Attainment of Low-Density Lipoprotein Cholesterol Goals and Statin Use in Patients With Atherosclerotic Cardiovascular Disease in Australian General Practice: Are We Doing Enough?

AIM: We sought to investigate the use of lipid-lowering therapy (LLT) and the attainment of low-density lipoprotein cholesterol (LDL-C) goals in patients with atherosclerotic cardiovascular disease (ASCVD) in Australian general practices. The study aimed to investigate the discrepancies between guideline recommendations and clinical practice.

METHOD: This retrospective study used electronic data from Australian general practitioners, extracted from IQVIA's "general practice electronic medical record" data set, covering the period from January 2010 to June 2022. Descriptive statistics examined the relationships between demographics, clinical characteristics, treatment patterns, adherence to LLT, and the achievement of guideline-recommended LDL-C goals, with data stratified by gender, age, and LDL-C levels.

RESULTS

Of 13,644 patients with ASCVD identified, 64% of the patients with ASCVD were men, and the overall mean age was 70 years (±13.5 standard deviation). Only 51.9% of patients had a recorded LDL-C test at their most recent general practice physician visit. Of those tested, 60.5% and 50.6% had increased LDL-C levels >1.8 mmol/L and >2.0 mmol/L, respectively. Statin therapy was prescribed to n=11,100 (81.3%) of patients during the study period, but this fell to n=8,918 (65.4%) by the last consult. Of those on treatment at their last review, statin monotherapy was the most common (n=7,861, 57.6%), with a low use of combination therapies (n=1,004, 7.36%). At 1 year, 80.1% of patients on statin monotherapy were adherent (proportion of days covered ≥0.8), but this fell to 47.9% at 5 years. The use of non-high-intensity statins were associated with the highest persistence, being 47.5% adherent at 5 years. There were no significant differences in persistence between females and males nor across age categories <44, 44-65, and>65 years old.

CONCLUSIONS

The study highlights gaps in the management of ASCVD in Australian general practice, including the lack of monitoring of LDL-C levels, under-prescription of proven LLT, and increasingly poor adherence and persistence with LLT over time.