Mental health-related quality of life is associated with sustained lipid-lowering therapy adherence after acute coronary syndrome.

BACKGROUND

Acute coronary syndrome (ACS) is a critical manifestation of cardiovascular disease, which necessitates rigorous secondary prevention to reduce recurrent events and mortality. While lipid-lowering therapy (LLT) is integral to post-ACS secondary prevention, long-term adherence remains a significant clinical challenge. This study evaluated psychological, socioeconomic, and clinical factors associated with LLT adherence in patients after ACS, with a specific focus on mental health components and chronic comorbidities.

METHODS

ACS survivors were included from the Transitions, Risks, and Actions in Coronary Events-Center for Outcomes Research and Education cohort (TRACE-CORE). Baseline demographic, medical history and mental health data - including the 36-Item Short Form Survey (SF-36) Mental Component (MCS) and Physical Component Scores (PCS) and the Patient Health Questionnaire-9 (PHQ-9)- were collected during hospitalization. Adherence to LLT was assessed up to twelve-months post-discharge. We performed a comparative analysis between patients with complete versus incomplete follow-up and utilized binary logistic regression to identify factors associated with adherence to LLT.

RESULTS

Of the cohort, 51% completed the 12-month follow-up. Completers were significantly older, had higher education, better mental health metrics (higher MCS, lower PHQ-9), and higher prevalence of chronic conditions including diabetes, hypertension, and hyperlipidemia. Participants in the adherent group were more likely to be males and White and had higher MCS and PCS scores. Lower income (<$35,000) was associated with adherence in unadjusted analyses but did not remain independently associated after multivariable adjustment. In the regression, each 10-point increase in MCS (OR 1.24; 95% CI 1.07-1.44), hyperlipidemia (OR 1.42;1.05-1.92), male sex (OR 1.36;1.02-1.81) and white race (1.47;1.02-2.13) were associated with increased odds of adherence.

CONCLUSIONS

Mental health-related quality of life, as measured by MCS, along with hyperlipidemia, male sex, and White race, was associated with LLT adherence after ACS. These findings suggest that post-ACS secondary prevention may benefit from incorporating patient-reported mental health assessment to identify individuals at increased risk for nonadherence.