LDL 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

Background Monitoring LDL cholesterol (LDL-C) and prescribing appropriate treatment is crucial for secondary prevention in primary care.

Aim We studied LDL-C levels and treatments for ischemic heart disease patients according to target recommendations and assessed factors influencing prescribed drug intensity.

Design & setting We examined electronic health records of patients with ischemic heart disease from three primary care centers.

Method LDL-C levels were assessed using the most recent registry, and LDL-C-lowering treatments were categorized by their theoretical efficacy. Factors associated with LDL-C target attainment were analyzed using univariate and multivariate regression models. Prescription intensity was studied with ordinal logistic regression models.

Results We studied 1,936 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 12.6%, respectively. The factor associated with the<55 mg/dL threshold was type 2 diabetes mellitus (OR: 0.55, 95% CI: 0.42; 0.73), with men showing better LDL-C levels (OR: 0.34, 95% CI: 0.23; 0.51). Men had higher-intensity prescriptions (OR: 1.57, 95% CI: 1.27; 1.94), and older patients had lower-intensity treatments (OR: 0.96, 95% CI: 0.95; 0.97).

Conclusion Increased LDL-C drug treatment improvement, monitoring, and adherence to guideline recommendations are necessary for patients with ischemic heart disease. Sex and age are potential factors associated with inadequate lipid-lowering treatment intensity and poor LDL-C control, might worsen cardiovascular outcomes in high-risk patients, leading to avoidable inequity among patients who visit the primary health setting.