Reinforcing adherence to lipid-lowering therapy after an acute coronary syndrome: A pragmatic randomized controlled trial. (April 2021)

• Record Type: Journal Article
• 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
• Is Part Of: Atherosclerosis. Volume 323(2021)
• Page Start: 37
• Page End: 43
• Publication Date: 2021-04
• Subjects: Acute coronary syndromes -- Dyslipidemia -- LDL-C goal -- Medication adherence; Arteriosclerosis -- Periodicals; Electronic journals; 616.136
• DOI: 10.1016/j.atherosclerosis.2021.03.013
• Languages: English
• ISSNs: 0021-9150

Abstract

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. Graphical abstract: Image 1 Highlights: 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.