Does BMI influence the choice of lipid-lowering therapy?

Takeaway

• Study suggests that physicians’ decisions are directly influenced by patients’ BMI when choosing statin dose.
• Patients with high BMI receive high dose of statin treatment even after correcting for potential confounding factors such as diabetes or a history of ischaemic heart disease.
• Study proposes the use of established risk scores to guide clinical decision making lipid-lowering therapy.

Why this matters

• Current guidelines recommend lowering low-density lipoprotein cholesterol (LDL-C) as the main focus for treatment of dyslipidaemia.
• Statins form the backbone of lipid-lowering treatment; however, there is no clarity on the factors influencing their prescription in clinical practice.

Study design

• Cross-sectional, observational study of 52,916 patients with dyslipidaemia undergoing statin treatment from the Dyslipidaemia International Study (DYSIS).
• Funding: None disclosed.

Key results

• Overall, 1.1% of the patients were underweight (BMI, <18.5 kg/m²), 33.1% had normal weight (18.5-24.9 kg/m²), 41.5% were overweight (25-29.9 kg/m²), 17.1% had class I obesity (30.0-34.9 kg/m²), 5.0% had class II obesity (35-39.9 kg/m²) and 2.1% had class III obesity (≥40 kg/m²).
• BMI showed a negative correlation with high-density lipoprotein cholesterol, positive correlation with triglycerides (P<.0001 for both) and no correlation with LDL-C (P=.51).
• Statin dosage showed a positive correlation with BMI (P=.001) and remained significant even after adjustments (OR, 2.4; 95% CI, 2.0-3.0).

Limitations

• Observational study.