ArticleJournal of Korean medical science2026
Physician Disagreement With Guidelines as a Critical Barrier to Achieving LDL-C Targets in Very High-Risk Patients: An Implementation Science Study.
Article in Journal of Korean medical science, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundWe aimed to investigate the challenges Korean physicians face in assisting their high-risk atherosclerotic cardiovascular disease (ASCVD) patients in achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) levels.
methodsWe performed a prospective, implementation science study including 704 patients at very high risk of ASCVD with baseline LDL-C ≥ 70 mg/dL (1.8 mmol/L) while receiving maximally tolerated statins and/or ezetimibe for secondary prevention between 2020 and 2022. The primary evaluation criteria were the proportions of participants achieving LDL-C < 70 mg/dL at each visit. The secondary evaluation criteria included the proportions of participants in diverse situations associated with guideline adoption.
resultsThe proportions of participants achieving LDL-C < 70 mg/dL at visits 2 (week 6-16) and 3 (week 18-30) were 56.3% and 58.7%, respectively. Among 307 patients on maximally tolerated statins and 397 patients on maximally tolerated statins and ezetimibe at baseline, physicians did not have an intention to intensify the lipid-lowering treatment regimen of 171 patients (55.7%) and 299 patients (75.3%) at visit 1, respectively. In both groups, physician disagreement with the guidelines was the major reason for not adopting the recommended therapy (70.8% and 46.2%, respectively), followed by patient refusal for reasons other than the cost, medical limitations such as comorbidities, and drug costs.
conclusionThis implementation science study for secondary prevention involving very high-risk ASCVD patients revealed that the proportion of patients achieving LDL-C < 70 mg/dL via lipid-lowering therapy was less than 60%. The main reason for not adopting the recommended LDL-C-lowering therapy was physician disagreement with the guidelines.
trial registrationClinical Research Information Service Identifier: KCT0005488.
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