Abstract Introduction In patients with coronary artery disease (CAD), secondary prevention according to Guideline-based recommendations for cardiovascular (CV) risk factor modification is essential for clinical outcomes. There is evidence from observational data that secondary prevention remains suboptimal in real-world clinical practice and especially in patients with low socioeconomic status and among ethnic-minority groups. Material and Methods The DISCOVER-LDL registry included 76,264 patients with CAD enrolled in North West of a city primary care between 2015-2022. Patients were categorized into those with acute coronary syndromes (ACS) or chronic coronary syndromes (CCS). Socioeconomic status was defined as low or high based on North West of a city neighborhood residency. Patients were also divided based on the ethnicity in white and non-white, which included Asian, Latino and African population. Results 76,264 patients were recruited in the DISCOVER LDL registry, of which 58,184 had CCS and 16,813 ACS. 21,106 (60%) patients were considered high socioeconomic (SE) status (24410 CCS and 7089 ACS), while 32,035 (40%) low SE (16087 CCS and 4651 ACS). 36501 (53%) patients were white ethnicity (28565 CCS and 7327 ACS) while 32392 (47%) non-white (24168 CCS and 7736 ACS). MACE and all-cause death were significantly higher in patients with LDL never checked in the first year compared to patients with LDL checked once and twice or more, the latter showing the lowest risk (p trend 0.001 and p trend0.001 respectively) in both ACS and CCS groups. No interaction was observed for both MACE and all-cause death according to socioeconomic status (p for interaction in the multivariable model 0.54 and 0.67). White patients experienced a higher incidence of both MACE and all-cause death compared to non-white patients, however, no interaction was observed in the multivariable model (p for interaction=0.50 and 0.62) with LDL checks on both MACE and all-cause death. The same results were observed for statin prescription and dose at discharge. Conclusion In this real world, representative primary-care registry enrolling a high-risk cohort of patients with ACS and CCS, a low frequency of serum lipid measurements in the first year as well as statin prescription and dosage at discharge were associated with increased MACE and mortality at follow-up independently by socioeconomic status and ethnicity.
Bruno et al. (Sat,) studied this question.