LIpid Response to Statins ± Ezetimibe In Mumbai (LIRIM): A Cross-sectional Observational Study

Area of Science:

• Cardiovascular Medicine
• Pharmacology
• Lipid Metabolism

Background:

• India faces a high burden of cardiovascular disease (CVD), with underachievement of lipid-lowering goals, particularly low-density lipoprotein cholesterol (LDL-C), post-percutaneous coronary intervention (PCI).
• Ethnic variations in statin response necessitate careful dosing, with lower doses often used in Asian populations to achieve target LDL-C levels.

Purpose of the Study:

• To determine the specific doses of statin (atorvastatin/rosuvastatin) with or without ezetimibe needed to achieve European Society of Cardiology (ESC) LDL-C goals (<55 mg/dL) in Indian patients with established atherosclerotic cardiovascular disease (ASCVD).
• To evaluate the effectiveness of high-intensity statin therapy plus ezetimibe in reaching target lipid levels in a real-world Indian cohort.

Main Methods:

• A retrospective, single-center, observational study in Mumbai involving 542 patients with established ASCVD.
• Patients achieving LDL-C goals (<55 mg/dL) at initial visit or follow-up were analyzed.
• Focus on rosuvastatin 40 mg ± ezetimibe 10 mg (R40 ± E10) for patients not meeting LDL-C goals (>55 mg/dL) on prior therapy.

Main Results:

• Following treatment with R40, 42.16% achieved LDL-C <55 mg/dL; with R40 + E10, 43.28% achieved this goal.
• Non-high-density lipoprotein cholesterol (non-HDL-C) <85 mg/dL was achieved by 39.3% with R40 and 47.4% with R40 + E10.
• Approximately 20% of patients on high-intensity statin ± ezetimibe therapy failed to reach their LDL-C and non-HDL-C goals.

Conclusions:

• A significant proportion (around 20%) of high-risk Indian ASCVD patients on dual therapy (statin ± ezetimibe) do not achieve optimal LDL-C goals.
• The findings suggest a need to consider additional therapies, such as bempedoic acid, PCSK9 inhibitors, or inclisiran, to address residual cardiovascular risk.
• Further research is required to establish the most effective treatment regimens for lipid management in this specific patient population in India.