Sánchez-Ruano Núria, Fibla-Matamoros Anna, Falces Carles, Sánchez Encarna, Sisó-Almirall Antoni, González-de Paz Luis
Consorci d'Atenció Primària de Salut Barcelona Esquerra, Barcelona, Spain.
Cardiovascular Institute, Hospital Clínic de Barcelona, Barcelona, Spain.
BJGP Open. 2025 Jul 23;9(2). doi: 10.3399/BJGPO.2024.0220. Print 2025.
Monitoring low-density lipoprotein cholesterol (LDL-C) and prescribing appropriate treatment is crucial for secondary prevention in primary care.
To study LDL-C levels and treatments for patients with ischaemic heart disease according to target recommendations and assess factors influencing prescribed drug intensity.
DESIGN & SETTING: A cross-sectional study was undertaken. We examined electronic health records of patients with ischaemic heart disease from three primary care centres in Spain.
LDL-C levels were assessed using the most recent registry, and LDL-C-lowering treatments were categorised by their theoretical efficacy. Factors associated with LDL-C target attainment were analysed using univariate and multivariate regression models. Prescription intensity was studied with ordinal logistic regression models.
We studied 1936 patients, 14.88% of whom received no LDL-C-lowering treatment. The percentages of patients who achieved LDL-C thresholds of<70 mg/dl and<55 mg/dl were 35.0% and 12.65%, respectively. The factor associated with the <55 mg/dl threshold was type 2 diabetes mellitus (odds ratio [OR] 0.55, 95% confidence interval [CI] = 0.42 to 0.73), with males showing better LDL-C levels (OR 0.34, 95% CI = 0.23 to 0.51). Males had higher-intensity prescriptions (OR 1.57, 95% CI = 1.27 to 1.94) and older patients had lower-intensity treatments (OR 0.96, 95% CI = 0.95 to 0.97).
Increased LDL-C drug treatment improvement, monitoring, and adherence to guideline recommendations are necessary for patients with ischaemic heart disease. Sex and age are potential factors associated with inadequate lipid-lowering treatment intensity and poor LDL-C control that might worsen cardiovascular outcomes in high-risk patients, leading to avoidable inequity among patients who visit the primary health setting.
监测低密度脂蛋白胆固醇（LDL-C）并开具适当治疗方案对基层医疗中的二级预防至关重要。
根据目标建议研究缺血性心脏病患者的LDL-C水平及治疗情况，并评估影响处方药物强度的因素。
进行了一项横断面研究。我们检查了西班牙三个基层医疗中心缺血性心脏病患者的电子健康记录。
使用最新登记数据评估LDL-C水平，并根据其理论疗效对降低LDL-C的治疗进行分类。使用单变量和多变量回归模型分析与LDL-C目标达成相关的因素。使用有序逻辑回归模型研究处方强度。
我们研究了1936例患者，其中14.88%未接受降低LDL-C的治疗。达到LDL-C阈值<70mg/dl和<55mg/dl的患者百分比分别为35.0%和12.65%。与<55mg/dl阈值相关的因素是2型糖尿病（优势比[OR]0.55，95%置信区间[CI]=0.42至0.73），男性的LDL-C水平较好（OR 0.34，95%CI=0.23至0.51）。男性的处方强度较高（OR 1.57，95%CI=1.27至1.94），老年患者的治疗强度较低（OR 0.96，95%CI=0.95至0.97）。
对于缺血性心脏病患者，有必要加强LDL-C药物治疗的改进、监测并遵循指南建议。性别和年龄是与降脂治疗强度不足和LDL-C控制不佳相关的潜在因素，这可能会使高危患者的心血管结局恶化，导致在基层医疗就诊的患者中出现可避免的不平等情况。
