Abstract
AimsTo explore differences in the use of lipid lowering therapy and/or achievement of lipid guideline targets in patients with and without prior depression and influence of sex in very high-risk coronary patients.Methods & findingsA retrospective observational cohort study was conducted using individual-level linked electronic health record data in patients who underwent percutaneous coronary intervention (2012–2017) in Wales. The cohort comprised of 13,781 patients (27.4% female), with 26.1% having prior depression. Lipid levels were recorded in 10,050 patients of whom 25% had depression. History of depression was independently associated with not having lipids checked (OR 0.79 95%CI 0.72–0.87 p<0.001). Patients with prior depression were less likely to achieve targets for low density lipoprotein cholesterol (LDL-C <1.8mmol/l), non-high density lipoprotein cholesterol (non-HDL-C <2.6mmol/l) and triglycerides (<2.3mmol/l) than patients without depression (OR 0.86 95%CI 0.78–0.96 p = 0.007, OR 0.80 95%CI 0.69–0.92 p = 0.003 & OR 0.69 95CI% 0.61–0.79 p<0.001 respectively). Females were less likely to achieve targets for LDL-C and non-HDL-C than males (OR 0.55 95%CI 0.50–0.61 p<0.001 & OR 0.63 95%CI 0.55–0.73 p<0.001). There was an additive effect of depression and sex; females with depression were not only least likely to be tested (OR 0.74 95%CI 0.65–0.84 p<0.001) but also (where levels were known) less likely to achieve LDL-C (OR 0.47 95%CI 0.41–0.55 p<0.001) and non-HDL-C targets (OR 0.50 95%CI 0.41–0.60 p<0.001). It was not possible to look at the influence of medication adherence on achievement of lipid targets due to limitations of the use of anonymised routinely-held clinical care data.ConclusionPatients with prior depression were less likely to have their lipids monitored and achieve guideline targets within 1-year. Females with depression are the least likely to be tested and achieve lipid targets, suggesting not only a greater risk of future events, but also an opportunity to improve care.
Highlights
We have previously shown in a cohort of Percutaneous coronary intervention (PCI) patients that only 48% and 23% met the European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) 2016 and 2019 lipid guidelines targets for low density lipoprotein cholesterol (LDL-C) [8]
Access to data and linkage was through the privacy-protecting trusted research environment (TRE) the Secure Anonymised Information Linkage (SAIL) Databank [10, 11]
Ischaemic heart disease, chronic kidney disease (CKD) stage 4 +, depression, anxiety, severe mental illness, prescriptions for lipid lowering and antidepressant therapy and recorded lipid levels were identified from primary care data from the Welsh Longitudinal General Practice (WLGP) data
Summary
Common mental disorders such as depression and anxiety, are increasingly recognised to play a role in our physical health. The association between depression and increased risk of developing cardiovascular disease (CVD), and recurring coronary events is well known, but not always considered when managing these patients [1, 2]. Percutaneous coronary intervention (PCI) is an effective revascularisation treatment for patients with acute coronary syndrome and stable coronary artery disease. Patients with depression have been shown to have worse outcomes following PCI [3]. The reasons for this are not fully understood. Differences in effectiveness of management of conventional risk factors may be a contributing factor, as in patients with severe mental illness [4, 5]. Whilst some evidence suggests that those with depression may be less likely to adhere to medication and reach targets for lipids and blood pressure [6]
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