Digital health interventions for lipid management in atherosclerotic cardiovascular disease: a systematic review and meta-analysis of randomised controlled trials

Background: Atherosclerotic cardiovascular disease (ASCVD) remains the leading cause of morbidity and mortality worldwide. Lipid management is a key component of secondary prevention, but the majority of patients fail to achieve low-density lipoprotein cholesterol (LDL-c) goals. Digital health may serve as an innovative and cost-effective approach to improve lipid control, but a systematic quantitative synthesis is lacking. This study aimed to evaluate the effect of digital health interventions on LDL-c reduction and lipid target attainment in patients with ASCVD. Methods: A systematic search was performed in Medline, Embase, CINAHL, and CENTRAL from inception to May 27, 2025. Randomised controlled trials (RCTs) evaluating the effect of digital health interventions in patients with ASCVD and reporting lipid outcomes were included. The primary outcomes were change in mean LDL-c and achievement of lipid control (LDL-c < 1.8 mmol/L). Pooled estimates were calculated using random-effects models. Heterogeneity was assessed using the I2 statistic, and publication bias was assessed by visual inspection of a funnel plot and Egger’s test. The Cochrane Risk of Bias 2 was used to evaluate risk of bias. The protocol was registered with PROSPERO (CRD42024575196). Findings: Of the 4997 records identified, 18 RCTs from 11 regions (n = 12,970) were included in the systematic review. Risk of bias was scored as high across all included trials. Overall, digital health was associated with greater reductions in LDL-c compared with usual care [mean difference (MD) = −0.10 mmol/L (95% CI −0.17 to −0.04); p = 0.003; I2 = 74%]. No evidence of publication bias was detected. Lipid control was also improved [risk ratio (RR) = 1.15 (95% CI 1.03–1.28); p = 0.02; I2 = 57%]. In subgroup analyses, multi-component interventions showed the greatest reduction in LDL-c [MD = −0.22 mmol/L (−0.38 to −0.07); I2 = 78%], compared to SMS-only interventions [MD = −0.03 mmol/L (−0.14 to 0.08); I2 = 70%], SMS combined with supportive material [MD = −0.05 mmol/L (−0.14 to 0.03); I2 = 36%], and smartphone applications [MD = −0.07 mmol/L (−0.21 to 0.06); I2 = 47%], although differences between delivery modes were not statistically significant (p = 0.21). Self-reported medication adherence was slightly improved in the digital health group compared with controls [RR = 1.08 (1.00–1.16); p = 0.04; I2 = 88%]. In addition, digital health was associated with a reduced risk of hospitalisation [RR = 0.64 (0.50–0.81); p < 0.001; I2 = 18%]. Interpretation: Our findings suggest that digital health interventions can support LDL-c reduction and lipid control in patients with ASCVD. Multi-component interventions were most effective, particularly when combined with high-frequency delivery, bidirectional communication, and telemonitoring. High heterogeneity and high risk of bias were observed across studies, and LDL-c reduction was not a primary outcome in most trials, warranting careful interpretation. Nevertheless, digital health shows potential for integration in lipid management, and warrants future research to optimise effectiveness and support implementation in clinical practice. Funding: Innovative Health Initiative Joint Undertaking.