Achieving low-density lipoprotein cholesterol (LDL-C) targets is a cornerstone of secondary prevention for patients with established atherosclerotic cardiovascular disease. Despite clinical guidelines recommending aggressive lipid-lowering strategies, real-world data consistently show suboptimal LDL-C control. This study evaluated lipid profile management among secondary prevention patients across the country using the Spanish Primary Care Clinical Database (BDCAP), a nationally representative registry of electronic health records.
A repeated cross-sectional analysis was conducted from 2019 to 2023, including patients with prior diagnoses of ischaemic heart disease, stroke, or peripheral artery disease who received lipid-lowering therapy. Data on therapy type, LDL-C serum levels, and demographic and socioeconomic factors were analysed. Trends over time and differences between autonomous communities were examined.
In 2023, 1,565,429 patients received lipid-lowering therapy for secondary prevention (678.3 per 1,000 individuals attended), with higher rates among men. Only 33.7% of treated patients achieved LDL-C <70 mg/dl, and 65.6% reached LDL-C <100 mg/dl. Combination therapy was significantly more effective than monotherapy in achieving both LDL-C thresholds.
Regional disparities were notable. Treatment coverage ranged from 53.9% to 87.9% across autonomous communities, while the use of combination therapy varied from 15.7% to 36.7%. These differences were statistically significant (p<0.001 for both overall treatment and combination therapy). Patients with ischaemic heart disease were most likely to receive lipid- lowering therapy (82.1% in 2023), followed by those with a history of stroke (64.2%) and peripheral artery disease (56.7%). Regional differences were also evident in the achievement of LDL-C targets, with some communities consistently outperforming others in both treatment intensity and outcomes. Gender differences were also apparent, with women consistently less likely to achieve LDL-C targets, independent of disease prevalence.
In conclusion, a substantial proportion of secondary prevention patients in Spain do not meet LDL-C targets. Marked regional disparities in treatment coverage and effectiveness highlight the need for more intensive lipid management strategies, improved guideline adherence, and targeted interventions to address inequities in cardiovascular risk reduction across the country.