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Achievement of European Society of Cardiology/European Atherosclerosis Society lipid targets in very high-risk patients: Influence of depression and sex

Libby Ellins Orcid Logo, Daniel Harris, Arron S. Lacey Orcid Logo, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Dave Smith Orcid Logo, Geraint Jenkins Orcid Logo, Daniel Obaid Orcid Logo, Alexander Chase, Ann John Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

PLOS ONE, Volume: 17, Issue: 2, Start page: e0264529

Swansea University Authors: Libby Ellins Orcid Logo, Daniel Harris, Arron S. Lacey Orcid Logo, Ashley Akbari Orcid Logo, Fatemeh Torabi Orcid Logo, Daniel Obaid Orcid Logo, Alexander Chase, Ann John Orcid Logo, Michael Gravenor Orcid Logo, Julian Halcox Orcid Logo

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Abstract

AimsTo explore differences in the use of lipid lowering therapy and/or achievement of lipid guideline targets in patients with and without prior depression and influence of sex in very high-risk coronary patients.Methods & findingsA retrospective observational cohort study was conducted using in...

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Published in: PLOS ONE
ISSN: 1932-6203
Published: Public Library of Science (PLoS) 2022
Online Access: Check full text

URI: https://cronfa.swan.ac.uk/Record/cronfa59420
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Abstract: AimsTo explore differences in the use of lipid lowering therapy and/or achievement of lipid guideline targets in patients with and without prior depression and influence of sex in very high-risk coronary patients.Methods & findingsA retrospective observational cohort study was conducted using individual-level linked electronic health record data in patients who underwent percutaneous coronary intervention (2012–2017) in Wales. The cohort comprised of 13,781 patients (27.4% female), with 26.1% having prior depression. Lipid levels were recorded in 10,050 patients of whom 25% had depression. History of depression was independently associated with not having lipids checked (OR 0.79 95%CI 0.72–0.87 p<0.001). Patients with prior depression were less likely to achieve targets for low density lipoprotein cholesterol (LDL-C <1.8mmol/l), non-high density lipoprotein cholesterol (non-HDL-C <2.6mmol/l) and triglycerides (<2.3mmol/l) than patients without depression (OR 0.86 95%CI 0.78–0.96 p = 0.007, OR 0.80 95%CI 0.69–0.92 p = 0.003 & OR 0.69 95CI% 0.61–0.79 p<0.001 respectively). Females were less likely to achieve targets for LDL-C and non-HDL-C than males (OR 0.55 95%CI 0.50–0.61 p<0.001 & OR 0.63 95%CI 0.55–0.73 p<0.001). There was an additive effect of depression and sex; females with depression were not only least likely to be tested (OR 0.74 95%CI 0.65–0.84 p<0.001) but also (where levels were known) less likely to achieve LDL-C (OR 0.47 95%CI 0.41–0.55 p<0.001) and non-HDL-C targets (OR 0.50 95%CI 0.41–0.60 p<0.001). It was not possible to look at the influence of medication adherence on achievement of lipid targets due to limitations of the use of anonymised routinely-held clinical care data.ConclusionPatients with prior depression were less likely to have their lipids monitored and achieve guideline targets within 1-year. Females with depression are the least likely to be tested and achieve lipid targets, suggesting not only a greater risk of future events, but also an opportunity to improve care.
College: Swansea University Medical School
Funders: This work was supported by Health Data Research UK (www.hdruk.ac.uk), which receives its funding from Health Data Research United Kingdom Ltd (HDR-9006) funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation (BHF), and the Wellcome Trust (AA, JH, FT & AL). DH was also supported by Swansea Bay University Health Board Research and Development Department (https://sbuhb.nhs.wales/hospitals/a-z-hospital-services/researchand-development/).
Issue: 2
Start Page: e0264529