What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Ischemic heart disease (n=1936). Intervention: LDL-C-lowering treatments vs. No treatment or lower-intensity treatment. Primary outcome: Receipt of higher-intensity LDL-C lowering treatments (Male vs Female) (OR 1.57, 95% CI 1.27-1.94).

March 12, 2025Open Access

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

Q: What does this research mean for the field?

In patients with ischemic heart disease in primary care, only 12.6% achieve the recommended LDL-C target of <55 mg/dL, and men are significantly more likely to receive higher-intensity lipid-lowering prescriptions than women. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Key Result

In patients with ischemic heart disease, only 12.6% achieved the LDL-C target of <55 mg/dL, with men being significantly more likely to receive higher-intensity prescriptions (OR 1.57) than women.

Study Design

Type

Cross-Sectional (n=1,936)

Multicenter

Yes

Structured PICO

Population

1936 patients with ischaemic heart disease from three primary care centres in Spain

Intervention

LDL-C-lowering treatments

Outcome

LDL-C target attainment (<70 mg/dl and <55 mg/dl) and prescribed drug intensitysurrogate

A significant proportion of patients with ischaemic heart disease in primary care do not achieve recommended LDL-C targets, with notable age and sex disparities in treatment intensity.

Main Result

Effect estimate: OR 1.57 (95% CI 1.27-1.94)

Limitations

Could not assess iPSCK9 prescriptions managed through hospital systems
Focused on active drug prescriptions rather than drug adherence
Lack of data on shared decision-making processes
Cross-sectional design did not capture conditions at the time of the event

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.

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