Although guidelines recommend low-density lipoprotein cholesterol (LDL-C) to be at least < 70 mg/dL (and more optimally <55 mg/dL) in patients with atherosclerotic cardiovascular disease (ASCVD), the rate of achieving this goal remains suboptimal.
A
new study sought to understand real world contemporary practice patterns of LDL-C management in patients with ASCVD, and whether LDL-C testing influenced management across US health systems.
STUDY
A retrospective cohort study utilizing electronic medical record data from five health systems participating in the CardioHealth Alliance was performed on patients with an LDL-C measurement in 2021 and prior ASCVD.
RESULTS
Among 216,074 patients with ASCVD, 129,886 (60%) had uncontrolled LDL-C (i.e. ≥ 70 mg/dL).
Compared with participants with controlled LDL-C (< 70 mg/dL), those with uncontrolled LDL-C were more frequently female (51% vs. 35%), or Black (14% vs. 10%), and less commonly had coronary artery disease as the form of vascular disease (73% vs. 84% %), heart failure (21% vs. 29% %), diabetes (34% vs. 48%), atrial fibrillation (19% vs. 26%), or chronic kidney disease (25% vs. 32%).
In multivariable analyses, the factors most strongly associated with failure to achieve LDL-C control were female sex and Black race.
Among the 53,957 (42%) of those with uncontrolled LDL-C ≥70 mg/dL not on lipid lowering therapy (LLT) at baseline, only 21% were initiated on any LLT within 6 months of the uncontrolled LDL-C value.
CONCLUSIONS
Within 5 diverse large health systems in the CardioHealth Alliance, more than half of the patients with ASCVD had uncontrolled LDL-C with significant disparities based on sex and race at baseline.
The vast majority were not initiated on any lipid lowering therapy within 6 months of an elevated test result indicating persistent gaps in care that will likely worsen health inequities in outcomes.
At the Kahn Center for Cardiac Longevity, we strive to achieve an LDL-C <55 mg/dl in patients with ASCVD and are very successful at hitting that goal with a combination of plant diet, exercise, low dose statin Rx, and ezetimibe therapy in combination. Supplements like red yeast rice, berberine, garlic, and bergamot are also used in combination.
