The burdens and barriers of optimizing LDL-C management: A survey of physicians in the United States

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2025-05-01 DOI:10.1016/j.jacl.2025.04.011

Taruja Karmarkar PhD, Jordan Schmier MA, Sayeli Jayade MPH, Kyle Roney MPH, Ross Simpson Jr. MD, Jason Exter PharmD, Seth Baum MD, Lawrence Leiter MD, Lori Bash PhD

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引用次数: 0

Abstract

Funding

This research was supported by Merck & Co., Inc.

Background/Synopsis

Despite evidence of the benefits of lowering low-density lipoprotein cholesterol (LDL-C) in reducing the risk of atherosclerotic cardiovascular disease (ASCVD) and the availability of safe and effective lipid lowering therapies (LLT) to do so, the burden of elevated LDL-C and underuse of LLT remain high.

Objective/Purpose

We describe barriers related to optimizing LDL-C management, which are not yet well understood.

Methods

From April 2024 through June 2024, US cardiologists and primary care providers (PCPs) (practicing for > 2 years, prescribing LLT to > 50 patients monthly), were invited to participate in a 30-minute online survey on the barriers of managing LDL-C and optimizing LLT. The survey was informed by literature and expert opinion and analyzed descriptively.

Results

We report on 200 cardiologists and 200 PCPs (mean age 49 years, mostly male [76.5%] and white [53%]) who treat an average of 299 patients/month, of whom 55% manage at least 100 patients with LLT monthly. Overall, ∼8% of physicians reported their patients refuse any LLT more than half of the time; in contrast, more than twice as many (∼23%) physicians reported patient refusal of injectable LLT more than half of the time. The most often reported reasons for patients declining LLT were preferences for lifestyle changes (82%), concern about potential side effects (83%), and not wanting medication in general (75%). The most frequently reported reasons for declining injectables were cost/insurance reasons (73%) and fear/discomfort of injections (73%). Most cardiologists (55%) and PCPs (57%) reported counseling of patients takes longer when prescribing PCSK9is than for oral LLTs due to time spent educating on administration. Of those surveyed, physicians perceived secondary prevention patients, those with LLT experience, and those with greater understanding of ASCVD risk (compared to primary prevention, LLT-naïve and those with less understanding of their risk) to have higher LLT adherence.

Conclusions

Among 400 US physicians surveyed, a number of barriers to optimal lipid management were reported. These included more patient refusals specific to LLT injectables than LLT in general, with different reasons for refusal, as well as physician concerns related to time and resource constraints when initiating treatment. Responses suggest patient, clinician, and system barriers may all hinder LDL-C management and adherence. Further research is required to understand the association between perceived barriers and real-world behaviors to better inform optimization of lipid management.

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优化LDL-C管理的负担和障碍：对美国医生的调查

本研究由Merck &；背景/摘要尽管有证据表明降低低密度脂蛋白胆固醇（LDL-C）在降低动脉粥样硬化性心血管疾病（ASCVD）风险方面的益处，以及安全有效的降脂疗法（LLT）的可用性，但LDL-C升高和LLT使用不足的负担仍然很高。目的/目的我们描述了与优化LDL-C管理相关的障碍，这些障碍尚未得到很好的理解。方法：从2024年4月到2024年6月，美国心脏病专家和初级保健提供者（pcp）(执业>；2年，给患者开LLT；每月50名患者)被邀请参加一项30分钟的在线调查，调查内容是管理LDL-C和优化LLT的障碍。该调查以文献和专家意见为依据，并进行描述性分析。结果我们报告了200名心脏病专家和200名pcp（平均年龄49岁，主要为男性[76.5%]和白人[53%]），他们平均每月治疗299例患者，其中55%每月至少治疗100例LLT患者。总体而言，约8%的医生报告他们的患者超过一半的时间拒绝任何LLT；相比之下，超过两倍（约23%）的医生报告患者在一半以上的时间内拒绝注射LLT。患者减少LLT的最常见原因是对生活方式改变的偏好（82%），对潜在副作用的担忧（83%）和一般不想服药（75%）。减少注射的最常见原因是成本/保险原因（73%）和害怕/注射不舒服（73%）。大多数心脏病专家（55%）和pcp（57%）报告说，由于需要花费时间进行管理教育，当处方pcsk9时，患者的咨询时间比口服llt要长。在接受调查的患者中，医生认为二级预防患者，有LLT经验的患者，以及对ASCVD风险了解更多的患者（与一级预防相比，LLT-naïve和对其风险了解较少的患者）具有更高的LLT依从性。在接受调查的400名美国医生中，报告了一些达到最佳脂质管理的障碍。其中包括与一般LLT相比，更多的患者拒绝注射LLT，拒绝的原因不同，以及医生在开始治疗时对时间和资源限制的担忧。结果表明，患者、临床医生和系统障碍都可能阻碍LDL-C管理和依从性。需要进一步的研究来了解感知障碍与现实世界行为之间的关系，以更好地为脂质管理优化提供信息。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. Sections of Journal of clinical lipidology will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.