Effects of sex and depression on achieving lipid reduction targets in patients at high-risk of coronary heart disease

Researchers have examined whether sex and depression might influence how effectively blood lipids are treated in high-risk heart disease patients. Lipids are blood fats that, amongst other substances, include cholesterol and triglycerides.

They looked at whether lipid levels were checked and if so whether guideline target levels for lipids were achieved through the prism of depression and sex in very high-risk patients. The team explored retrospective data available in the SAIL Databank, consisting of patients in Wales who underwent a PCI. Anonymised, individual-level data over a 6-year period were included in the study.

The study was supported by funding from Health Data Research UK and undertaken by the cardiovascular Population Data Science research team at Swansea University Medical School.

Read the full paper here – https://doi.org/10.1371/journal.pone.0264529

A brief background

In 2016 the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) published a guideline advising on target levels of lipids in patients with and at risk of heart disease. Patients who have had Percutaneous Coronary Intervention (PCI); a procedure to widen the arteries that supply oxygenated blood to the heart would be considered amongst the highest risk.

The European Society of Cardiology is a volunteer-led, not-for-profit medical society whose members are scientists, clinicians, nurses and allied professionals working in all fields of cardiology. The European Atherosclerosis Society’s purpose is to teach clinicians how to manage high lipid levels and how to prevent atherosclerosis – a condition whereby a build-up of plaque lines the walls of arteries, caused by lipids, which reduces blood flow and oxygen supply to the body’s organs.

Dr Libby Ellins

We asked the lead researcher tell us more about the study,

  • Why is this study needed?


We know that patients who have had a heart event are at high risk of having another. Management of risk factors such as lipids have been shown to reduce this risk. Recent joint guidelines from the ESC and EAS have considered new clinical trial evidence and recommended much lower targets, particularly in high-risk patients. Previous work has also shown that patients with depression who have heart disease are at greater risk of future events than those without depression. Also, females who are more likely to have depression than males, have worse outcomes post PCI. We wanted to see whether depression and sex influenced the likelihood of patients having lipid levels checked and achievement of guideline targets.


  • How did you use SAIL Databank to support your work?


The SAIL Databank enabled us to use hospital records to find patients who had undergone PCI between 2012 and 2017 and link these data with their GP records. This let us see who had had their lipid levels checked, what lipid lowering medications were prescribed and whether ESC/EAS guideline targets were achieved in the year after their procedure. It also allowed us to explore whether sex and depression might have influenced these outcomes.


  • What did the data tell you?


We found that patients who had depression prior to the PCI were less likely to have their lipid levels checked in the year following PCI, having taken into account other factors such as previous heart disease and diabetes. We also found that females with depression were the group least likely to have their lipid levels checked and to reach guideline targets. These targets have been set based on evidence showing that achievement of these levels lead to further reduction of the risk of future cardiac events such as heart attacks.


  • What are the potential implications for clinical practice because of this research?


This has identified a group of very high-risk patients who could potentially be at greater risk of future events as a consequence of suboptimal treatment and should benefit from improved lipid management to reduce this risk.

Read the full paper here – https://doi.org/10.1371/journal.pone.0264529