Therapeutic inertia in hypercholesterolaemia is associated with ischaemic events in primary care patients. A case-control study

Abstract

The frequency of therapeutic inertia (TI) is very high in the management of vascular risk factors, although its impact on the incidence of ischaemic events is not well-established. Our aim was to investigate the relationship between TI in the treatment of hypercholesterolaemia and the appearance of ischaemic events. An observational, multicentre, case-control study was conducted in 70 primary care centres in Spain. Case subjects (n=235) were high-risk hypercholesterolaemic patients (both genders, ≥18years) who had had a first event in the 12months prior to recruitment. They were matched with 235 controls (by vascular risk, age and gender). The observation period was 18months prior to the onset of a first event (cases) or to date of recruitment (control subjects). The TI in the basal visit (an average of 7.8months before the event) was slightly higher in cases than in controls (39.7% vs. 34.8%, NS). However, the accumulated TI was similar in both groups (70.7% for cases and 73.95% for controls, NS). The multivariate analysis, taking ischaemic events as the dependent variable, showed that the TI at baseline visit was significantly associated with the development of the event [OR 2.18 (95% CI 1.04-4.51), p<0.05]. Other variables also associated with the ischaemic event were a family history of premature vascular disease [OR 3.38 (95% CI 1.35-8.49), p<0.05] and uncontrolled hypertension [OR 2.35 (95% CI 1.02-5.43), p<0.05]. The TI in high-risk hypercholesterolaemic patients in primary prevention in Spanish primary care centres doubled the risk of an ischaemic event in the short term.