Low density lipoprotein target achivement in very high and extreme cardiovascular risk patients during a cardiac...

Area of Science:

• Cardiology
• Preventive Cardiology
• Lipid Management

Background:

• Low Density Lipoprotein (LDL) cholesterol targets are frequently unmet in real-world settings, especially for patients with higher cardiovascular (CV) risk.
• Cardiac Rehabilitation (CR) programs offer a structured environment to manage CV risk factors.

Purpose of the Study:

• To assess the achievement of LDL cholesterol targets in very high and extreme CV risk patients upon completion of a CR program.
• To evaluate trends in LDL target attainment over time within a CR program cohort.

Main Methods:

• Analysis of 940 patients with coronary syndrome enrolled in a CR program from January 2012 to December 2023.
• Defined LDL targets varied by date and risk category (<70 mg/dL, <55 mg/dL, and <40 mg/dL for extreme risk).
• Data collected on patient demographics, LDL cholesterol levels, and pharmacotherapies including high-intensity statins, ezetimibe, PCSK9 inhibitors, and bempedoic acid.

Main Results:

• Mean LDL cholesterol decreased from 107.3 ± 39.3 mg/dL to 64.5 ± 24.6 mg/dL.
• Overall, 53.1% of patients achieved their LDL target, with higher rates observed in recent years (e.g., 75.7% in 2023).
• Only 16.4% of extreme CV risk patients (29.8% of the cohort) achieved the stringent LDL target of <40 mg/dL, though this rate improved to 22.7% in 2023.

Conclusions:

• LDL target achievement in CR programs is encouraging and improving over time, likely due to increased awareness and new therapies.
• Despite overall progress, a significant gap remains in achieving LDL targets for patients with extreme CV risk.
• Enhanced identification and tailored treatment strategies are crucial for optimizing lipid management in the highest CV risk populations.