P0388Missed Opportunities in Cardiovascular Prevention for Patients with Ulcerative Colitis: Insights from Routine Primary-Care Reviews in Rural General Practice

Background Ulcerative colitis (UC) is increasingly recognised as an independent risk factor for atherosclerotic cardiovascular disease (ASCVD), mediated in part by chronic systemic inflammation1,2. However, ASCVD risk assessment & lipid optimisation may be inconsistently embedded within routine UC care, particularly in rural primary-care settings. This cross-sectional retrospective review evaluated ASCVD risk, lipid management & treatment intensity in a rural UC cohort. Methods Data were extracted from a structured UC primary-care review in a single rural English practice. Demographics, QRISK score, prevention status (primary/secondary), blood-pressure targets, lipid-lowering therapies (statins, bempedoic acid, ezetimibe, icosapent ethyl, inclisiran) and LDL-cholesterol (LDL-C) before and after treatment were collated. Where data were missing, this reflected non-collection or patient non-attendance/decline. Quantitative analysis used descriptive statistics, including categorisation of QRISK ≥10% and ≥20% as high & very high estimated 10-year CVD risk. A qualitative comparative analysis of prescribing patterns and documentation gaps was undertaken to contextualise quantitative findings. Results 63 patients were reviewed (mean age 65.37y, SD 16.97; 34 men, 29 women), all self-described as White British; 56(88.9%) were in primary & 7(11.1%) in secondary prevention. Mean QRISK was 21.7%; 42/63(66.7%) had QRISK ≥10%, 30/63(47.6%) ≥20%, & 9/63(14.3%) ≥40%, indicating a substantial burden of high/very-high risk. Overall, 25/63(39.7%) received statins; 10(15.9%) were prescribed bempedoic acid, 10(15.9%) ezetimibe, 6(9.5%) icosapent ethyl, & 2(3.2%) inclisiran, suggesting selective use of intensive lipid-lowering strategies. Baseline LDL-C was recorded in 58/63 (92.1%), & paired pre-/post-treatment values were available in 30(47.6%), with mean LDL-C falling from 3.37 to 1.69 mmol/L (≈50% relative reduction). Mean on-treatment LDL-C approached the ESC high-risk target of < 1.8 mmol/L but remained above the very-high-risk goal of < 1.4 mmol/L3. Conclusion Despite a high burden of ASCVD risk, fewer than half of this rural UC cohort were receiving statin therapy, with more advanced agents used in a minority. Marked missingness in follow-up LDL-C suggests real-world challenges in sustained monitoring. Patterns of stepped-intensity therapy indicate clinician awareness of elevated risk but potential under-treatment relative to contemporary ESC targets. Rural UC patients exhibit substantial ASCVD risk with incomplete uptake & monitoring of lipid-lowering therapy. Embedding systematic CVD risk assessment, guideline-directed LDL-C targets and structured follow-up into UC care pathways may help mitigate excess cardiovascular burden in this population. References: 1. Cainzos-Achirica, M., et al. (2020). Inflammatory bowel disease and atherosclerotic cardiovascular diseases. Journal of the American College of Cardiology, 76(24), 2895–2905. 2. Chen, B., et al. (2022). Inflammatory bowel disease and cardiovascular disease. The American Journal of Medicine, 135(10), 1184–1194. 3. Visseren, F. L. J., et al. (2021). 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal, 42(34), 3227–3337. Conflict of interest: Dr. Deaney, Carl: Non-promotional grant from Ferring Ellis, Victoria: Non-promotional grant from Ferring Koliandris, Stephanie: Non-promotional grant from Ferring Donaldson, Meredith: Non-promotional grant from Ferring Meskauskiene, Agne: Non-promotional grant from Ferring.