The article analyzes data from clinical studies on the efficacy and safety of azilsartan medoxomil/chlorthalidone combination and its components. According to the analyzed sources, both individual components and their combination have proven their efficacy and safety in patients with hypertension, including those with comorbid pathology. Azilsartan medoxomil demonstrated greater efficacy with comparable safety in terms of lowering blood pressure, both office and ambulatory, compared to candesartan, valsartan, olmesartan. Chlorthalidone showed greater hypotensive efficacy compared to hydrochlorothiazide and proved its protective effect in cardiovascular risk reduction. The combination of azilsartan medoxomil/chlorthalidone, in turn, has proven its safety and greater hypotensive efficacy compared to both the combination of olmesartan medoxomil/hydrochlorothiazide and azilsartan medoxomil/hydrochlorothiazide.

Despite the existing recommendations for the diagnosis and treatment of arterial hypertension, a wide selection of antihypertensive drugs, the efficacy of treatment of arterial hypertension remains low. The main cause for unsatisfactory control of arterial hypertension is patients’ non-adherence to treatment, which adversely affects the prognosis for cardiovascular complications. The first step in increasing adherence to antihypertensive therapy is to determine its level. There are various methods characterized by their accessibility and accuracy for assessing adherence. There are several categories of factors influencing the level of adherence. Identifying the cause in a subsequent patient is a significant step in reducing adherence to antihypertensive therapy. In addition, it’s necessary to use strategies to increase adherence to antihypertensive therapy, including both “simplification” of the treatment regimen and strengthening the doctor-patient interaction. The aim of this consensus is to summarize and supplement knowledge about the prevalence of adherence to antihypertensive therapy in patients with arterial hypertension, methods for assessing the level of adherence, the reasons for low adherence to the treatment of arterial hypertension and approaches to improving adherence to antihypertensive medications.

The article is focused on the issues of poor patient adherence to medication treatments, including antiplatelet drugs, its reasons, and solutions for overcoming compliance barriers. As of today, treatment adherence remains low leading to a higher risk of cardiovascular complications. Poor adherence to acetylsalicylic acid (ASA) treatment is mainly linked to a relatively frequent development of gastrointestinal side effects. The solutions for overcoming this problem include the use of lowest effective doses and the development of different acetylsalicylic acid (ASA) formulations: enteric coated and buffered. The efficacy and safety of these formulations are compared in the article. Buffered formulation (e.g. ASA + magnesium hydroxide) is similar to plain ASA as regards its antiplatelet activity and the prevalence of "aspirin- resistance", while its intake is associated with a lower risk of enteropathy and gastropathy as compared to plain and even enteric coated ASA. This is particularly important for patients with obesity and diabetes mellitus, as these conditions are associated with an affected rate of absorption from the small intestine. Based on the study findings a conclusion is made that buffered ASA should be the preferred formulation for use. The literature review is illustrated by a clinical case. KEYWORDS: chronic ischemic heart diseases, secondary prevention, adherence to therapy, acetylsalicylic acid, antiaggregant therapy, acetylsalicylic acid buffered and enteric coated formulations, aspirin-resistance. FOR CITATION: Ageev F.T., Smirnova M.D., Fofanova T.V. Poor patient adherence to medication treatments and solutions for overcoming compliance barriers as illustrated by antiplatelet therapy. Russian Medical Inquiry. 2023;7(1):56–61 (in Russ.). DOI: 10.32364/2587-6821- 2023-7-1-56-61.

