Prevalence and factors associated with lipid-lowering medications use for primary and secondary prevention of cardiovascular diseases among Malaysians: the REDISCOVER study

Abstract

Background Lipid-lowering medications (LLM) are commonly used for secondary prevention, as well as for primary prevention among patients with high global cardiovascular risk and with diabetes. This study aimed to determine the prevalence of LLM use among high-risk individuals [participants with diabetes, high Framingham general cardiovascular (FRS-CVD) score, existing cardiovascular disease (CVD)] and the factors associated with it. Methods This is a cross-sectional analysis from the baseline recruitment (years 2007 to 2011) of an ongoing prospective study involving 11,288 participants from 40 rural and urban communities in Malaysia. Multiple logistic regression was used to identify characteristics associated with LLM use. Results Majority (74.2%) of participants with CVD were not on LLM. Only 10.5% of participants with high FRS-CVD score, and 17.1% with diabetes were on LLM. Participants who were obese (OR = 1.80, 95% CI: 1.15–2.83), have diabetes (OR = 2.38, 95% CI: 1.78–3.19), have hypertension (OR = 2.87, 95% CI: 2.09–3.95), and attained tertiary education (OR = 2.25, 95% CI: 1.06–4.78) were more likely to be on LLM. Rural residents had lower odds of being on LLM (OR = 0.58, 95% CI: 0.41–0.82). In the primary prevention group, participants with high FRS-CVD score (OR = 3.81, 95% CI: 2.78–5.23) and high-income earners (OR = 1.54, 95% CI: 1.06–2.24) had higher odds of being on LLM. Conclusions LLM use among high CVD-risk individuals in the primary prevention group, and also among individuals with existing CVD was low. While CVD risk factors and global cardiovascular risk score were positively associated with LLM use, sociodemographic disparities were observed among the less-educated, rural residents and low-income earners. Measures are needed to ensure optimal and equitable use of LLM.

Undertreatment and Underachievement of LDL-C Target among Individuals with High and Very High Cardiovascular Risk in the Malaysian Community

“…This study discovered that among the VHR participants, about 75.8% were not on LLT. Another local study by Baharudin et al reported a comparable finding where 74.2% of those with existing CVD were also not using any LLT [ 30 ]. In addition, in the present study, the majority of participants on LLT did not achieve LDL-C target levels for their respective risk categories, at the time of evaluation.…”

“…Baharudin et al highlighted the need for the LLT to be prescribed appropriately based on the patient’s clinical condition. With the proper prescription of LLT, those medically eligible subjects with socio-demographic disadvantages will have equal access to LLT, particularly for common LLT, such as statins, which are free to all Malaysian attending government healthcare facilities [ 30 ]. Furthermore, the poor achievement of the therapeutic LDL-C target from this study, particularly among those in the HR and VHR categories, emphasised an urgent need to improve the awareness of the general public and healthcare providers on the importance of early detection and efficient treatment of dyslipidaemia.…”

“…However, to the best of our knowledge, there has been no report on the prevalence of elevated LDL-C according to CVD risk categories. While the prevalence of LLT among Malaysian and HR individuals was previously described by local studies [ 29 , 30 ], the literature regarding the achievements of LDL-C treatment targets according to risk categories remains scarce. Thus, this study aimed to determine the prevalence of dyslipidaemia subtypes, including elevated LDL-C according to risk categories, the proportions of LLT use and the achievement of LDL-C treatment targets for HR and VHR individuals.…”

The Malaysian HEalth and WellBeing AssessmenT (MyHEBAT) Study Protocol: An Initiation of a National Registry for Extended Cardiovascular Risk Evaluation in the Community

“…Furthermore, through MyHEBAT, the participants were informed of their health status which made them aware of whether they have CVD risk or were at the borderline of having the risk. This is essential, as several studies have reported that Malaysians have poor awareness about their risks, diseases, treatment and medication, which could lead to poor control of their CVD risk factors [ 5 , 60 , 61 , 79 , 80 ]. Overall, evidence from the MyHEBAT study will bridge the gaps in the literature and guide academics, policy makers and the industry in their collaborative efforts to battle CVD risk, morbidity and mortality.…”

Physical Activity in Malaysia: Are We Doing Enough? Findings from the REDISCOVER Study

“…The study duration is 25 years, and data collection is repeated every three years. The methodology for the REDISCOVER Study has been published elsewhere [ 23 , 24 , 25 , 26 ], whereby specific methods were highlighted as relevant to the sub topics. In previous publications, the number of baseline data was different, as the baseline data collection was still ongoing.…”