Treatment and control of low-density lipoprotein for primary prevention in patients in Wales with and without depression: a study of whole-population electronic health records
Carla White, Richard Summers, Ann John, David PJ Osborn, Keith Lloyd, Ashley Akbari, Michael B Gravenor, Julian P Halcox, Elizabeth A EllinsAim
This study investigated the influence of depression status on lipid lowering therapy (LLT) prescribing and achievement of guideline targets for low density lipoprotein cholesterol (LDL-C) levels in patients after first documentation of a high risk of developing atherosclerotic cardiovascular disease (ASCVD). Associations with sex, socioeconomic status and location of residence on these relationships were also explored.
Methods
A retrospective observational cohort study (2010–2019) using individual-level linked, anonymised, routinely collected electronic health record data sources. Patients with/without depression and documentation of a high global QRISK risk score (HQR) were included. Outcome variables were LLT prescription within 6 months of HQR documentation and recording of LDL-C level within European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) targets and achievement of >40% reduction in LDL-C according to National Institute for Health and Care Excellence guidance within 1 year of HQR. Logistic regression analysis explored the association between depression and outcome variables adjusting for sex, age group, deprivation, location of residence and other risk factors.
Results
QRISK was documented in 284 859 (12.8%) patients. In the 103 340 HQR patients, depression (identified pre-HQR or post-HQR documentation) was associated with a higher likelihood of LLT prescription (pre-OR 1.15, 95% CI 1.08 to 1.23; post-OR 1.39, 95% CI 1.19 to 1.64). Depression was not associated with achievement of LDL-C control as per EAS/ESC guidelines (<2.6 mmol/L; pre-OR 1.10, 95% CI 1.00 to 1.23; post-OR 1.00, 95% CI 0.79 to 1.28). Depression pre-HQR was associated with achievement of a >40% reduction in LDL-C (pre-OR 1.16, 95% CI 1.02 to 1.32; post-OR 0.94, 95% CI 0.70 to 1.25)
Conclusion
Only a small proportion of patients had a documented QRISK score in their record. While high ASCVD risk patients with depression were more likely to be prescribed LLT, this was not necessarily associated with better LDL-C control.