BACKGROUND:Maintaining sustained adherence to medication for optimal management of chronic noninfectious diseases, such as atherosclerotic vascular disease, is a well-documented therapeutic challenge.OBJECTIVE:The DIAPAsOn study was a 6-month, multicenter prospective observational study in the Russian Federation that examined adherence to a preparation of highly purified omega-3 polyunsaturated fatty acids (Omacor) in 2167 adult patients with a history of recent myocardial infarction or endogenous hypertriglyceridemia.METHODS:A feature of DIAPAsOn was the use of a bespoke electronic patient engagement and data collection system to monitor adherence. Adherence was also monitored by enquiry at clinic visits. A full description of the study's aims and methods has appeared in JMIR Research Protocols.RESULTS:The net average reduction from baseline in both total and low-density lipoprotein cholesterol was approximately 1 mmol/L and the net average increase in high-density lipoprotein cholesterol was 0.2 (SD 0.53) mmol/L (P<.001 for all outcomes vs baseline). The mean triglyceride level was 3.0 (SD 1.3) mmol/L at visit 1, 2.0 (SD 0.9) mmol/L at visit 2, and 1.7 (SD 0.7) mmol/L at visit 3 (P<.001 for later visits vs visit 1). The percentage of patients with a triglyceride level <1.7 mmol/L rose from 13.1% (282/2151) at baseline to 54% (1028/1905) at the end of the study. Digital reporting of adherence was registered by 8.3% (180/2167) of patients; average scores indicted poor adherence. However, a clinic-based enquiry suggested high levels of adherence. Data on health-related quality of life accrued from digitally engaged patients identified improvements among patients reporting high adherence to study treatment, but patient numbers were small.CONCLUSIONS:The lipid and lipoprotein findings indicate that Omacor had nominally favorable effects on the blood lipid profile. Less than 10% of patients enrolled in DIAPAsOn used the bespoke digital platform piloted in the study, and the level of self-reported adherence to medication by these patients was also low. Reasons for this low uptake and adherence are unclear. Better adherence was recorded in clinical reports.TRIAL REGISTRATION:ClinicalTrials.gov NCT03415152; https://clinicaltrials.gov/ct2/show/NCT03415152.

Aim . To evaluate the contribution of subclinical atherosclerosis to the stratification of patients with a SCORE risk of cardiovascular events (CVEs) <5% based on a 10-year follow-up. Material and methods . The study included 379 patients with SCORE risk of CVEs <5% (82 men, 297 women). In 2009, all patients underwent clinical examination, carotid artery (CA) ultrasound with the detection of plaques, total CA occlusion, intima-media thickness (IMT) of the common carotid artery (CCA). The plaque number was determined as the total number of all plaques in 6 following segments: both CCAs, both CCA bifurcations and both internal carotid arteries. The total stenosis was calculated as the sum of stenoses in 6 CA segments in %. In 2019, a telephone survey of patients was conducted with a questionnaire assessing the following CVEs: all-cause death, cardiovascular death, myocardial infarction (MI), stroke, myocardial revascularization, cardiovascular hospitalizations, and composite endpoint. Results . The initial patients’ age ranged from 35 to 67 years (51,1±7,5 years). Plaques from 20% to 50% were detected in 303 participants (79,94%). Over the past 10 years, there have been 5 cardiovascular deaths (1,3%), 7 MIs (1,8%), 5 cases of unstable angina (1,3%), 12 cases of myocardial revascularization (3,2%), 15 strokes (4,0%), 51 cardiovascular hospitalizations (13,5%). The proportion of patients with registered endpoints (CVE+) was 22,4% (n=85). The groups of patients with and without CVEs differed in the level of systolic blood pressure (BP) and blood triglycerides, and did not differ in the level of diastolic BP, lipid profile, glucose, heart rate, smoking status, sex, and age. In the CVE+ group, there were higher values of CCA IMT (0,65 (0,64; 0,70) mm vs 0,62 (0,62; 0,66) mm, p<0,05), total CA stenosis (102,5 (88,1; 120,8)% vs 80 (72,5; 88,1)%, p=0,01), and the CA plaque amount (4,0 (2,8; 3,9) vs 3,0 (2,6; 3,1), p=0,01), respectively. Total CA stenosis was an independent predictor of CVEs when adjusted for sex, age, systolic and diastolic BP (β=0,149; p<0,05), but not for lipid profile. A ROC-analysis revealed a cut-off point for total CA stenosis of 82,5% (AUC=0,598, 95% confidence interval 0,5243-0,673, p<0,05). Conclusion . The total CA stenosis has shown itself to be an independent predictor of CVEs in patients with a SCORE risk <5%.

