A retrospective cohort study on factors influencing the initiation of lipid-lowering therapy in hospitalized patients following a cardio-cerebrovascular event

Introduction: Current European guidelines on cardiovascular prevention recommend lipid-lowering therapies for patients who have experienced an atherosclerotic cardiovascular disease (ASCVD) event. Objectives: This study aims to provide updated data on the prescription of lipid-lowering therapies in patients discharged after an ASCVD event and to investigate the characteristics associated with a higher likelihood of receiving such therapy following the event. Methods: Using administrative data from the Lombardy region, individuals of both sexes aged ≥40 years hospitalized for an incident ASCVD event during the first nine months of 2019 were identified. The prevalence of those receiving a prescription for lipid-lowering therapy within 90 days of the event was assessed. A multivariable logistic regression model was applied to evaluate the impact of various factors on the likelihood of initiating treatment (odds ratio [OR] and 95% confidence intervals [95%CI]). Results: In a cohort of 18,370 individuals with an incident ASCVD event, 50.70% did not receive a prescription for any lipid-lowering therapy. The likelihood of initiating therapy was higher in individuals who experienced a cardiovascular event compared to a cerebrovascular event (OR 2.94, 95%CI 2.74-3.14), in patients aged 51-60 years (OR 1.22, 95%CI 1.10-1.36, compared to 61-70 years), and in those receiving antidiabetic (OR 1.42, 95%CI 1.25-1.61) or antihypertensive therapy (OR 1.77, 95%CI 1.64-1.92). Conversely, older age (71-80 years: OR 0.70, 95%CI 0.64-0.77; >80 years: OR 0.38, 95%CI 0.35-0.42), female sex (OR 0.81, 95%CI 0.75–0.87), prior exposure to antithrombotic medication (OR 0.67, 95%CI 0.60-0.73), and excessive polypharmacy (OR 0.57, 95%CI 0.49-0.66 for ≥10 medications) were associated with a lower likelihood of initiating treatment after the event. Conclusions: The study highlights a suboptimal initiation of lipid-lowering therapy in patients discharged after an ASCVD event. Additionally, the results emphasize the importance of understanding influencing factors to improve patient management in secondary prevention.