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

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 wheth...

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Published in:Atherosclerosis 2021-04, Vol.323, p.37-43
Main Authors: Zafeiropoulos, Stefanos, Farmakis, Ioannis, Kartas, Anastasios, Arvanitaki, Alexandra, Pagiantza, Areti, Boulmpou, Aristi, Tampaki, Athina, Kosmidis, Diamantis, Nevras, Vassileios, Markidis, Eleftherios, Papadimitriou, Ioannis, Vlachou, Anastasia, Arvanitakis, Konstantinos, Miyara, Santiago J., Ziakas, Antonios, Molmenti, Ernesto P., Kassimis, George, Zanos, Stavros, Karvounis, Haralambos, Giannakoulas, George
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Language:English
Subjects:
Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - drug therapy
Acute coronary syndromes
Cholesterol, LDL
Dyslipidemia
Dyslipidemias
Female
Humans
LDL-C goal
Male
Medication adherence
Middle Aged
Secondary Prevention
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creator Zafeiropoulos, Stefanos
Farmakis, Ioannis
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Boulmpou, Aristi
Tampaki, Athina
Kosmidis, Diamantis
Nevras, Vassileios
Markidis, Eleftherios
Papadimitriou, Ioannis
Vlachou, Anastasia
Arvanitakis, Konstantinos
Miyara, Santiago J.
Ziakas, Antonios
Molmenti, Ernesto P.
Kassimis, George
Zanos, Stavros
Karvounis, Haralambos
Giannakoulas, George
description 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. 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 (
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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. 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&gt;80%), and LDL-C goal (&lt;70 mg/dl or 50% reduction from baseline) achievement rate at one year. 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. Α multifaceted intervention improved LLT adherence in post-ACS patients without a significant difference in LDL-C goal attainment. [Display omitted] •Good adherence was associated with low-density lipoprotein cholesterol (LDL-C) goal achievement and greater LDL-C reduction from baseline.•The group that received a reinforcing intervention improved adherence and increased odds of good adherence compared to controls.•No difference was found in LDL-C goal achievement rates and clinical outcomes between the two groups at 1 year.</description><identifier>ISSN: 0021-9150</identifier><identifier>EISSN: 1879-1484</identifier><identifier>DOI: 10.1016/j.atherosclerosis.2021.03.013</identifier><identifier>PMID: 33780749</identifier><language>eng</language><publisher>Ireland: Elsevier B.V</publisher><subject>Acute Coronary Syndrome - diagnosis ; Acute Coronary Syndrome - drug therapy ; Acute coronary syndromes ; Cholesterol, LDL ; Dyslipidemia ; Dyslipidemias ; Female ; Humans ; LDL-C goal ; Male ; Medication adherence ; Middle Aged ; Secondary Prevention</subject><ispartof>Atherosclerosis, 2021-04, Vol.323, p.37-43</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. 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subjects Acute Coronary Syndrome - diagnosis
Acute Coronary Syndrome - drug therapy
Acute coronary syndromes
Cholesterol, LDL
Dyslipidemia
Dyslipidemias
Female
Humans
LDL-C goal
Male
Medication adherence
Middle Aged
Secondary Prevention
title Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial
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