1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece; Elmezzi Graduate School of Molecular Medicine and Feinstein Institutes for Medical Research at Northwell Health, Manhasset, NY, USA.
1st Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece.
Atherosclerosis. 2021 Apr;323:37-43. doi: 10.1016/j.atherosclerosis.2021.03.013. Epub 2021 Mar 17.
Achieving the low-density lipoprotein cholesterol (LDL-C) goal following an acute coronary syndrome (ACS) is a milestone often missed due to suboptimal adherence to secondary prevention treatments. Whether improved adherence could result in reduced LDL-C levels is unclear. We aimed to evaluate whether an educational-motivational intervention increases long-term lipid-lowering therapy (LLT) adherence and LDL-C goal attainment rate among post-ACS patients.
IDEAL-LDL was a parallel, two-arm, single-center, pragmatic, investigator-initiated randomized controlled trial. Hospitalized patients for ACS were randomized to a physician-led integrated intervention consisting of an educational session at baseline, followed by regular motivational interviewing phone sessions or usual care. Co-primary outcomes were the LLT adherence (measured by Proportion of Days Covered (PDC); good adherence defined as PDC>80%), and LDL-C goal (<70 mg/dl or 50% reduction from baseline) achievement rate at one year.
In total, 360 patients (mean age 62 years, 81% male) were randomized. Overall, good adherence was positively associated with LDL-C goal achievement rate at one year. Median PDC was higher in the intervention group than the control group [0.92 (IQR, 0.82-1.00) vs. 0.86 (0.62-0.98); p = 0.03] while the intervention group had increased odds of good adherence (odds ratio: 1.76 (95% confidence interval 1.02 to 2.62; p = 0.04). However, neither the LDL-C goal achievement rate (49.6% in the intervention vs. 44.9% in the control group; p = 0.49) nor clinical outcomes differed significantly between the two groups.
Α multifaceted intervention improved LLT adherence in post-ACS patients without a significant difference in LDL-C goal attainment.
急性冠状动脉综合征（ACS）后，实现低密度脂蛋白胆固醇（LDL-C）目标是一个经常错过的里程碑，因为二级预防治疗的依从性不理想。改善依从性是否会导致 LDL-C 水平降低尚不清楚。我们旨在评估教育动机干预是否能提高 ACS 后患者的长期降脂治疗（LLT）依从性和 LDL-C 目标达标率。
IDEAL-LDL 是一项平行、双臂、单中心、实用、研究者发起的随机对照试验。因 ACS 住院的患者被随机分配到以医生为主导的综合干预组，该干预组在基线时进行一次教育课程，然后定期进行动机访谈电话会话或常规护理。主要结局是 LLT 依从性（通过用药天数比例（PDC）衡量；定义为 PDC>80%为良好依从性）和 LDL-C 目标（<70mg/dl 或比基线降低 50%）在一年时的达标率。
共 360 例患者（平均年龄 62 岁，81%为男性）被随机分配。总体而言，良好的依从性与 LDL-C 目标在一年时的达标率呈正相关。干预组的 PDC 中位数高于对照组[0.92（IQR，0.82-1.00）比 0.86（0.62-0.98）；p=0.03]，而干预组的良好依从性的可能性更高（比值比：1.76（95%置信区间 1.02 至 2.62；p=0.04）。然而，两组之间 LDL-C 目标达标率（干预组为 49.6%，对照组为 44.9%；p=0.49）或临床结局均无显著差异。
多方面的干预措施提高了 ACS 后患者的 LLT 依从性，但 LDL-C 目标达标率无显著差异。
