntemler: Çalışma gözlemsel ve çok merkezli bir çalışmadır (ClinicalTrials.gov identifier: NCT02608645). En az 18 yaşında olan, kardiyoloji kliniklerine başvuran ikincil korunma (SK) grubunda ve çok yüksek, yüksek riskli birincil korunma (PK) grubundaki ardışık hastalar çalışmaya alındı. Çalışma popülasyonu, Türkiye’de 40 bölgeden 1868 hasta içermektedir. SK grubunda hastaların üçte ikisine (%67.5) statin verildi, PK hastalarının sadece %30.1’ine statin tedavisi verildi (p<0.001).Bulgular: Düşük yoğunluklu lipoprotein kolesterol (LDL-C) düzeyi önerilen düzeyde olan hastaların oranı PK’da %10.6, SK’da %18 idi (p<0.001). Hastaya özgü anket, PK ve SK gruplarındaki hastaların neredeyse yarısının kolesterol seviyelerinin yüksek olduğunu bildiğini ortaya koydu. Medya programlarındaki statin tedavisi ile ilgili olumsuz bilgiler (%9.4) tedavinin kesilmesinin en yaygın nedeniydi.Sonuç: Gerçek yaşam pratiğinde birincil ve ikincil korunma ile ilgili algı, bilgi ve uyum artmıştır, ancak istenen seviyelerin çok altındadır. Hastalar ve hekimler hiperlipideminin tedavisi hakkında daha fazla bilgi sahibi olmalıdır. Ayrıca, medya programlarını kontrollerinin sağlanması, hastaların yanlış bilgilendirilmesini önleyebilir.

Anahtar Kelime:

Belge Türü: Makale Makale Türü: Araştırma Makalesi Erişim Türü: Erişime Açık

1. Cui Y, Blumenthal RS, Flaws JA, Whiteman MK, Langenberg P, Bachorik PS, et al. Non-high-density lipoprotein cholesterol level as a predictor of cardiovascular disease mortality. Arch Intern Med 2001;161:1413–9.
2. Pekkanen J, Linn S, Heiss G, Suchindran CM, Leon A, Rifkind BM, et al. Ten-year mortality from cardiovascular disease in relation to cholesterol level among men with and without preexisting cardiovascular disease. N Engl J Med 1990;322:1700–7.
3. Baigent C, Keech A, Kearney PM, Blackwell L, Buck G, Pollicino C, et al; Cholesterol Treatment Trialists’ (CTT) Collaborators. Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins. Lancet 2005;366:1267–78.
4. Besseling J, Hovingh GK, Huijgen R, Kastelein JJP, Hutten BA. Statins in Familial Hypercholesterolemia: Consequences for Coronary Artery Disease and All-Cause Mortality. J Am Coll Cardiol 2016;68:252–60.
5. Brugts JJ, Yetgin T, Hoeks SE, Gotto AM, Shepherd J, Westendorp RG, et al. The benefits of statins in people without established cardiovascular disease but with cardiovascular risk factors: meta-analysis of randomised controlled trials. BMJ 2009;338:b2376.
6. LaRosa JC, He J, Vupputuri S. Effect of statins on risk of coronary disease: a meta-analysis of randomized controlled trials. JAMA 1999;282:2340–6.
7. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al; ESC Scientific Document Group. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016;37:2999–3058.
8. Reiner Ž, De Backer G, Fras Z, Kotseva K, Tokgözoglu L, Wood D, et al; EUROASPIRE Investigators. Lipid lowering drug therapy in patients with coronary heart disease from 24 European countries-Findings from the EUROASPIRE IV survey. Atherosclerosis 2016;246:243–50.
9. Ünüvar N, Mollahaliloglu S, Yardim N, Refik Saydam. Hygiene Center. School of Public Health, on behalf of The Ministry of Health of Turkey (MoH). Turkey Burden of Disease Study 2004. 1th ed. Ankara: MoH Publication; 2007. p. 4–8.
10. Turkish Statistical Institute. National Health Report of 2014. Turkey in Statistics 2014. Publication No: 4380. Ankara; 2014. Available at: http://www.turkstat.gov.tr/. Accessed Sep 2, 2016.
11. European Commission. Eurostat Death Statistics Report of 2011. Eurostat regional yearbook 2011. Luxemburg: Publications Office of the European Union; 2011. Available at: http:// ec.europa.eu/eurostat/. Accessed Sep 2, 2016.
12. Tokgözoğlu L, Kaya EB, Erol C, Ergene O; EUROASPIRE III Turkey Study Group. EUROASPIRE III: a comparison between Turkey and Europe. [Article in Turkish]. Turk Kardiyol Dern Ars 2010;38:164–72.
13. Tokgözoğlu L, Kayıkçıoğlu M, Altay S, Aydoğdu S, Barçın C, Bostan C, et al. EUROASPIRE-IV: European Society of Cardiology study of lifestyle, risk factors, and treatment approaches in patients with coronary artery disease: Data from Turkey. [Article in Turkish]. Turk Kardiyol Dern Ars 2017;45:134–44.
14. Tokgözoğlu L, Bariş Kaya E. Atherosclerotic vascular disease and risk factors in Turkey: from past to present. J Atheroscler Thromb 2008;15:286–91.
15. Doğan V, Başaran Ö, Özlek B, Çelik O, Özlek E, Mert KU, et al. Rationale, design, and methodology of the Evaluation of Perceptions, Knowledge, and Compliance with the Guidelines in Real Life Practice: A Survey on the Under-treatment of Hypercholesterolemia. Turk Kardiyol Dern Ars 2018;46:47– 53.
16. Catapano AL, Graham I, De Backer G, Wiklund O, Chapman MJ, Drexel H, et al; ESC Scientific Document Group. 2016 ESC/EAS Guidelines for the Management of Dyslipidaemias. Eur Heart J 2016;37:2999–3058.
17. Pearson TA, Laurora I, Chu H, Kafonek S. The lipid treatment assessment project (L-TAP): a multicenter survey to evaluate the percentages of dyslipidemic patients receiving lipid-lowering therapy and achieving low-density lipoprotein cholesterol goals. Arch Intern Med 2000;160:459–67.
18. Catalan VS, LeLorier J. Predictors of long-term persistence on statins in a subsidized clinical population. Value Health 2000;3:417–26.
19. Yiğiner O, Ozmen N, Ozçelik F, Inanç T, Kardeşoğlu E, Uz O, et al. Adherence to statin therapy and LDL cholesterol goal attainment in type 2 diabetics and secondary prevention patients: the role of education and knowledge. [Article in Turkish]. Turk Kardiyol Dern Ars 2010;38:544–50.
20. Tokgözoğlu L, Özdemir R, Altındağ R, Ceyhan C, Yeter E, Öztürk C, et al. Patient characteristics and statin discontinuation-related factors during treatment of hypercholesterolemia: an observational non-interventional study in patients with statin discontinuation (STAY study). Turk Kardiyol Dern Ars 2016;44:53–64.

