title: Medical and psychosocial factors and unfavourable low-density lipoprotein cholesterol control in coronary patients.
abstract: Objective Understanding the determinants of low-density lipoprotein cholesterol (LDL-C) control constitutes the basis of modelling interventions for optimal lipid control and prognosis. We aim to identify medical and psychosocial (study) factors associated with unfavourable LDL-C control in coronary patients. Methods A cross-sectional explorative study used logistic and linear regression analysis to investigate the association between study factors and LDL-C in 1095 patients, hospitalized with myocardial infarction and/or a coronary revascularization procedure. Data were collected from hospital records, a comprehensive self-report questionnaire, clinical examination and blood samples after 2-36 months follow-up. Results Fifty-seven per cent did not reach the LDL-C target of 1.8 mmol/l at follow-up. Low socioeconomic status and psychosocial factors were not associated with failure to reach the LDL-C target. Statin specific side-effects (odds ratio 3.23), low statin adherence (odds ratio 3.07), coronary artery by-pass graft operation as index treatment (odds ratio 1.95), ≥ 1 coronary event prior to the index event (odds ratio 1.81), female gender (odds ratio 1.80), moderate- or low-intensity statin therapy (odds ratio 1.62) and eating fish < 3 times/week (odds ratio 1.56) were statistically significantly associated with failure to reach the LDL-C target, in adjusted analyses. Only side-effects (standardized β 0.180), low statin adherence ( β 0.209) and moderate- or low-intensity statin therapy ( β 0.228) were associated with LDL-C in continuous analyses. Conclusions Statin specific side-effects, low statin adherence and moderate- or low-intensity statin therapy were the major factors associated with unfavourable LDL-C control. Interventions to improve LDL-C should ensure adherence and prescription of sufficiently potent statins, and address side-effects appropriately.
authors.affiliation: 1 Department of Medicine, Drammen Hospital, Norway.
authors.forename: John
authors.initials: J
authors.lastname: Munkhaugen
authors.affiliation: 1 Department of Medicine, Drammen Hospital, Norway.|2 Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Norway.
authors.forename: Elise
authors.initials: E
authors.lastname: Sverre
authors.affiliation: 3 Department of Medicine, Vestfold Hospital, Norway.
authors.forename: Jan E
authors.initials: JE
authors.lastname: Otterstad
authors.affiliation: 3 Department of Medicine, Vestfold Hospital, Norway.|4 Department of Cardiology, Oslo University Hospital Rikshospitalet and Faculty of Medicine, University of Oslo, Norway.
authors.forename: Kari
authors.initials: K
authors.lastname: Peersen
authors.affiliation: 1 Department of Medicine, Drammen Hospital, Norway.
authors.forename: Erik
authors.initials: E
authors.lastname: Gjertsen
authors.affiliation: 5 Department of Cardiology, Public Health Department, Linnaeus University, Kalmar, Sweden.
authors.forename: Joep
authors.initials: J
authors.lastname: Perk
authors.affiliation: 4 Department of Cardiology, Oslo University Hospital Rikshospitalet and Faculty of Medicine, University of Oslo, Norway.
authors.forename: Lars
authors.initials: L
authors.lastname: Gullestad
authors.affiliation: 2 Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Norway.
authors.forename: Torbjørn
authors.initials: T
authors.lastname: Moum
authors.affiliation: 2 Department of Behavioural Sciences in Medicine and Faculty of Medicine, University of Oslo, Norway.
authors.forename: Toril
authors.initials: T
authors.lastname: Dammen
authors.affiliation: 1 Department of Medicine, Drammen Hospital, Norway.
authors.forename: Einar
authors.initials: E
authors.lastname: Husebye
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D016009:Chi-Square Distribution; D008078:Cholesterol, LDL / Q000097:blood*; D001026:Coronary Artery Bypass; D003324:Coronary Artery Disease / Q000097:blood / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D003430:Cross-Sectional Studies; D000072001:Diet, Healthy; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy* / Q000523:psychology; D005260:Female; D006760:Hospitalization; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000097:blood / Q000175:diagnosis / Q000523:psychology / Q000628:therapy*; D009664:Norway; D016017:Odds Ratio; D062645:Percutaneous Coronary Intervention; D012189:Retrospective Studies; D012307:Risk Factors; D040242:Risk Reduction Behavior; D017747:Seafood; D057566:Self Report; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors
keywords: Secondary prevention; coronary heart disease; drug adherence; low-density lipoprotein cholesterol; psychosocial factors