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Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales
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Ashley Akbari ,
Michael Gravenor ,
Mathew Lawrence,
Clive Weston ,
Chris Hopkins ,
Leighton Phillips ,
Julian Halcox
European Journal of Preventive Cardiology, Volume: 31, Issue: 15, Pages: 1778 - 1789
Swansea University Authors:
Daniel Harris, Daniel King , Ashley Akbari , Michael Gravenor , Clive Weston , Julian Halcox
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DOI (Published version): 10.1093/eurjpc/zwae233
Abstract
AimsEuropean clinical guidelines recommend that patients with atherosclerotic cardiovascular disease (ASCVD), including ischaemic heart disease (IHD), stroke and peripheral arterial disease (PAD), are prescribed lipid lowering treatment (LLT) and treated to target low-density lipoprotein cholesterol...
| Published in: | European Journal of Preventive Cardiology |
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| ISSN: | 2047-4873 2047-4881 |
| Published: |
Oxford University Press (OUP)
2024
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| Online Access: |
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| URI: | https://cronfa.swan.ac.uk/Record/cronfa67165 |
| Abstract: |
AimsEuropean clinical guidelines recommend that patients with atherosclerotic cardiovascular disease (ASCVD), including ischaemic heart disease (IHD), stroke and peripheral arterial disease (PAD), are prescribed lipid lowering treatment (LLT) and treated to target low-density lipoprotein cholesterol (LDL-C) levels. This study aimed to document trends in ASCVD including treatment, monitoring, and achievement of target LDL-C.MethodA retrospective observational population study using linked health-care data (2010-22).ResultsOver the study period the number of patients with ASCVD increased from 181,153 to 207,747 (8882 to 9398 per 100,000). The proportion of patients prescribed LLT decreased from 75.3% in 2010 to 67.1% in 2022; high-intensity statin therapy increased from 9.4% to 25.2% and non-high-intensity statin therapy decreased from 59.6% to 38.2%. The prescribing of high-intensity statin therapy was consistently higher amongst patients with IHD (10.9% in 2010 increasing to 28.0% in 2022) than in patients with stroke (4.7% to 21.6%) or PAD (3.9% to 10.6%).The proportion of cases with documented LDL-C decreased from 58.0% in 2010 to 49.3% in 2022. Of those with documented LDL-C in 2022, 44.0% achieved LDL-C <1.8 mmol/L, including 45.2% of those with IHD, 42.0% of those with stroke and only 32.8% of those with PAD.ConclusionPrescribing of LLT, including HI-statin therapy, documentation of LDL-C and achievement of target LDL-C levels was relatively low, especially in PAD patients. Although target achievement in “tested patients” increased over time, the proportion of patients undergoing lipid testing declined. More rigorous lipid management requires prioritisation, especially for PAD and stroke patients. |
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| Keywords: |
Lipids, cholesterol, atherosclerosis, statin, pharmacoepidemiology |
| College: |
Faculty of Medicine, Health and Life Sciences |
| Funders: |
Swansea University |
| Issue: |
15 |
| Start Page: |
1778 |
| End Page: |
1789 |