Lipid-Lowering Therapy Preferences in the LISTEN-LDL-US Study

BACKGROUND: Low-density lipoprotein cholesterol (LDL-C), among other lipids, is a strong causal and modifiable risk factor for atherosclerotic cardiovascular disease (ASCVD). However, lipid-lowering therapy (LLT) is underutilized and many patients do not reach LDL-C goals. OBJECTIVES: This study aimed to evaluate patient preferences for LLT attributes to inform shared decision-making and improve treatment adoption and adherence. METHODS: Adults ≥40 years with elevated LDL-C and a recommendation for LLT completed a cross-sectional, web-based survey assessing treatment experiences and preferences. A discrete choice experiment elicited preferences across 7 attributes: LDL-C reduction, stroke risk, heart attack risk, revascularization risk, new-onset diabetes, musculoskeletal pain, and regimen/mode of administration. Survey responses were analyzed using univariate and bivariate methods. Preference weights (PW) and relative importance were estimated using hierarchical Bayesian modeling. RESULTS: Among 508 participants (mean age: 62.8 ± 11.4 years), 49.0% had prior ASCVD, 55.3% were female, and 43.9% were current or former smokers. Participants prioritized immediate and tangible treatment features over long-term benefits. Mode of administration was the most influential attribute (relative importance = 25.9). A once-daily oral pill was most preferred (PW = 1.75), followed by a daily pill plus a second oral pill before breakfast (PW = 0.17), whereas regimens including biweekly injections were least preferred (PW = -1.13). Higher perceived ASCVD risk was associated with greater emphasis on cardiovascular risk reduction and less emphasis on regimen. CONCLUSIONS: Mode of administration is a key driver of LLT preferences. Incorporating patient preferences into shared decision-making may improve adherence and implementation of guideline-directed therapy.