Low-Density Lipoprotein Cholesterol Target Attainment in Lithuania: A Nationwide Analysis of Real-World Health Data.

Background and

Objectives

Low-density lipoprotein cholesterol (LDL-C) reduction is critical for cardiovascular disease (CVD) prevention. This study aimed to assess the proportion of patients achieving the LDL-C target in Lithuania and to identify factors associated with target achievement. Materials and

Methods

This retrospective study used anonymized health data from the Electronic Health Services and Cooperation Infrastructure Information System (ESPBI IS) in Lithuania. Adults aged ≥40 years with at least one LDL-C measurement in 2023 and no documented cancer diagnosis were included. The primary outcome was the proportion of patients achieving LDL-C < 1.8 mmol/L, the target recommended by the European Society of Cardiology guidelines for high-risk individuals. Univariate logistic regression analysis was conducted to identify factors associated with achieving the LDL-C target.

Results

The study included 396,835 patients (mean age, 66.9 years). The mean LDL-C concentration was 3.32 mmol/L, and only 8.1% of patients achieved LDL-C < 1.8 mmol/L. Target achievement was higher among patients in the secondary CVD prevention group compared to primary prevention (20.6% vs. 7.3%). Over half of patients (56.4%) received no lipid-lowering therapy (LLT). Statin monotherapy was the most prescribed LLT (31.3%), while only 2.7% of patients received statin and ezetimibe combination. In logistic regression analysis, secondary prevention status, more frequent cardiologist consultations, and higher LLT prescription frequency were associated with LDL-C target achievement. Compared to patients not receiving LLT, the odds of achieving LDL-C < 1.8 mmol/L were significantly higher in those receiving statin monotherapy (odds ratio [OR]: 3.153, 95% confidence interval [CI]: 3.069-3.240), statin and ezetimibe (OR: 7.631, 95% CI: 7.267-8.013), or statin and antihypertensive (OR: 3.945, 95% CI: 3.803-4.092).

Conclusions

LDL-C target attainment remains low in Lithuania, with the underuse of LLT. Broader implementation of guideline-recommended lipid-lowering strategies is needed to improve LDL-C control.