Risk factor monitoring, management and use of prevention medicines in those with a history of premature coronary heart disease

TL;DR

People with early heart disease are less likely to get preventive medications, despite similar monitoring of risk factors as those without early heart disease.

Contribution

This study reveals disparities in medication prescriptions for secondary prevention in patients with premature coronary heart disease.

Findings

Patients with pCHD were less likely to be prescribed statins, antihypertensives, and antiplatelets.

Women with pCHD were even less likely to receive blood pressure-lowering and antiplatelet medications.

Risk factor monitoring rates were similar between pCHD and non-pCHD patients.

Abstract

Those with premature coronary heart disease (pCHD) have a lower 5-year risk of repeat events; however, their lifetime risk is high. The aim of this study was to assess secondary prevention (SP) medical therapy and risk factor (RF) monitoring in patients with pCHD compared with those without pCHD.

Analysis of a national primary care database including patients attending the same practice between January 2015 and March 2021 with at least 3 follow-up appointments, a history of CHD and a follow-up duration of at least 2 years. pCHD was defined as males under 55 and females under 65 at age of diagnosis of their CHD.

Among the 64 704 with CHD, 21 035 (32.5%) had pCHD (10 339 women <65 years of age and 10 696 men <55 years of age). Patients with pCHD compared with non-pCHD were more likely to be smokers (59.4% vs 52.6%, p<0.001), less likely to have hypertension (61.9% vs 73.2%, p<0.001) and similar rates of dyslipidaemia (57.8% and 57.5%, p=0.806) and diabetes (30.8% vs 30%, p=0.696). After adjusting for RF, pCHD was not associated with odds of blood pressure (BP) assessment (OR 0.63, 95% CI 0.40 to 1.00), measurement of glycated haemoglobin (OR 0.99, 95% CI 0.94 to 1.04) and any lipid monitoring (OR 1.05, 95% CI 0.96 to 1.14). Patients with PCHD had lower odds of prescription of statins (OR 0.81, 95% CI 0.76 to 0.87), any antiplatelets (OR 0.81, 95% CI 0.77 to 0.86), antihypertensive medication (OR 0.73, 95% CI 0.67 to 0.79) and beta blockers (OR 0.94, 95% CI 0.90 to 0.98) after adjustment for baseline RF. Women with pCHD were even less likely to be prescribed SP medicines of BP lowering and antiplatelets, both p value for interaction <0.000.1

Patients with a history of pCHD had similar rates of RF monitoring to patients without pCHD, but patients with pCHD were less likely to be prescribed SP medication of statins, antihypertensives and antiplatelets.

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