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LDL cholesterol target attainment in cardiovascular high- and very-high-risk patients with statin intolerance: a

Julius L Katzmann1, Paulina E Stürzebecher2, Silvia Kruppert3

  • 1Klinik und Poliklinik für Kardiologie, Universitätsklinikum Leipzig, Leipzig, Germany. julius.katzmann@medizin.uni-leipzig.de.

Scientific Reports
|January 3, 2024
PubMed

Insights

Statin intolerance (SI) hinders LDL-C target achievement. Alternative therapies like ezetimibe and bempedoic acid significantly increase the likelihood of reaching lipid goals in high-risk patients with SI.

Area of Science:

  • Cardiology
  • Pharmacology
  • Public Health

Background:

  • Statin intolerance (SI) is a significant barrier to achieving guideline-recommended low-density lipoprotein cholesterol (LDL-C) targets.
  • Patients experiencing SI necessitate alternative lipid-lowering therapies (LLT) to manage hypercholesterolemia and reduce cardiovascular risk.
  • Electronic medical records (EMR) provide valuable data for defining and analyzing patient populations with SI.

Purpose of the Study:

  • To simulate LDL-C target achievement using oral LLT (ezetimibe, bempedoic acid) in patients with SI.
  • To assess the effectiveness of ezetimibe and bempedoic acid as monotherapies and in combination for SI patients.
  • To evaluate the proportion of high and very-high cardiovascular risk patients achieving LDL-C targets with alternative LLT.

Main Methods:

  • A simulation study utilizing representative data from 2.06 million German outpatients.
  • SI was defined using literature-informed criteria applied to EMR data.
  • LDL-C target achievement was simulated with stepwise addition of ezetimibe and bempedoic acid in patients with hypercholesterolemia and high/very-high cardiovascular risk.

Main Results:

  • 8.6% of 130,778 eligible patients met the SI definition; only 7.7% achieved LDL-C targets at baseline.
  • Simulated treatment with ezetimibe and bempedoic acid increased LDL-C target achievement to 22.6% and 52.0%, respectively.
  • Combination therapy with ezetimibe and bempedoic acid demonstrated substantial potential for increasing LDL-C reductions in SI patients.

Conclusions:

  • Oral LLT, including ezetimibe and bempedoic acid, can significantly improve LDL-C target attainment in patients with SI and high cardiovascular risk.
  • The combination of ezetimibe and bempedoic acid offers a promising strategy for managing hypercholesterolemia in patients intolerant to statins.
  • These findings highlight the importance of alternative LLT in achieving cardiovascular risk reduction goals for patients with SI.

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