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Disparities in achieving low-density lipoprotein cholesterol goals after revascularization in a diverse real-world
Garred S Greenberg1, Daniel Lorenzatti1, Annalisa Filtz1
1Cardiology Division, Montefiore Health System/Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY 10467, USA.
Insights
Many patients with atherosclerotic cardiovascular disease (ASCVD) undergoing revascularization lack timely low-density lipoprotein cholesterol (LDL-C) testing, hindering lipid-lowering therapy (LLT) use. Female and non-Hispanic Black patients were less likely to achieve LDL-C goals.
Area of Science:
- Cardiology
- Public Health
- Health Services Research
Background:
- Atherosclerotic cardiovascular disease (ASCVD) management relies on low-density lipoprotein cholesterol (LDL-C) reduction via lipid-lowering therapies (LLT).
- Optimal LDL-C testing and LLT utilization are crucial for secondary prevention in high-risk ASCVD patients.
Purpose of the Study:
- To evaluate the patterns of LDL-C testing and LLT use in a diverse, real-world cohort of patients with ASCVD who underwent revascularization.
- To identify factors associated with achieving target LDL-C levels (<70 mg/dL).
Main Methods:
- Retrospective cohort study of 6,405 patients undergoing percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or peripheral artery disease (PAD) revascularization (2018-2023).
- Data extracted from electronic health records; multivariable logistic regression used to assess associations.
- Follow-up LDL-C testing rates, time to testing, and achievement of LDL-C goals were analyzed.
Main Results:
- 67% of patients had follow-up LDL-C testing, with a median time of 11 months; only 35% tested within 6 months.
- Early LDL-C testing was linked to increased use of high-intensity statins, ezetimibe, and PCSK9 inhibitors.
- 52% achieved LDL-C <70 mg/dL; female sex (OR 0.70) and non-Hispanic Black race/ethnicity (OR 0.57) were associated with lower achievement rates.
Conclusions:
- A significant proportion of revascularized ASCVD patients lack timely follow-up LDL-C testing, impacting LLT effectiveness.
- Achievement of LDL-C goals remains suboptimal, with disparities observed in female and non-Hispanic Black populations.
- Strategies are needed to improve LDL-C monitoring and LLT adherence, particularly in underrepresented groups.
Aims:
Low-density lipoprotein cholesterol (LDL-C) testing and the use of lipid-lowering therapies (LLTs) both reduce risk in patients with atherosclerotic cardiovascular disease (ASCVD). This study aims to assess LDL-C testing and the utilization of LLT in a diverse real-world cohort.
Methods And Results:
This retrospective cohort study assessed 6405 patients who underwent percutaneous coronary intervention (PCI), coronary artery bypass graft (CABG), or a peripheral artery disease (PAD) revascularization between 2018 and 2023 at a New York City health system. Patient-level data were extracted from the electronic health record. Multivariable logistic regression analyses were employed to evaluate associations. Overall, 4319 patients (67%) had a follow-up LDL-C test. The median time to follow-up LDL-C testing was 11 months, with 35% having follow-up testing within 6 months. Early LDL-C testing (within 6 months) was associated with higher utilization of high-intensity statins, ezetimibe, and proprotein convertase subtilisin/kexin type 9 inhibitors (PCSK9i) monoclonal antibodies (mAbs). At follow-up, 2259 (52%) patients had an LDL-C < 70 mg/dL (1.8 mmol/L). Female sex (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.61, 0.80) and non-Hispanic Black race/ethnicity (OR 0.57; 95% CI 0.49, 0.67) were independently associated with a lower likelihood of achieving a follow-up LDL-C < 70 mg/dL (1.8 mmol/L) after multivariable adjustment.
Conclusion:
Among patients with ASCVD who underwent revascularization, a large proportion did not have follow-up LDL-C testing, and in those who did, testing was delayed. Only half of patients achieved LDL-C levels below 70 mg/dL (1.8 mmol/L), with female and non-Hispanic Black patients less likely to attain this goal.
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