Related Experiment Video
Updated: May 15, 2025
Cell-free Biochemical Fluorometric Enzymatic Assay for High-throughput Measurement of Lipid Peroxidation in High Density Lipoprotein
Published on: October 12, 2017
Achievement of low-density lipoprotein cholesterol thresholds in very high-risk atherosclerotic cardiovascular
Elisa A Worledge1, Sarah J Billups1, Oliver J Titus1
1Department of Clinical Pharmacy, University of Colorado Anschutz Medical Campus Skaggs School of Pharmacy, Aurora, CO (Drs Worledge, Billups and Saseen, and Mr. Titus).
Insights
Only 21% of very high-risk patients achieved the new LDL-C goal of <55 mg/dL. This indicates a gap in implementing aggressive lipid-lowering strategies in real-world practice.
Area of Science:
- Cardiology
- Preventive Cardiology
- Health Services Research
Background:
- The 2022 ACC Expert Consensus Pathway recommends a lower LDL-C target (<55 mg/dL) for very high-risk ASCVD patients.
- European guidelines also support this aggressive LDL-C lowering strategy.
- Real-world data on the implementation of this new recommendation is limited.
Purpose of the Study:
- To assess the proportion of very high-risk ASCVD patients achieving an LDL-C <55 mg/dL.
- To identify characteristics differentiating patients who met the LDL-C goal from those who did not.
Main Methods:
- Retrospective cohort study of 8974 adult patients with very high-risk ASCVD.
- Data collected from January 1, 2023, to December 31, 2023, within a large academic health system.
- Very high-risk ASCVD defined by a major event and at least two high-risk conditions.
Main Results:
- Only 21.0% of patients achieved the target LDL-C <55 mg/dL.
- 39.5% achieved the prior guideline threshold of <70 mg/dL.
- Over half of the cohort were on high-intensity statin therapy.
Conclusions:
- Achievement of the <55 mg/dL LDL-C goal in very high-risk ASCVD patients is low within this academic health system.
- Current clinical practice lags behind the 2022 ACC recommendations for aggressive LDL-C reduction.
- Implementation of nonstatin therapies alongside statins may be insufficient.
Background:
The 2022 American College of Cardiology Expert Consensus Decision Pathway on the Role of Nonstatin Therapies recommended more aggressive management of low-density lipoprotein cholesterol (LDL-C) compared to the 2018 American Heart Association/American College of Cardiology/Multisociety Guideline. In congruence with European guidelines, a target LDL-C threshold of 55 mg/dL is recommended for patients with very high-risk atherosclerotic cardiovascular disease (ASCVD). Real-world status of the early implementation of this recommendation remains uncertain.
Objective:
To determine the proportion of patients with very high-risk ASCVD achieving an LDL-C <55 mg/dL and characterize differences between patients who did and did not achieve this LDL-C value.
Methods:
This retrospective cohort study evaluated patients between January 1, 2023, and December 31, 2023, who were ≥ 18 years old with very high-risk ASCVD from the University of Colorado Health system primary care practices. Very high-risk ASCVD was defined as a history of a major ASCVD event with at least 2 high-risk conditions.
Results:
A total of 8974 patients met inclusion criteria for very high-risk ASCVD. Of these, only 21.0% achieved an LDL-C <55 mg/dL, while 39.5% of patients achieved the previously recommended LDL-C threshold of <70 mg/dL. More than half of patients were prescribed a high-intensity statin-based regimen.
Conclusion:
Within a large, academic health-system, achievement of LDL-C threshold among patients with very high-risk ASCVD was low. Recommendations from the 2022 ACC Expert Consensus Decision Pathway that endorse more aggressive LDL-C lowering and emphasize nonstatin therapies as an adjunct to statins are not fully implemented in real-world clinical practice.
Related Concept Videos
01:25Blood Studies for Cardiovascular System III: Serum Lipid Profile
Serum lipids are fats and fatty substances in the blood and are crucial for various bodily functions, including energy storage, cellular structure, and hormone production. Serum lipids consist of cholesterol, triglycerides, and phospholipids.
Cholesterol is a soft, fat-like substance found in all body cells. It is crucial for producing hormones, vitamin D, and substances that aid...
01:20Lipid-Lowering Drugs: Statins and Miscellaneous Agents
01:18Lipids: Dietary Sources and Requirements
01:29Cholesterol: Significance and Regulation
Considering cholesterol and...
01:38Inflammation