APA	doğan v, basaran o, ÖZLEK B, ÇELİK O, ÖZLEK E, ÇİL C, özdemir i, RENCÜZOĞULLARI İ, ÖZPAMUK KARADENİZ F, BEKAR L, AKTAŞ M, RESULZADE M, KALÇIK M, aksan g, Çinier G, HALLİ AKAY K, MERT K, BİTEKER M, Kayikcioglu M (2019). Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. , 599 - 608. 10.5543/tkda.2019.39293
Chicago	doğan volkan,basaran ozcan,ÖZLEK BÜLENT,ÇELİK OĞUZHAN,ÖZLEK EDA,ÇİL CEM,özdemir ibrahim halil,RENCÜZOĞULLARI İbrahim,ÖZPAMUK KARADENİZ FATMA,BEKAR Lütfü,AKTAŞ Müjdat,RESULZADE Mübariz murat,KALÇIK Macit,aksan gökhan,Çinier Göksel,HALLİ AKAY Kadriye,MERT Kadir Uğur,BİTEKER MURAT,Kayikcioglu Meral Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. (2019): 599 - 608. 10.5543/tkda.2019.39293
MLA	doğan volkan,basaran ozcan,ÖZLEK BÜLENT,ÇELİK OĞUZHAN,ÖZLEK EDA,ÇİL CEM,özdemir ibrahim halil,RENCÜZOĞULLARI İbrahim,ÖZPAMUK KARADENİZ FATMA,BEKAR Lütfü,AKTAŞ Müjdat,RESULZADE Mübariz murat,KALÇIK Macit,aksan gökhan,Çinier Göksel,HALLİ AKAY Kadriye,MERT Kadir Uğur,BİTEKER MURAT,Kayikcioglu Meral Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. , 2019, ss.599 - 608. 10.5543/tkda.2019.39293
AMA	doğan v,basaran o,ÖZLEK B,ÇELİK O,ÖZLEK E,ÇİL C,özdemir i,RENCÜZOĞULLARI İ,ÖZPAMUK KARADENİZ F,BEKAR L,AKTAŞ M,RESULZADE M,KALÇIK M,aksan g,Çinier G,HALLİ AKAY K,MERT K,BİTEKER M,Kayikcioglu M Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. . 2019; 599 - 608. 10.5543/tkda.2019.39293
Vancouver	doğan v,basaran o,ÖZLEK B,ÇELİK O,ÖZLEK E,ÇİL C,özdemir i,RENCÜZOĞULLARI İ,ÖZPAMUK KARADENİZ F,BEKAR L,AKTAŞ M,RESULZADE M,KALÇIK M,aksan g,Çinier G,HALLİ AKAY K,MERT K,BİTEKER M,Kayikcioglu M Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. . 2019; 599 - 608. 10.5543/tkda.2019.39293
IEEE	doğan v,basaran o,ÖZLEK B,ÇELİK O,ÖZLEK E,ÇİL C,özdemir i,RENCÜZOĞULLARI İ,ÖZPAMUK KARADENİZ F,BEKAR L,AKTAŞ M,RESULZADE M,KALÇIK M,aksan g,Çinier G,HALLİ AKAY K,MERT K,BİTEKER M,Kayikcioglu M "Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia." , ss.599 - 608, 2019. 10.5543/tkda.2019.39293
ISNAD	doğan, volkan vd. "Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia". (2019), 599-608. https://doi.org/10.5543/tkda.2019.39293

