Key result
Pre-existing depression linked to ~15% higher LLT prescription but not better LDL-C control.
Why the study?
The study investigated how depression status influences lipid-lowering therapy prescribing and guideline-target LDL-C achievement after first documentation of high ASCVD risk.
Does depression status influence lipid lowering therapy prescribing and achievement of LDL-C targets in patients at high risk of ASCVD?
Cohort (n=103,340)
Does depression status influence lipid lowering therapy prescribing and achievement of LDL-C targets in patients at high risk of ASCVD?
Odds Ratio: 1.15 (95% CI 1.08–1.23)
High ASCVD risk patients with depression are more likely to be prescribed lipid-lowering therapy, but this does not necessarily translate to better LDL-C control.
Depression was associated with higher LLT prescription in observational data; leaves open effects on LDL-C control and clinical outcomes.
AIM: This study investigated the influence of depression status on lipid lowering therapy (LLT) prescribing and achievement of guideline targets for low density lipoprotein cholesterol (LDL-C) levels in patients after first documentation of a high risk of developing atherosclerotic cardiovascular disease (ASCVD). Associations with sex, socioeconomic status and location of residence on these relationships were also explored. METHODS: A retrospective observational cohort study (2010-2019) using individual-level linked, anonymised, routinely collected electronic health record data sources. Patients with/without depression and documentation of a high global QRISK risk score (HQR) were included. Outcome variables were LLT prescription within 6 months of HQR documentation and recording of LDL-C level within European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) targets and achievement of >40% reduction in LDL-C according to National Institute for Health and Care Excellence guidance within 1 year of HQR. Logistic regression analysis explored the association between depression and outcome variables adjusting for sex, age group, deprivation, location of residence and other risk factors. RESULTS: QRISK was documented in 284 859 (12.8%) patients. In the 103 340 HQR patients, depression (identified pre-HQR or post-HQR documentation) was associated with a higher likelihood of LLT prescription (pre-OR 1.15, 95% CI 1.08 to 1.23; post-OR 1.39, 95% CI 1.19 to 1.64). Depression was not associated with achievement of LDL-C control as per EAS/ESC guidelines (<2.6 mmol/L; pre-OR 1.10, 95% CI 1.00 to 1.23; post-OR 1.00, 95% CI 0.79 to 1.28). Depression pre-HQR was associated with achievement of a >40% reduction in LDL-C (pre-OR 1.16, 95% CI 1.02 to 1.32; post-OR 0.94, 95% CI 0.70 to 1.25) CONCLUSION: Only a small proportion of patients had a documented QRISK score in their record. While high ASCVD risk patients with depression were more likely to be prescribed LLT, this was not necessarily associated with better LDL-C control.
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White et al. (2026) conducted a cohort in High risk of developing atherosclerotic cardiovascular disease (ASCVD) (n=103,340). Depression vs. Without depression was evaluated on Lipid lowering therapy (LLT) prescription within 6 months of HQR documentation (OR 1.15, 95% CI 1.08 to 1.23). In patients at high risk for ASCVD, pre-existing depression was associated with a higher likelihood of lipid-lowering therapy prescription (OR 1.15; 95% CI 1.08-1.23) but not better LDL-C control.
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