Authors: (including presenting author): :
Wai CF(1)(2), Cheng WY(1), Fan SH(1)
Affiliation: :
(1)Pharmacy Department, Pamela Youde Nethersole Eastern Hospital. (2) Pharmacy Department, The University of Sunderland
Introduction: :
This study demonstrated the practice of lipid control in the patients with high cardiovascular risk.
Objectives: :
The objective of the study was to identify the gap between the local practice and guidelines concerning lipid management in patients with high cardiovascular risk. We aimed to evaluate 1. the percentage attainment of Low-density lipoprotein cholesterol (LDL-C) goal, 2. the follow-up interval; and 3. the prescribing pattern of lipid-lowering drugs.
Methodology: :
This is a retrospective, observational study conducted in Pamela Youde Nethersole Eastern Hospital. Patients who had established cardiovascular diseases, stage 4 or 5 chronic kidney disease, and/or diabetes mellitus and were followed-up in cardiology or diabetic clinics from 1 January 2011 to 31 December 2017 were included for analysis.
Result & Outcome: :
1872 patients were included, with a total of 18,846 attendances and 4594 LDL-C level records. Their mean age was 66.5 ± 11.41 years old. 1023 (55%) patients and 812 (43%) patients were diagnosed to have chronic ischemic heart disease and diabetes mellitus, respectively. 317 (17%) patients underwent ≥1 percutaneous coronary intervention (PCI) during the study.
1459 (78%) patients had ≥1 LDL-C record attaining the LDL-C goal of < 2.6 mmol/L whereas 1274 (68%) patients’ LDL-C were maintained at < 2.6 mmol/L throughout the study period. Besides, 247 (13%) patients attained the LDL-C goal of < 1.8 mmol/L at the end of the study period.
The mean LDL-C level was 2.28 ± 0.72 mmol/L; the mean time interval between follow-up was 110.48 ± 118.47 days.
10,976 (58%) prescriptions of the 18,846 prescriptions that were generated during the study period had ≥1 lipid-lowering therapy. These lipid-lowering drug prescriptions were generated for 1340 (72%) patients. Statin was the most prevalent treatment option (10,842 prescriptions; 99%), of which 7573 (70%) were moderate-intensity statin and 366 (3%) were high-intensity statin.
Within the 762 patients with myocardial infarction, angina, or coronary artery procedure, 26 (3.41%) patients did not receive statin therapy. 23 (3.02%) cases did not document the reason, whereas 3 (0.39%) cases did not receive statin due to drug intolerance or the patient’s preference.
Conclusions: 68% of this high cardiovascular risk patient attained the LDL-C goal of < 2.6 mmol/L. This number dropped to 13% at the end of the study period if an LDL-C goal of < 1.8 mmol/L was applied. A more intensive statin therapy could be suggested to increase the number of patients achieving the lower LDL-C goal.
