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. 2024 Oct 31;13(21):6562.
doi: 10.3390/jcm13216562.

A Nation-Wide Evaluation of Suboptimal Lipid-Lowering Treatment Patterns Among Patients Undergoing Intervention for Acute Coronary Syndrome in Hungary

Gergely Gyorgy Nagy  1   2 , Laszlo Mark  3 , Andrea Gerencser  4 , Istvan Reiber  5 , Norbert Kiss  4 , Gyorgy Rokszin  6 , Ibolya Fabian  6 , Zoltan Csanadi  7 , Istvan Karadi  8 , Daniel Aradi  9   10 , Laszlo Bajnok  11 , Gyorgy Paragh  12
Affiliations

A Nation-Wide Evaluation of Suboptimal Lipid-Lowering Treatment Patterns Among Patients Undergoing Intervention for Acute Coronary Syndrome in Hungary

Gergely Gyorgy Nagy et al. J Clin Med. .

Abstract

Background/Objectives: A significant gap exists between guideline recommendations and everyday practice. Stringent treatment is needed for vulnerable patients with acute coronary syndrome (ACS). Methods: Data on the lipid-lowering therapy (LLT), including the adherence, persistence, and mortality of patients undergoing percutaneous coronary intervention or bypass surgery in Hungary in 2018 were followed up and analyzed based on the National Health Insurance Fund database until the end of 2020. Results: A total of 12,997 patients underwent revascularization for ACS in 2018, whose discharge therapy included any LLT, a high- or moderate-intensity statin, or ezetimibe at a proportion of 91%, 75%, 12%, and 4%, respectively. By the end of the observation period, the frequency of ezetimibe administration increased to 11%. Persistence decreased, reaching 50% for all therapeutic regimens by month 16. Patients on moderate statin doses had a significantly higher mortality rate at the end of follow-up than those receiving high-intensity statin with (20% vs. 9%, p < 0.0001) or without (20% vs. 14%, p = 0.00029) ezetimibe. Those taking less potent statin doses had higher rates of comorbidities; for example, a minimum of three comorbidities were present in 39% of patients taking medium statin doses and 23% among those on high-intensity statin therapy (p < 0.0001). Conclusions: LLT persistence decreased during follow-up. The administration of a higher-intensity lipid-lowering regimen was associated with better persistence and adherence, along with more favorable mortality rates. Multimorbidity was associated with the use of lower statin doses. The results suggest that more attention is needed in terms of lipid control of females, elderly people, and individuals with several comorbidities, and emphasis should be placed on improving persistence and increasing the frequency of combined LLT prescriptions.

Keywords: acute coronary syndrome; adherence; ezetimibe; lipid-lowering therapy; persistence; statins.

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Conflict of interest statement

G.G.N.: lecture fees from Amgen, AstraZeneca, Bayer, Boehringer, Novartis, and NovoNordisk. L.M.: lectures fees from Hungarian branches of EGIS, Richter Gedeon, KRKA, Novartis, Sandoz. A.G. and N.K.: working at Novartis Hungary Ltd., Budapest. I.R.: lectures fees from Hungarian branches of EGIS, KRKA, Mylan, Richter Gedeon. G.R. and I.F. are employed by RxTarget Ltd. Their contribution to this study analysis was financially compensated by Novartis Hungary Lt. Z.C.: lecture fees from Hungarian branches of EGIS, Richter Gedeon, KRKA, Bayer AG, Boehringer Ingelheim, Novartis, Novo Nordisk, MSD Pharma, Medtronic. I.K.: lecture fees from Hungarian branches of EGIS, Sanofi, Novartis. D.A.: lecture fees from Amgen, Bayer AG, Pfizer, Boehringer Ingelheim, Krka, Novartis, Novo Nordisk, MSD Pharma, Richter, Teva. L.B.: lectures fees and/or travel grants from Hungarian branches of Richter. Gedeon, KRKA, Novartis, Sandoz, Novo Nordisk, Pfizer, Bausch Health. G.P.: lectures fees from Hungarian branches of Novartis, Richter Gedeon, and Sandoz.

Figures

Figure 1
Figure 1
Distribution of lipid-lowering therapy after the index event in Hungarian patients with ACS in 2018.
Figure 2
Figure 2
Cumulative distribution of comorbidities in post-ACS patients with high- and moderate-intensity statin dose groups.
Figure 3
Figure 3
Persistence of lipid-lowering therapy in post-ACS patients across different therapeutic regimens by 60-day grace period. Selected time points are presented in numerical format (with 95% confidence intervals) for illustration.
Figure 4
Figure 4
Survival analysis of patients on different lipid-lowering therapeutic regimens during the follow-up period. Selected time points are presented in numerical format (with 95% confidence intervals) for illustration.
See this image and copyright information in PMC

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