Cardiovascular Risk Stratification and Low-Density Lipoprotein Cholesterol Target Achievement in Primary Health Care: A Cross-Sectional Study

Abstract

Background:

Cardiovascular diseases (CVDs) remain the leading cause of mortality in Brazil. Effective dyslipidemia management is essential for preventing major adverse cardiovascular events (MACE); however, previous studies have reported low rates of lipid target achievement and inadequate statin prescribing in primary health care (PHC) settings.

Objective:

To evaluate low-density lipoprotein cholesterol (LDL-C) target achievement and the appropriateness of statin prescriptions according to cardiovascular risk among patients receiving PHC in a medium-sized Brazilian city.

Methods:

This cross-sectional study was conducted in 18 PHC units in Rio do Sul, Santa Catarina, Brazil, between January 13 and May 30, 2025. The study included 180 adults aged 30-59 years of both sexes who had been followed for at least 6 months and had a lipid profile assessment within the previous year. Cardiovascular risk was estimated using the Framingham Risk Score. Data were analyzed using the chi-square, Mann-Whitney, and Kruskal-Wallis tests. Statistical significance was set at p < 0.05.

Results:

Among the 180 participants, 95 (52.7%) did not achieve LDL-C targets. LDL-C goal attainment was more frequent among low-risk (85.7%) and intermediate-risk (23.9%) individuals and less frequent among high-risk (15.1%) and very high-risk (0.0%) individuals. Cardiovascular risk was significantly associated with lipid control (p < 0.05). Median LDL-C was 106.8 mg/dL (Interquartile Range (IQR), 88.4-136.2), with significant differences across risk categories (p < 0.05). Among the 56 statin prescriptions identified, only 26 (46.4%) were consistent with guideline-recommended statin intensity.

Conclusion:

The low rate of LDL-C target achievement and the high prevalence of inadequate statin therapy highlight the need for more effective lipid management strategies and structured interventions in PHC.