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Missed Opportunities in Implementation and Optimization of Lipid-Lowering Therapies in Very-High-Risk Patients

Kristen Kopp1, Lukas Motloch1,2, Alexander Berezin1,3

  • 1Department of Internal Medicine II, Division of Cardiology, Paracelsus Medical University, 5020 Salzburg, Austria.

Journal of Clinical Medicine
|September 9, 2023
PubMed

Insights

Lipid-lowering therapy (LLT) is underutilized in ST-segment elevation myocardial infarction (STEMI) patients, especially very-high-risk individuals. Poor low-density lipoprotein cholesterol (LDL-C) target achievement highlights significant gaps in current cardiovascular care delivery.

Area of Science:

  • Cardiovascular Medicine
  • Clinical Cardiology
  • Public Health

Background:

  • ST-segment elevation myocardial infarction (STEMI) represents a critical cardiovascular event requiring aggressive secondary prevention.
  • European guidelines emphasize stringent low-density lipoprotein cholesterol (LDL-C) targets for very-high-risk patients post-STEMI.
  • Lipid-lowering therapy (LLT) is a cornerstone of secondary prevention to reduce recurrent cardiovascular events.

Purpose of the Study:

  • To assess real-world implementation of lipid-lowering therapy (LLT) in ST-segment elevation myocardial infarction (STEMI) patients.
  • To evaluate low-density lipoprotein cholesterol (LDL-C) target achievement in very-high-risk STEMI populations.
  • To identify deficits in care delivery impacting LLT optimization and LDL-C control.

Main Methods:

  • Retrospective analysis of 910 STEMI patients treated between 2018-2020 at a tertiary center.
  • Stratification of patients into very-high-risk cohorts based on European guidelines.
  • Descriptive analysis of LLT use (statin intensity, combination therapy) and LDL-C levels at the time of STEMI.

Main Results:

  • Prevalence of high-intensity statin use and ezetimibe combination therapy was low (<22% and <6% respectively) among very-high-risk patients.
  • A significant proportion of very-high-risk patients (27-73%) were not on any LLT, despite managing hypertension and/or diabetes.
  • Less than 22% of very-high-risk patients achieved the recommended LDL-C target (<55 mg/dL) at the time of STEMI.

Conclusions:

  • Severe underutilization and suboptimal implementation of LLT were observed in STEMI patients, particularly those at very-high risk.
  • Poor LDL-C target attainment underscores critical gaps in secondary prevention strategies and care delivery.
  • Urgent improvements in LLT optimization are necessary to mitigate recurrent cardiovascular events in this high-risk population.

Keywords:
ESC/EAS guidelinesLDL-CSTEMIlipid-lowering therapyvery-high risk

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