Knowledge Gaps and Nonadherence Among Japanese Patients with Atherosclerotic Cardiovascular Disease.

Abstract

Aim: Reducing low-density lipoprotein cholesterol (LDL-C) levels is crucial for preventing atherosclerotic cardiovascular disease (ASCVD). Recommended lipid-lowering therapy (LLT) includes both oral (e.g., statins) and injectable agents. However, patient awareness of LDL-C management and adherence to it remain uncertain.

Methods: This cross-sectional study surveyed 415 Japanese patients with ASCVD using a web-based platform. The participants reported their understanding of LDL-C target values and the effects of LLT. Medication adherence was evaluated using the Extent of Nonadherence scale, and a binomial logistic regression analysis was performed to identify the factors associated with nonadherence.

Results: Approximately 58.1%-60.2% of the participants reported confidence in knowing their correct lipid target values and managing dyslipidemia appropriately. However, only 22.2% reported LDL-C targets of ＜50 or ＜70 mg/dL, and 43.4% believed their targets to be ＜50, ＜70, or ＜100 mg/dL. In contrast, 56.7% either reported LDL-C targets of ＜120, ＜140, or ＜160 mg/dL or did not know their targets. Regarding LLT, 65.8% were unaware that extreme lowering of LDL-C levels with LLT had no disadvantages, and 74.2% were unaware that injectable LLTs were available. Overall, 39.0% of the participants were nonadherent. Higher out-of-pocket costs (≥ 3,001 yen; adjusted odds ratio [OR]: 1.83, p = 0.024) and experience with self-injections (adjusted odds ratio: 2.34, p = 0.027) were significantly associated with nonadherence.

Conclusions: Our findings highlight a considerable gap in patient knowledge and adherence to dyslipidemia management strategies. Interventions that promote patient education and shared decision-making are essential for improving adherence and achieving optimal LDL-C targets.