Cholesterol management in US adults with ASCVD in the Family Heart Database® during 2022–23: Current state of care and opportunities for improvement

Background: Adults with atherosclerotic cardiovascular disease (ASCVD) have increased risk of recurrent events and need optimized low density lipoprotein-cholesterol (LDL-C) lowering therapy, yet the factors contributing to LDL-C management are not well understood. Methods: This cohort study of the national Family Heart Database aims to characterize the current state of LDL-C management in US adults with ASCVD. Adults with ASCVD and ≥1 medication claim yearly and ≥1 LDL-C measure during 2022 or 2023 were included. The lowest LDL-C level reported (<55 mg/dL; 55-69 mg/dL; ≥70 mg/dL); intensity of dispensed LDL-C therapy (high intensity; low/moderate intensity; none); and duration of dispensed LDL-C therapy (>20 of 24 months; 13 to 20 months; >0 to <13 months; none) were characterized. Results: < 70 mg/dL, 41 % received high intensity LDL-C therapy (statin and nonstatin), and 35 % were dispensed LDL-C therapy for >20 of 24 months; only 13 % were found to have LDL-C management across all three of these components. According to multivariable logistic regression models, women, Black individuals, those <50 years old, and those with peripheral arterial and cerebrovascular disease were less well managed. Conclusions and Relevance: In this cohort of 3.6 million US adults with ASCVD there was a substantial gap between guideline recommended LDL-C management and clinical care. Several factors contributed to this gap including low use of nonstatin LDL-C therapies in this high-risk population.