Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex

Ellins, Libby; Harris, Daniel; Lacey, Arron S.; Akbari, Ashley; Torabi, Fatemeh; Smith, Dave; Jenkins, Geraint; Obaid, Daniel; Chase, Alexander; John, Ann; Gravenor, Michael; Halcox, Julian

doi:10.1371/journal.pone.0264529

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Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex

Libby Ellins

, Daniel Harris, Arron S. Lacey

, Ashley Akbari

, Fatemeh Torabi

, Dave Smith

, Geraint Jenkins

, Daniel Obaid

, Alexander Chase, Ann John

, Michael Gravenor

, Julian Halcox

PLOS ONE, Volume: 17, Issue: 2, Start page: e0264529

Swansea University Authors: Libby Ellins , Daniel Harris, Arron S. Lacey , Ashley Akbari , Fatemeh Torabi , Daniel Obaid , Alexander Chase, Ann John , Michael Gravenor , Julian Halcox

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DOI (Published version): 10.1371/journal.pone.0264529

Abstract

AimsTo explore differences in the use of lipid lowering therapy and/or achievement of lipid guideline targets in patients with and without prior depression and influence of sex in very high-risk coronary patients.Methods & findingsA retrospective observational cohort study was conducted using in...

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Lacey</name><active>true</active><ethesisStudent>true</ethesisStudent></author><author><sid>aa1b025ec0243f708bb5eb0a93d6fb52</sid><ORCID>0000-0003-0814-0801</ORCID><firstname>Ashley</firstname><surname>Akbari</surname><name>Ashley Akbari</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>f569591e1bfb0e405b8091f99fec45d3</sid><ORCID>0000-0002-5853-4625</ORCID><firstname>Fatemeh</firstname><surname>Torabi</surname><name>Fatemeh Torabi</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>1cb4b49224d4f3f2b546ed0f39e13ea8</sid><ORCID>0000-0002-3891-1403</ORCID><firstname>Daniel</firstname><surname>Obaid</surname><name>Daniel Obaid</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>a3b0da49be6a585449e0a4588880df17</sid><firstname>Alexander</firstname><surname>Chase</surname><name>Alexander Chase</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>ed8a9c37bd7b7235b762d941ef18ee55</sid><ORCID>0000-0002-5657-6995</ORCID><firstname>Ann</firstname><surname>John</surname><name>Ann John</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>70a544476ce62ba78502ce463c2500d6</sid><ORCID>0000-0003-0710-0947</ORCID><firstname>Michael</firstname><surname>Gravenor</surname><name>Michael Gravenor</name><active>true</active><ethesisStudent>false</ethesisStudent></author><author><sid>3676f695eeda169d0f8c618adf27c04b</sid><ORCID>0000-0001-6926-2947</ORCID><firstname>Julian</firstname><surname>Halcox</surname><name>Julian Halcox</name><active>true</active><ethesisStudent>false</ethesisStudent></author></swanseaauthors><date>2022-02-17</date><deptcode>HDAT</deptcode><abstract>AimsTo explore differences in the use of lipid lowering therapy and/or achievement of lipid guideline targets in patients with and without prior depression and influence of sex in very high-risk coronary patients.Methods & findingsA retrospective observational cohort study was conducted using individual-level linked electronic health record data in patients who underwent percutaneous coronary intervention (2012–2017) in Wales. The cohort comprised of 13,781 patients (27.4% female), with 26.1% having prior depression. Lipid levels were recorded in 10,050 patients of whom 25% had depression. History of depression was independently associated with not having lipids checked (OR 0.79 95%CI 0.72–0.87 p<0.001). Patients with prior depression were less likely to achieve targets for low density lipoprotein cholesterol (LDL-C <1.8mmol/l), non-high density lipoprotein cholesterol (non-HDL-C <2.6mmol/l) and triglycerides (<2.3mmol/l) than patients without depression (OR 0.86 95%CI 0.78–0.96 p = 0.007, OR 0.80 95%CI 0.69–0.92 p = 0.003 & OR 0.69 95CI% 0.61–0.79 p<0.001 respectively). Females were less likely to achieve targets for LDL-C and non-HDL-C than males (OR 0.55 95%CI 0.50–0.61 p<0.001 & OR 0.63 95%CI 0.55–0.73 p<0.001). There was an additive effect of depression and sex; females with depression were not only least likely to be tested (OR 0.74 