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Achievement of LDL-Cholesterol Goals in Patients Receiving LLT in Primary Care: TERESA-AP Study: LDL-Cholesterol
Sergio Cinza-Sanjurjo1,2,3,4, Vivencio Barrios5,6, David Fierro-González7
1Milladoiro Health Centre Santiago de Compostela Health Area, Santiago de Compostela, Spain.
Insights
Only 26% of patients on lipid-lowering drugs in primary care achieved their LDL-cholesterol goals. This highlights challenges in managing cardiovascular risk factors, particularly for those with chronic kidney disease.
Area of Science:
- Cardiology
- Primary Care Medicine
- Pharmacotherapy
Background:
- Low-density lipoprotein cholesterol (LDL-C) is a critical, yet challenging, cardiovascular risk factor.
- Stricter LDL-C goals since 2019 underscore its significance in atherosclerotic plaque development.
- Effective management of LDL-C is vital for reducing overall cardiovascular risk.
Purpose of the Study:
- To assess LDL-C control in patients receiving lipid-lowering drug treatment (LLT) within primary care settings.
- To analyze the achievement of therapeutic targets in a real-world primary care population.
- To identify factors influencing LDL-C goal attainment in treated patients.
Main Methods:
- An observational, multicenter, cross-sectional, nationwide study.
- Recruitment of 929 patients from 50 primary care physicians, on LLT for ≥6 months.
- Data collection on cardiovascular risk factors and LDL-C control.
Main Results:
- Only 26.0% of patients achieved their recommended LDL-C goals.
- Goal attainment was higher in patients with cardiovascular disease (26.7%) and diabetes mellitus (35.5%).
- Patients with chronic kidney disease had significantly lower goal attainment (12.1%).
- Moderate-intensity statin monotherapy (69.0%) and statin-ezetimibe combination (27.6%) were the most common treatments.
Conclusions:
- A significant majority of primary care patients on LLT do not reach their LDL-C therapeutic targets.
- Specific comorbidities like CVD and DM show slightly better, but still suboptimal, control rates.
- CKD presents a particular challenge for achieving LDL-C goals.
- Moderate-intensity statins, alone or with ezetimibe, are the predominant treatment strategies.
Abstract:
Background and Aim: Since 2019, LDL-cholesterol (LDL-C) is the risk factor with the strictest goals and the most difficult to reach, due to its role in the development of atherosclerotic plaque and, therefore, cardiovascular risk. The objective of the TERESA-AP study is to analyze the degree of LDL-C control in patients followed up in primary care with lipid-lowering drug treatment (LLT). Methods: Observational, multicenter, cross-sectional, nationwide study was conducted, in which 50 PC physicians recruited 929 patients who were receiving LLT during at least the preceding 6 months. The variables required to estimate the patients' cardiovascular risk and LDL control were recorded. Results: Nearly half of sample was women (50.5%), and the mean age was 67.8 (10.4) years. High blood pressure (65.3%) and sedentary lifestyle (59.7%) were the most frequent risk factors. Recommended goals were reached in 26.0% (95% CI: 23.3%-29.0%) of patients, with a slightly higher percentage in patients with cardiovascular disease (CVD) (26.7%), diabetes mellitus (DM) (35.5%), and a lower one in patients with chronic kidney disease (CKD) (12.1%). The most frequent drug treatments were statin monotherapy (69.0%) and statin with ezetimibe combination (27.6%), with moderate-intensity statins being the most commonly used in both groups. Conclusions: On average, only a quarter of the patients followed up in PC and who receive drug treatment reach their therapeutic targets. This percentage is slightly higher if the patients have CVD and DM and lower if they have CKD. The most commonly used therapeutic strategy is moderate-intensity statins, both in monotherapy and in combination with ezetimibe.
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