Introduction: Guidelines recommend that patients with coronary artery disease (CAD) lower their low-density lipoprotein cholesterol (LDL-C) using maximally tolerated statin therapy to prevent recurrent events. Gaps in ambulatory LDL-C management (i.e., non-use of statins and elevated LDL-C) may reflect missed opportunities for secondary prevention and, if frequent, may warrant quality improvement interventions. Research question: What is the proportion of known CAD patients who do not take a statin or have elevated LDL-C before a recurrent event? Methods: We analyzed the prevalence of non-statin use and an LDL-C level ≥70 mg/dL in patients ≥18 years of age in the Get With The Guidelines-CAD registry who had known CAD and were hospitalized for a new myocardial infarction or unstable angina in 2023-2024. Data collection on statin use and LDL-C at the initial evaluation is optional in the registry. Information on the intensity of statin therapy is not available. Results: After excluding 17% of patients without data on prior statin use, 34,003 were included in the analysis (mean age 68 years; 71% male; 73% white). Overall, 31.6% of patients did not use a statin. No statin use was more prevalent among women than men, and less prevalent among Black vs White patients ( Table 1 ). LDL-C was not documented in 30.7% of patients. An LDL-C ≥70 mg/dL was more common in patients not taking vs those taking a statin (74.6% and 49.8%, respectively, multivariable-adjusted prevalence ratio 1.45; 95% CI 1.41, 1.48). Women were more likely than men to have an LDL-C level ≥70 mg/dL among those taking and not taking a statin, separately ( Table 2, Panel A). Black and Hispanic patients were more likely to have an LDL-C level ≥70 mg/dL compared to their white counterparts among those taking a statin, but there were no statistically significant differences by race/ethnicity among those not taking a statin ( Table 2, Panel B). Among patients discharged alive, 93.6% were prescribed a statin, and 85.2% were prescribed a high-intensity statin. Conclusion: The current results reveal that more than 30% of known CAD patients do not receive guideline-recommended statin therapy before a recurrent event. Furthermore, half of the patients taking a statin and three out of four of those not taking a statin have an LDL-C level above the guideline-recommended thresholds. Urgent, targeted quality improvement initiatives are needed to address these gaps and reduce the burden of recurrent CAD hospitalizations.
Colantonio et al. (Tue,) studied this question.