APA	doğan v, basaran o, ÖZLEK B, ÇELİK O, ÖZLEK E, ÇİL C, özdemir i, RENCÜZOĞULLARI İ, ÖZPAMUK KARADENİZ F, BEKAR L, AKTAŞ M, RESULZADE M, KALÇIK M, aksan g, Çinier G, HALLİ AKAY K, MERT K, BİTEKER M, Kayikcioglu M (2019). Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. Türk Kardiyoloji Derneği Arşivi, 47(7), 599 - 608. 10.5543/tkda.2019.39293
Chicago	doğan volkan,basaran ozcan,ÖZLEK BÜLENT,ÇELİK OĞUZHAN,ÖZLEK EDA,ÇİL CEM,özdemir ibrahim halil,RENCÜZOĞULLARI İbrahim,ÖZPAMUK KARADENİZ FATMA,BEKAR Lütfü,AKTAŞ Müjdat,RESULZADE Mübariz murat,KALÇIK Macit,aksan gökhan,Çinier Göksel,HALLİ AKAY Kadriye,MERT Kadir Uğur,BİTEKER MURAT,Kayikcioglu Meral Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. Türk Kardiyoloji Derneği Arşivi 47, no.7 (2019): 599 - 608. 10.5543/tkda.2019.39293
MLA	doğan volkan,basaran ozcan,ÖZLEK BÜLENT,ÇELİK OĞUZHAN,ÖZLEK EDA,ÇİL CEM,özdemir ibrahim halil,RENCÜZOĞULLARI İbrahim,ÖZPAMUK KARADENİZ FATMA,BEKAR Lütfü,AKTAŞ Müjdat,RESULZADE Mübariz murat,KALÇIK Macit,aksan gökhan,Çinier Göksel,HALLİ AKAY Kadriye,MERT Kadir Uğur,BİTEKER MURAT,Kayikcioglu Meral Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. Türk Kardiyoloji Derneği Arşivi, vol.47, no.7, 2019, ss.599 - 608. 10.5543/tkda.2019.39293
AMA	doğan v,basaran o,ÖZLEK B,ÇELİK O,ÖZLEK E,ÇİL C,özdemir i,RENCÜZOĞULLARI İ,ÖZPAMUK KARADENİZ F,BEKAR L,AKTAŞ M,RESULZADE M,KALÇIK M,aksan g,Çinier G,HALLİ AKAY K,MERT K,BİTEKER M,Kayikcioglu M Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. Türk Kardiyoloji Derneği Arşivi. 2019; 47(7): 599 - 608. 10.5543/tkda.2019.39293
Vancouver	doğan v,basaran o,ÖZLEK B,ÇELİK O,ÖZLEK E,ÇİL C,özdemir i,RENCÜZOĞULLARI İ,ÖZPAMUK KARADENİZ F,BEKAR L,AKTAŞ M,RESULZADE M,KALÇIK M,aksan g,Çinier G,HALLİ AKAY K,MERT K,BİTEKER M,Kayikcioglu M Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia. Türk Kardiyoloji Derneği Arşivi. 2019; 47(7): 599 - 608. 10.5543/tkda.2019.39293
IEEE	doğan v,basaran o,ÖZLEK B,ÇELİK O,ÖZLEK E,ÇİL C,özdemir i,RENCÜZOĞULLARI İ,ÖZPAMUK KARADENİZ F,BEKAR L,AKTAŞ M,RESULZADE M,KALÇIK M,aksan g,Çinier G,HALLİ AKAY K,MERT K,BİTEKER M,Kayikcioglu M "Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia." Türk Kardiyoloji Derneği Arşivi, 47, ss.599 - 608, 2019. 10.5543/tkda.2019.39293
ISNAD	doğan, volkan vd. "Evaluation of perceptions, knowledge and compliance with guidelines in real-life practice: A survey on the under-treatment of hypercholesterolemia". Türk Kardiyoloji Derneği Arşivi 47/7 (2019), 599-608. https://doi.org/10.5543/tkda.2019.39293