Abstract

Introduction: Dyslipidemia, particularly elevated serum low-density lipoprotein cholesterol (LDL-C), plays a crucial role in the development and progression of atherosclerosis. This study aimed to determine the rate of LDL-C non-achievement according to the European Society of Cardiology/European Atherosclerosis Society 2019 (ESC/EAS 2019) guidelines and related factors in the elderly.

Methods: This was a cross-sectional study involving 555 individuals (age 69.30 ± 6.54, male/female ratio 4.55/1) in an outpatient clinic in Ca Mau province from October 2020 to June 2021. Demographic information, medical history, clinical characteristics, and tested cholesterol, including LDL-C level, were collected to assess cardiovascular risk and determine factors related to LDL-C control status.

Results: The non-achievement rate of the LDL-C goal in participants was 77.1%. In the adjusted model, factors associated with an increased risk of non-achievement of the LDL-C goal were non-adherence to treatment (odds ratio (OR) 7.75, 95% confidence interval (CI) 3.65-16.47, p < 0.001), being at very high risk (OR 15.48, 95% CI 6.34-37.76, p < 0.001), and at high risk (OR 4.03, 95% CI 2.20-7.40, p < 0.001). Conversely, factors related to a decreased risk were exercise (OR 0.53, 95% CI 0.30-0.95, p = 0.032) and a history of myocardial infarction or unstable angina (OR 0.192, 95% CI 0.05-0.72, p = 0.014), or coronary revascularization (OR 0.20, 95% CI 0.08-0.48, p < 0.001).

Conclusions: The rate of non-achievement in the LDL-C goal among participants was notable. Non-adherence to treatment and classification as high to very high risk were identified as factors associated with an increased risk of non-achievement of LDL-C, while regular exercise was linked to a decreased risk. This study emphasizes the necessity of an aggressive strategy for high and very high-risk groups with a comprehensive approach incorporating pharmacological and non-pharmacological individual treatment for achieving the LDL-C target.

Introduction

Viet Nam is experiencing a rapid increase in its aging population, making it one of the fastest-aging countries in the world. In 2019, the percentage of individuals aged 60 and above in Viet Nam was 11.9%. Projections indicate that by 2038, this figure is expected to increase significantly to 20.2%1. As individuals age, the prevalence of chronic conditions tends to increase. A systematic review and meta-analysis of 83 studies conducted between 2000 and 2020 revealed that in Vietnam, the estimated prevalence of hypertension is 6.0%, while the prevalence of type 2 diabetes stands at 25%. Additionally, the study found that among individuals aged 65-74, the prevalence of those having more than four out of nine major cardiovascular risk factors (hypertension, diabetes, dyslipidemia, obesity, smoking, excessive alcohol intake, unhealthy diet, physical inactivity, and stress) was 28.3% for women and 36.2% for men2. Notably, cerebrovascular disease and ischemic heart disease are the leading causes of mortality in Viet Nam3. Dyslipidemia, particularly elevated serum low-density lipoprotein cholesterol (LDL-C), plays a crucial role in the development and progression of atherosclerosis4, 5. According to the Framingham study, every 1% increase in LDL-C levels is associated with a 2% increase in the risk of developing coronary artery disease over 6 years6. Controlling LDL-C is a key measure of the overall risk of death and cardiovascular events. In 2019, the European Society of Cardiology and the European Society of Atherosclerosis (ESC/EAS 2019) published updated recommendations that offer a comprehensive approach to managing lipid levels, placing particular emphasis on achieving the target LDL-C based on cardiovascular risk stratification7. In South Asian countries, particularly Viet Nam, few studies have assessed the attainment of LDL-C goals and the associated factors. The objective of this study was to assess the rate of LDL-C non-attainment in elderly Vietnamese outpatients and identify the factors associated with this non-achievement.

Methods Study Design, Inclusion and Exclusion Criteria

The cross-sectional study was conducted in an outpatient clinic in Ca Mau province from October 2020 to June 2021. The inclusion criteria were as follows: elderly outpatients (≥ 60 years old) who voluntarily agreed to participate in the study and had been taking medication for dyslipidemia for at least 3 months. Exclusion criteria included: (1) cognitive impairment, severe dementia, or inability to communicate; (2) advanced cancer; (3) non-adherence to follow-up.

Procedure

From elderly outpatients who met the inclusion and exclusion criteria, we collected demographic and clinical information, including place of residence (urban or rural); smoking status (currently smoking or stopped 1 alcohol unit/day, equivalent to 300 mL beer or 60 mL hard liquor); exercise frequency (≥ 30 minutes/day and ≥ 5 days/week). Major cardiovascular risk factors were also recorded, including diabetes mellitus (DM)8; hypertension9; chronic kidney disease (CKD)10; atherosclerotic cardiovascular disease (ASCVD), including a history of previous acute coronary syndrome (ACS) (myocardial infarction (MI) or unstable angina), coronary revascularization (percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), and other arterial revascularization procedures), stroke or transient ischemic attack (TIA), and peripheral arterial disease. Cardiovascular risk stratification according to ESC/EAS 2019 included very-high risk, high risk, moderate risk, and low risk (Supplementary table). After that, fasting lipid profiles were measured by the clinic laboratory with standard processes and checked for accuracy by a biochemist. Participants were assessed to determine if they achieved the LDL-C goal based on risk stratification7.

Statistical Analysis

The data were analyzed using Statistical Product and Service Solutions (SPSS) software (version 22.0; IBM Corp., Armonk, NY, USA). The comparison of categorical variables employed the Chi-square test or Fisher’s exact test for small sample sizes, while continuous variables were compared using a t-test. The multivariable logistic regression model included variables with p

Ethics Declarations

The study protocol received approval from the Ethics Committee of the University of Medicine and Pharmacy at Ho Chi Minh City (reference number: 763/ĐHYD-HĐĐĐ), and each participant provided written informed consent.

Table 1.

General characteristics of the participants

Characteristics All (n = 555) Male (n = 455) Female (n = 100) p-value Age (years) 69.30 ± 6.54 69.22 ± 6.71 69.67 ± 5.77 0.536# Age group 0.171* 60-69 328 (59.1) 275 (60.4) 53 (53.0) ≥ 70 227 (40.9) 180 (39.6) 47 (47.0) Living Location 0.117* Urban 446 (80.4) 360 (79.1) 86 (86.0) Rural 109 (19.6) 95 (20.9) 14 (14.0) BMI (kg/m 2 ) 24.49 ± 2.78 24.60 ± 2.77 24.00 ± 2.77 0.052# BMI subgroups 0.057* 4 (0.7) 4 (0.9) 0 (0.0) 18.5-22.9 156 (28.1) 122 (26.8) 34 (34.0)