Background, objectives and methods DIAPAsOn was a 6-month prospective observational multicenter study in the Russian Federation that examined adherence to a preparation of highly purified omega-3 polyunsaturated fatty acids (OMACOR) in adult patients with a history of recent myocardial infarction or endogenous hypertriglyceridemia. A full description of the study’s aims and methods has appeared in JMIR Res Protoc. A feature of DIAPAsOn was the use of a bespoke electronic patient engagement and data collection system.Results The net average reduction from baseline in both total and low-density lipoprotein cholesterol was approximately 1 mmol/L and the net average increment in high-density lipoprotein cholesterol was 0.2±0.53 mmol/L. Mean triglyceride levels declined by ∼1.3 mmol/, from an initial level of 2.99±1.29 mmol/L to 1.67± 0.67 mmol/L. The percentage of patients with triglyceride <1.7 mmol/L rose from 13.1% at baseline to 54% at study-end.Digital reporting of adherence was registered by 8.3% of patients (n=180) and average scores indicted poor adherence. However, clinic-based enquiry suggested high levels of adherence.Data on health-related quality of life accrued from digitally-engaged patients identified improvements among patients reporting high adherence to study treatment, but patient numbers were small.Conclusions The lipid and lipoprotein findings indicate that OMACOR had nominally favorable effects on the blood lipid profile. Less than 10% of patients enrolled in DIAPAsOn used the bespoke digital platform piloted in the study and the level of self-reported adherence to medication by those patients was also low. Reasons for this low uptake and adherence are unclear. Better adherence was recorded by clinical report.### Competing Interest StatementGPA has not received any educational grants from any companies and has not received any fees or non-financial support from healthcare companies related to this study. GPA reports receiving honoraria for professional lectures at regional/national medical educational events from healthcare companies, including Abbott, Bayer, Boehringer Ingelheim, Servier. AGA has not received any educational grants from any companies and has not received any fees or non-financial support from healthcare companies related to this study. AGA reports receiving honoraria for professional lectures at regional/national medical educational events from healthcare companies, including Abbott, Bayer, Boehringer Ingelheim, Servier. FTA does not have any conflicts of interest. TVF does not have any conflicts of interest. ### Clinical TrialNCT03415152### Funding StatementThe study is supported by Abbott.### Author DeclarationsI confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained.YesThe details of the IRB/oversight body that provided approval or exemption for the research described are given below:Ethical oversight of the DIAPAsOn study was exercised by the Ethics Committee of Pirogov Russian National Research Medical University(Moscow, Russian Federation).I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).YesI have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll relevant data are within the paper and its Supplementary Materials.

Background. Adherence in cardiological patients is a leading challenge due to a high society burden imposed by cardiovascular diseases (CVDs) through morbidity, reduced life expectancy, disability and high mortality rates in population. Despite the availability of highly effective medicines and high-technology care, the success of CVD treatment remains insufficient. A particular focus should be placed on patients with previous coronary artery bypass grafting (CABG).Objectives. A review of reasoning for non-adherence to medication and non-medication management in post-CABG patients and current methods influencing it.Methods. Russian-language and foreign literature was mined in the eLibrary and PubMed databases with the query keywords “medication adherence” [приверженность терапии], “coronary artery disease” [ишемическая болезнь сердца], “coronary artery bypass surgery” [коронарное шунтирование], “coronary revascularisation” [вторичная профилактика после коронарного шунтирования]. The review included papers published within 2016–2020, as well as selected relevant publications from 2003–2015, to cover 52 sources irrespective of study design and language. Content and descriptive analyses were used as research tools.Results. Coronary heart disease (CHD) poses an important health, social and economic problem worldwide as a leading cause of reduced life expectancy, disability and high mortality. Non-compliance with medication significantly bursts medical expenditures [1]. Coronary artery bypass grafting is used widely to treat multivessel coronary lesions both in stable and acute CHD. Secondary preventive techniques successfully preclude adverse post-CABG events, but adherence to post-CABG treatment is often low. The non-adherence rationale rarely links to a single factor but is rather complex and multifaceted. It includes social and economic reasons, systemic health care or personnel, therapy and patient-related factors. Methods are developing and refining to improve adherence to both non-medication and medication interventions.Conclusion. Clinical trials to improve secondary prevention adherence in patients after coronary artery bypass grafting will allow a wider implementation of relevant methods in outpatient management of this patient category.

