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Prevalence of lipid abnormalities before and after introduction of lipid modifying therapy among Swedish patients with dyslipidemia (PRIMULA)

Billie Pettersson12*, Baishali Ambegaonkar3, Vasilisa Sazonov3, Mats Martinell4, Jan Stålhammar4 and Per Wändell5

Author Affiliations

1 Center for Medical Technology Assessment, Linköping University, Linköping, Sweden

2 Merck Sharp & Dohme (Sweden) AB, Sollentuna, Sweden

3 Merck & Co., Inc., Whitehouse Station, New Jersey, USA

4 Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden

5 Centre for Family and Community Medicine, Karolinska Institute, Huddinge, Sweden

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BMC Public Health 2010, 10:737  doi:10.1186/1471-2458-10-737

Published: 29 November 2010



Data on the prevalence of dyslipidemia and attainment of goal/normal lipid levels in a Swedish population are scarce. The objective of this study is to estimate the prevalence of dyslipidemia and attainment of goal/normal lipid levels in patients treated with lipid modifying therapy (LMT).


This longitudinal retrospective observational study covers time periods before and after treatment. Data were collected from 1994-2007 electronic patient records in public primary healthcare centers in Uppsala County, Sweden. Patients were included if they had been treated with LMT and had at least one lipid abnormality indicating dyslipidemia and if complete lipid profile data were available. Thresholds levels for lipids were defined as per Swedish guidelines.


Among 5,424 patients included, at baseline, the prevalence of dyslipidemia (≥1 lipid abnormality) was by definition 100%, while this figure was 82% at follow-up. At baseline, 60% had elevated low-density lipoprotein (LDL-C) combined with low high-density lipoprotein (HDL-C) and/or elevated triglycerides (TG s), corresponding figure at follow-up was 36%. Low HDL-C and/or elevated TGs at follow-up remained at 69% for patients with type 2 diabetes mellitus (T2DM), 50% among patients with coronary heart disease (CHD) and 66% among patients with 10 year CHD risk >20%. Of the total sample, 40% attained goal levels of LDL-C and 18% attained goal/normal levels on all three lipid parameters.


Focusing therapy on LDL-C reduction allows 40% of patients to achieve LDL-C goal and helps reducing triglyceride levels. Almost 60% of patients experience persistent HDL-C and/or triglyceride abnormality independently of LDL-C levels and could be candidates for additional treatments.