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Inadequate Intensification of LDL-cholesterol lowering therapy after coronary revascularization: Insights from the
Benjamin E Peterson1, Deepak L Bhatt2, Christie M Ballantyne3
1St Elizabeth Heart and Vascular Institute, Edgewood, KY, USA; University of Kentucky College of Medicine, USA.
Insights
Patients with prior coronary revascularization need better LDL-C lowering strategies. Despite intensive lipid-lowering therapy, few achieved goals, highlighting the need for improved cardiovascular event reduction approaches.
Area of Science:
- Cardiology
- Lipid Metabolism
- Preventive Cardiology
Background:
- Patients with prior coronary revascularization face elevated risks of cardiovascular events and mortality.
- Lowering low-density lipoprotein cholesterol (LDL-C) post-revascularization is crucial for risk reduction.
Purpose of the Study:
- To compare LDL-C lowering therapies in patients with and without prior coronary revascularization.
- To evaluate baseline and 24-month follow-up lipid-lowering therapy (LLT) strategies and LDL-C levels within the GOULD registry.
Main Methods:
- Analysis of a prospective multicenter cohort study (GOULD registry).
- Comparison of baseline and 24-month follow-up data on LDL-C levels and LLT intensity.
- Evaluation of treatment strategies, including PCSK9 inhibitors (PCSK9i).
Main Results:
- Patients with prior revascularization (43.8%) had lower baseline LDL-C and more intensive LLT.
- At 24 months, LDL-C reductions were modest and similar between groups; intensive LLT increased in both.
- PCSK9i showed similar LDL-C reductions irrespective of revascularization status.
Conclusions:
- Few patients, even with prior revascularization, achieved the target LDL-C <70 mg/dL.
- LLT intensification was infrequent over 24 months, indicating suboptimal management.
- Enhanced systems-based and personalized strategies are essential to improve LDL-C lowering and reduce cardiovascular events in high-risk patients.
Background:
Patients with a history of coronary revascularization are at a higher risk for subsequent cardiovascular events and all-cause mortality. Lowering LDL-cholesterol (LDL-C) levels post-revascularization significantly reduces these risks.
Methods:
This analysis compared LDL-C-lowering therapies at baseline and over time among patients with and without prior coronary revascularization in the GOULD registry (a prospective multicenter cohort study). Baseline- and 24-month follow-up characteristics-including LDL-C levels and strategies for lipid-lowering therapy (LLT)-were evaluated.
Results:
Out of 5006 patients, 2195 (43.8%) had prior coronary revascularization. At baseline, these patients had lower LDL-C (99.2 mg/dL vs. 102.5 mg/dL; p < 0.001) and were more likely to be on intensive LLT (52.8% vs. 42.7%; p < 0.001). At 24 months, they had small reductions in LDL-C (-15.6% vs. -13.7%; p = 0.145) and were more likely to be on intensive LLT (61.9% vs. 51.5%; p < 0.001). Similar LDL-C reductions were observed in the PCSK9i group regardless of revascularization status.
Conclusions:
Despite slightly better baseline LLT among patients with prior revascularization, few patients met the <70 mg/dL goal and LLT was rarely escalated during 24 months of follow-up. Improved systems-based strategies and personalized treatment approaches are urgently needed to enhance LDL-C lowering and reduce cardiovascular events, especially in patients with a history of coronary revascularization.
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