Use of Lipid-modifying Therapy and LDL-C Goal Attainment in a High-Cardiovascular-Risk Population in the Netherlands

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Public Health

Background:

• High-cardiovascular-risk populations require effective lipid-modifying therapy (LMT) for secondary prevention.
• Attaining low-density lipoprotein cholesterol (LDL-C) goals is crucial in managing cardiovascular disease (CVD).
• Real-world data on LMT utilization and goal attainment in diverse high-risk groups are essential for clinical practice improvement.

Purpose of the Study:

• To investigate the utilization of lipid-modifying therapy (LMT).
• To assess low-density lipoprotein cholesterol (LDL-C) goal attainment.
• To evaluate these outcomes in a real-world, high-cardiovascular-risk population in the Netherlands.

Main Methods:

• A cohort of 61,839 patients aged ≥18 years with an LDL-C measurement in 2012 was selected from the PHARMO Database Network.
• Patients were classified into high-cardiovascular-risk categories: familial hypercholesterolemia (FH), recent acute coronary syndrome (ACS), coronary heart disease, ischemic stroke, peripheral arterial disease, and diabetes mellitus.
• LMT use and LDL-C goal attainment (<100 mg/dL) were assessed at the index date.

Main Results:

• Overall, 67% of patients received LMT, with usage varying by risk category (e.g., 77% for ACS, 53% for FH).
• Standard-potency statins were most prescribed; 55% of patients attained an LDL-C goal <100 mg/dL.
• Among LMT users, goal attainment varied by therapy type: high-potency statins (69%), standard-potency statins (70%), and nonstatin LMTs (20%).

Conclusions:

• Modest LMT use in this high-risk cohort resulted in 46% failing to achieve LDL-C goals <100 mg/dL.
• Underuse and suboptimal use of LMTs highlight significant opportunities for quality improvement.
• Targeted interventions are needed to optimize LMT strategies and reduce future cardiovascular events.