Mind the Gap: A Single-center Study on Low-density Lipoprotein Cholesterol Target Gaps in Atherosclerotic Cardiovascular Disease Prevention

Background: Cardiovascular diseases (CVDs) remain the leading cause of death globally. Statin therapy significantly reduces cardiovascular risk in both primary and secondary prevention; however, real-world implementation of guideline-directed therapy and achievement of target low-density lipoprotein cholesterol (LDL-C) levels remain suboptimal, especially in low- and middle-income settings. Materials and Methods: This cross-sectional observational study was conducted at the Hospital and Research Centre, including 198 adults (≥25 years) eligible for statin therapy based on atherosclerotic CVD (ASCVD) risk assessment or established CVD. Patients were categorized into primary or secondary prevention groups. Lipid profiles were assessed to determine LDL-C target attainment (<70 mg/dL) after at least 3 months of statin therapy. Factors contributing to nonachievement of the target LDL-C were analyzed descriptively. Results: Of 198 patients, 67.7% were eligible for primary prevention, yet only 3.7% were initiated on statins. All secondary prevention patients received statins, but only 4.7% achieved the target LDL-C. The most frequent reasons for nonattainment included inadequate dose escalation (59.0%), low patient perception of therapy importance (52.5%), financial barriers (49.2%), and pill burden (39.3%). True statin intolerance was rare (3.3%). Demographic analysis revealed a mean age of 62.18 ± 12.84 years and a male predominance (80.3%). Conclusion: This study highlights critical gaps in statin use and LDL-C target attainment in both primary and secondary prevention. Systematic incorporation of ASCVD risk calculators, regular follow-up lipid profiling, structured dose optimization, patient education, and enhanced medication affordability are essential to improving real-world cardiovascular risk reduction and achieving global prevention targets.