Statin intensity, prescribing patterns, and LDL‑C reduction following ACS and in CCD patients who underwent PCI in a
Sara Abdelrady1, Seeba Zachariah2, Sony Mathew3,4
1Department of Pharmacy Practice, Gulf Medical University, Ajman, UAE.
Insights
Lipid-lowering therapy (LLT) use in patients with coronary artery disease (CAD) largely followed guidelines, achieving significant LDL-C reductions. However, many patients did not reach target LDL-C levels, indicating a need for optimized treatment strategies.
Area of Science:
- Cardiology
- Pharmacology
- Public Health
Background:
- Atherosclerotic cardiovascular disease (ASCVD) is a leading cause of death, with dyslipidemia as a key modifiable risk factor.
- Real-world lipid-lowering therapy (LLT) use and LDL-C target attainment remain suboptimal.
- This study examines LLT prescribing and LDL-C reduction in patients with acute coronary syndrome (ACS) or chronic coronary disease (CCD) undergoing percutaneous coronary intervention (PCI).
Purpose of the Study:
- To evaluate LLT prescribing patterns in patients hospitalized for ACS or undergoing elective PCI for CCD.
- To assess LDL-C reduction at 6 months post-discharge.
- To identify gaps in achieving guideline-recommended LDL-C targets.
Main Methods:
- Retrospective observational study of adult patients hospitalized between June 2020 and June 2024.
- Electronic medical records were reviewed for demographics, risk factors, LLT, and lipid profiles.
- Statistical analysis included non-parametric tests for continuous variables and Chi-Square for categorical variables.
Main Results:
- Of 314 included patients, 98 had 6-month follow-up lipid data.
- Statin monotherapy was prescribed at discharge in 81.5%, with high-intensity statins predominantly used.
- Significant LDL-C reductions were observed, but only 47.95% achieved the target of <70 mg/dL.
Conclusions:
- LLT prescribing patterns were generally consistent with guidelines, leading to significant LDL-C reductions.
- A substantial proportion of patients did not achieve guideline-recommended LDL-C targets.
- Further optimization of LLT and adherence strategies are necessary to improve lipid control in post-ACS and post-PCI populations.
Background:
Atherosclerotic cardiovascular disease (ASCVD) remains a major cause of morbidity and mortality, with dyslipidemia representing a key modifiable risk factor in secondary prevention. Despite clear guideline recommendations, real‑world lipid‑lowering therapy (LLT) use and LDL‑C target attainment remain suboptimal in many regions. This study evaluated LLT prescribing patterns and LDL‑C reduction among patients admitted with acute coronary syndrome (ACS) or undergoing percutaneous coronary intervention (PCI) for chronic coronary disease (CCD) in a tertiary care center.
Methods:
This retrospective observational study included adult patients hospitalized between June 2020 and June 2024 for ACS or elective PCI for CCD. Electronic medical records were screened by independent chart review. Demographics, cardiovascular risk factors, LLT prescriptions, and lipid profiles at baseline and 6 (± 3) months were collected. LLT regimens and the reduction in LDL were analyzed. Non-normally distributed continuous variables were analyzed using non‑parametric methods Wilcoxon Signed Ranks Test and Kruskal-Wallis test, while categorical variables were evaluated using Chi-Square test.
Results:
Of 363 screened patients, 314 met inclusion criteria, and 98 had follow‑up lipid measurements at 6 (± 3) months. Statin monotherapy was prescribed in 81.5% of patients at discharge, while 12.4% received combination therapy. High‑intensity statins were predominantly used, although some patients received only moderate‑intensity therapy. Prior statin exposure significantly influenced discharge prescribing patterns (p < 0.001). Significant LDL‑C reductions were observed at 6 (± 3) months among patients with and without prior LLT (p < 0.001). Overall, 47.95% achieved LDL‑C target of < 70 mg/dL, others needed improvements in their adherence and therapy optimization.
Conclusion:
In the patient cohort studied, prescribing pattern were largely consistent with guideline recommended statin therapy. Although all treatment groups achieved significant reductions in the LDL‑C levels, a proportion of patients remained above guideline‑recommended targets, reflecting need for exploring additional strategies to optimize lipid control. Continued follow‑up and broader implementation of guideline‑directed LLT intensification are warranted to improve LDL‑C control in post‑ACS and post‑PCI CCD populations.
Trial Registration:
Not applicable.
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