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Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales

Daniel Harris, Daniel King Orcid Logo, Ashley Akbari Orcid Logo, Michael Gravenor Orcid Logo, Mathew Lawrence, Clive Weston Orcid Logo, Chris Hopkins Orcid Logo, Leighton Phillips Orcid Logo, Julian Halcox Orcid Logo

European Journal of Preventive Cardiology, Volume: 31, Issue: 15, Pages: 1778 - 1789

Swansea University Authors: Daniel Harris, Daniel King Orcid Logo, Ashley Akbari Orcid Logo, Michael Gravenor Orcid Logo, Clive Weston Orcid Logo, Julian Halcox Orcid Logo

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DOI (Published version): 10.1093/eurjpc/zwae233

Abstract

AimsEuropean clinical guidelines recommend that patients with atherosclerotic cardiovascular disease (ASCVD), including ischaemic heart disease (IHD), stroke and peripheral arterial disease (PAD), are prescribed lipid lowering treatment (LLT) and treated to target low-density lipoprotein cholesterol...

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Published in: European Journal of Preventive Cardiology
ISSN: 2047-4873 2047-4881
Published: Oxford University Press (OUP) 2024
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URI: https://cronfa.swan.ac.uk/Record/cronfa67165
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This study aimed to document trends in ASCVD including treatment, monitoring, and achievement of target LDL-C.MethodA retrospective observational population study using linked health-care data (2010-22).ResultsOver the study period the number of patients with ASCVD increased from 181,153 to 207,747 (8882 to 9398 per 100,000). The proportion of patients prescribed LLT decreased from 75.3% in 2010 to 67.1% in 2022; high-intensity statin therapy increased from 9.4% to 25.2% and non-high-intensity statin therapy decreased from 59.6% to 38.2%. The prescribing of high-intensity statin therapy was consistently higher amongst patients with IHD (10.9% in 2010 increasing to 28.0% in 2022) than in patients with stroke (4.7% to 21.6%) or PAD (3.9% to 10.6%).The proportion of cases with documented LDL-C decreased from 58.0% in 2010 to 49.3% in 2022. Of those with documented LDL-C in 2022, 44.0% achieved LDL-C &lt;1.8 mmol/L, including 45.2% of those with IHD, 42.0% of those with stroke and only 32.8% of those with PAD.ConclusionPrescribing of LLT, including HI-statin therapy, documentation of LDL-C and achievement of target LDL-C levels was relatively low, especially in PAD patients. Although target achievement in &#x201C;tested patients&#x201D; increased over time, the proportion of patients undergoing lipid testing declined. More rigorous lipid management requires prioritisation, especially for PAD and stroke patients.</abstract><type>Journal Article</type><journal>European Journal of Preventive Cardiology</journal><volume>31</volume><journalNumber>15</journalNumber><paginationStart>1778</paginationStart><paginationEnd>1789</paginationEnd><publisher>Oxford University Press (OUP)</publisher><placeOfPublication/><isbnPrint/><isbnElectronic/><issnPrint>2047-4873</issnPrint><issnElectronic>2047-4881</issnElectronic><keywords>Lipids, cholesterol, atherosclerosis, statin, pharmacoepidemiology</keywords><publishedDay>1</publishedDay><publishedMonth>10</publishedMonth><publishedYear>2024</publishedYear><publishedDate>2024-10-01</publishedDate><doi>10.1093/eurjpc/zwae233</doi><url/><notes/><college>COLLEGE NANME</college><department>Medical School</department><CollegeCode>COLLEGE CODE</CollegeCode><DepartmentCode>MEDS</DepartmentCode><institution>Swansea University</institution><apcterm>SU Library paid the OA fee (TA Institutional Deal)</apcterm><funders>Swansea University</funders><projectreference/><lastEdited>2024-11-20T16:08:40.7079537</lastEdited><Created>2024-07-24T10:37:45.5403537</Created><path><level id="1">Faculty of Medicine, Health and Life Sciences</level><level id="2">Swansea University Medical School - Biomedical