Clinical inertia in lipid screening and prescribing statins for primary prevention: Experience from a low-to-middle income country

Abstract

Introduction: Most adults who should be screened for dyslipidemia do not undergo lipid testing in low- to middle-income countries due to lack of resources and clinical inertia. Those eligible for statin therapy for cardiovascular disease (CVD) prevention are under treated possibly due to clinical inertia. This study aimed to find out the present lipid screening practices and prescribing of statins for primary prevention in a low- to middle-income country. Methods: This study was conducted at medical wards of Colombo South Teaching Hospital in patients with a first-time acute coronary syndrome (ACS), who have not been on treatment with statins and not diagnosed with dyslipidemia prior to this admission. Eligibility for lipid screening was assessed using U.S. preventive services task force recommendations. CVD risk prior to ACS was assessed by QRISK2 score. Lipid profile was done within 24 h. Results: Out of 125 participants, 70.4% had a QRISK2 >10 and were eligible for statins prior to their first episode of ACS. Eighty-four percent have not had a lipid screening and 91.4% were not aware of the need for it. 54.4% were not aware that the elevation of certain types of cholesterol leads to ACS. Of 125 patients (100 males/25 females), mean age 55.78 (26–82). Body mass index >23kg/m2 in 65.6%. 65.6% had some lipid abnormality. Total cholesterol >200 in 29.6%, low-density lipoprotein cholesterol >130 in 28.8%, triglyceride >150 in 31.2%, high-density lipoprotein cholesterol suboptimal in 67.2%. Discussion: Lipid screening is suboptimal. Most patients who were eligible for statins based on their CVD risk prior to their first episode of ACS, were not receiving statins prior to their first ACS. Patients should have their CVD risk estimated and statins should be given to eligible patients for prevention of ACS.