Digital Intervention to Optimize LDL-C and Lipid Management in Patients at High and Very High Cardiovascular Risk: The Findings of the REMEXDIS Study in Real-World Clinical Practice

Inadequate management of low-density lipoprotein cholesterol (LDL-C) in patients at high and very high cardiovascular risk remains a major clinical challenge due to poor adherence, therapeutic inertia, and limited follow-up. Digital tools may improve adherence, prompt treatment intensification, and increase attainment of lipid targets. We evaluated the REMEXDIS mobile app in a prospective, comparative, multicenter, real-world, quasi-experimental study with 12 months’ follow-up among adults at high or very high cardiovascular risk treated at Mexican Social Security Institute facilities. Materials and methods: Participants voluntarily downloaded the app, which provided reminders, personalized feedback, and physician alerts when LDL-C exceeded targets. Longitudinal changes among app users were assessed over 12 months, and 12-month LDL-C outcomes were additionally compared between app users and a contemporaneous non-app comparison group using multivariable adjusted analyses. Results: Median age was 64 years and 54.3% were female. Among 14,497 app users with paired baseline and 12-month data, median LDL-C decreased from 60 to 48 mg/dL, while LDL-C target attainment increased from 55.4% to 77.5%. In the high-risk subgroup, target attainment increased from 61.3% to 85.8%, and in the very-high-risk subgroup from 48.9% to 68.4%. Monotherapy decreased from 84.2% to 54.0%, whereas dual therapy increased from 13.4% to 43.8%. In adjusted analyses, app use was associated with an 11.53 mg/dL lower LDL-C level at 12 months compared with non-app use (95% CI, 10.08–12.98; p < 0.01) and with higher odds of achieving the LDL-C target at 12 months (adjusted OR 2.89, 95% CI, 2.54–3.28; p < 0.01). Conclusions: In this large real-world cohort, REMEXDIS app use was associated with more favorable 12-month LDL-C levels and target attainment after multivariable adjustment. However, because app use was not randomized, these findings should be interpreted as associations rather than causal effects. Further studies are needed to evaluate long-term clinical outcomes, cost-effectiveness, and the contribution of specific components of the digital intervention.