Use of Preventive Lipid-lowering therapy in patients who develop premature coronary artery disease. 

<h2 id="background">Background</h2><ul><li>Prevalence of cardiovascular risk factors in young and middle-aged adults is increasing, and rates of premature coronary artery disease (CAD) are stagnant.</li><li>Lipid-lowering therapy (LLT) is effective in preventing CAD.</li><li>LLT is is underutilized in younger patients, the reasons for which are not fully understood.</li></ul><h2 id="aim">Aim</h2><p>The study aims to assess pre presentation health care encounters, eligibility, usage patterns, and predictors of initiation of LLT and its relationships with the severity of clinical presentation of CAD.</p><h2 id="methods">Methods</h2><p>Health care encounters, cardiovascular risk, and medication dispensations in females &lt; 55 and males &lt; 50 years old who presented with angiographically confirmed premature CAD were analyzed using administrative databases and a clinical registry.</p><h2 id="results">Results:</h2><ul><li>In 3 years before presentation, 11,445 patients (27.6% females, age 46.14 ± 5.05 years) were evaluated, of which 93.3% were eligible for lipid screening and 92.2% had health care visits, but only14.8% received LLT dispensations, and 5.9% displayed good adherence.</li><li>In multivariable analysis, groups less likely to receive LLT were&nbsp;<ul><li>Females (OR: 0.75)</li><li>Rural residents (OR: 0.75)&nbsp;</li><li>Smokers (OR: 0.65)</li></ul></li><li>Among patients who at least once filled a prescription for LLT, adherence pattern is shown in figure 1A and the variation of the therapy intensity is shown in figure 1B.</li></ul><p><strong>Figure 1: Characteristics of Lipid-Lowering Therapy Prior to Presentation With Premature Coronary Artery Disease, Overall and by Type of Presentation.</strong></p><figure class="image"><img style="aspect-ratio:528/336;" src="https://cdn.megawecare.com/GHBY/Internal-Images/cardiology%20update%20-%20figure-1.webp" width="528" height="336"></figure><ul><li>High-intensity LLT vs no LLT was associated with lower odds of presenting with acute coronary syndrome (OR: 0.25) (Figure 2).</li></ul><p><strong>Figure 2: Effect of Intensity of Lipid-Lowering Therapy and Treatment Adherence on Risk of Presentation With ACS vs Stable Angina When Adjusted for Demographics, Major Cardiovascular Risk Factors, Comorbidities, and Treatment With Antiglycemic and Cardiovascular Medications</strong></p><figure class="image"><img style="aspect-ratio:669/292;" src="https://cdn.megawecare.com/GHBY/Internal-Images/cardiology%20update%20-%20figure-2.webp" width="669" height="292"></figure><ul><li>In 470 clinical registry participants (27.4% females, mean age 45.72 ± 5.07 years), 70.2% had lipids assessed, 55.7% were eligible for LLT based on the estimated cardiovascular risk, 18.9% received treatment recommendations,and 12.1% received dispensations of LLT before presentation.</li></ul><p><strong>Illustration: Eligibility for Lipid Screening and Lipid Lowering, Health Care Encounters and Treatment Initiation, and Adherence in 3 Years Prior to Presentation With Premature CAD.</strong></p><figure class="image"><img style="aspect-ratio:617/482;" src="https://cdn.megawecare.com/GHBY/Internal-Images/cardiology%20update%20-%20figure-3.webp" width="617" height="482"></figure><h2 id="conclusion">Conclusion</h2><ul><li>LLT was infrequently used among patients who went on to develop premature CAD, despite of a high burden of cardiovascular risk factors, near universal eligibility for lipid screening, and frequent health care system encounters.</li><li>Use of LLT was associated with lower odds of an ACS dependent on both treatment adherence and intensity.</li><li>To reduce the burden of premature CAD, strategies aimed at optimizing the initiation and persistence of guideline-recommended preventive LLT are needed.<br>&nbsp;</li></ul>

Cardiology Update   Issue 6   Nov 2024

<ul><li><a href="#background">Background</a></li><li><a href="#aim">Aim</a></li><li><a href="#methods">Methods</a></li><li><a href="#results">Results</a></li><li><a href="#conclusion">Conclusion</a></li></ul>

Use of Preventive Lipid-lowering therapy in patients who develop premature coronary artery disease.

Reference