Attaining LDL-cholesterol target post major coronary event: Care gap, associated factors and clinical outcomes

Despite evidence supporting low-density lipoprotein cholesterol (LDL-C) reduction below 70 mg/dL after a major acute coronary event (MACE), many patients fail to reach this target.

Retrospective cohort study (baseline 2012-2022) with follow-up through 12/31/2024 (median follow-up: 5.1 years). Participants were 47,416 adults with nonfatal myocardial infarction and/or coronary revascularization discharged on lipid-lowering therapy. Main exposures were LDL-C levels within 1-year postevent and annually for 10 years. Outcomes were incident ASCVD events (myocardial infarction, revascularization, ischemic stroke, CHD death) and composite CVD events (ASCVD, heart failure, peripheral vascular disease, CVD death).

The cohort's mean (SD) age was 66 (12) years; 72% were male, and 58% white. In year 1, 12% lacked LDL-C testing; this rose from 44% in year 2% to 64% in year 10. Target LDL-C attainment was 67% in year 1 and 57% to 60% in years 2 to 10. Women and African American patients had lower target attainment. There was a clear upward trend of improved target control over time (58% in 2012, 77% in 2022). Comorbidities, cardiac rehabilitation participation, and adherence to lipid lowering therapy were associated with improved LDL-C control. Achieving LDL-C <70 mg/dL was associated with lower risk of ASCVD (HR 0.79, 95% CI: 0.77-0.82) and composite CVD (HR 0.84, 95% CI: 0.82-0.87); both P < .001. Numbers needed to treat (NNT) to prevent one ASCVD or composite CVD event were 19.7 and 26.3, respectively.

Significant gaps exist in LDL-C monitoring and treatment goal attainment post-MACE. Notable disparities by sex and race/ethnicity were observed. Failure to meet LDL-C targets was associated with a significant increase in ASCVD and CVD risk.