Low-density lipoprotein cholesterol levels and treatment intensity in secondary prevention of patients with ischaemic heart disease in the primary care setting: a real-world data registry study.

Abstract

Background: Monitoring low-density lipoprotein cholesterol (LDL-C) and prescribing appropriate treatment is crucial for secondary prevention in primary care. Aim: To study LDL-C levels and treatments for patients with ischaemic heart disease according to target recommendations and assess factors influencing prescribed drug intensity. Design & setting: A cross-sectional study was undertaken. We examined electronic health records of patients with ischaemic heart disease from three primary care centres in Spain. Method: LDL-C levels were assessed using the most recent registry, and LDL-C-lowering treatments were categorised by their theoretical efficacy. Factors associated with LDL-C target attainment were analysed using univariate and multivariate regression models. Prescription intensity was studied with ordinal logistic regression models. Results: We studied 1936 patients, 14.88% of whom received no LDL-C-lowering treatment. The percentages of patients who achieved LDL-C thresholds of<70 mg/dl and<55 mg/dl were 35.0% and 12.65%, respectively. The factor associated with the <55 mg/dl threshold was type 2 diabetes mellitus (odds ratio [OR] 0.55, 95% confidence interval [CI] = 0.42 to 0.73), with males showing better LDL-C levels (OR 0.34, 95% CI = 0.23 to 0.51). Males had higher-intensity prescriptions (OR 1.57, 95% CI = 1.27 to 1.94) and older patients had lower-intensity treatments (OR 0.96, 95% CI = 0.95 to 0.97). Conclusion: Increased LDL-C drug treatment improvement, monitoring, and adherence to guideline recommendations are necessary for patients with ischaemic heart disease. Sex and age are potential factors associated with inadequate lipid-lowering treatment intensity and poor LDL-C control that might worsen cardiovascular outcomes in high-risk patients, leading to avoidable inequity among patients who visit the primary health setting.