Among a cohort of more than a quarter million patients with atherosclerotic CVD in Canada, only about two-thirds were prescribed lipid-lowering therapy and of those, more than a third did not reach recommended LDL cholesterol levels, according to findings recently published in the Canadian Journal of Cardiology.
“Despite diagnostic advances and established treatment guidelines, atherosclerotic CVD remains a leading cause of morbidity and mortality in Canada and worldwide,” Guanmin Chen, MD, a senior biostatistician at the Libin Cardiovascular Institute of Alberta at the University of Calgary, told Healio Primary Care.
Although there is an abundance of research showing the benefits of statins and lowering LDL cholesterol levels in patients with atherosclerotic CVD, there is little information to help clinicians understand how these patients are treated, according to researchers.
To fill in this research gap, they examined clinical characteristics, treatments and LDL cholesterol assessments of 281,665 patients with atherosclerotic CVD in Alberta, Canada.
Chen and colleagues found that 77.9% of the patients had an index LDL cholesterol test, 55.1% were prescribed lipid-lowering therapy before the test and 65.9% were prescribed lipid-lowering therapy after it.
In addition, 60.6% of the patients who received any lipid-lowering therapy were receiving moderate-/high-intensity statins. Among the 32.6% of the cohort who underwent two LDL cholesterol tests, 48.5% of patients who received lipid-lowering therapy did not achieve LDL cholesterol levels consistent with the 2016 Canadian Cardiovascular Society guideline of less than 2 mmol/L or a reduction of 50% or more, and 36.6% of patients did not reach that target at the follow-up test.
Chen explained how primary care physicians can help close what he and his co-authors described as a “remarkable treatment gap.”
“This may include using risk stratification tools and current guidelines for recommended lipid-lowering therapy. In addition, routine follow-up of lipid profiles and adjustments of treatments as needed would also benefit these patients,” he said in the interview.
“In addition, for patients with established atherosclerotic CVD, physicians should redouble their effort to get patients back on their statins with a goal of treating to new lower [dyslipidemia] targets,” Chen continued, adding that new strategies are also needed to improve the management of, and reduce the burden of disease among, patients with atherosclerotic CVD.
In a related editorial, Robert T. Sparrow, MD, faculty of medical science at the Schulich School of Medicine and Dentistry, Western University in London, Ontario, Canada and colleagues wrote that there is no “magic bullet approach to improving statin compliance.”
However, they noted that previous studies have identified patient-focused and physician-focused approaches to improve statin prescribing, which have had varying levels of success in improving the lives of patients with atherosclerotic CVD. – by Janel Miller
Disclosures: Chen reports being a consultant for Medlior and receiving research funding from the Canadian Institutes for Health Research. Sparrow reports no relevant financial disclosures. Please see the study and editorial for all other relevant financial disclosures.