What do us physicians and patients think about LLTs and goals of treatment?

Physician and patient perceptions of benefits, risks, and treatment goals of lipid-lowering therapy: Results from GOULD registry.

Key Takeaway

The structured questionnaires in a large US cohort with cardiovascular disease and treating physicians, revealed substantial gaps in patients’ knowledge and understanding of the disease and treatments, which may result in poorer adherence to medications and healthy lifestyle choices.

• Most patients had knowledge gaps in understanding the risk of cardiovascular disease and recurrent cardiovascular events, cholesterol levels/goals, and the benefit of cholesterol medications.
• Most physicians believed that non-adherence was primarily attributed to the lack of understanding of the importance and efficacy of statins.

Why this matters

• Patients' understanding and perceptions of the benefits, risks, and treatment goals of LLT and physicians’ understanding on how best to manage LLT in patients with ASCVD are not well known.
• The questionnaires were implemented among patients with ASCVD and suboptimal LDL-C control or on a PCSK9 inhibitor, as well as physicians to provide the required insights.

Study Design

Gould, a US-based registry describing longitudinal cholesterol treatment patterns among patients with ASCVD, enrolled patients from 119 sites*

• Patients were contacted by telephone for a structured interview at enrollment, and enrolling physicians completed a written questionnaire

Eligible patients

• Clinically relevant ASCVD (coronary artery disease, prior myocardial infarction, coronary/other arterial revascularization, ischemic stroke/ transient ischemic attack, peripheral artery disease, and carotid artery stenosis)
• LDL-C ≥70 mg/dL or on PCSK9 inhibitor at enrollment

Questionnaire modules

• Patients: Demographics and risk factor assessment, usual source of care/access to care, LLT use and statin adherence; side effects; rechallenge, PCSK9 inhibitors, and ASCVD risk awareness
• Physicians: Lipid measurement, statin use, use of nonstatin LLTs, PCSK9 inhibitors, familial hypercholesterolemia, and patient education

Key Results

Structured questionnaires were conducted in US outpatients (N = 5,006; response rate: 93.4%) and in physicians (N = 113; response rate: 100%).

• Patient-demographics: Mean age: 67.8 ± SD 9.9 years; men: 60.3% and white race: 86.1%
• Physician-specifications: Mean age: 56.1 ± SD 9.9 years; average practice: 23.0 ± SD 11.0 years; cardiologists: 45.1%; primary care: 45.1%; other specialties: 9.8%

Patient perceptions	Results from patient-questionnaire (% patients)
Heart disease as leading cause of death	62.9% in men	46.3% in women
Unable to estimate risk of having a heart attack/ stroke in next 10 years	54.7%
Lower risk of heart attack/stroke as main reason to take llt	27.8%,
Statin-side-effect experienced	35.5% (mostly muscle related)

Patients in the PCSK9 inhibitor cohort (vs LDL-C cohort), men (vs women), and younger patients (vs those aged ≥65 years) were generally more knowledgeable about their disease and its management

Physician perceptions	Results from physician-questionnaire (% physicians)
Evidence for high-intensity statins in patients with ascvd as strong/very strong	78.1 %
LDL-c goals	<70 mg/dL: 73.3% No LDL-C goals: 6.3% Depend on patient’s risk factors: 8.9%
Reasons cited for non-adherence to statins	Patient-belief that the medication did not work (66.4%), vs cost (8.8%) or side effects (0.9%)
Side-effects experienced	19.5% ± SD 13.2% (% patients on statins)

Patient education on importance of the medication in reducing cardiovascular events was the most commonly used strategy by physicians to make their patients tolerate statins.

Limitations

• Patients were less diverse*.
• The knowledge gaps which would be most important to target to improve adherence to LLT and healthy lifestyle choices were unclear.
• The results were based on questionnaires administered at patient enrollment† and did not consider updated lipid guidelines.
• Other clinical factors which may impact patient’s individual risk of heart attack/stroke and risk reduction with cholesterol-lowering medications could not be accounted.
• Questionnaire results were limited by small number and selected nature of participating physicians.

*In age, race, and socioeconomic status.
†Between December 2016–July 2018.

MAT-KW-2200305/v2/Jan 2024