Studies reveal gaps in LDL-C management in patients with high CV risk
Significant therapeutic gaps exist in LDL-cholesterol (LDL-C) management among patients with high cardiovascular (CV) risk in Hong Kong, according to two studies reported at the European Society of Cardiology (ESC) Congress 2019 and World Congress of Cardiology (WCC) 2019.
In a retrospective study among 10,168 patients with high CV risk (mean age, 70.6 years; 62.4 percent male) discharged from three hospitals in Hong Kong between 2013 and 2017, <50 percent achieved the LDL-C goal of <1.8 mmol/L at 12 months. [Yan BPY, et al, ESC 2019, abstract P944]
The LDL-C goal was achieved in a significantly lower proportion of patients with critical limb ischaemia (CLI; n=253) than in those with acute coronary syndrome (ACS; n=6,503) or stroke (n=3,412) (29.9 percent, 48.2 percent and 45.6 percent, respectively; p<0.001).
The mean residual distance to target LDL-C was also greatest in patients with CLI (0.8 mmol/L or 27.1 percent reduction; ACS, 0.7 mmol/L or 24.3 percent reduction; stroke, 0.6 mmol/L or 22.9 percent reduction; p<0.01), due to their less aggressive treatment with lipid-lowering therapy.
At discharge, statin use was reported in 52.6 percent of CLI patients, compared with 88.4 percent of ACS patients and 78.3 percent of stroke patients (p<0.01). Use of high-potency statin (HP-S; rosuvastatin 20 mg, atorvastatin 40 mg or simvastatin 80 mg) was very low – in only 2 percent of CLI patients and 3 percent of stroke patients, compared with 21.4 percent of ACS patients (p<0.01).
At 12 months, 51.4 percent of CLI patients, 34.3 percent of stroke patients and 28.8 percent of ACS patients were on no lipid-lowering therapy (p<0.01). The use of HP-S did not change significantly (1.2 percent in CLI; 3 percent in stroke; 19.8 percent in ACS).
“Despite the poor achievement of LDL-C goal in CLI patients, a significantly lower proportion [0.8 percent] of them switched to HP-S compared with patients with stroke [1.3 percent] or ACS [5.2 percent] [p<0.01],” reported the investigators from the Chinese University of Hong Kong (CUHK).
In another retrospective study among 5,025 patients (mean age, 69.1 years; 56.3 percent male) admitted with ischaemic stroke or transient ischaemic attack between January 2005 and September 2017, 62.4 percent failed to achieve LDL-C goal at 12 months after the index stroke. Moreover, 16.7 percent, 80.9 percent and 2.4 percent of patients were on no statin, no non-high potency statin (NHP-S) and no HP-S, respectively. [Yan BPY, et al, ESC 2019, abstract P2781]
Among NHP-S and HP-S users, 58.1 percent and 60.7 percent, respectively, failed to reach LDL-C goal at 12 months after the index stroke. The mean LDL-C level of these patients was 2.5 mmol/L and 2.8 mmol/L, respectively.
According to the CUHK investigators, 34.9 percent, 57.2 percent, 84.5 percent and 98.6 percent of NHP-S users were projected to reach LDL-C target by uptitration or switching to HP-S, by addition of ezetimibe, by uptitration to HP-S plus ezetimibe, and by addition of a proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitor, respectively. For HP-S users, 43.2 percent and 94.6 percent were projected to reach LDL-C target by the addition of ezetimibe or a PCSK9 inhibitor.