95%CI 0.65–0.84 p<0.001) but also (where levels were known) less likely to achieve LDL-C (OR 0.47 95%CI 0.41–0.55 p<0.001) and non-HDL-C targets (OR 0.50 95%CI 0.41–0.60 p<0.001). It was not possible to look at the influence of medication adherence on achievement of lipid targets due to limitations of the use of anonymised routinely-held clinical care data.ConclusionPatients with prior depression were less likely to have their lipids monitored and achieve guideline targets within 1-year. Females with depression are the least likely to be tested and achieve lipid targets, suggesting not only a greater risk of future events, but also an opportunity to improve care.</abstract><type>Journal Article</type><journal>PLOS ONE</journal><volume>17</volume><journalNumber>2</journalNumber><paginationStart>e0264529</paginationStart><paginationEnd/><publisher>Public Library of Science (PLoS)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint/><issnElectronic>1932-6203</issnElectronic><keywords/><publishedDay>25</publishedDay><publishedMonth>2</publishedMonth><publishedYear>2022</publishedYear><publishedDate>2022-02-25</publishedDate><doi>10.1371/journal.pone.0264529</doi><url/><notes/><college>COLLEGE NANME</college><department>Health Data Science</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>HDAT</DepartmentCode><institution>Swansea University</institution><apcterm/><funders>This work was supported by Health Data Research UK (www.hdruk.ac.uk), which receives its funding from Health Data Research United Kingdom Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF), and the Wellcome Trust (AA, JH, FT & AL). DH was also supported by Swansea Bay University Health Board Research and Development Department (https://sbuhb.nhs.wales/hospitals/a-z-hospital-services/researchand-development/).</funders><lastEdited>2022-03-03T12:43:52.4922491</lastEdited><Created>2022-02-17T10:58:02.9273055</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Medicine</level></path><authors><author><firstname>Libby</firstname><surname>Ellins</surname><orcid>0000-0001-5164-6416</orcid><order>1</order></author><author><firstname>Daniel</firstname><surname>Harris</surname><order>2</order></author><author><firstname>Arron S.</firstname><surname>Lacey</surname><orcid>0000-0001-7983-8073</orcid><order>3</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>4</order></author><author><firstname>Fatemeh</firstname><surname>Torabi</surname><orcid>0000-0002-5853-4625</orcid><order>5</order></author><author><firstname>Dave</firstname><surname>Smith</surname><orcid>0000-0001-6648-7577</orcid><order>6</order></author><author><firstname>Geraint</firstname><surname>Jenkins</surname><orcid>0000-0002-3685-242x</orcid><order>7</order></author><author><firstname>Daniel</firstname><surname>Obaid</surname><orcid>0000-0002-3891-1403</orcid><order>8</order></author><author><firstname>Alexander</firstname><surname>Chase</surname><order>9</order></author><author><firstname>Ann</firstname><surname>John</surname><orcid>0000-0002-5657-6995</orcid><order>10</order></author><author><firstname>Michael</firstname><surname>Gravenor</surname><orcid>0000-0003-0710-0947</orcid><order>11</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>12</order></author></authors><documents><document><filename>59420__22501__415d12b32369440b89f03c10f78f8095.pdf</filename><originalFilename>59420.pdf</originalFilename><uploaded>2022-03-03T12:41:31.6795808</uploaded><type>Output</type><contentLength>1027383</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>© 2022 Ellins et al. 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spelling	2022-03-03T12:43:52.4922491 v2 59420 2022-02-17 Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex 553ce2abe05a6396e7dd6eadb6b90a6d 0000-0001-5164-6416 Libby Ellins Libby Ellins true false e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false 7af5c8bdd1197f85720e4f3d65e803eb 0000-0001-7983-8073 Arron S. Lacey Arron S. Lacey true true aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false f569591e1bfb0e405b8091f99fec45d3 0000-0002-5853-4625 Fatemeh Torabi Fatemeh Torabi true false 1cb4b49224d4f3f2b546ed0f39e13ea8 0000-0002-3891-1403 Daniel Obaid Daniel Obaid true false a3b0da49be6a585449e0a4588880df17 