Low-Density Lipoprotein Cholesterol Goal Achievement and Self-Reported Medication Adherence: Insights from the JET-LDL Registry

Abstract

In patients with recent acute coronary syndromes (ACS), current guidelines recommend a low-density lipoprotein cholesterol (LDL-C) level <55 mg/100 ml. Despite the widespread use of different potent lipid-lowering therapies (LLT), this goal is not always achieved, often owing to less medication adherence. In this prespecified subanalysis of the JET-Low Density Lipoprotein (JET-LDL) registry, we sought to evaluate the relation between LDL-C targets achievement and LLT adherence in a cohort of patients hospitalized for ACS. The patients' self-reported medication adherence was assessed using the Morisky Medication Adherence Scale (MMAS) at 3-month follow-up. Depending on the score obtained, the population was divided into 2 groups: high adherence (HA, MMAS ≥6) versus low adherence (LA, MMAS <6). The occurrence of the primary end point (LDL-C reduction >50% from baseline or level <55 mg/100 ml at 1 month) was compared in the 2 groups. A total of 963 patients were included in the present analysis; in 277 cases (28.7%), an MMAS score <6 was reported (LA group), whereas in the remaining 686 (71.3%), the score obtained was ≥6 (HA group). No difference between the 2 groups was observed regarding LDL-C levels at admission and LLT prescribed at discharge. At 1 month, the primary end point occurred in 62.5% of cases, with a statistically significant difference between the 2 groups (LA 60% vs HA 65%, p = 0.034). At multivariate logistic regression analysis, LA was identified as an independent predictor of not achieving the primary end point (odds ratio 0.48, 0.39 to 0.85, p = 0.006). In conclusion, in a real-world cohort of patients with ACS, less medication adherence to LLT was a common event (28.7%), negatively affecting LDL-C goal achievement.

Keywords: acute coronary syndrome; lipid-lowering therapies; low-density lipoprotein cholesterol; medication adherence.