(P159) ACCESS TO HEALTHCARE, PREVENTIVE LIPID-LOWERING THERAPY, AND CHARACTERISTICS AT PRESENTATION IN A CONTEMPORARY POPULATION OF YOUNG ADULTS WHO GO ON TO DEVELOP PREMATURE CORONARY ARTERY DISEASE

Background: Guidelines on cardiovascular prevention are continuously evolving to improve risk assessment and facilitate preventive treatment of patients with high cardiovascular risk. However, rates of premature coronary artery disease (CAD) have remained stagnant in the past two decades. The objectives of the study were to characterize pre-presentation treatment with lipid-lowering therapy (LLT) in a contemporary population of patients with premature obstructive CAD.

METHODS AND RESULTS: In this retrospective cohort study, we included all women < 55 years old and men < 50 years old in British Columbia (BC) who newly presented with obstructive CAD (stenosis ≥ 50%) or underwent coronary revascularization between 2000 and 2017. Data were obtained from Population Data BC and Cardiac Services BC registry and included demographics, outpatient visits, hospitalizations, and prescription medication dispenses during the 3 years prior to first CAD presentation, as well as details of invasive coronary angiography. In total, 14,470 patients (29.7% females) met the study criteria. Over 96.5% of patients were eligible for lipid screening 3 years before presentation with CAD. More than 93% had visits with primary care physicians, and 57% had visits with specialist physicians (Figure 1A). LLT was initiated in 20% of patients (23% females vs 20% males, p< 0.001). More than half of them discontinued treatment, were not adherent to the treatment, or filled prescriptions for LLT only once before presenting with CAD (Figure 1B). Rates of treatment initiation were different for urban regions compared to rural (21.0% vs 16.7%, p< 0.001) and varied between five regional health authorities of BC (Figure 1C). Most treated patients were initially prescribed moderate (77.8%) or low (13.6%) intensity statins. In 3.7% of patients the therapy was later intensified. Patients who received LLT had a higher prevalence of hypertension, hyperlipidemia, diabetes, and obesity (Table 1), and a greater plaque burden as determined by the number of vessels with stenoses ≥50%. Treated patients also presented with CAD at an older age, were less likely to present with an acute coronary syndrome (54.1% vs 79.0%, p< 0.001), and were less likely to require revascularization (65.4% vs 77.7%, p< 0.001).

Conclusion: Despite nearly universal eligibility for screening and availability of care, only one in five patients with premature CAD started LLT prior to presentation. Despite being used in those with higher risk, primary preventive treatment was associated with a later onset of disease, less severe disease presentation, and lesser need for revascularization.