Real-world LDL-C goal attainment among hypertensive patients in primary care in Vietnam: a 6-month prospective cohort study

AIMS: To assess LDL-C goal attainment, medication adherence, treatment intensification, and short-term safety among hypertensive patients in Vietnamese primary care. PATIENTS AND METHODS: This prospective observational cohort followed hypertensive adults aged 40-79 years for 6 months, with lipid measurements at baseline, 3 months, and 6 months. LDL-C goals were defined according to ESC/EAS risk categories using SCORE2/SCORE2-OP/SCORE2-Diabetes. Adherence was assessed by interview. Predictors of 6-month non-attainment were examined using Firth logistic regression. RESULTS: Among 189 patients (mean age 64.7 ± 7.9 years; 52.9% female), median LDL-C decreased from 2.69 mmol/L at baseline to 2.43 at 3 months and 2.49 at 6 months ( < 0.001). Goal attainment increased from 9.0% to 13.2% and 16.9%, respectively ( = 0.004). Adherence at 6 months was 37.0%. Higher baseline LDL-C (aOR 10.04, 95% CI 4.21-28.00) and older age (aOR 1.16/year, 95% CI 1.08-1.25) predicted non-attainment, while prior lipid-lowering therapy was protective (aOR 0.29, 95% CI 0.11-0.75). No AST/ALT elevation >3× upper limit occurred. CONCLUSIONS: LDL-C goal attainment remained low despite modest improvement over six months. Higher baseline LDL-C, older age, and no prior lipid-lowering therapy independently predicted non-attainment. These findings highlight gaps between guideline-recommended care and routine practice, supporting greater treatment intensification, adherence support, and broader risk-guided lipid management.