Background. Adherence in cardiological patients is a leading challenge due to a high society burden imposed by cardiovascular diseases (CVDs) through morbidity, reduced life expectancy, disability and high mortality rates in population. Despite the availability of highly effective medicines and high-technology care, the success of CVD treatment remains insufficient. A particular focus should be placed on patients with previous coronary artery bypass grafting (CABG). Objectives. A review of reasoning for non-adherence to medication and non-medication management in post-CABG patients and current methods influencing it. Methods. Russian-language and foreign literature was mined in the eLibrary and PubMed databases with the query keywords “medication adherence” [приверженность терапии], “coronary artery disease” [ишемическая болезнь сердца], “coronary artery bypass surgery” [коронарное шунтирование], “coronary revascularisation” [вторичная профилактика после коронарного шунтирования]. The review included papers published within 2016–2020, as well as selected relevant publications from 2003–2015, to cover 52 sources irrespective of study design and language. Content and descriptive analyses were used as research tools. Results. Coronary heart disease (CHD) poses an important health, social and economic problem worldwide as a leading cause of reduced life expectancy, disability and high mortality. Non-compliance with medication significantly bursts medical expenditures [1]. Coronary artery bypass grafting is used widely to treat multivessel coronary lesions both in stable and acute CHD. Secondary preventive techniques successfully preclude adverse post-CABG events, but adherence to post-CABG treatment is often low. The non-adherence rationale rarely links to a single factor but is rather complex and multifaceted. It includes social and economic reasons, systemic health care or personnel, therapy and patient-related factors. Methods are developing and refining to improve adherence to both non-medication and medication interventions. Conclusion. Clinical trials to improve secondary prevention adherence in patients after coronary artery bypass grafting will allow a wider implementation of relevant methods in outpatient management of this patient category.

BACKGROUND:Sustained adherence and persistence with prescription medications is considered essential to achieve maximal treatment benefit for patients with major chronic, noncommunicable diseases such as hyperlipidemia and lipid-associated cardiovascular disease. It is widely documented, however, that many patients with these conditions have poor long-term adherence to their treatments. The population of Russia is affected by poor adherence in the same ways as populations elsewhere and continues to have high rates of cardiovascular disease.OBJECTIVE:The purpose of this study was to examine patient adherence to a prescription-only preparation of highly purified omega-3 polyunsaturated fatty acids (1.2 to 1 eicosapentaenoic acid to docosahexaenoic ratio, 90% purity) in a large sample of patients at risk for cardiovascular diseases using digital technology to monitor patient behavior and as an outreach facility for patient education and engagement.METHODS:We conducted a 6-month prospective observational study (DIAPAsOn) at >100 centers in the Russian Federation. A bespoke electronic data capture and patient engagement system were developed with a well-established Russian technology supplier that enables information obtained during clinic visits to be supplemented by remote patient self-reporting. Other aspects of the program included raising patients' awareness about their condition via educational materials available in personal patient accounts in the electronic system.RESULTS:From an initial cohort of 3000 patients, a safety population of 2572 patients (age: mean 60 years) with an equal proportion of men and women has been characterized. There was widespread concomitant cardiovascular pathology and commensurate use of multiple classes of cardiovascular medication, notably lipid-modifying and antihypertensive drugs. The program was completed by 1975 patients, of whom 780 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for secondary prevention after myocardial infarction and 1195 were prescribed highly purified omega-3 polyunsaturated fatty acid supplements for hypertriglyceridemia. Data collection and analysis have been completed.CONCLUSIONS:DIAPAsOn will provide insights into patient adherence with prescription-grade omega-3 polyunsaturated fatty acid therapy and perspectives on the role of mobile technology in monitoring and encouraging adherence to therapy.

