OBJECTIVES

The attainment of low-density lipoprotein cholesterol (LDL-C) therapeutic goals in real-world settings is not well characterised, especially among patients receiving combination lipid-lowering therapy (LLT). We evaluated the LDL-C goal achievement in patients treated with combination LLT in the Australian primary care setting.

METHODS

A retrospective analysis of LDL-C data in patients aged ≥18 years treated with combination LLT (statins plus non-statins, either as a fixed-dose combination or as separate formulations) from general practitioner electronic medical records across Australia from 2013 to 2019. Based on Australian guidelines, the target for LDL-C was < 2 mmol/L (77 mg/dL).

RESULTS

Our study included 9,173 individuals treated with combination LLT. Mean age was 65.8 years (standard deviation [SD] 11.5), 60.1% were males, and 56.7% had at least one cardiovascular risk factor. The median recorded treatment duration was 948 days (interquartile range [IQR] = 397-1715 days) and the median time from the first statin prescription to the first non-statin prescription was 125 days (IQR = 0-820). The median LDL-C was 2.1 mmol/L (IQR = 1.6-2.8), and overall 45.4% of the study population met LDL-C goals, with individuals on fixed-dose combination of statins plus ezetimibe having the highest rates of achievement (49.8%). Factors associated with LDL-C goal achievement were male sex (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.3-1.6, p < 0.001), older age (>80 years, OR = 4.2, 95% CI 1.5 – 6.6, p = 0.006), and a history of T2DM (OR = 1.7; 95% CI 1.5-1.9, p < 0.001) or coronary heart disease (OR = 1.4, 95% CI 1.2 – 1.6, p < 0.001).

CONCLUSIONS

More than half the population treated with combination LLT did not achieve LDL-C goals according to Australian clinical guidelines.