Managing atherosclerotic cardiovascular disease: gaps identified

By Melanie Hinze

New Australian research, published in Heart, Lung and Circulation, has identified gaps in the management of atherosclerotic cardiovascular disease (ASCVD) in Australian general practice.

The retrospective study used electronic data from Australian GPs that were extracted from the IQVIA GP Electronic Medical Record dataset between January 2010 and June 2022. Data on 13,644 patients with ASCVD were examined (64% men; mean age 70 ± 13.5 years).

The study authors examined relationships between demographics, clinical characteristics, treatment patterns, adherence to lipid-lowering therapy and the achievement of guideline-recommended low-density lipoprotein cholesterol (LDL-C) goals.

They found that 51.9% of patients had recorded an LDL-C test at their most recent general practice appointment, and of those tested, 60.5% had LDL-C levels greater than 1.8 mmol/L and 50.6% levels greater than 2.0 mmol/L.

Statin therapy was prescribed to 81.3% of patients during the study period; however, this fell to 65.4% by the last consult. At one year, 80.1% of patients on statin monotherapy were adherent; however, this dropped to 47.9% at five years.

First author, Associate Professor Ralph Audehm, GP and Clinical Associate Professor at the University of Melbourne’s Department of General Practice, Melbourne, told Medicine Today that one of the notable findings from this research was the number of people stopping their cholesterol-lowering medications, even after a heart attack, with one in five stopping after a year, and more than half by five years.

‘Further to this, over 60% were not at target LDL-C, and these were people who had had an event or who were at very high risk and so needed to be treated to target,’ he said.

‘The third point was the use of monotherapy – many people were on a statin but only 6% on a statin plus ezetimibe and yet most people were not at target.’

Associate Professor Audehm said that easy improvements might include GP practices checking that their patients were persisting with their medication.

‘They can be searching their database for people who have ischaemic heart disease and have an LDL-C greater than 1.4 mmol/L, and then call them in for a review to optimise treatment,’ he said, adding that ‘this will save lives.’

Associate Professor Audehm also suggested using the Heart Foundation’s MyHeart MyLife resource for people who had had an event or who were at high risk (https://www.myheartmylife.org.au).

Heart Lung Circ 2025; https://doi.org/10.1016/j.hlc.2025.07.012.