Aim. To create an advanced algorithm for predicting cardiovascular events (CVE) in low/moderate risk patients using a complex of traditional and new factors.Material and methods. The study included 700 patients with Systematic Coronary Risk Evaluation (SCORE) <5%, examined in 20092010. In addition to standard investigations, blood biochemistry tests, including high-sensitivity C-reactive protein (hsCRP), and sphygmography were carried. In 2019, a follow-up phone call was made to participants to identify recent CVEs: cardiovascular death, myocardial infarction, unstable angina, stroke, revascularization. The response rate was 79,6% (n=557; men, 100; women, 457).Results. CVEs were observed in 48 (8,6%) patients. The risk of CVEs increases systolic blood pressure (SBP) >130 mmHg (odds ratio (OR), 1,9 (95% confidence interval (CI), 1,0-3,6)), hsCRP >2,3 mg/L (OR, cardio-ankle vascular index (CAVI) >8,05 (OR, 1,25 (95% CI, 1,0-1,6)). In patients with a combination of ≥2 lipid profile abnormalities, SBP >130 mm Hg, hsCRP >2,3 mg/L and pulse wave velocity >13 m/s, the probability of developing CVEs (including cardiovascular death) increases 3,55 times (95% CI, 1,32-7,67).Conclusion. Levels of pulse wave velocity, CAVI, urea and hsCRP should be considered as additional risk factors for CVE in patients with low/moderate risk, estimated using standard scales. Combinations of traditional and new risk factors demonstrate a cumulative effect.

Aim. To assess the contribution of anxiety (A) and depression (D) to the increased risk of cardiovascular events (CVEs) in patients with Systematic Coronary Risk Evaluation (SCORE) <5% according to 10-year follow-up.Material and methods. The work included 190 patients with SCORErisk <5%, examined in 2009-2010. In addition to the standard examination, a questionnaire was carried out using Hospital Anxiety and Depression Scale (HADS). In 2019, we contacted participants by telephone to identify CVEs over the past time: death from cardiovascular diseases (CVDs), acute myocardial infarction (MI), unstable angina, stroke, revascularization. The response was 86,3%.Results. CVEs occurred in 17 (10,2%) patients and included following outcomes: 3 deaths from CVDs, 6 acute MIs, 4 cases of unstable angina, 12 revascularizations. Patients with and without CVEs differed only in the depression level — 7 (5; 7) vs 5.0 (4; 5) points (p=0,0001). HADS-D score >6 increased the probability of CVEs — odds ratio (OR) 2,9 (1,1-7,7). In individuals with HADS-D score >6 and/or HADS-A score >7, the probability of CVEs increased — OR 4,9 (1,4-17,9). A combination of impaired two or more parameters of the lipid profile, systolic blood pressure >130 mm Hg and HADS-D score >6 and/or HADS-A score >7 increased the risk of CVE — OR 7,3 (2,48-21,36).Conclusion. Depression, including subclinical depression, is associated with an increased risk of CVEs in patients with a SCORE risk <5%.

Психологический статус больных и развитие сердечно-сосудистых осложнений у больных артериальной гипертонией с низким

Abstract Not only “classic” risk factors such as age, sex, smoking status, blood pressure (BP) and cholesterol (HS) levels, but also additional factors, one of which is the psychological status of the patient, need to be considered to improve the prediction of cardiovascular complications. This is especially true for low/moderate risk patients on the SCORE scale, whose risk of cardiovascular complications (CVC) is often underestimated. Aim To assess the contribution of psychological status of hypertensive patients and SCORE<5% to increase the risk of development of cardiovascular complications for a period of 10 years of observation. Materials and methods In 2009, 142 hypertensive patients with SCORE risk <5% (37 men and 105 women) in addition to the clinical examination, were interviewed on the HADS scale to assess the level of anxiety and depression. In 2019, these patients were interviewed by phone for CVC suffered over the past 10 years: all-cause mortality, cardiovascular death (CVD), fatal and nonfatal myocardial infarction (MI), stroke, revascularization, hospitalization for cardiac events. Results At the time of inclusion in the study, the age of the patients was 50, 9±8.2 years. At the first visit systolic BP (SBP) level was 130.0 (128.4; 133.7) mm Hg and diastolic BP (DBP) 80.0 (81.3; 84.5) mm Hg. The HS level was 6.1 (5.9; 6.3) mmol/L, triglycirides 1.4 (1.5:1.8) mmol/L, low dencity lipoproteins 3.8 (3.6; 4.0) mmol/L, high density lipoproteins 1.3 (1.4; 1.5) mmol/L. Level of anxiety (A) was 7.0 (7.0; 8.2) points, depression (D) – 5.7 (5.2; 6.2) points. The patients without the expressed symptom of D (0–7 points) – 76.8% (n=109), A (0–7 points) – 52% (n=74). The patients with clinically significant D (>11 points) – 8.5% (n=12), A (>11 points) – 18.3% (n=26). 2 CVD occurred in the observed group in 10 years (1.4%), 6 MI, 12 percutaneous coronary intervention (8 acute coronary syndrome), 4 strokes, 34 cardiovascular hospitalizations. 14 new onset cases of coronary artery disease (9.6%). Thus 31.7% of observed patients had CVC. Comparison of the initial data of the group with CVC with the group without CVC revealed a difference only in the level of D: 7.0 (5.6; 7.3) points in patients with CVC vs 5.0 (4.7; 5.8) p=0.04) – Fig. 1. The patients were comparable in sex and age. BP, lipid profile, glucose, heart rate, smoking status, levels of A did not differ significantly. Multi-factor regression analysis has demonstrated that depression levels D is an independent predictor of the development of complications in a model involving age, sex, BP, HS and A (β=0,218, p=0,03). Conclusion Level D is an independent risk factor development of CVC in hypertensive patients low/moderate risk on SCORE. Funding Acknowledgement Type of funding source: None

