Abstract
(1) Background: Although current guidelines recommend regular lipid testing for dyslipidemia patients, the effectiveness of regular lipid profile monitoring in clinical outcomes is unclear. (2) Methods: We assessed 64,664 newly diagnosed dyslipidemia patients from the Korean National Health Insurance Service Health Screening Cohort from 2003–2011 For lipid-testing frequency from all admission and outpatient records for 3 years after diagnosis. Participants were followed until 31 December 2015 for stroke. We used Cox regression analysis to determine the adjusted hazard ratio (aHR) for stroke according to lipid-testing interval. (3) Results: Compared to patients with lipid-testing intervals of ≤6 months, patients with >6 to ≤12 (aHR 1.32, 95% confidence interval (CI) 1.08–1.61), >12 to ≤18 (aHR 1.48, 95% CI 1.20–1.82), and >18 (aHR 1.54, 95% CI 1.25–1.90) month testing intervals had elevated risk of total stroke (p for trend <0.001). A significant association existed between lipid-testing interval and total and ischemic stroke risk in the >6 to ≤12 (aHR 1.62, 95% CI 1.19–2.21), >12 to ≤18 (aHR 1.87, 95% CI 1.36–2.58), and >18 (aHR 1.79, 95% CI 1.30–2.48) month interval groups, but no significant association existed between lipid-testing interval and hemorrhagic stroke risk. (4) Conclusions: Lipid-testing intervals of more than 6 months may lead to increased stroke risk among newly diagnosed dyslipidemia patients after initiation of statin treatment. Lipid testing every 6 months can lower stroke risk among dyslipidemia patients.
Highlights
Statin therapy has become the most important advancement in stroke prevention since the introduction of aspirin and blood pressure-lowering therapies
A significant association existed between lipid-testing interval and total and ischemic stroke risk in the >6 to ≤12, >12 to ≤18, and >18 month interval groups, but no significant association existed between lipid-testing interval and hemorrhagic stroke risk
Acronyms: outpatient department visits (OPD), outpatient department; MPR, medication possession ratio. In this retrospective cohort study, we showed that an association existed between increased lipid-testing intervals of more than 6 months and elevated risk of total stroke among newly diagnosed dyslipidemia patients initiated on statins
Summary
Statin therapy has become the most important advancement in stroke prevention since the introduction of aspirin and blood pressure-lowering therapies. Drugs used for lipid-lowering therapy, such as statins, reduce the level of LDL-C and triglycerides levels, and increase HDL-C through modulation of cholesterol ester transfer protein [5,6]. Regular lipid profile follow-up is needed to check for an adequate patient response to lipid-lowering therapy and evaluate whether dyslipidemia is well-managed [7,8]. Lipid measurements are essential for calculating an individual’s risk of atherosclerotic cardiovascular disease (ASCVD), which includes stroke in addition to coronary heart disease and peripheral arterial disease, and determine when to initiate, adjust, or change lipid-lowering therapy [8,9]. Recent lipid-management guidelines favor a risk-assessment approach that emphasizes lowering ASCVD risk rather than targeting specific LDL-C levels [9,10,11]. A limited number of studies have investigated the frequency of measuring lipid levels in patients who take lipid-lowering medications and its effects on long-term health such as risk of stroke, stroke is one of the leading causes of death and disability worldwide [12]
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