Trends and factors associated with LDL-C treatment target attainment rates among patients with secondary prevention setting of ASCVD: assessments from japanese health checkup data

Background According to the latest Japanese Guidelines for the Prevention of Atherosclerotic Disease in 2022, the target for secondary prevention of low-density lipoprotein cholesterol (LDL-C) in patients with a history of coronary heart disease is LDL-C <100 mg/dL, and in patients with acute coronary syndrome (ACS), familial hypercholesterolemia (FH), diabetes, or atherothrombotic stroke is LDL-C <70 mg/dL. However, it is still unclear 1) if the LDL-C treatment target attainment rates are in upward trend, and 2) what are the factors associated with LDL-C treatment target attainment. Aims We aimed to investigate 1) trends of LDL-C treatment target attainment rates and 2) factors associated with LDL-C treatment target attainment in the general population of Japan. Methods Using the Health Checkup data in our city obtained in 2008(n=38,546), 2012(n=45,719), 2017(n=51,969), and 2022(n=48,636) when the Japanese Guidelines for Prevention of Atherosclerotic Diseases had been revised, we analyzed 1) the trends of secondary prevention of LDL-C treatment target attainment rates in patients with a history of heart disease by Cochran-Armitage trend test. Additionally, we analyzed 2) factors associated with LDL-C treatment target attainment by logistic regression analysis using patient basic variables, blood test results, and lifestyle questionnaires from the 2022 health examination. Results The LDL-C treatment target attainment rates were 24.6% in 2008, 30.2% in 2012, 33.0% in 2017, and 34.7% in 2022. We found that there was a significantly upward trend over time (P<0.001). Nextly, we also found that, male sex (odds ratio[OR]: 2.64, 95% confidence interval[CI]: 1.72-4.06, P<0.001), systolic blood pressure (OR: 0.99, 95% CI: 0.98-1.00, P=0.015), ALT (OR: 1.01, 95% CI: 1.00-1.03, P=0.044), uric acid (OR: 0.79, 95% CI: 0.72-0.88, P<0.001), use of medication to reduce blood pressure (OR: 1.92, 95% CI: 1.48-2.49, P<0.001), use of medication to reduce blood sugar or insulin injection (OR: 0.38, 95% CI: 0.24-0.58, P<0.001), weight gain of 10 kg or more since age 20 (OR: 0.71, 95% CI: 0.53-0.93, P=0.015), walking or any equivalent amount of physical activity for more than one hour a day in daily life (OR: 0.73, 95% CI: 0.57-0.92, P=0.009), and eating speed quicker than others (OR: 1.31, 95% CI: 1.03-1.67, P=0.027), were significantly associated with LDL-C treatment target attainment. Conclusions The LDL-C treatment target attainment rates among Japanese patients under secondary prevention tended to increase over time. However, there are several clinical as well as lifestyle factors associated with LDL-C treatment target attainment. Interventions for specific lifestyles and more intensive treatments for women should be considered to achieve better LDL-C control among patients with preexisting coronary heart disease.