Key result
Patients with prior depression were significantly less likely to achieve the LDL-C target of <1.8 mmol/L within 1 year following percutaneous coronary intervention compared to those without depression (OR 0.86).
Why the study?
To explore differences in lipid-lowering therapy use and guideline target achievement in very high-risk coronary patients with and without prior depression, and to assess the influence of sex.
Does prior depression reduce the likelihood of having lipids checked and achieving guideline lipid targets in very high-risk coronary patients post-PCI?
Cohort (n=13,781)
Does prior depression reduce the likelihood of having lipids checked and achieving guideline lipid targets in very high-risk coronary patients post-PCI?
Odds Ratio: 0.86 (95% CI 0.78–0.96)
Absolute Event Rate: 42.2% vs 49.2%
p-value: p=0.007
Patients with prior depression, particularly females, are significantly less likely to have their lipids monitored and achieve guideline-directed lipid targets following percutaneous coronary intervention.
Depression history was associated with fewer lipid checks; leaves open whether integrated screening improves secondary prevention.
AIMS: To explore differences in the use of lipid lowering therapy and/or achievement of lipid guideline targets in patients with and without prior depression and influence of sex in very high-risk coronary patients. METHODS & FINDINGS: A retrospective observational cohort study was conducted using individual-level linked electronic health record data in patients who underwent percutaneous coronary intervention (2012-2017) in Wales. The cohort comprised of 13,781 patients (27.4% female), with 26.1% having prior depression. Lipid levels were recorded in 10,050 patients of whom 25% had depression. History of depression was independently associated with not having lipids checked (OR 0.79 95%CI 0.72-0.87 p<0.001). Patients with prior depression were less likely to achieve targets for low density lipoprotein cholesterol (LDL-C <1.8mmol/l), non-high density lipoprotein cholesterol (non-HDL-C <2.6mmol/l) and triglycerides (<2.3mmol/l) than patients without depression (OR 0.86 95%CI 0.78-0.96 p = 0.007, OR 0.80 95%CI 0.69-0.92 p = 0.003 & OR 0.69 95CI% 0.61-0.79 p<0.001 respectively). Females were less likely to achieve targets for LDL-C and non-HDL-C than males (OR 0.55 95%CI 0.50-0.61 p<0.001 & OR 0.63 95%CI 0.55-0.73 p<0.001). There was an additive effect of depression and sex; females with depression were not only least likely to be tested (OR 0.74 95%CI 0.65-0.84 p<0.001) but also (where levels were known) less likely to achieve LDL-C (OR 0.47 95%CI 0.41-0.55 p<0.001) and non-HDL-C targets (OR 0.50 95%CI 0.41-0.60 p<0.001). It was not possible to look at the influence of medication adherence on achievement of lipid targets due to limitations of the use of anonymised routinely-held clinical care data. CONCLUSION: Patients with prior depression were less likely to have their lipids monitored and achieve guideline targets within 1-year. Females with depression are the least likely to be tested and achieve lipid targets, suggesting not only a greater risk of future events, but also an opportunity to improve care.
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Ellins et al. (2022) conducted a cohort in Coronary artery disease post-percutaneous coronary intervention (n=13,781). Prior depression vs. No prior depression was evaluated on Achievement of LDL-C target (<1.8mmol/L) within 1 year (OR 0.86, 95% CI 0.78-0.96, p=0.007). Patients with prior depression were significantly less likely to achieve the LDL-C target of <1.8 mmol/L within 1 year following percutaneous coronary intervention compared to those without depression (OR 0.86).
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