Unused potential of lipid-lowering therapy in very high-risk patients with atherosclerotic cardiovascular disease. A...

Area of Science:

• Cardiology
• Pharmacology
• Public Health

Background:

• Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death in Europe.
• Current guidelines recommend strict low-density lipoprotein cholesterol (LDL-C) targets (<55 mg/dL) for very high-risk patients.
• Achievement of these LDL-C targets remains suboptimal despite lipid-lowering therapy (LLT) and lifestyle interventions.

Purpose of the Study:

• To evaluate the utilization and adjustments of LLT in ASCVD patients who exceeded LDL-C target levels upon hospital admission.
• To assess LLT use and lifestyle recommendations at hospital discharge for ASCVD patients.
• To identify potential barriers to achieving LDL-C treatment goals in a real-world clinical setting.

Main Methods:

• Retrospective analysis of 1091 ASCVD patients (angina pectoris, acute myocardial infarction, chronic ischemic heart disease, peripheral artery disease) with LDL-C >100 mg/dL between January 2017 and February 2020.
• Examination of LLT use at admission and discharge, including statins, ezetimibe, and PCSK9 inhibitors.
• Analysis of lifestyle and nutritional advice provided to patients.

Main Results:

• 51% of ASCVD patients were not on LLT at admission.
• At discharge, 91% received statin prescriptions and 87% received lifestyle advice.
• High-intensity statin use varied by ASCVD type (62-92%).
• Use of ezetimibe (16%) and PCSK9 inhibitors (1%) was low.
• 25% of patients on high-intensity statins still had insufficient dosages.

Conclusions:

• There is a low uptake of intensified lipid-lowering strategies, including high-intensity statins, ezetimibe, and PCSK9 inhibitors, in chronic ASCVD patients.
• Despite increased statin use at discharge, target LDL-C levels were frequently not achieved.
• Optimizing LLT intensity and adherence is crucial for improving cardiovascular outcomes in high-risk ASCVD populations.