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Estimate of Brazilians Under Secondary Prevention of Cardiovascular Events Who Do Not Achieve LDL Cholesterol Targets

Andressa Braga1, Marisa Santos1, Carlos Magliano1,2

  • 1Instituto Nacional de Cardiologia Núcleo de Avaliação de tecnologias em saúde, Rio de Janeiro, RJ - Brasil.

Arquivos Brasileiros De Cardiologia
|August 20, 2025
PubMed

Insights

Many patients undergoing secondary cardiovascular prevention in Brazil do not reach the recommended low-density lipoprotein cholesterol (LDL-c) target. This highlights a need for additional LDL-c-lowering therapies for approximately 1.15 million individuals.

Area of Science:

  • Cardiovascular Medicine
  • Public Health
  • Pharmacotherapy

Background:

  • The 2017 Brazilian Guideline recommends a low-density lipoprotein cholesterol (LDL-c) target of <50 mg/dL for secondary cardiovascular prevention.
  • Statin therapy with ezetimibe is the initial approach; additional pharmacotherapy is indicated if targets are unmet.

Purpose of the Study:

  • To estimate the number of patients in secondary cardiovascular prevention not achieving recommended LDL-c targets in Brazil.
  • Utilized data from public and supplementary health systems, alongside epidemiological data and expert consensus.

Main Methods:

  • Combined population data from Brazilian Unified Health System (SUS) and supplementary health insurance.
  • Employed the Delphi method with 29 and 24 specialists in two rounds.
  • Estimated the size of the population not achieving LDL-c targets.

Main Results:

  • Estimated secondary prevention population: 5.8 million (SUS) and 1.2 million (supplementary).
  • Projected 1 million SUS patients and 150,000 supplementary patients will not reach LDL-c targets with current oral therapy.
  • Approximately 9% to 19% of patients are not achieving target LDL-c levels.

Conclusions:

  • A significant proportion of patients under secondary prevention do not meet LDL-c goals.
  • These patients represent candidates for advanced LDL-c-lowering treatments.
  • The findings underscore the need for intensified lipid-lowering strategies in Brazil.
Abstract

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