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Randomized Controlled Trial
. 2021 Apr:323:37-43.
doi: 10.1016/j.atherosclerosis.2021.03.013. Epub 2021 Mar 17.

Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial

Stefanos Zafeiropoulos  1 , Ioannis Farmakis  2 , Anastasios Kartas  2 , Alexandra Arvanitaki  3 , Areti Pagiantza  4 , Aristi Boulmpou  5 , Athina Tampaki  2 , Diamantis Kosmidis  2 , Vassileios Nevras  2 , Eleftherios Markidis  2 , Ioannis Papadimitriou  2 , Anastasia Vlachou  2 , Konstantinos Arvanitakis  6 , Santiago J Miyara  7 , Antonios Ziakas  2 , Ernesto P Molmenti  8 , George Kassimis  9 , Stavros Zanos  10 , Haralambos Karvounis  2 , George Giannakoulas  11
Affiliations
Randomized Controlled Trial

Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial

Stefanos Zafeiropoulos et al. Atherosclerosis. 2021 Apr.

Abstract

Background and aims: Achieving the low-density lipoprotein cholesterol (LDL-C) goal following an acute coronary syndrome (ACS) is a milestone often missed due to suboptimal adherence to secondary prevention treatments. Whether improved adherence could result in reduced LDL-C levels is unclear. We aimed to evaluate whether an educational-motivational intervention increases long-term lipid-lowering therapy (LLT) adherence and LDL-C goal attainment rate among post-ACS patients.

Methods: IDEAL-LDL was a parallel, two-arm, single-center, pragmatic, investigator-initiated randomized controlled trial. Hospitalized patients for ACS were randomized to a physician-led integrated intervention consisting of an educational session at baseline, followed by regular motivational interviewing phone sessions or usual care. Co-primary outcomes were the LLT adherence (measured by Proportion of Days Covered (PDC); good adherence defined as PDC>80%), and LDL-C goal (<70 mg/dl or 50% reduction from baseline) achievement rate at one year.

Results: In total, 360 patients (mean age 62 years, 81% male) were randomized. Overall, good adherence was positively associated with LDL-C goal achievement rate at one year. Median PDC was higher in the intervention group than the control group [0.92 (IQR, 0.82-1.00) vs. 0.86 (0.62-0.98); p = 0.03] while the intervention group had increased odds of good adherence (odds ratio: 1.76 (95% confidence interval 1.02 to 2.62; p = 0.04). However, neither the LDL-C goal achievement rate (49.6% in the intervention vs. 44.9% in the control group; p = 0.49) nor clinical outcomes differed significantly between the two groups.

Conclusions: Α multifaceted intervention improved LLT adherence in post-ACS patients without a significant difference in LDL-C goal attainment.

Trial registration: ClinicalTrials.gov NCT02927808.

Keywords: Acute coronary syndromes; Dyslipidemia; LDL-C goal; Medication adherence.

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