Introduction: Lipid-lowering therapies (LLTs), including statins and proprotein
convertase subtilisin/kexin type 9 inhibitors (PCSK9is), are used to manage elevated
low-density lipoprotein cholesterol (LDL-C). Over time, LLT prescribing patterns have
been shaped by evolving guidelines. However, national data on LLT utilisation
patterns and the quality of lipid control in Kuwait remain unknown.
Methods: This thesis comprised three nationwide quantitative studies conducted
across healthcare settings governed by the Ministry of Health in Kuwait. First, a
retrospective, repeated cross-sectional study utilising data from the Central Medical
Store (CMS) was conducted to quantify utilisation trends of LLTs over an 11-year
period (2012–2022). Second, a nationwide, cross-sectional design among patients
attending primary healthcare centres (PHCCs) was employed to evaluate LLT
prescribing patterns and assess the extent of lipid control. Third, a retrospective
cohort study utilising routinely collected dispensing data from a tertiary cardiac care
centre was performed to evaluate the real-world effectiveness of PCSK9is between
2016 and 2022. All data were analysed using descriptive statistics and regression
methods, as appropriate.
Results: At the national level, findings from the CMS data demonstrated a significant
overall increase in both utilisation and expenditure trends of LLTs. Utilisation,
measured by number of supplied units per thousand inhabitants per year, rose by
52% (n= 71,839), from 138,549 in 2012 to 210,388 in 2022, while defined daily doses
per thousand inhabitants per day increased by 119% (n= 62.2), from 52.4 in 2012 to
114.6 in 2022. Statins accounted for the increase in utilisation. At the PHCC level,
findings from the cross-sectional study showed that most patients were prescribed
statins (98.8%, n= 429/434). Lipid control was suboptimal, with only 20.4% (n=
65/318) achieving LDL-C targets across all cardiovascular (CV) risk categories. At the
tertiary care level, the real-world effectiveness study showed that PCSK9is significantly reduced LDL-C levels (n=104) by 41.9% (95% CI: -50.9% to -24.1%,
p
| Date of Award | 27 Apr 2026 |
|---|
| Original language | English |
|---|
| Awarding Institution | - University Of Strathclyde
|
|---|
| Sponsors | Kuwait Cultural Office / EMBASSY OF THE STATE OF KUWAIT |
|---|
| Supervisor | Amanj Kurdi (Supervisor) & Marion Bennie (Supervisor) |
|---|