Adherence to lipid-lowering guidelines for secondary prevention and potential reduction in CVD events in Swedish primary care: a cross-sectional study

Abstract

ObjectivesThe protective effect of lipid-lowering treatment for secondary prevention after coronary heart disease (CHD) has been well documented. Current guidelines recommend a target level for low-density lipoprotein cholesterol (LDL-C) of ≤1.8 mmol/L. The aim was to describe lipid-lowering treatment patterns and to provide an estimate of the potential reductions in cardiovascular disease (CVD) events with improved adherence to guidelines.DesignCross-sectional.SettingPrimary care in a large Swedish region.Participants37 120 patients with CHD in a Swedish regional primary care quality register (QregPV), by 31 December 2015.Primary and secondary outcome measuresProportion of patients on statin treatment and proportion of patients achieving LDL-C ≤1.8 mmol/L. Estimated number of CVD events calculated for (1) current treatment, (2) improved treatment and (3) lowered LDL-C, based on applying rate reductions from meta-analyses of randomised trials to the potentially undertreated population. Risk estimation modelling was based on 52 042 patients in the same register on January 2011 followed for 5 years.ResultsOf 37 120 patients, 18% reached LDL-C ≤1.8 mmol/L and 32% were not on statin treatment. Based on individual risks, the estimated number of CVD events in the study group over 5 years was 9209/37 120. If all patients without a statin or with less potent statin treatment were given atorvastatin 80 mg, an estimated reduction of CVD events by 14% (7901 vs 9209) was seen. If all patients achieved LDL-C ≤1.8 mmol/L, the number of events was estimated to be reduced by 18% (7577 vs 9209).ConclusionOne-third of patients with CHD in primary care were not on lipid-lowering treatment. Based on the assumption that included patients would react to statin therapy the same way as the patients in randomised trials, improved adherence to treatment guidelines could lead to a substantial reduction in new CVD events.

Trends in statin utilization and ischemic heart disease mortality in Lithuania and Sweden, 2000–2020

“…From 2017, high-intensity statins became the most utilized ones in terms of DDDs. However, a cross-sectional register study performed in a primary care setting in Sweden found that of the 37120 patients in the secondary prevention, only 18% reached the recommended LDL-C goal of ≤1.8 mmol/L, and one-third of patients with CHD were not even on lipid-lowering treatment ( 25 ). Based on individual risks, the estimated number of CVD events in the study population might be reduced by 14% if all patients without a statin or with less potent statin treatment were given atorvastatin 80 mg.…”

Intensity of and Adherence to Lipid‐Lowering Therapy as Predictors of Major Adverse Cardiovascular Outcomes in Patients With Coronary Heart Disease

“…However, observational studies from routine care show that many patients do not receive high‐intensity LLT as first‐line therapy, fail to be switched to high‐intensity LLT, and have suboptimal adherence rates. 7 , 8 , 9 , 10 Suboptimal LLT management may affect cardiovascular disease (CVD) recurrence and LDL‐C goal attainment, but this is not well studied. Some studies have explored the separate or combined associations between LLT adherence, intensity, and poor clinical outcomes.…”