Science</level></path><authors><author><firstname>Daniel</firstname><surname>Harris</surname><order>1</order></author><author><firstname>Daniel</firstname><surname>King</surname><orcid>0000-0002-9700-7158</orcid><order>2</order></author><author><firstname>Ashley</firstname><surname>Akbari</surname><orcid>0000-0003-0814-0801</orcid><order>3</order></author><author><firstname>Michael</firstname><surname>Gravenor</surname><orcid>0000-0003-0710-0947</orcid><order>4</order></author><author><firstname>Mathew</firstname><surname>Lawrence</surname><order>5</order></author><author><firstname>Clive</firstname><surname>Weston</surname><orcid>0000-0002-8995-8199</orcid><order>6</order></author><author><firstname>Chris</firstname><surname>Hopkins</surname><orcid>0000-0003-2496-3832</orcid><order>7</order></author><author><firstname>Leighton</firstname><surname>Phillips</surname><orcid>0000-0003-4918-8174</orcid><order>8</order></author><author><firstname>Julian</firstname><surname>Halcox</surname><orcid>0000-0001-6926-2947</orcid><order>9</order></author></authors><documents><document><filename>67165__31182__c5694ac8901d4abca0e277be14ed9a93.pdf</filename><originalFilename>67165.VoR.pdf</originalFilename><uploaded>2024-08-29T17:25:52.8283503</uploaded><type>Output</type><contentLength>1191329</contentLength><contentType>application/pdf</contentType><version>Version of Record</version><cronfaStatus>true</cronfaStatus><documentNotes>&#xA9; The Author(s) 2024. 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spelling 2024-11-20T16:08:40.7079537 v2 67165 2024-07-24 Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales e60c9c73b645f0e8033ae26fa8e634b8 Daniel Harris Daniel Harris true false e23c527859999beb492e07947eb380e5 0000-0002-9700-7158 Daniel King Daniel King true false aa1b025ec0243f708bb5eb0a93d6fb52 0000-0003-0814-0801 Ashley Akbari Ashley Akbari true false 70a544476ce62ba78502ce463c2500d6 0000-0003-0710-0947 Michael Gravenor Michael Gravenor true false df85e4e0e139d0f46eb683174eba98a9 0000-0002-8995-8199 Clive Weston Clive Weston true false 3676f695eeda169d0f8c618adf27c04b 0000-0001-6926-2947 Julian Halcox Julian Halcox true false 2024-07-24 MEDS AimsEuropean clinical guidelines recommend that patients with atherosclerotic cardiovascular disease (ASCVD), including ischaemic heart disease (IHD), stroke and peripheral arterial disease (PAD), are prescribed lipid lowering treatment (LLT) and treated to target low-density lipoprotein cholesterol (LDL-C) levels. This study aimed to document trends in ASCVD including treatment, monitoring, and achievement of target LDL-C.MethodA retrospective observational population study using linked health-care data (2010-22).ResultsOver the study period the number of patients with ASCVD increased from 181,153 to 207,747 (8882 to 9398 per 100,000). The proportion of patients prescribed LLT decreased from 75.3% in 2010 to 67.1% in 2022; high-intensity statin therapy increased from 9.4% to 25.2% and non-high-intensity statin therapy decreased from 59.6% to 38.2%. The prescribing of high-intensity statin therapy was consistently higher amongst patients with IHD (10.9% in 2010 increasing to 28.0% in 2022) than in patients with stroke (4.7% to 21.6%) or PAD (3.9% to 10.6%).The proportion of cases with documented LDL-C decreased from 58.0% in 2010 to 49.3% in 2022. Of those with documented LDL-C in 2022, 44.0% achieved LDL-C <1.8 mmol/L, including 45.2% of those with IHD, 42.0% of those with stroke and only 32.8% of those with PAD.ConclusionPrescribing of LLT, including HI-statin therapy, documentation of LDL-C and achievement of target LDL-C levels was relatively low, especially in PAD patients. Although target achievement in “tested patients” increased over time, the proportion of patients undergoing lipid testing declined. More rigorous lipid management requires prioritisation, especially for PAD and stroke patients. Journal Article European Journal of Preventive Cardiology 31 15 1778 1789 Oxford University Press (OUP) 2047-4873 2047-4881 Lipids, cholesterol, atherosclerosis, statin, pharmacoepidemiology 1 10 2024 2024-10-01 10.1093/eurjpc/zwae233 COLLEGE NANME Medical School COLLEGE CODE MEDS Swansea University SU Library paid the OA fee (TA Institutional Deal) Swansea University 2024-11-20T16:08:40.7079537 2024-07-24T10:37:45.5403537 Faculty of Medicine, Health and Life Sciences Swansea University Medical School - Biomedical Science Daniel Harris 1 Daniel King 0000-0002-9700-7158 2 Ashley Akbari 0000-0003-0814-0801 3 Michael Gravenor 0000-0003-0710-0947 4 Mathew Lawrence 5 Clive Weston 0000-0002-8995-8199 6 Chris Hopkins 0000-0003-2496-3832 7 Leighton Phillips 0000-0003-4918-8174 8 Julian Halcox 0000-0001-6926-2947 9 67165__31182__c5694ac8901d4abca0e277be14ed9a93.pdf 67165.VoR.pdf 2024-08-29T17:25:52.8283503 Output 1191329 application/pdf Version of Record true © The Author(s) 2024. This is an Open Access article distributed under the terms of the Creative Commons Attribution License. true eng https://creativecommons.org/licenses/by/4.0/
title Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales
spellingShingle Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales
Daniel Harris
Daniel King
Ashley Akbari
Michael Gravenor
Clive Weston
Julian Halcox
title_short Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales
title_full Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales
title_fullStr Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales
title_full_unstemmed Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales
title_sort Trends in atherosclerotic cardiovascular disease and lipid management: a population-level observational cohort study in Wales
author_id_str_mv e60c9c73b645f0e8033ae26fa8e634b8
e23c527859999beb492e07947eb380e5
aa1b025ec0243f708bb5eb0a93d6fb52
70a544476ce62ba78502ce463c2500d6
df85e4e0e139d0f46eb683174eba98a9
3676f695eeda169d0f8c618adf27c04b
author_id_fullname_str_mv e60c9c73b645f0e8033ae26fa8e634b8_***_Daniel Harris
e23c527859999beb492e07947eb380e5_***_Daniel King
aa1b025ec0243f708bb5eb0a93d6fb52_***_Ashley Akbari
70a544476ce62ba78502ce463c2500d6_***_Michael Gravenor
df85e4e0e139d0f46eb683174eba98a9_***_Clive Weston
3676f695eeda169d0f8c618adf27c04b_***_Julian Halcox
author Daniel Harris
Daniel King
Ashley Akbari
Michael Gravenor
Clive Weston
Julian Halcox
author2 Daniel Harris
Daniel King
Ashley Akbari
Michael Gravenor
Mathew Lawrence
Clive Weston
Chris Hopkins
Leighton Phillips
Julian Halcox
format Journal article
container_title European Journal of Preventive Cardiology
container_volume 31
container_issue 15
container_start_page 1778
publishDate 2024
institution Swansea University
issn 2047-4873
2047-4881
doi_str_mv 10.1093/eurjpc/zwae233
publisher Oxford University Press (OUP)
college_str Faculty of Medicine, Health and Life Sciences
hierarchytype
hierarchy_top_id facultyofmedicinehealthandlifesciences
hierarchy_top_title Faculty of Medicine, Health and Life Sciences
hierarchy_parent_id facultyofmedicinehealthandlifesciences
hierarchy_parent_title Faculty of Medicine, Health and Life Sciences
department_str Swansea University Medical School - Biomedical Science{{{_:::_}}}Faculty of Medicine, Health and Life Sciences{{{_:::_}}}Swansea University Medical School - Biomedical Science
document_store_str 1
active_str 0
description AimsEuropean clinical guidelines recommend that patients with atherosclerotic cardiovascular disease (ASCVD), including ischaemic heart disease (IHD), stroke and peripheral arterial disease (PAD), are prescribed lipid lowering treatment (LLT) and treated to target low-density lipoprotein cholesterol (LDL-C) levels. This study aimed to document trends in ASCVD including treatment, monitoring, and achievement of target LDL-C.MethodA retrospective observational population study using linked health-care data (2010-22).ResultsOver the study period the number of patients with ASCVD increased from 181,153 to 207,747 (8882 to 9398 per 100,000). The proportion of patients prescribed LLT decreased from 75.3% in 2010 to 67.1% in 2022; high-intensity statin therapy increased from 9.4% to 25.2% and non-high-intensity statin therapy decreased from 59.6% to 38.2%. The prescribing of high-intensity statin therapy was consistently higher amongst patients with IHD (10.9% in 2010 increasing to 28.0% in 2022) than in patients with stroke (4.7% to 21.6%) or PAD (3.9% to 10.6%).The proportion of cases with documented LDL-C decreased from 58.0% in 2010 to 49.3% in 2022. Of those with documented LDL-C in 2022, 44.0% achieved LDL-C <1.8 mmol/L, including 45.2% of those with IHD, 42.0% of those with stroke and only 32.8% of those with PAD.ConclusionPrescribing of LLT, including HI-statin therapy, documentation of LDL-C and achievement of target LDL-C levels was relatively low, especially in PAD patients. Although target achievement in “tested patients” increased over time, the proportion of patients undergoing lipid testing declined. More rigorous lipid management requires prioritisation, especially for PAD and stroke patients.
published_date 2024-10-01T02:52:52Z
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