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Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled

Stefanos Zafeiropoulos1, Ioannis Farmakis2, Anastasios Kartas2

  • 11st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Elmezzi Graduate School of Molecular Medicine and Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA.

Atherosclerosis
|March 29, 2021
PubMed

Insights

An educational intervention improved lipid-lowering therapy adherence in acute coronary syndrome patients. However, this did not significantly increase low-density lipoprotein cholesterol goal achievement rates.

Area of Science:

  • Cardiology
  • Preventive Medicine
  • Health Behavior Research

Background:

  • Achieving low-density lipoprotein cholesterol (LDL-C) goals post-acute coronary syndrome (ACS) is critical for secondary prevention.
  • Suboptimal adherence to lipid-lowering therapy (LLT) often hinders LDL-C goal attainment in ACS survivors.
  • The impact of improved adherence on LDL-C reduction in this population remains unclear.

Purpose of the Study:

  • To evaluate if an educational-motivational intervention enhances long-term LLT adherence among post-ACS patients.
  • To determine if this intervention improves the rate of LDL-C goal achievement at one year.

Main Methods:

  • A randomized controlled trial (IDEAL-LDL) involving 360 hospitalized ACS patients.
  • Patients were assigned to an integrated intervention (education + motivational interviewing) or usual care.
  • Co-primary outcomes included LLT adherence (Proportion of Days Covered >80%) and LDL-C goal attainment (<70 mg/dL or 50% reduction) at one year.

Main Results:

  • The intervention group showed significantly higher median Proportion of Days Covered (PDC) compared to the control group (0.92 vs. 0.86, p=0.03).
  • Patients receiving the intervention had increased odds of good LLT adherence (OR 1.76, p=0.04).
  • No significant difference was observed in LDL-C goal achievement rates between the intervention (49.6%) and control (44.9%) groups (p=0.49).

Conclusions:

  • A multifaceted educational-motivational intervention effectively improved LLT adherence in patients after ACS.
  • Despite improved adherence, the intervention did not lead to a statistically significant increase in LDL-C goal attainment.
  • Further strategies may be needed to translate improved adherence into better LDL-C goal achievement in post-ACS care.
Abstract

Keywords:
Acute coronary syndromesDyslipidemiaLDL-C goalMedication adherence

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