Alexander Chase Alexander Chase true false ed8a9c37bd7b7235b762d941ef18ee55 0000-0002-5657-6995 Ann John Ann John true false 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2022-02-17 HDAT AimsTo explore differences in the use of lipid lowering therapy and/or achievement of lipid guideline targets in patients with and without prior depression and influence of sex in very high-risk coronary patients.Methods & findingsA retrospective observational cohort study was conducted using individual-level linked electronic health record data in patients who underwent percutaneous coronary intervention (2012–2017) in Wales. The cohort comprised of 13,781 patients (27.4% female), with 26.1% having prior depression. Lipid levels were recorded in 10,050 patients of whom 25% had depression. History of depression was independently associated with not having lipids checked (OR 0.79 95%CI 0.72–0.87 p<0.001). Patients with prior depression were less likely to achieve targets for low density lipoprotein cholesterol (LDL-C <1.8mmol/l), non-high density lipoprotein cholesterol (non-HDL-C <2.6mmol/l) and triglycerides (<2.3mmol/l) than patients without depression (OR 0.86 95%CI 0.78–0.96 p = 0.007, OR 0.80 95%CI 0.69–0.92 p = 0.003 & OR 0.69 95CI% 0.61–0.79 p<0.001 respectively). Females were less likely to achieve targets for LDL-C and non-HDL-C than males (OR 0.55 95%CI 0.50–0.61 p<0.001 & OR 0.63 95%CI 0.55–0.73 p<0.001). There was an additive effect of depression and sex; females with depression were not only least likely to be tested (OR 0.74 95%CI 0.65–0.84 p<0.001) but also (where levels were known) less likely to achieve LDL-C (OR 0.47 95%CI 0.41–0.55 p<0.001) and non-HDL-C targets (OR 0.50 95%CI 0.41–0.60 p<0.001). It was not possible to look at the influence of medication adherence on achievement of lipid targets due to limitations of the use of anonymised routinely-held clinical care data.ConclusionPatients with prior depression were less likely to have their lipids monitored and achieve guideline targets within 1-year. Females with depression are the least likely to be tested and achieve lipid targets, suggesting not only a greater risk of future events, but also an opportunity to improve care. Journal Article PLOS ONE 17 2 e0264529 Public Library of Science (PLoS) 1932-6203 25 2 2022 2022-02-25 10.1371/journal.pone.0264529 COLLEGE NANME Health Data Science COLLEGE CODE HDAT Swansea University This work was supported by Health Data Research UK (www.hdruk.ac.uk), which receives its funding from Health Data Research United Kingdom Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF), and the Wellcome Trust (AA, JH, FT & AL). DH was also supported by Swansea Bay University Health Board Research and Development Department (https://sbuhb.nhs.wales/hospitals/a-z-hospital-services/researchand-development/). 2022-03-03T12:43:52.4922491 2022-02-17T10:58:02.9273055 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Medicine Libby Ellins 0000-0001-5164-6416 1 Daniel Harris 2 Arron S. Lacey 0000-0001-7983-8073 3 Ashley Akbari 0000-0003-0814-0801 4 Fatemeh Torabi 0000-0002-5853-4625 5 Dave Smith 0000-0001-6648-7577 6 Geraint Jenkins 0000-0002-3685-242x 7 Daniel Obaid 0000-0002-3891-1403 8 Alexander Chase 9 Ann John 0000-0002-5657-6995 10 Michael Gravenor 0000-0003-0710-0947 11 Julian Halcox 0000-0001-6926-2947 12 59420__22501__415d12b32369440b89f03c10f78f8095.pdf 59420.pdf 2022-03-03T12:41:31.6795808 Output 1027383 application/pdf Version of Record true © 2022 Ellins et al. This is an open access article distributed under the terms of the Creative Commons Attribution License true eng http://creativecommons.org/licenses/by/4.0/
title	Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex
spellingShingle	Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex Libby Ellins Daniel Harris Arron S. Lacey Ashley Akbari Fatemeh Torabi Daniel Obaid Alexander Chase Ann John Michael Gravenor Julian Halcox
title_short	Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex
title_full	Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex
title_fullStr	Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex
title_full_unstemmed	Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex
