Abstract
BackgroundLipid-lowering medications (LLM) are commonly used for secondary prevention, as well as for primary prevention among patients with high global cardiovascular risk and with diabetes. This study aimed to determine the prevalence of LLM use among high-risk individuals [participants with diabetes, high Framingham general cardiovascular (FRS-CVD) score, existing cardiovascular disease (CVD)] and the factors associated with it.MethodsThis is a cross-sectional analysis from the baseline recruitment (years 2007 to 2011) of an ongoing prospective study involving 11,288 participants from 40 rural and urban communities in Malaysia. Multiple logistic regression was used to identify characteristics associated with LLM use.ResultsMajority (74.2%) of participants with CVD were not on LLM. Only 10.5% of participants with high FRS-CVD score, and 17.1% with diabetes were on LLM. Participants who were obese (OR = 1.80, 95% CI: 1.15–2.83), have diabetes (OR = 2.38, 95% CI: 1.78–3.19), have hypertension (OR = 2.87, 95% CI: 2.09–3.95), and attained tertiary education (OR = 2.25, 95% CI: 1.06–4.78) were more likely to be on LLM. Rural residents had lower odds of being on LLM (OR = 0.58, 95% CI: 0.41–0.82). In the primary prevention group, participants with high FRS-CVD score (OR = 3.81, 95% CI: 2.78–5.23) and high-income earners (OR = 1.54, 95% CI: 1.06–2.24) had higher odds of being on LLM.ConclusionsLLM use among high CVD-risk individuals in the primary prevention group, and also among individuals with existing CVD was low. While CVD risk factors and global cardiovascular risk score were positively associated with LLM use, sociodemographic disparities were observed among the less-educated, rural residents and low-income earners. Measures are needed to ensure optimal and equitable use of LLM.
Highlights
Lipid-lowering medications (LLM) are commonly used for secondary prevention, as well as for primary prevention among patients with high global cardiovascular risk and with diabetes
Participants who had Cardiovascular diseases (CVD) risk factors, such as obesity (OR = 1.80, 95% Confidence interval (CI): 1.15–2.83), diabetes (OR = 2.38, 95% CI: 1.78–3.19), and hypertension (OR = 2.87, 95% CI: 2.09–3.95) were more likely to be on LLM
Income group was a significant factor in this model, where those who earned equal or more than Ringgit Malaysia (RM) 4850 were 1.5 times more likely to be on LLM, compared to those from the lower income group (OR = 1.54, 95% CI: 1.06–2.24)
Summary
Lipid-lowering medications (LLM) are commonly used for secondary prevention, as well as for primary prevention among patients with high global cardiovascular risk and with diabetes. This study aimed to determine the prevalence of LLM use among high-risk individuals [participants with diabetes, high Framingham general cardiovas‐ cular (FRS-CVD) score, existing cardiovascular disease (CVD)] and the factors associated with it. Local and international guidelines recommend the use of LLM, statins for secondary prevention, as well as for primary prevention among those with high risk to develop CVD [3,4,5,6] All these guidelines consistently recommend stratifying patient’s CVD risk to guide LLM use, and to determine individual patient’s treatment target [3,4,5,6]. For Malaysians, high-risk individuals include those who have more than 20% of 10-year CVD risk calculated using the FRS-CVD score, those with diabetes or existing CVD [3, 4]
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