What are the underlying factors contributing to the low achievement rate of target LDL levels in patients with coronary artery disease?

Abstract

Objective: Cardiovascular disease (CVD) is closely associated with traditional risk factors; however, the role of socioeconomic status (SES), as an important social determinant of health, has not been fully clarified. Understanding how SES contributes to cardiovascular risk may help identify and address health inequalities. In this study, we aimed to evaluate factors associated with failure to achieve target low-density lipoprotein (LDL) levels, with particular attention to socioeconomic status alongside conventional risk factors. Methods: Patients presenting to the outpatient clinic with acute coronary syndrome (ACS) were prospectively included. Data were collected through structured, face-to-face interviews. The relationship between LDL target attainment and clinical variables—including body mass index (BMI), age, sex, diabetes mellitus (DM), hypertension (HT), smoking status, family history, chronic kidney disease (CKD), chronic obstructive pulmonary disease (COPD), socioeconomic status, and place of residence—was analyzed. Results: Factors associated with failure to achieve target LDL levels were evaluated. Statistically significant associations were found for chronic kidney disease (CKD) (p<0.001), family history (p=0.005), and socioeconomic status (p=0.012). No significant associations were observed for the other variables examined. Conclusion: In addition to established clinical risk factors, socioeconomic status may be associated with failure to achieve target LDL levels, possibly reflecting differences in access to care, treatment adherence, and health literacy. However, as this association was not significant in multivariate analysis, it should be interpreted cautiously. These findings suggest that both clinical and social factors should be considered when addressing residual cardiovascular risk and improving lipid management.

Keywords

• coronary artery disease
• LDL target
• socioeconomic status
• health disparities

Koroner arter hastalığı olan hastalarda hedef LDL düzeylerine ulaşılamamasına katkıda bulunan temel faktörler nelerdir?

Abstract

Amaç: Kardiyovasküler hastalıkların (KVH) geleneksel risk faktörleriyle yakından ilişkili olduğu bilinmektedir; ancak sağlıkta sosyal belirleyicilerden biri olan sosyoekonomik statünün (SES) bu risk üzerindeki katkısı tam olarak açıklığa kavuşmamıştır. SES’in kardiyovasküler risk üzerindeki etkisinin daha iyi anlaşılması, sağlık eşitsizliklerinin belirlenmesi açısından önemlidir. Bu çalışmada, geleneksel risk faktörlerine ek olarak sosyoekonomik statü de dikkate alınarak, hedef düşük yoğunluklu lipoprotein (LDL) düzeylerine ulaşılamaması ile ilişkili faktörlerin değerlendirilmesi amaçlanmıştır. Yöntemler: Akut koroner sendrom (AKS) nedeniyle polikliniğe başvuran hastalar prospektif olarak çalışmaya dahil edilmiştir. Veriler, yapılandırılmış anket formları kullanılarak yüz yüze görüşmelerle toplanmıştır. LDL hedeflerine ulaşma durumu ile beden kitle indeksi (BKİ), yaş, cinsiyet, diyabetes mellitus (DM), hipertansiyon (HT), sigara kullanımı, aile öyküsü, kronik böbrek hastalığı (KBH), kronik obstrüktif akciğer hastalığı (KOAH), sosyoekonomik statü ve yaşanılan yer arasındaki ilişkiler analiz edilmiştir. Bulgular: Hedef LDL düzeylerine ulaşılamaması ile ilişkili faktörler değerlendirildiğinde, kronik böbrek hastalığı (p<0,001), aile öyküsü (p=0,005) ve sosyoekonomik statü (p=0,012) ile istatistiksel olarak anlamlı ilişkiler saptanmıştır. İncelenen diğer değişkenler ile anlamlı ilişki bulunmamıştır. Sonuç: Geleneksel klinik risk faktörlerine ek olarak, sosyoekonomik statü hedef LDL düzeylerine ulaşılamaması ile ilişkili olabilir ve bu durum sağlık hizmetlerine erişim, tedaviye uyum ve sağlık okuryazarlığı gibi faktörleri yansıtabilir. Ancak çok değişkenli analizde anlamlılık göstermemesi nedeniyle bu ilişkinin dikkatli yorumlanması gerekmektedir. Bulgular, kardiyovasküler riskin azaltılmasında klinik faktörlerin yanı sıra sosyal belirleyicilerin de göz önünde bulundurulması gerektiğini düşündürmektedir.

Keywords

• koroner arter hastalığı
• hedef LDL
• sosyoekonomik statü
• sağlık eşitsizlikleri.

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