Key result
ASCVD patients post-revascularization faced significant care gaps, with only 47.9% receiving follow-up lipid panels and 19.3% having lipid-lowering therapy intensified within 15 months.
Why the study?
Intensive lipid-lowering therapy post-revascularization is recommended, but LDL-C often remains elevated and therapy intensification is infrequent, prompting evaluation of post-revascularization management.
There are significant missed opportunities in clinical practice to reassess lipids and intensify lipid-lowering therapy in ASCVD patients following revascularization.
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“In this study, most revascularized ASCVD patients did not have follow-up lipid panels, LLT intensification, and did not achieve an LDL-C < 70 mg/dL, suggesting numerous opportunities for improvement.”
“How is your institution doing with lipid monitoring? You may be as surprised as we were. Great opportunity for quality improvement.”
Urgent QI needed for lipid monitoring and LLT intensification post-revascularization; supports research on barriers to optimize ASCVD care.
Background Intensive lipid‐lowering therapy (LLT) to achieve low‐density lipoprotein cholesterol (LDL‐C) levels < 70 mg/dL is recommended to lower the risk of atherosclerotic cardiovascular disease (ASCVD) events following revascularization. However, LDL‐C remains elevated in most patients and LLT intensification is infrequent. To evaluate post‐revascularization management of LLT in patients with various forms of ASCVD. Methods This retrospective cohort study evaluated LLT intensification in adults with ASCVD after coronary, cerebrovascular, or peripheral revascularization between July 2021 and July 2022. Patients were identified from procedure lists. Exclusion criteria included no baseline LDL‐C, baseline LDL‐C < 70 mg/dL, triglycerides > 500 mg/dL, end‐stage renal disease, and no documented follow‐up care. The last documented LDL‐C, LLT prescribing patterns, and all follow‐up visits with primary care providers and ASCVD specialists were evaluated during post‐revascularization follow‐up (15 months). We compared patient characteristics and LLT practice patterns between patients achieving LDL‐C < 70 mg/dL (goal) and those with LDL‐C ≥ 70 mg/dL (not‐at‐goal) during a 15‐month follow‐up period. Results 119 patients were included. Within 15 months, 57 (47.9%) patients had a follow‐up lipid panel for evaluation, 27 (47.7%) of whom were at goal. Only 23 (19.3% of the entire cohort) patients had LLT intensified. Patient characteristics were similar between those at goal and not‐at‐goal except for race (fewer non‐White patients, p < 0.01) and revascularization type (more coronary revascularization, p < 0.05) in those at goal. Patients with follow‐up lipid panel(s) had significantly more ambulatory care visits (6 [4–10] vs. 3 [1–6], p < 0.001) and had higher rates of LLT intensification (28.1% vs. 11.3%, p < 0.001) than those without. Among patients without follow‐up lipid panels, there were 269 missed opportunities to reassess lipids and/or intensify LLT. Conclusion In this study, most revascularized ASCVD patients did not have follow‐up lipid panels, LLT intensification, and did not achieve an LDL‐C < 70 mg/dL, suggesting numerous opportunities for improvement.
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Ayers et al. (2026) studied this question. ASCVD patients post-revascularization faced significant care gaps, with only 47.9% receiving follow-up lipid panels and 19.3% having lipid-lowering therapy intensified within 15 months.
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