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Low-density lipoprotein cholesterol goal attainment and mortality in ischaemic heart disease: a two-year
Ying Hui Mak1, Fionn Chua2, Xuan Han Koh3
1Department of Pharmacy, Changi General Hospital, Singapore.
Insights
Many high-risk cardiovascular patients struggle to reach low-density lipoprotein cholesterol (LDL-C) goals, highlighting gaps in lipid-lowering therapy (LLT). Achieving LDL-C < 1.8 mmol/L significantly reduced 24-month mortality in this cohort.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Achieving low-density lipoprotein cholesterol (LDL-C) targets is crucial for preventing atherosclerotic cardiovascular events.
- High-risk cardiovascular patients often exhibit suboptimal LDL-C goal attainment and inadequate lipid-lowering therapy (LLT) prescriptions.
Purpose of the Study:
- To evaluate LLT prescription patterns, LDL-C goal attainment, and cardiovascular mortality in high-risk patients in Singapore.
- To identify treatment gaps in lipid management among ischaemic heart disease (IHD) patients.
Main Methods:
- Prospective observational cohort study of 555 IHD patients admitted in 2020.
- Assessment of LLT prescriptions, LDL-C levels, and cardiovascular outcomes over a 24-month period.
- Multivariable Cox proportional hazards regression analysis.
Main Results:
- High-intensity statin use increased significantly from admission to discharge and remained high.
- Combination LLT prescriptions and use of second-line agents like ezetimibe increased over time.
- LDL-C goal attainment rates were 22.1% (< 1.4 mmol/L) and 47.2% (< 1.8 mmol/L).
- Achieving LDL-C < 1.8 mmol/L was associated with reduced 24-month all-cause mortality (HR 0.53).
Conclusions:
- Significant treatment gaps persist, with 80% of patients not achieving LDL-C goals.
- Statin monotherapy is insufficient for many high-risk patients.
- Enhanced strategies are imperative to improve LDL-C goal attainment and reduce cardiovascular mortality.
Introduction:
Achieving low-density lipoprotein cholesterol (LDL-C) levels is key to preventing atherosclerotic cardiovascular events. However, many high-risk cardiovascular patients still experience poor LDL-C goal attainment and receive suboptimal lipid-lowering therapy (LLT) prescriptions. Herein, we evaluated LLT prescription patterns, LDL-C goal attainment and cardiovascular mortality among this population group in Singapore.
Methods:
This prospective observational cohort study included 555 patients with ischaemic heart disease (IHD) admitted to the hospital in 2020. The LLT prescriptions, corresponding LDL-C levels and cardiovascular outcomes were assessed over a 24-month period.
Results:
Most participants were male (82.3%), with 48.5% identified as Chinese. High-intensity statin prescriptions increased from 45.4% at hospital admission to 87.1% at discharge and remained stable at approximately 80% at 6, 12, and 24 months post-discharge. Combination LLT prescriptions increased from 12.3% at discharge to 33.8% by 24 months. Ezetimibe was the most commonly prescribed second-line LLT (40.8%), followed by inclisiran (1.09%) and anti-proprotein convertase subtilisin/kexin type 9 monoclonal antibody therapies (0.87%). Over 24 months, LDL-C goal attainment rates were 22.1% for LDL-C < 1.4 mmol/L and 47.2% for LDL-C < 1.8 mmol/L. Multivariable Cox proportional hazards regression indicated that achieving LDL-C < 1.8 mmol/L goal was associated with a reduction in all-cause mortality at 24 months (hazard ratio 0.53, 95% confidence interval 0.30-0.94, P = 0.030).
Conclusion:
Treatment gaps in lipid management persist in 80% of the study population, indicating that statin monotherapy alone is insufficient to achieve LDL-C goals. Greater efforts to improve LDL-C goal attainment rates in high-risk cardiovascular patients are imperative.
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