OBJECTIVES

Little is known about the real-world attainment of low-density lipoprotein cholesterol (LDL-C) targets in patients who are receiving statin therapy in Australia.

METHODS

A retrospective study was conducted in patients using statins between 2013 and 2019. LDL-C goal attainment was defined as LDL-C levels <2 mmol/L for all risk groups, in line with Australian guidelines. Multivariable logistic regression was used to identify the factors associated with LDL-C goal attainment.

RESULTS

Overall, 61,407 patients were included. The mean age was 65 years (± standard deviation 12.1); 52.0% were males; 12.3% had a recorded diagnosis of stroke, coronary heart disease or peripheral artery disease; 31.7% had recorded hypertension, smoking or dyslipidaemia and 14.2% had recorded diabetes. The median time between the first and the last statin prescriptions was 1,258 days (IQR = 756-2,100). Overall, the median LDL-C level was 2.3 mmol/L (IQR = 1.8 - 2.8) and 36.0% of the study population met therapeutic goals. Factors associated with LDL-C goal attainment included male sex (odds ratio [OR] =1.40, 95% confidence interval [CI] 1.30 - 1.50, p < 0.001), having dyslipidaemia (OR = 0.59, 95% CI 0.55 – 0.64, p < 0.001), hypertension (OR = 0.91, 95% CI 0.83 – 1.00, p < 0.05) or being a current smoker (OR = 0.71, 95% CI 0.71 – 1.00, p < 0.05). Patients aged ≥46 years had a higher likelihood of achieving LDL-C-targets (OR=2.14, 95%CI 1.34-3.41) than those <46 years of age. Those using statins for >2 years were 2.8 times more likely to achieve the LDL-C target levels (OR =2.82, 95%CI 2.53-3.13, p<0.001).

CONCLUSIONS

Nearly two thirds of Australians treated with statins do not achieve target LDL-C levels, regardless of the type, duration and intensity of statins. Novel, patient-tailored strategies to improve lipid management are needed in order to further reduce the already-large preventable burden of cardiovascular disease.