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Achievement Rates for Low-Density Lipoprotein Cholesterol Goals in Patients at High Risk of Atherosclerotic
Hironobu Mitani1, Kota Suzuki1, Junya Ako2
1Medical Affairs Division, Novartis Pharma K.K.
Insights
Low-density lipoprotein cholesterol (LDL-C) goal achievement remains low for high-risk secondary prevention patients, even with intensive statin and ezetimibe combination therapy. Real-world data highlights challenges in meeting lipid targets for atherosclerotic cardiovascular disease prevention.
Area of Science:
- Cardiology
- Pharmacotherapy
- Public Health
Background:
- The 2017 Japan Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases (JAS GL2017) established new low-density lipoprotein cholesterol (LDL-C) goals.
- Real-world data is crucial for assessing the effectiveness of LDL-C-lowering therapies in achieving these updated guidelines.
- Understanding goal achievement rates informs clinical practice and patient management strategies for cardiovascular disease prevention.
Purpose of the Study:
- To evaluate low-density lipoprotein cholesterol (LDL-C) goal achievement rates in patients undergoing LDL-C-lowering therapy.
- To analyze achievement rates based on different risk categories defined by the Japan Atherosclerosis Society Guidelines (JAS GL2017).
- To assess the impact of specific lipid-lowering treatments, including statin monotherapy and combination therapy with ezetimibe, on LDL-C goal attainment.
Main Methods:
- Retrospective analysis of real-world data from the Medical Data Vision claims database (July 2018 - June 2021).
- Patients were stratified into three groups based on JAS GL2017 risk categories: primary prevention high risk (Group I, LDL-C <120 mg/dL), secondary prevention (Group II, LDL-C <100 mg/dL), and secondary prevention high risk (Group III, LDL-C <70 mg/dL).
- Lipid-lowering treatments, including intensive statin monotherapy and statin-ezetimibe combinations, were analyzed for their association with LDL-C goal achievement.
Main Results:
- Overall LDL-C goal achievement rates were 65.5% (Group I), 60.6% (Group II), and 25.4% (Group III).
- Intensive statin monotherapy showed achievement rates of 83.9%, 75.3%, and 29.5% across Groups I, II, and III, respectively.
- Statin and ezetimibe combination therapy improved achievement rates to 82.3%, 86.4%, and 46.4% in Groups I, II, and III, respectively, though rates remained low in high-risk secondary prevention patients, including those with familial hypercholesterolemia (32.5% in Group III).
Conclusions:
- A significant proportion of patients, particularly those in the high-risk secondary prevention group (Group III), do not achieve their LDL-C goals.
- While statin and ezetimibe combination therapy improves LDL-C goal attainment compared to monotherapy, it is insufficient for many high-risk patients.
- Further strategies are needed to optimize lipid-lowering therapy and improve LDL-C goal achievement in high-risk populations to reduce atherosclerotic cardiovascular disease risk.
Aims:
The study aimed to investigate low-density lipoprotein cholesterol (LDL-C) goal achievement rates in patients receiving LDL-C-lowering therapy using recent real-world data, following the 2017 revision of the Japan Atherosclerosis Society Guidelines for Prevention of Atherosclerotic Cardiovascular Diseases (JAS GL2017).
Methods:
Patients with documented LDL-C test results were extracted from the Medical Data Vision claims database between July 2018 and June 2021 and divided into three groups according to JAS GL2017: primary prevention high risk (Group I, LDL-C goal ＜120 mg/dL), secondary prevention (Group II, LDL-C goal ＜100 mg/dL), and secondary prevention high risk (Group III, LDL-C goal ＜70 mg/dL).
Results:
The mean LDL-C value was 108.7 mg/dL (n=125,235), 94.4 mg/dL (n=57,910), and 90.6 mg/dL (n=33,850) in Groups I, II, and III, respectively. Intensive statin monotherapy (pitavastatin, rosuvastatin, or atorvastatin) was the most frequently prescribed lipid-lowering treatment (21.6%, 30.8%, and 42.7% in Groups I, II, and III, respectively), followed by ezetimibe (2.5%, 7.1%, and 8.5% in Groups I, II, and III, respectively). LDL-C goals were achieved by 65.5%, 60.6%, and 25.4% of patients overall in Groups I, II, and III, respectively. Achievement rates were 83.9%, 75.3%, and 29.5% in patients prescribed intensive statin monotherapy and 82.3%, 86.4%, and 46.4% in those prescribed statin and ezetimibe combinations in Groups I, II, and III, respectively. In Group III, the proportion of patients with familial hypercholesterolemia prescribed statin and ezetimibe combinations achieving LDL-C goals was low (32.5%).
Conclusions:
The proportion of patients achieving LDL-C goals for secondary prevention in the high-risk group remains low even with statin and ezetimibe combination therapy.
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