Abstract Background Long-term adherence to lipid-lowering treatment is a challenge. Purpose To develop a technical tool, an auto-call program, aimed to increase patient adherence to lipid-lowering therapy, and patient outcome in ambulatory care. Methods 919 ambulatory patients were studied, divided to three groups: with low or moderate risk of developing atherosclerosis complications (Group 1); with high or very high risk of atherosclerosis complications, but without coronary artery disease (CAD) symptoms (Group 2); patients with symptomatic CAD (Group 3). At baseline, patients were invited to participate in the auto-call program (call-reminder to take the medication); the duration of study was 1 year. 663 patients (71.3%) consented to auto-calls received, 256 patients (28.7%) declined auto-calls. These two groups were comparable according to age, gender, the presence of comorbidities, the level of baseline adherence to lipid-lowering therapy, and the level of anxiety and depression. Treatment adherence was evaluated using Morisky-Green Medication Adherence Scale. Results Group 1. After 1 year, the auto-call group showed a significantly higher degree of decrease in low-density lipoprotein cholesterol, LDL-C (p=0.001) and triglyceride, TG (p=0.002), and increase in high-density lipoprotein cholesterol, HDL-C (p=0.03) compared to the auto-call rejection group. Group 2. After 1 year, the auto-call group showed a significantly higher degree of decrease in total cholesterol, TC (p<0.02) and LDL-C (p<0.01), and increase in HDL-C (p=0.2) compared to the auto-call rejection group. Moreover, in the auto-call group, the baseline TC level was higher (6.4±1.5 mmol/l vs 6.0±1.4 mmol/l, p=0.03). Group 3. After 1 year, the auto-call group showed a significantly higher degree of decrease in TC (p<0.005) and TG (p<0.05). The degree of decline in LDL-C was higher in the auto-call group (−25.9 (−27.3; −17.0) vs −20.1 (−21.3; −0.2), however, non-significant. After 1 year, treatment adherence increased in the total cohort from 1.91 score (1.80; 2.02) to 2.6 score (2.52; 2.80), p<0.000001. However, in Group 3, a significant increase in scores from 2.0 (1.9; 2.2) to 3.0 (2.6; 3.1) was observed only in the auto-call group (p<0.00001). In Group 1 and Group 2, the increase in adherence did not depend on the presence or absence of auto-calls. It should be noted that adherence to therapy in patients of Group 3 was significantly higher at baseline (2.0 (1.9; 2.2) than in Group 1 (1.7 (1.6; 1.9), p<0.005) and Group 2 (1.9 (1.7; 2.1), p<0.05), respectively. Conclusions Utilizing a high-tech auto-call reminder tool in patients with hyperlipidemia and CAD was associated with increased adherence to lipid-lowering therapy, which, in turn, resulted in significant decrease in LDL-C compared to patients who declined to participate in the auto-call program. Funding Acknowledgement Type of funding source: None