title_sort	Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex
author_id_str_mv	553ce2abe05a6396e7dd6eadb6b90a6d e60c9c73b645f0e8033ae26fa8e634b8 7af5c8bdd1197f85720e4f3d65e803eb aa1b025ec0243f708bb5eb0a93d6fb52 f569591e1bfb0e405b8091f99fec45d3 1cb4b49224d4f3f2b546ed0f39e13ea8 a3b0da49be6a585449e0a4588880df17 ed8a9c37bd7b7235b762d941ef18ee55 70a544476ce62ba78502ce463c2500d6 3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv	553ce2abe05a6396e7dd6eadb6b90a6d_*_Libby Ellins e60c9c73b645f0e8033ae26fa8e634b8__Daniel Harris 7af5c8bdd1197f85720e4f3d65e803eb__Arron S. Lacey aa1b025ec0243f708bb5eb0a93d6fb52__Ashley Akbari f569591e1bfb0e405b8091f99fec45d3__Fatemeh Torabi 1cb4b49224d4f3f2b546ed0f39e13ea8__Daniel Obaid a3b0da49be6a585449e0a4588880df17__Alexander Chase ed8a9c37bd7b7235b762d941ef18ee55__Ann John 70a544476ce62ba78502ce463c2500d6__Michael Gravenor 3676f695eeda169d0f8c618adf27c04b_*_Julian Halcox
author	Libby Ellins Daniel Harris Arron S. Lacey Ashley Akbari Fatemeh Torabi Daniel Obaid Alexander Chase Ann John Michael Gravenor Julian Halcox
author2	Libby Ellins Daniel Harris Arron S. Lacey Ashley Akbari Fatemeh Torabi Dave Smith Geraint Jenkins Daniel Obaid Alexander Chase Ann John Michael Gravenor Julian Halcox
format	Journal article
container_title	PLOS ONE
container_volume	17
container_issue	2
container_start_page	e0264529
publishDate	2022
institution	Swansea University
issn	1932-6203
doi_str_mv	10.1371/journal.pone.0264529
publisher	Public Library of Science (PLoS)
college_str	Faculty of Medicine, Health and Life Sciences
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hierarchy_top_id	facultyofmedicinehealthandlifesciences
hierarchy_top_title	Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id	facultyofmedicinehealthandlifesciences
hierarchy_parent_title	Faculty of Medicine, Health and Life Sciences
department_str	Swansea University Medical School - Medicine{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Medicine
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description	AimsTo explore differences in the use of lipid lowering therapy and/or achievement of lipid guideline targets in patients with and without prior depression and influence of sex in very high-risk coronary patients.Methods & findingsA retrospective observational cohort study was conducted using individual-level linked electronic health record data in patients who underwent percutaneous coronary intervention (2012–2017) in Wales. The cohort comprised of 13,781 patients (27.4% female), with 26.1% having prior depression. Lipid levels were recorded in 10,050 patients of whom 25% had depression. History of depression was independently associated with not having lipids checked (OR 0.79 95%CI 0.72–0.87 p<0.001). Patients with prior depression were less likely to achieve targets for low density lipoprotein cholesterol (LDL-C <1.8mmol/l), non-high density lipoprotein cholesterol (non-HDL-C <2.6mmol/l) and triglycerides (<2.3mmol/l) than patients without depression (OR 0.86 95%CI 0.78–0.96 p = 0.007, OR 0.80 95%CI 0.69–0.92 p = 0.003 & OR 0.69 95CI% 0.61–0.79 p<0.001 respectively). Females were less likely to achieve targets for LDL-C and non-HDL-C than males (OR 0.55 95%CI 0.50–0.61 p<0.001 & OR 0.63 95%CI 0.55–0.73 p<0.001). There was an additive effect of depression and sex; females with depression were not only least likely to be tested (OR 0.74 95%CI 0.65–0.84 p<0.001) but also (where levels were known) less likely to achieve LDL-C (OR 0.47 95%CI 0.41–0.55 p<0.001) and non-HDL-C targets (OR 0.50 95%CI 0.41–0.60 p<0.001). It was not possible to look at the influence of medication adherence on achievement of lipid targets due to limitations of the use of anonymised routinely-held clinical care data.ConclusionPatients with prior depression were less likely to have their lipids monitored and achieve guideline targets within 1-year. Females with depression are the least likely to be tested and achieve lipid targets, suggesting not only a greater risk of future events, but also an opportunity to improve care.
published_date	2022-02-25T04:16:43Z
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Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex

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