Perspective of primary care physicians on the management of dyslipidaemia in patients without atherosclerotic cardiovascular disease: a cross-sectional study

Abstract

Evidence suggests many dyslipidemic patients do not reach target low-density lipoprotein and cholesterol (LDL-C) levels in primary health care. We aimed to describe the pharmacologic therapeutic management of dyslipidemia in patients without established atherosclerotic cardiovascular diseases (ASCVD) from the primary care physician's perspective in Spain. We conducted a cross-sectional study through an online survey directed to primary care physicians to explore their therapeutic management of dyslipidemia in patients without ASCVD, focusing on their knowledge and adherence to the 2019 European Society of Cardiology/ European Atherosclerosis Society (ESC/EAS) guidelines and their perspective concerning the barriers to achieving LDL-C therapeutic targets. In total, 279 primary care physicians completed the survey. Most interviewees (80.65%) stated they had already adopted the 2019 ESC/EAS guidelines in their clinical practice. Nevertheless, around 30% adhered to therapeutic targets by previous ESC/EAS guidelines (2016), and most treated their patients mainly with statins in monotherapy, prescribing doses below the maximum tolerated. Additionally, 50.18% were classified as low adherence to the 2019 ESC/EAS guidelines, especially to the treatment algorithm. According to the physicians, the underestimation of patients' cardiovascular risk and the reluctance to increase doses or use combined therapy were the most critical barriers to achieving LDL-C targets. Although primary care physicians in our survey reported adherence to the 2019 ESC/EAS guidelines recommendations, our observations indicate they need to integrate them better into their clinical practice.