Lipid Profile Management in Secondary Prevention in Spain: Data from the BDCAP Registry in Spain (LIPIDSPAIN)

Introduction: Achieving LDL cholesterol (LDL-C) targets is critical in secondary cardiovascular prevention. Despite clinical guidelines promoting aggressive lipid-lowering strategies, many patients fail to reach recommended LDL-C levels. This study aimed to evaluate lipid profile management among secondary prevention patients in Spain using the Spanish Primary Care Clinical Database (BDCAP) registry. Methods: A repeated cross-sectional study was conducted using 2019-2023 data from the BDCAP. Patients with prior diagnoses of ischemic heart disease, stroke, or peripheral artery disease, and receiving lipid-lowering therapy, were included. Data on therapy type (monotherapy or combination therapy with lipid-lowering drugs), LDL-C serum levels, and demographic and socioeconomic factors were analyzed. Trends from 2019 to 2023 and regional differences were also explored. Results: In 2023, 1,565,429 patients received lipid-lowering drugs for secondary prevention (678.3 per 1000 attended), with higher rates in men. Combination therapy increased over time, from 88.9 to 191.1 per 1000 between 2019 and 2023. Regional disparities were notable, with treatment coverage ranging from 53.9% to 87.9%. Only 33.7% of treated patients achieved LDL-C < 70 mg/dL, and 65.6% achieved <100 mg/dL. Combination therapy was significantly more effective than monotherapy in reaching both LDL-C thresholds. Conclusions: Despite the growing use of combination lipid-lowering therapy, a substantial proportion of secondary prevention patients in Spain do not meet LDL-C targets. These findings highlight the need for more intensive lipid management strategies and improved adherence to clinical guidelines to optimize cardiovascular risk reduction.