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Achieving optimal lipid goals in patients with coronary artery disease
Dean G Karalis1, Raghunandan Dudda Subramanya, Scott E Hessen
1Cardiology Consultants of Philadelphia, Philadelphia, PA, USA. dean.karalis@drexelmed.edu
Insights
Most coronary artery disease patients meet basic low-density lipoprotein (LDL) cholesterol goals, but few reach intensive targets. Many still have high triglycerides or low high-density lipoprotein (HDL) cholesterol, indicating a need for more aggressive lipid management.
Area of Science:
- Cardiology
- Lipid Metabolism
- Public Health
Background:
- Current guidelines emphasize intensive low-density lipoprotein (LDL) cholesterol reduction for coronary artery disease (CAD) patients.
- Prior research indicates suboptimal achievement of LDL goals and persistent dyslipidemia (high triglycerides, low high-density lipoprotein [HDL] cholesterol) in many high-risk individuals.
- Real-world data is crucial to assess current lipid management practices and goal attainment in CAD populations.
Purpose of the Study:
- To evaluate the achievement of lipid goals in a large, real-world cohort of patients with coronary artery disease (CAD).
- To identify patient subgroups less likely to achieve lipid targets.
- To assess the current utilization of combination lipid-lowering therapy.
Main Methods:
- Retrospective review of electronic medical records from 10,040 patients with CAD.
- Data collected from a large cardiology subspecialty practice between September 2008 and September 2009.
- Analysis of achievement rates for LDL cholesterol, non-HDL cholesterol, triglyceride, and HDL cholesterol goals.
Main Results:
- 79% of patients achieved LDL cholesterol <100 mg/dL, but only 35% reached <70 mg/dL.
- Non-HDL cholesterol goals were met by 79% (<130 mg/dL) and 44% (<100 mg/dL).
- Normal triglyceride levels were achieved by 69%; normal HDL cholesterol levels were achieved by 63% of men and 56% of women. Women and younger men were less likely to achieve their lipid goals.
- Combination lipid-lowering therapy was infrequently used.
Conclusions:
- While most CAD patients attain a minimal LDL cholesterol goal, aggressive targets (<70 mg/dL) remain largely unmet.
- A significant proportion of treated CAD patients exhibit persistent dyslipidemia, including elevated triglycerides and low HDL cholesterol.
- There is a substantial opportunity to improve lipid management by more aggressively applying guideline-recommended therapies, including combination treatments, to achieve optimal lipid levels.
Abstract:
Guidelines for lipid-lowering therapy recommend intensive low-density lipoprotein (LDL) cholesterol lowering for patients with coronary artery disease. Previous studies have found that many high-risk patients are not achieving their LDL cholesterol goals, and many patients, despite being treated with lipid-lowering therapy, also have elevated triglycerides or low levels of high-density lipoprotein (HDL) cholesterol. To evaluate lipid goals in a "real world" clinical setting, the electronic medical records of 10,040 patients with coronary artery disease from a large cardiology subspecialty practice from September 2008 to September 2009 were reviewed. Overall, 79% of patients achieved an LDL cholesterol goal of <100 mg/dl, while only 35% achieved the more aggressive goal of <70 mg/dl. Non-HDL cholesterol goals of <130 and <100 mg/dl were achieved in 79% and 44% of patients, respectively. Only 69% achieved normal triglyceride levels, and only 63% of men and 56% of women achieved normal levels of HDL cholesterol. Women and younger men were less likely to achieve their lipid goals. In conclusion, most patients with coronary artery disease achieve the minimal LDL cholesterol goal of 100 mg/dl, but few achieve the more aggressive goals of <70 mg/dl. Many high-risk patients have elevated levels of triglycerides or low levels of HDL cholesterol despite treatment. Combination lipid-lowering therapy is used infrequently in practice. There exists a significant opportunity for physicians to more aggressively treat lipids to achieve the levels recommended by clinical guidelines.
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